CBC Results Research Articles

A-037 A1c by separation and enzymatic methods: what's the difference?

Abstract Background Accurate values for hemoglobin A1c (HbA1c) are crucial for diagnosing and monitoring diabetes mellitus. Two common methods to measure HbA1c are capillary electrophoresis (CE) and immunoassay (IA). Many methods used to measure HbA1c are prone to interferences from hemoglobin variants and abnormalities affecting the red blood cell’s (RBC) turnover. Consequently, the average estimated glucose levels using the HbA1c value can be unreliable in diabetics with hemoglobinopathies and other RBC lifetime disorders. Separation methods such as CE can capture hemoglobinopathy information, while IA methods may not. We performed this study in a population with relatively high levels of hemoglobin disorders to evaluate the performance of HbA1c testing on the Alinity platform (IA) against the Sebia Capillarys 3 Tera instrument (CE). Methods Samples were identified retrospectively based on a search of the Electronic Medical Record for all patients with an ordered and resulted HbA1c and complete blood count in the Montefiore Medical Center the day prior to sampling. Routine HbA1c testing was performed by an Abbott Immunoassay method on the Abbott Alinity Instrument and CBC results were obtained from a Sysmex XN2100 instrument. Records were compared by patient name, medical record number, and sample collection time to identify all patients with CBC and HbA1c drawn within one hour of each other. Those samples were retrieved from storage (a 4° automated refrigerator) within 48 hours of draw and tested via the Sebia Capillarys 3 Tera instrument using HBA1c kits. Results In this large representative population study (N=2075), there was overall excellent agreement between IA and CE. The correlation coefficient (R2) of the whole dataset was 0.989, with an average bias of 2.7% between the two methods. Additional analysis was performed on those with possible RBC turnover disorder (patients with RBC counts below 4x106/uL or above 6x106/uL, MCVs above 96 fL or below 80 fL, RDW above 17%, or abnormal A2 value: total of 638 samples), those with a hemoglobin variant as detected by the Capillarys 3 instrument (162 samples), or with a measurable hemoglobin F value detected by the Capillarys 3 instrument (37 samples). Samples were sorted into these groups independently and thus there was significant overlap between groups, notably with 23 of 37 samples with elevated HbF also having a hemoglobin variant. In both the RBC disorder and hemoglobinopathies group, similar low bias and high correlations were seen. The elevated F samples showed a clear negative bias (5.6%) for all patients on the IA method as compared with CE. The IA method states that samples with HbF above 5% should not be tested. However, as this is not a separation method, there is no way to test samples for HbF before analysis, and bias was seen for samples below 5%. Conclusions The IA and CE methods showed similar performance across patients regardless of RBC lifetime or hemoglobin disorder status, though presence of HbF is a potential interference and should be considered. Further questions remain for these instruments in terms of correlation with average glucose levels as calculated through CGM instruments.

Epidemiological, clinical, biological and evolutionary profile of scorpion envenomed children under one year to 15 years in the Souss Massa region of Morocco

Morocco is one of the main countries affected in North African with the scorpion envenomations. Faced with the threat, significant morbidity and a major risk of death especially in children, a detailed identification of scorpionic profile of stings remains important for health authorities at national or even regional level. The current study aims to establish the epidemiological, clinical, biological and evolutionary data of the scorpionism by analyzing 383 cases of scorpion stings in children from three age groups (<1 year, 1–5 years and >5 years), admitted at the Regional Hospital Hassan II-Agadir in the Souss Massa region during the period of 9 years and 10 months from January 2013 to October 2022. Our results showed that patients under 1 year of age presented the most severe cases and had the highest mortality rate. However, the clinical signs and symptoms observed illustrated severe damages to vital systems, particularly the cardiovascular, neurological and pulmonary systems, although the signs associated with the latter were present only in cases admitted in grades 2 and 3 for the three age categories studied. Fluctuations in vital constants (temperature and peripheral oxygen saturation, blood pressure, heart rate and respiratory rate), biochemical parameters (ASAT, ALAT, urea and blood creatine, as well as blood sugar) and CBC results revealed major functional disturbances in vital organs, especially in envenomated cases admitted in grade 3. A positive correlation was mentioned between the state of evolution and the various epidemiological parameters, digestive symptoms, as well as signs and symptoms linked to hemodynamic state, general and neurological state. The main interest is to illustrate the seriousness of scorpion envenomations, especially in the high-risk population, for whom an improved therapeutic approach in health centers will undoubtedly be reinforced, and the admission of immunotherapy, as a fundamental part of the treatment, remains important.

