Clinical Hematology Research Articles

Perbedaan Parameter Eritrosit Dan Retikulosit Pada Pasien Talasemia Beta Minor Dan Anemia Defisiensi Besi Ringan

Beta thalassemia and iron deficiency anemia (IDA) are most common microcytic hypochromic anemia. It is difficult to distinguish minor β thalassemia from mild iron deficiency anemia only by clinical findings and routine hematology examinations, it requires confirmatory tests which are limited in availability and relatively expensive. The presence of additional erythrocyte and reticulocyte parameters (RDW-CV, RBC-He, %MicroR, %Hypo-He, Ret-He, IRF) in hematology analysers are expected to be screening parameters in differentiating minor β thalassemia from mild IDA. The purpose of this study was to determine the differences in the values ​​of RDW-CV, RBC-He, %MicroR, %Hypo-He, Ret-He, and IRF between minor β thalassemia patients and mild IDA. This study was an observational, analytical, comparative, with a cross sectional design. Research was conducted at RSU Kota Tangerang Selatan from July to October 2020. Subjects were children who went to an outpatient clinic/medical check-up, or with laboratory data of minor β thalassemia or had β thalassemia families. Samples were analysed using Sysmex XN 1000. Statistical analysis was performed by the independent t test for normally distributed data and the Mann Whitney difference test for abnormally distributed data. The RBC-He and Ret-He values ​​were lower in minor β thalassemia than mild IDA and significantly different with p value 0.005 and 0.004, respectively. The %MicroR and %Hypo-He values were higher in minor β thalassemia than mild IDA and significantly different with p values ​ 0.000 and 0.003, respectively. The RDW-CV and IRF values ​​were higher in minor β thalassemia than mild IDA but were not significantly different with the p value 0.076 and 0.528 respectively. Conclusion: RBC-He and Ret-He values which reflect hemoglobin content in erythrocytes and reticulocytes ​​were lower in minor β thalassemia patients compared to mild IDA and were significantly different. The values ​​of %MicroR and %Hypo-He which reflect microcytic and hypochromic in erythrocyte population were higher in patients with minor β thalassemia than mild IDA and were significantly different. RDW-CV which reflects variation size of erythrocytes and IRF which reflects erythropoiesis activity and ineffective erythropoiesis were higher in patients with minor β thalassemia than mild IDA and were not significantly different.

Evaluation of anti-Fel d 1 IgY ingredient for pet food on growth performance in kittens.

The domestic cat (Felis catus) is one of the most common pets. Worldwide, approximately one in five adults are sensitive to cat allergens. The major cat allergen is the secretoglobulin Fel d 1, which is primarily produced in the salivary and sebaceous glands. Chickens produce IgY antibodies, which are similar in structure to mammalian IgG. When chickens are exposed to Fel d 1, anti-Fel d 1-specific IgY (AFD1) is produced and is naturally concentrated in egg yolk. The aim of this study was to evaluate the tolerability, effects on growth and food consumption, and potential adverse effects of a chicken egg product ingredient containing AFD1 in kittens. This was a blinded, controlled study. Twenty-seven (27) eight-week old kittens were randomly assigned to three feeding groups containing 0 ppm AFD1 (Group 0), 8 ppm AFD1 (Group 1), and 16 ppm AFD1 (Group 2) for 84 days. Veterinary exams and bloodwork were performed on Day 42 and Day 84, and body weight and body condition score (BCS) were monitored weekly. Throughout the study, there were no signs of nutritional deficiency or adverse clinical events in any of the subjects. Administration of a chicken egg product ingredient containing AFD1 in the diet (whether in coating or combination of coating and top dress) had no significant effect on body weight nor food consumption, and all subjects maintained a healthy Body Condition Score (BCS) throughout the study. Moreover, there were no biologically significant differences in the mean clinical chemistry and hematology parameters. This study demonstrated that a diet formulated to contain up to 16 ppm AFD1, included in the coating and the top-dress of dry kitten food, was well tolerated, promoted adequate growth, and exhibited no adverse effects.