Persistent or New Cytopenias Predict Relapse Better than Routine Bone Marrow Aspirate Evaluations After Hematopoietic Cell Transplantation for Acute Leukemia or Myelodysplastic Syndrome in Children and Young Adult Patients

The clinical value of serial routine bone marrow aspirates (rBMAs) in the first year after allogeneic hematopoietic cell transplantation (alloHCT) to detect or predict relapse of acute leukemia (AL) and myelodysplastic syndrome (MDS) in pediatric and young adult patients is unclear. The purpose of this analysis was to determine if assessment of minimal residual disease (MRD) by multiparameter flow cytometry (MFC, MFC-MRD) or donor chimerism (DC) in rBMAs or serial complete blood counts (CBCs) done in the year after alloHCT predicted relapse of AL or MDS in pediatric and young adult patients. We completed a retrospective analysis of patients with AL or MDS who had rBMAs performed after alloHCT between January 2012 and June 2018. Bone marrow (BM) was evaluated at approximately 3, 6, and 12 months for disease recurrence by morphology, MFC-MRD, and percent DC by short tandem repeat molecular testing. CBCs were performed at every clinic visit. The main outcome of interest was an assessment of whether MFC-MRD or DC in rBMAs or serial CBCs done in the year after alloHCT predicted relapse in AL or MDS pediatric and young adult patients. A total of 121 recipients with a median age of 13 years (range 1 to 32) were included: 108 with AL and, 13 with MDS. A total of 423 rBMAs (median 3; 0 to 13) were performed. Relapse at 2 years was 23% (95% CI: 16% to 31%) and at 5 years 25% (95% CI: 18% to 33%). One hundred fifty-four of 157 (98%) rBMAs evaluated for MRD by MFC were negative and did not preclude subsequent relapse. Additionally, low DC (<95%) did not predict relapse and high DC (≥95%) did not preclude relapse. For patients alive without relapse at 1 year, BM DC (P = .74) and peripheral T-cell DC (P = .93) did not predict relapse. Six patients with low-level T-cell and/or BM DC had a total of 8 to 20 BM evaluations, none of these patients relapsed. However, CBC results were informative for relapse; 28 of 31 (90%) relapse patients presented with an abnormal CBC with peripheral blood (PB) blasts (16 patients), cytopenias (9 patients), or extramedullary disease (EMD, 3 patients). Two patients with BM blasts >5% on rBMA had circulating blasts within 5 weeks of rBMA. Neutropenia (ANC <1.5 K/mcl) at 1 year was predictive of relapse (P = .01). Neutropenia and thrombocytopenia (<160 K/mcl) were predictive of disease-free survival (DFS) with inferior DFS for ANC <1.5 K/mcl, P = .001, or platelet count <160 K/mcl (P = .04). These results demonstrate rBMAs after alloHCT assessed for MRD by MFC and/or for level of DC are poor predictors for relapse in pediatric and young adult patients with AL or MDS. Relapse in these patients presents with PB blasts, cytopenias, or EMD. ANC and platelet count at 1-year were highly predictive for DFS.

Evaluation of Hematological Parameters in Dengue Patients of Peshawar

Background: Dengue fever is caused by a virus called Dengue virus. A positive sense RNA virus belongs to flaviviridae family having four serotypes. The word “Dengue” is derived from Swahilli language which means seizure-like cramps. Human-to-human transmission is through vector (Mosquito) Aedes aegypti and Aedes albopictus. Dengue virus was discovered in 1779 in Batavia. Dengue fever is differentiated into Dengue Fever, Dengue hemorrhagic fever, and Dengue shock syndrome. Material and Methods: Dengue-suspected patients were screened for Dengue virus. Among these 120 were found positive for dengue virus. All the patients were screened using the NS1 strip method. A complete blood count test was performed for all the dengue-positive patients for evaluation of hematological changes. Data were entered in Microsoft Excel 2020, and further analyzed through SPSS-22. Results: Among the dengue suspected patients 120 were found positive for dengue virus infection. Out of 120 patients 76(63%) were male and 44(36%) were female. 68% of the patients were in the middle age group (16-40 years), 7.5% of patients were lower age group (1-15 years) and 24.1% of patients were in the old age group (41-70 years). CBC results showed variation in hematological parameters. 41% of patients were found with low platelet count while in 73% of patients, WBC count was decreased below the normal range. A small portion of the patients showed low hemoglobin levels. Neutrophil levels also decreased in more than 70% of patients. In a few cases, the hematocrit level was out of range. Conclusion: The study was conducted for the evaluation of hematological changes that occurred in patients infected by dengue. According to our study on dengue viral infection, a total of 120 patients were included of which 76(63%) were males and 44(36%) were females. Male frequency was higher than females affected by dengue fever. The median age group in our study was most affected by dengue fever. Platelet counts were low in 41% of infected patients, WBC levels were decreased than normal ranges in 73% and neutrophil levels were also affected which shows similarities with previous studies.

Accuracy of Umbilical Cord Complete Blood Count in Detecting Early-Onset Neonatal Thrombocytopenia.

Neonatal thrombocytopenia (NTCP) is a common hematological disorder whose platelet count falls below the normal limitof 150 x 109/L. NTCP can causelate complications if left untreated. The current study aimed to evaluate the accuracy of the umbilical cord complete blood count (UC CBC) in detecting early-onsetneonatal thrombocytopenia(EO-NTCP). Further, the prevalence of NTCP was also investigated. Methods: A cross-sectional study with a matched control was conducted on all newborns delivered at a tertiary care center in Jeddah, Saudi Arabia, between May 2016 and 2019. After exclusions, 40 neonateswith EO-NTCP (cases) and 80 without EO-NTCP (controls) were included. The case-to-control ratio was 1:2. The results of UC CBC were compared with those of follow-up CBC, performed within 72 hours.A p-value of <0.05 was considered statistically significant. All data were analyzed using IBM SPSS version 28 for Windows (IBM Corp., Armonk, NY). The prevalence of NTCP was approximately 1.02% (111/10,936). Lack of antenatal care was found in12 (30%) neonates with EO-NTCP vs. 10 (12.5%)neonates without EO-NTCP (p = 0.02). Neonates with EO-NTCP were more likely to have experiencedintrauterine growth restriction (5 (37.5%) vs. 5 (6.3%), p < 0.001)and oligohydramnios (5 (12.5%) vs. 0 (0%), p = 0.003). Neonates who developed EO-NTCP were more likely to be admitted to the NICU (34 (85%) vs. 35 (43.8%), p < 0.001) and receiveantibiotics (22 (55%) vs. 25 (31.3%), p = 0.012). Also, neonates with EO-NTCP were more frequently diagnosed with neonatal sepsis (7 (17.5%) vs. 3 (3.8%), p = 0.015)and more likely to receiveplatelet transfusions (15 (37.5% vs. 1 (1.3%), p < 0.001). They also had a higher median length of hospital stay(13 (interquartile range (IQR) 3-28) vs. 4(IQR 2-9) days, p = 0.006). The mortality rates of neonates with EO-NTCP and those without were 6 (15%) vs. 2 (2.5%) neonates (p = 0.016). The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of UC CBC were 62.50%, 97.50%, 20.40%, and 99.61%, respectively. The prevalence of EO-NTCP in King Abdulaziz Medical City is comparable to international and national figures, and itis associated with preceding maternal comorbidities, serious neonatal morbidity, and even mortality. Therefore, proper antenatal care is vital in preventing maternal and neonatal morbidities, including the risks of NTCP and itsrelatedcomplications. With high NPV, using UC CBC as a universal screening method could assist in safely discharging newborns. However, because of its low sensitivity, a comprehensive clinical examination with confirmatory laboratory tests are stillthe cornerstone in diagnosing EO-NTCP. Future trials should aim to study the cost-effectiveness of universal UC CBC and the long-term outcomes of infants diagnosed with EO-NTCP.

Variations in Complete Blood Count Reference Limits Among Hospitals in the US and Their Clinical Significance