Hodgkin's Lymphoma In Low-Income Countries: Experience Of Togo

While highly curable in developed countries, Hodgkin's lymphoma (HL), remains a significant challenge for resource-limited ones. This study aimed to describe the profile of HL in Togo. This was a retrospective, descriptive study conducted at the Clinical Hematology Department of the Campus University Hospital Center in Lomé, Togo. It focused on patient records diagnosed with HL between January 1, 2006, and December 31, 2022. Various variables such as age, gender, histological type of HL, Ann Arbor stage, prognostic classification, therapeutic protocol used, and patient outcomes were examined. The annual incidence of HL was 1.5 with a mean age of 38.7 years (range 12-63). Lymph node enlargement was the primary clinical sign (100%). Histologically, classical HL was found in 21 patients (87.5%). Staging was conducted for 16 (66.7%) patients, among whom 11 (66.7%) were at an advanced stage, and 6 (37.5%) had an unfavorable prognosis. The ABVD protocol was used in 13 patients (54.2%), receiving between 1 and 6 cycles. One patient achieved complete remission (4.1%), three deceased (12.5%), and 17 (71%) were lost to follow-up. Hodgkin's lymphoma prognosis remains unfavorable with low remission rates in Togo. Improving the technical facilities will ensure better management of this lymphoma.

MLPA in the initial genetic screening of patients with acute myeloid leukemia.

This study aimed to assess the effectiveness of multiplex ligase-dependent probe amplification (MLPA) in the initial genetic screening of patients with acute myeloid leukemia (AML) since current risk stratification and clinical management depend on molecular-genetic markers. We performed a prospective case-control study on newly diagnosed patients from the Clinical hematology clinic of UMHAT "St. Marina", Varna, for the period 02.2022 - 02.2023. MLPA - a semiquantitative PCR-based method, was implemented with probes for 40 AML/myelodysplastic syndrome-typical genetic changes. We compared these findings with a parallelly carried out cytogenetic analysis, part of the routine diagnostic process. We assessed 61 patients - 29 females and 32 males, median age of 61 years for females and 65 for males (min-max 20-89). 34 (56%) of all showed pathological results, while the rest 27 (44%) did not. Of the 34, 22 (65%) had a single gene variant in genes NPM1, DNMT3A, FLT3, and IDH2, isolated or in combination. 18 (53%) of the same 34 also had copy number aberration (CNA) in chromosomes 4, 5, 6, 7, 11, 14, 17, and 21. The latter were either isolated or in combination with other findings. 8 of the 18 cases also underwent cytogenetic analysis, with concordance between the two methods in 4. MLPA is an informative method for initial genetic assessment in addition to cytogenetic analysis. Still, more patients are needed to draw finite conclusions on its eligibility for routine use. Given the significant percentage of normal results - 44%, simultaneous evaluation of more genetic markers, included in current guidelines, is reasonable.

Preclinical assessments of safety and tumorigenicity of very high doses of allogeneic human umbilical cord mesenchymal stem cells

Human umbilical cord-mesenchymal stem cells (hUC-MSCs) have been widely investigated as a new therapeutic agent to treat injuries and inflammatory-mediated and autoimmune diseases. Previous studies have reported on the safety of low-dose infusion of hUC-MSCs, but information on the cell behaviour at higher doses and frequency of injection of the cells remains uncertain. The aim of the present study was to demonstrate the safety and efficacy of hUC-MSCs by Cytopeutics® (Selangor, Malaysia) from low to an extremely high dose in different monitoring periods in healthy BALB/c mice as well as assessing the tumorigenicity of the cells in B-NDG SCID immunocompromised mice. Umbilical cord from two healthy human newborns was obtained and the isolation of the hUC-MSCs was performed based on previous established method. Assessment of the cells at different doses of single or multiple administrations was performed on healthy BALB/c mice in dose range finding, sub-acute (7 d and 28 d) and sub-chronic periods (90 d). Tumorigenicity potential of Cytopeutics® hUC-MSCs was also evaluated on B-NDG immunocompromised mice for 26 wk. Single or multiple administrations of Cytopeutics® hUC-MSCs up to 40 × 106 cells per kilogramme of body weight (kg BW) were found to have no adverse effect in terms of clinical symptoms, haematology and other laboratory parameters, and histology examination in healthy BALB/c mice. hUC-MSCs were also found to reduce pro-inflammatory cytokines (IL-6 and TNF-α) in a dose-dependent manner. No sign of tumor formation was observed in B-NDG mice in the 26-wk tumorigenicity assessment. Single or multiple administration of allogenic Cytopeutics® hUC-MSCs was safe even at very high doses, is non-tumorigenic and did not cause adverse effects in mice throughout the evaluation periods. In addition, Cytopeutics® hUC-MSCs exhibited immunomodulatory effect in a dose-dependent manner.

Clinico-Pathological Alterations and Therapeutic Management of Thiram Poisoning in Cattle

As there is very scarce literature on fungicide poisoning in livestock animals and in view of reporting fungicide poisoning in cattle in the study area, the present study was conducted to study the clinico-pathology of thiram poisoning in cattle and to standardize the therapeutic regime for the poisoning cases. Clinical cases suspected for Thiram poisoning on the basis of confirm evidence from animal owner were subjected to clinical examination, hematology and therapeutic management. Cases died of severe poisoning were subjected to post-mortem examination. A total of 17 cattle suspected for Thiram poisoning on the basis of history and evidence showed clinical signs of sudden onset of anorexia, salivation, shivering, teeth grinding, restlessness, prolonged sitting, tympany, colic, dyspnea and constipation or diarrhea in few cases. Significant increase in heart rate and respiration rate was observed while hematological analysis showed non-significant changes compared to healthy counterparts. Post-mortem and histopathological examination of cattle died of thiram poisoning showed mild hepatocellular degeneration, tubular necrosis in kidneys with focal infiltrates while marked edema and congestion was evident in lung tissues. The ailing cattle were treated with fluid therapy, anti-inflammatory drugs, vitamin B complex, atropine sulphate, antihistaminics along with laxative and prebiotics-probiotics showed good response to treatment with complete clinical recovery in 4-5 days of treatment. Being there is no specific antidote, the cases of fungicide like Thiram poisoning could be managed with symptomatic treatment and regular clinical assessment of the severity of the poisoning.

Perceptions and experiences of onco-haematology professionals in relation to advance care planning: a qualitative study.

The objective of this study is to identify the beliefs, values, perceptions, and experiences of medical oncology, radiation oncology, and clinical haematology professionals about the advance care planning process. Qualitative exploratory study. There were four focus groups with 14 nurses and 12 physicians (eight medical oncology, one radiation oncology, three haematology). A reflexive thematic analysis of the data obtained was performed. We identified 20 thematic categories, which we grouped into four themes: lack of knowledge about advance care planning; perception of the advance care planning process: knowledge acquired from practice; barriers and facilitators for the implementation of advance care planning; and communication as a key aspect of advance care planning. The participants valued advance care planning as an early intervention tool that promotes autonomy. They perceived difficulties in approaching planning due to lack of knowledge, training, and time. They identified the therapeutic relationship with the person, the participation of the person's loved ones, teamwork, and communication skills as essential to ensuring the quality of the process. Finally, they recognised that palliative care professionals provide added value in supporting planning processes.