Background Complete blood count (CBC) is the most common hematology test performed. Reference limits, aka normal values, are known to vary from one hospital to another. However, little is known about the values of the upper (UL) and lower (LL) limits of common elements reported in the CBC and how they differ among facilities. The objectives of our study were to report the UL and LL of CBC elements from various hospitals in the US, analyze the variances, and describe their clinical significance. Methods This study was approved by the Mayo Clinic institutional review board. We obtained the reference limits of CBCs from various hospitals using the Epic electronic medical records Care Everywhere health information exchange. CBCs from 2020-2023 were included. We included the following CBC elements: hemoglobin (Hgb; male and female), mean cell volume (MCV), white blood cell count (WBC), and platelet count (PLT). We performed descriptive statistics and calculated the coefficients of variation (COVs). In addition, we analyzed the data for clinical context using: A) World Health Organization (WHO) major criterion for polycythemia vera of Hgb &amp;gt;16.5 g/dL and &amp;gt;16.0 g/dL for males and females, respectively; B) WHO major criterion for essential thrombocytosis of PLT &amp;gt;450 x109/L; and C) common textbook reference limits for MCV (80-100 fL) and WBC (5-10 x109/L). Results We collected CBC reference limits from 143 hospitals across 43 states and 99 cities. Most (54.5%) hospitals were community-based, while the rest (45.5%) were academic. The statistics are shown in the Table. In general, there was minimal variance in the UL and LL of CBC elements, with COVs mostly under 8.0%. The one exception was WBC LL, in which the COV was 10.5%. There was no significant difference in the CBC reference limits between academic and community hospitals. The median Hgb UL and LL for males were 17.5 (range, 16.3-18.1) and 13.5 (range, 12.0-14.3), respectively. Similarly, the median Hgb UL and LL for females were 15.7 g/dL (range, 14.6-16.3) and 12.0 g/dL (range, 11.0-12.5), respectively. Majority (93.5%) of the hospitals' male Hgb UL exceeded 16.5 g/dL. In contrast, only few (3.6%) of the hospitals' female Hgb UL exceeded 16.0 g/dL (Figure A). The median MCV UL and LL were 99.0 fL (range, 92.2-103.0) and 80.0 fL (range, 77.0-88.0), respectively. A substantial minority (19.6%) of the hospitals' MCV UL exceeded 100 fL (Figure B). The median WBC UL and LL were 10.8 x109/L (range, 8.9-13.0) and 4.0 x109/L (range, 3.1-5.4), respectively. Most (80.4%) hospitals' WBC UL exceeded 10 x109/L (Figure C). The median PLT UL and LL were 400 x109/L (range, 317-500) and 150 x109/L (range, 125-172), respectively. Over a quarter (27.5%) of the hospitals' PLT UL were at or exceeded 450 x109/L (Figure D). Conclusions: There was minimal variance in CBC reference limits across hospitals in the US with WBC LL having the highest COV. Most MCV UL and WBC UL exceeded common textbook reference limits. Almost all male Hgb UL and over a quarter of PLT UL exceed the WHO major criteria of polycythemia vera and essential thrombocytosis, respectively. Since our findings suggest that there could be a risk of underdiagnosing these myeloproliferative neoplasms due to the commonly used reference limits, clinical context must be used when interpreting normal CBC results, especially when there is a suspicion of polycythemia vera or essential thrombocytosis.

Comparison of results of two hematological analyzer systems: Dirui BF-7200 and Sysmex XN-1000

Abstract Objectives Complete blood count (CBC) is performed using automated hematology analyzers. It is important that CBC results are comparable, reproducible, and reliable. In this study, our aim is to compare the results of Sysmex XN-1000 and Dirui BF-7200 hematology analyzers. Methods Patient samples randomly selected from the routine workflow for each instrument were measured 20 consecutive times to assess reproducibility. The mean, standard deviation, and coefficient of variation (CV%) were calculated for each hematological parameter. A comparison of results from the evaluated Dirui BF-7200 system with those from the current hematology analyzer Sysmex XN-1000 system was made for all of the samples included in the study. The compatibility between the parameters was evaluated using Passing–Bablok and Bland–Altman analyses. Results The within-run CV% values were outside the desirable biological variation database (European Federation of Clinical Chemistry and Laboratory Medicine) specification for CV% for eosinophil, basophil, mean corpuscular hemoglobin, mean corpuscular hemoglobin concentration, mean platelet volume and platelet distribution width expressed as standard deviation in the Sysmex XN-1000 instrument and eosinophil, basophil, hematocrit and indexes of red blood cell and platelet in the Dirui BF-7200 instrument. When the Bland–Altman and Passing–Bablok analysis results were evaluated together, most parameters showed poor agreement; only white blood cells and lymphocytes showed good agreement between the two instruments. Conclusions As there is variability between results from different hematology analyzers, we recommend analyzing patient samples in the same laboratory using the same analyzer to avoid different results that could be misinterpreted.

Effect of Night Shift Work in Clinical Laboratories on Pediatric Complete Blood Count Results.

There has been much research into the impact of shift systems on clinicians and nurses, but little research into quality control in clinical laboratories. This topic focuses on assessing the impact of shift systems on clinical laboratory scientists. A total of 34,955 CBCs from pediatric patients who visited the hospital during night-time hours over a period of three years were selected for analysis. The quality of routine blood tests was evaluated using four indica-tors: red blood cell count, white blood cell count, platelet count, and hemoglobin levels. The effects of gender, years of experience, and length of the night shift on test results were evaluated separately for each clinical laboratory scientist. The results showed that the gender and years of experience of the clinical laboratory scientists did not affect the CBC results. However, a significant impact was observed as the number of hours worked on night shifts increased. The findings of this study suggest that the night shift schedule of clinical laboratory scientists can have an impact on the accuracy of pediatric CBCs. It is essential for healthcare institutions to consider the length of night shifts for clinical laboratory scientists and implement measures to minimize the impact on test results.