Efficient leukocytes detection and classification in microscopic blood images using convolutional neural network coupled with a dual attention network

Leukocytes, also called White Blood Cells (WBCs) or leucocytes, are the cells that play a pivotal role in human health and are vital indicators of diseases such as malaria, leukemia, AIDS, and other viral infections. WBCs detection and classification in blood smears offers insights to pathologists, aiding diagnosis across medical conditions. Traditional techniques, including manual counting, detection, classification, and visual inspection of microscopic images by medical professionals, pose challenges due to their labor-intensive nature. However, traditional methods are time consuming and sometimes susceptible to errors. Here, we propose a high-performance convolutional neural network (CNN) coupled with a dual-attention network that efficiently detects and classifies WBCs in microscopic thick smear images. The main aim of this study was to enhance clinical hematology systems and expedite medical diagnostic processes. In the proposed technique, we utilized a deep convolutional generative adversarial network (DCGAN) to overcome the limitations imposed by limited training data and employed a dual attention mechanism to improve accuracy, efficiency, and generalization. The proposed technique achieved overall accuracy rates of 99.83%, 99.35%, and 99.60% for the peripheral blood cell (PBC), leukocyte images for segmentation and classification (LISC), and Raabin-WBC benchmark datasets, respectively. Our proposed approach outperforms state-of-the-art methods in terms of accuracy, highlighting the effectiveness of the strategies employed and their potential to enhance diagnostic capabilities and advance real-world healthcare practices and diagnostic systems.

Cardiovascular risk in elderly Egyptians with myelodysplastic syndromes

BackgroundMyelodysplastic syndromes (MDS) are a heterogeneous group of clonal stem cell-derived disorders manifested by cytopenias peripherally. MDS initiates an inflammatory process which lead to atherosclerosis. Patients with MDS have 1.5-fold higher risks of cardiovascular risks.ObjectiveEvaluation of cardiovascular risk and unraveling the possible correlation of carotid intima media thickness (CIMT) with clinical, hematologic, and laboratory variables in elderly patients with MDS.MethodsWe conducted a case–control research on 168 participants to elicit the serum level of homocysteine, serum high-sensitive C-reactive protein (Hs-CRP), and CIMT in relation to cardiovascular risk, 84 of whom had MDS diagnoses. From March 2021 to the end of May 2023, we chose them among the inpatients and outpatients of the Menoufia University Hospitals’ Clinical Hematology Division. We contrasted the chosen MDS patients with 84 healthy individuals as controls.ResultsRight and left CIMT were significantly higher in MDS patients than controls as well as for lipid profile, blood pressure, blood sugar, and Hs-CRP. Homocysteine was higher in MDS patients but of no statistical significance.ConclusionAs CIMT and C-reactive protein level were significantly higher in studied patients, we may consider MDS group of patients to have higher risk for cardiovascular disease than normal people.

Navigating the path to precision: ChatGPT as a tool in pathology

In recent years, the integration of Artificial Intelligence (AI) into medicine has marked a transformative shift in healthcare practices. This study explores the application of ChatGPT 3.5, an AI-based natural language processing model, in the field of pathology, with a focus on Clinical Pathology, Histopathology, and Hematology. Leveraging a dataset of 30 clinical cases from an online source, the model's performance was evaluated, revealing moderate proficiency in data analysis and decision support. While ChatGPT demonstrated strengths in swift narrative comprehension and foundational insights, limitations were observed in generating detailed and comprehensive information. The study emphasizes the evolving nature of AI in pathology, highlighting the need for ongoing refinement and collaborative efforts between AI researchers and healthcare professionals.

Correlation of RBC indices and RBC histogram obtained by automated hematology analyser with peripheral smear in the diagnosis of anemia