Uncommon Variant of CD4+ T-cell Large Granular Lymphocytic Leukemia

Abstract Introduction/Objective T-cell large granular lymphocytic leukemia (T-LGL) is a T-cell lymphoma with persistently increased large granular lymphocytes in peripheral blood. The majority of T-LGL is associated with CD8+ T-cells. However, the CD4+ variant is uncommonly seen. Methods/Case Report The patient is a 49-year-old female with a history of diabetes mellites and anemia who presented with shortness of breath, lower extremities edema, and fatigue. Physical examination showed a significantly distended abdomen. CBC results showed hemoglobin 6.9 g/dL, WBC 18.2 × 109/L with 88% lymphocytes, and PLT 190,000. The peripheral blood smear presented lymphocytosis with LGL cells, microcytic anemia, and increased target cells. Bone marrow biopsy showed lymphoid infiltrate as an intravascular pattern confirmed by immunochemical stains. A complete workup including flow cytometric, cytogenetics, and molecular studies was performed on the bone marrow. The lymphoma phenotype by flow shows positivity for CD2, CD3, CD4, CD5 (bright), CD7 (partial/dim), CD56, CD57 (majority), TCRαβ. T-cell gene rearrangement was detected and was further confirmed by PCR with the detection of clonal TCR beta gene rearrangements on molecular genetics analysis. However, STAT3 was not detected. The patient was diagnosed with CD4+ T-LGL leukemia. Results (if a Case Study enter NA) NA. Conclusion CD4+CD8- immunophenotype is an uncommon variant of T-LGL, which has a high incidence of activating STAT5B mutation, while CD8+CD4- T-LGLL tends to have STAT3 mutation. Clinically, those two subtypes behave similarly. Flow cytometry is the golden method to confirm the diagnosis. More research is needed to clarify the essence of CD4+ T-LGLL.

Frequency of Thrombocytopenia in Malaria Patient at Tertiary Care Hospital

Background: Hematological disorders, including anemia, thrombocytopenia and leukopenia are quite frequent among malaria patients. Objective: To assess the frequency of thrombocytopenia in malaria patient at tertiary care hospital Methodology: This study was descriptive, cross-sectional study carried out at the medicine department, Qazi Hussain Ahmad Medical Complex, Nowshera for a period of six months from May 2022 to October 2022. Pre-designed proforma was used to collect patient information, such as demographics and medical history. A hematology analyzer was used to calculate the hematological variables from the CBC results. All the collected data was analyzed by using IBM SPSS version 23. Results: There were 83 (55.33%) males and 67 (44.77%) females. The overall frequency of thrombocytopenia amongst 150 patients with malaria was 90% (n=135). Amongst patients with thrombocytopenia, grade 1 thrombocytopenia was observed in 75 (50%) patients, grade 2 in 38 (25.33%) patients, grade 3 in 23 (15.33%) patients while grade 4 thrombocytopenia was observed in 14 (9.33%) patients. Conclusion: Our study concludes that thrombocytopenia is highly prevalent amongst patients with malaria. This leads us to the conclusion that the platelet count is a useful first-stage screening parameter in individuals with acute febrile illness. Keywords: Thrombocytopenia; Malaria; p.vivax; p.falsiparum

Perioperative Management of Anemia in Emergency Abdominal Surgery at the National Hospital of Niamey

Aim of the study: To describe the perioperative care of anemia in emergency abdominal surgery in the National Hospital of Niamey. Patients and methods: This was a prospective and descriptive study that lasted 6months, from June 6th to December 9th, 2020. Were inclueded in the study, all the patients admitted in the department of surgical emergencies who presented acute surgical abdomen associated with anemia. The main studied variables were: age, gender, history, CBC results, American Society of Anesthesiologists score (ASA), indications, etiological diagnosis, incidents and intraoperative accidents, post operative complications, treatment of the anemia, evolution and duration of hospitalization. Statistical analysis of the data was done using SPSS version 25, graphics and data entry were done with Word and Excel 2016 softaware. The average values were calculated for each variable for each patient and examinated by the chi² test for qualitative variables. P value &lt; 0,05 was considered as significant. Results: Our study involved 147 patients out of 581 admissions, i.e a frequency of 25.30%. the average age of the patients was 16.27 years with extremes of 2 and 70 years, the male gender predominated with 64.63% (n=95) and a sex ratio of 1.83. The main preoperative diagnosis was acute peritonitis in 78.91% f cases (n=120) and peritonitis by ileal perforation was the first etiology with 63.94% (n=94). The majority of our patients had moderate preoperative anemia in 73.47% (n=108) and severe anemia in 21.09% (n=31) of cases. The management of anemia was based on blood transfusion which was performed in 10.20% of cases (n=15) preoperatively and 32.65% of cases (n=48) intraoperatively. In the postoperative period, the treatment of anemia was essentially based on oral iron supplementation. Intra operative incidents and accidents were significantly associated with the severity of anemia preoperatively. Parietal suppuration was the main postoperative complication, ie 70.6% ..

Co-Inheritance of Heterozygous β0-Thalassemia with Single Functional α-Globin Gene: Challenges of Carrier Detection in Pre-Marital Screening Program for Thalassemia

This is a report of a couple with abnormal hematological indices who were investigated for α &amp; β-thalassemia mutations. Based on CBC and capillary hemoglobin electrophoresis results, the male and female subjects were β &amp; α-thalassemia carriers, respectively. Multiplex-Gap-PCR and Sanger sequencing techniques were used for the identification of mutations on α and β-globin genes. The DNA test showed the presence of c.315 + 1 G &gt; A mutation on β-globin gene of male subject while the female case had – MED double gene deletion and c.427T &gt; C mutation on α-globin and, interestingly, she was also a carrier for c.315 + 1 G &gt; A mutation on β-globin gene. Cases with the coinheritance of heterozygous β0-thalassemia with one functional α-globin gene have normal HbA2 levels that may lead to their being misdiagnosed as β-thalassemia carriers, especially in premarital screening programs for thalassemia. Therefore, β-globin gene sequencing is recommended in cases with normal Hb electrophoresis and reduced hematological indices in premarital screening programs for thalassemia, especially in regions with a high frequency of β-globin mutations, in order to identify all the β-thalassemia carriers.

Customized middleware experience in a tertiary care hospital hematology laboratory

BackgroundIn the clinical laboratory, middleware is a software application that sits between the analyzer and the laboratory information system (LIS). One of the more common uses of middleware is to perform more efficient result autoverification than can be achieved by the LIS or analyzer alone. In addition to autoverification, middleware can support highly customized rules to handle samples and results from specific patient locations. The objective of this study was to review the impact of customized middleware rules that were designed and implemented in the hematology laboratory of a 1000-bed tertiary care adult academic center hospital. MethodsThree novel initiatives using middleware rules to achieve workflow efficiencies were retrospectively reviewed over different audit periods: preliminary neutrophil resulting for oncology patients, microcytosis interpretive comments, and 1 white blood cell differential (WBCD) reported per day. In addition, autoverification rates for complete blood count and differential (CBCD) and coagulation tests were calculated. ResultsA preliminary neutrophil count was released from middleware on average 64 min before the final CBCD for Leukemia/Bone Marrow Transplant (L/BMT) outpatients, and on average 59 min earlier for oncology patients. Reflexing interpretive comments for select instances of microcytosis removed on average 500 slides per month from technologist review with an estimated cost savings of approximately $3383.33 CAD per month. The 1 WBCD per day rule resulted in a 5.1% cancelation rate, resulting in an estimated monthly cost savings of $943.46 CAD in reagents and technologist time. Finally, middleware rules achieved very high autoverification rates of 97.2% and 88.3% for CBC and CBCD results, respectively. ConclusionsImplementation of customized middleware hematology rules in our institution resulted in multiple positive impacts on workflow, achieving high autoverification rates, reduced slide reviews, cost savings, and improved standardization.

Safety and Clinical Response Following a Repeat Intraarticular Injection of Tin-117m (117mSn) Colloid in Dogs with Elbow Osteoarthritis.

ObjectiveTo determine if a repeat intraarticular (IA) injection of a tin-117m colloid radiosynoviorthesis (RSO) agent can be safely given in the same joint 12 months after an initial injection for treatment of canine elbow osteoarthritis (OA), and to evaluate the pain reduction effect of the repeat injection.Methods and MaterialsNine client owned dogs with grade 1 or 2 elbow OA were given an IA injection of tin-117m colloid in both elbows, one of which had been treated ≤12 months earlier with the same RSO device. Treatment safety was evaluated by joint fluid analysis at baseline (BL) and at 180 days after treatment, and by urinalysis, CBC, and serum chemistry analysis of diagnostic samples obtained at BL and 180 days. Radiographs, computed tomography, and MRI scans were obtained at BL and 180 days to determine if disease progression differed in elbows given one versus two injections. Clinical response to treatment was assessed subjectively by dog owner responses to the Canine Brief Pain Inventory (CBPI) survey at BL, 90 and 180 days, and objectively by investigator-conducted force plate (FP) analysis of dogs at BL, 90, and 180 days.ResultsAll post-treatment urinalysis, CBC and clinical chemistry results were within normal ranges. Joint fluid analysis showed a significant (P=0.0411) reduction in the percentage of monocytes at 180 days, consistent with the tin-117m colloid mode of action of apoptosis of pro-inflammatory macrophages at the injection site. There was no significant difference in OA progression in elbows given one or two injections. The treatment success rate was 55.5% (5/9) on day 90 as determined either by CBPI responses or FP analysis, and 66.6% (6/9) on day 180 as determined by FP analysis.ConclusionThe tin-117m colloid can be safely given as a repeat injection 12 months after an initial injection, and can potentially provide a durable therapeutic response in dogs with elbow OA.

Non-albumin proteinuria in lupus nephritis with tubulointerstitial inflammation and its clinical significance

Abstract Background Tubulointerstitial inflammation (TI) associated with systemic lupus erythematosis is an increasing finding in lupus nephritis. TI severity may have prognostic significance in the renal outcomes of lupus nephritis. Here, we aimed to determine whether non-albumin proteinuria is associated with TI severity and with the renal response in lupus nephritis. Objective To investigate the possible association between non-albumin proteinuria, tubulointerstial inflammation severity and poor renal response after immunosuppressive treatment. Patients and Methods This is a case series study which was conducted on 100 patients with systemic lupus erythematosis recruited from the outpatient clinic of Clinical Immunology at Ain Shams University Hospitals. Subject ages were between 13-53 years old, each one was subjected to detailed history, physical examination, laboratory investigations including serum creatinine before and after treatment, protein/creatinine ratio before and after treatment, albumin/creatinine ratio, ESR, CRP, CBC, C3 C4, anti DNA, eGFR and renal biopsy Results Our results showed that non-albumin proteinuria (uPCR − uACR) was significantly higher in patients with moderate-to-severe TI than in patients with no-tomild TI. Further, higher uPCR − uACR levels at baseline were associated with poor renal response after 6 months of treatment. Conclusion we found that non-albumin proteinuria (uPCR-uACR) is associated with severe tubulointerstitial inflammation (TI) in lupus nephritis.

Assessment of 25 (OH) Vitamin D in Neonates with Hypoxic Ischemic Encephalopathy Mohammed Elsayed Hamed 1, Dina Gamal Abd Elhamed 2,

Background: Vitamin D is a hormone that affects a wide range of functions within the body. Neonatal hypoxic ischemic encephalopathy (HIE) is a serious disease that may lead to permanent brain injury. Objective: The present study aimed to study vitamin D status in hypoxic ischemic in encephalopathy. Patients and methods: A case control study carried out in newborn intensive care unit (NICU) of Zagazig University Children Hospitals. Total number of cases that met the inclusion and exclusion criteria was 49 full term neonates with HIE divided according to Sarnat stages: stage I; 20 full term neonates, stage II; 15 full term neonates and stage III; 14 full term neonates. Cases were compared to 16 healthy controls. Results: There was a statistical significant increase in Apgar score 1, 5, 10 in control group compared to all cases groups. There were no statistical significant differences between the studied groups in relation to CBC results. There was a statistical significant difference between the different stages of HIE in CRP and pH.There was a statistical significant increase in frequency of hypoxic change in stage III compared to stage II and I. All stages of HIE showed statistical significant increase in frequency of vitamin D deficiency compared to control group. Stage III had statistical significant increase in frequency of vitamin D deficiency compared to stage I and II. Conclusion: Serum 25(OH) vitamin D insufficiency is present in the majority of term HIE neonates. 25 (OH) vitamin D was significantly deficient in stage III more than stage I and II.

Is it possible to determine antibiotic resistance of E. coli by analyzing laboratory data with machine learning?

Abstract Objectives Microbial antibiotic resistance remains a serious public health problem worldwide. Conventional culture-based techniques are time-taking procedures; therefore, there is need for new approaches for detecting bacterial resistance. The aim of this study was to assess antibiotic resistance of Escherichia coli by analyzing biochemical parameters with machine learning systems without using antibiogram. Material and methods In this article, machine learning systems such as K-Nearest Neighbors, Artificial Neural Networks (ANN), Support Vector Machine and Decision Tree Learning were used to investigate whether E. coli is sensitive or resistant to antibiotics. The study was conducted based on the clinical records of 103 patients who were previously diagnosed with E. coli infection, including CBC and complete UA results, and CRP values. Results The accuracy rates of antibiotic resistance/susceptibility detected by ANN were as follows: Amikacin (96.0%), Ampicillin (77%), Ceftazidime (62%), Cefixime (63%), Cefotaxime (68%), Colistin (95%), Ciprofloxacin (76%), Cefepime (70%), Ertapenem (96%), Nitrofurantoin (90%), Phosphomycin (98%), Gentamicin (84%), Levofloxacin (98%), Piperacillin-Tazobactam (92%), and Trimethoprim-Sulfadiazine (79%). Conclusions The study determined the antibiotic resistance of E. coli with less time and cost compared to conventional culture-based methods machine learning based model contributes positively to artificial intelligence (AI) supported decision-making processes in laboratory medicine.

Analysis of risk factors associated with complications following mandibulectomy and maxillectomy in dogs.

To provide information about complication rates and the risk factors for complications with mandibulectomy and maxillectomy procedures in dogs. 459 client-owned dogs that underwent a mandibulectomy or maxillectomy between January 1, 2007, and January 1, 2018. Inclusion criteria included a complete medical record that contained an anesthesia record, surgical report, available histopathology results, and results of CBC and serum biochemical analysis before surgery. A minimum follow-up of 90 days after surgery was required. 271 complications occurred in 171 of 459 (37.3%) dogs. Eighteen complications were not given a severity description. Of the remaining 253 complications, most were considered minor (157/253 [62.1%]). Multivariable logistic regression analysis revealed that only increased surgical time had a significant (OR, 1.36; 95% CI, 1.12 to 1.54) association with the occurrence of ≥ 1 complication. For each additional hour of surgery, the odds of complications increased by 36%. Preoperative radiation therapy or chemotherapy increased the odds of incisional dehiscence or oral fistula formation (OR, 3.0; 95% CI, 1.3 to 7.2). Additionally, undergoing maxillectomy, compared with mandibulectomy, increased the odds of incisional dehiscence or oral fistula formation (OR, 1.8; 95% CI, 1.1 to 3.1). Two hundred forty-four of 271 (90.0%) complications occurred in the perioperative period (0 to 3 months after surgery). Compared with mandibulectomy, performing maxillectomy increased the risk for incisional dehiscence or oral fistula formation. Mandibulectomy and maxillectomy had a moderate risk for a complication.

Use of serum hyaluronic acid as a biomarker of endothelial glycocalyx degradation in dogs with septic peritonitis.

To describe daily changes in serum concentrations of hyaluronic acid (HA), a biomarker of endothelial glycocalyx degradation, in dogs with septic peritonitis and to determine whether relationships exist among serum concentrations of HA and biomarkers of inflammation and patient fluid status. 8 client-owned dogs. Serum samples that had been collected for a previous study and stored at -80°C were used. Blood samples were collected at admission and daily thereafter during hospitalization and were analyzed for concentrations of HA and interleukins 6, 8, and 10. Patient data including acute patient physiologic and laboratory evaluation score, type and amount of fluids administered daily, and daily CBC and lactate concentration results were recorded. To determine the significant predictors of HA concentration, a general linear mixed model for repeated measures was developed. All dogs survived to discharge. Concentrations of HA ranged from 18 to 1,050 ng/mL (interquartile [25th to 75th percentile] range, 49 to 119 ng/mL) throughout hospitalization. Interleukin-6 concentration was a significant predictor of HA concentration as was total administered daily fluid volume when accounting for interleukin-6 concentration. When fluid volume was analyzed independent of inflammatory status, fluid volume was not a significant predictor. Concentrations of HA did not significantly change over time but tended to increase on day 2 or 3 of hospitalization. Results supported the theory that inflammation is associated with endothelial glycocalyx degradation. Dogs recovering from septic peritonitis may become more susceptible to further endothelial glycocalyx damage as increasing fluid volumes are administered.

Intravenous administration of allogeneic Wharton jelly-derived mesenchymal stem cells for treatment of dogs with congestive heart failure secondary to myxomatous mitral valve disease.

To evaluate whether mesenchymal stem cells (MSCs) can be safely administered IV to dogs with congestive heart failure (CHF) secondary to myxomatous mitral valve disease (MMVD) to improve cardiac function and prolong survival time. 10 client-owned dogs with CHF secondary to MMVD. Dogs with an initial episode of CHF secondary to MMVD were enrolled in a double-blind, placebo-controlled clinical trial. Five dogs in the MSC group received allogeneic Wharton jelly-derived MSCs (2 × 106 cells/kg, IV), and 5 dogs in the placebo group received a 1% solution of autologous serum (IV) for 3 injections 3 weeks apart. Cell-release criteria included trilineage differentiation, expression of CD44 and CD90 and not CD34 and major histocompatability complex class II, normal karyotype, and absence of contamination by pathogenic microorganisms. Patients were followed for 6 months or until death or euthanasia. Echocardiographic data, ECG findings, serum cardiac biomarker concentrations, CBC, and serum biochemical analysis results were obtained prior to and 4 hours after the first injection and every 3 months after the final injection. Lymphocyte and eosinophil counts decreased significantly 4 hours after injection, and monocytes decreased significantly only in dogs that received an MSC injection. No significant differences were seen in the echocardiographic variables, ECG results, serum cardiac biomarker concentrations, survival time, and time to first diuretic drug dosage escalation between the 2 groups. This study showed that MSCs can be easily collected from canine Wharton jelly as an allogeneic source of MSCs and can be safely delivered IV to dogs with CHF secondary to MMVD.