: The impact of early diagnosis and management of anemia on patient outcome has been tremendous. Although conventional microscopic examination of blood using peripheral smear is unequivocal, the advent of automated hematology analyzer has revolutionized the field of clinical hematology and its practice. This study highlights the efficiency and utility of specific parameters obtained by hematology analyzer and its comparison with peripheral smear in the diagnosis of anemia, also determines the sensitivity of the same.: 501 Ethylenediamine tetra acetic acid blood samples collected at a tertiary care teaching hospital in Karnataka during one and half years from February 2021 to August 2022, were run on the Sysmex 6-part automated hematology analyzer and simultaneous peripheral smears were prepared and stained using Leishman stain based on standard operating procedures. The histogram and peripheral smear findings were noted.: Among the 501 cases, there were 269(53.7%) cases of Normocytic Normochromic Anemia in which 82.9% showed normal curve, 145(28.9%) cases of Microcytic Hypochromic Anemia in which 92.4% showed shift to left, 31(6.2%) cases of Dimorphic Anemia in which 61.3% showed normal curve contrary to the expected double peak, 24(4.8%) cases of Macrocytic Anemia in which 83.3% showed shift to right, 23(4.6%) cases of Pancytopenia in which 39.1% showed normal curve and 9 cases of Normocytic Hypochromic Anemia. : The Automated hematology Analyzer provides highly valuable information with limited sample and is an essential tool in diagnosis, classification and management of anemia.

Safety assessment of a proprietary fermented soybean solution, Symbiota®, as an ingredient for use in foods and dietary supplements: Non-clinical studies and a randomized trial.

A safety evaluation was performed of Symbiota®, which is made by a proprietary anaerobic fermentation process of soybean with multistrains of probiotics and a yeast. The battery of genotoxicity studies showed that Symbiota® has no genotoxic effects. Safety and tolerability were further assessed by acute or repeated dose 28- and 90-day rodent studies, and no alterations in clinical observations, ophthalmological examination, blood chemistry, urinalysis, or hematology were observed between the control group and the different dosing groups (1.5, 5, and 15 mL/kg/day). There were no adverse effects on specific tissues or organs in terms of weight and histopathology. Importantly, the Symbiota® treatment did not perturb hormones and other endocrine-related endpoints. Of note, the No-Observed-Adverse-Effect-Level was determined to be 15 mL/kg/day in rats. Moreover, a randomized, double-blind, placebo-controlled clinical trial was recently conducted with healthy volunteers who consumed 8 mL/day of placebo or Symbiota® for 8 weeks. Only mild adverse events were reported in both groups, and the blood chemistry and blood cell profiles were also similar between the two groups. In summary, this study concluded that the oral consumption of Symbiota® at 8 mL/day by the general population does not pose any human health concerns.

SARS-CoV-2 infection associated with hemopathies: An experience of a clinical hematology center in sub-Saharan Africa, Senegal

Abstract: INTRODUCTION: Many studies have reported the association of SARS-CoV-2 with benign and malignant hemopathies. Data from African series are scarce. This work was conducted in sub-Saharan Africa and aimed to study the clinical, biological, and evolutionary features of hemopathies associated with this infection. MATERIALS AND METHODS: It was a retrospective, cross-sectional study carried out over 32 months including 86 patients with benign or malignant hemopathies who underwent coronavirus disease-2019 (COVID-19) confirmed by the real-time reverse transcriptase-polymerase chain reaction or presenting with atypical clinical signs associated with highly suggestive computed tomography (CT) scan signs. RESULTS: The mean age of patients was 48.3 ± 18.7 years with a sex ratio of 0.75. The main benign hemopathies were sickle cell trait (SCT) (n = 51), sickle cell disease SS (n = 8), and sickle cell disease SC (n = 1), while malignant hemopathies were represented by multiple myeloma (n = 5), non-Hodgkin lymphoma (n = 5), and chronic lymphocytic leukemia (n = 4). The clinical symptoms mainly featured anemic syndrome (16.3%) and a vaso-occlusive crisis was found in 9.3% of homozygous sickle-cell patients. The infection was moderate in 48% of cases and severe in 19.7%. The severe forms were commonly found in patients with malignant hemopathies (47.6%) and the benign forms were noted in benign hemopathies (38.4%). Full blood count outlined anemia in 32.5% and lymphopenia in 23.2% of cases. On imaging, the CT scan reported severe lesions in 41.3% of cases. The outcome resulted in full recovery in 76.7% of cases, and mortality occurred in 23.3%. In univariate analysis, death was mainly noted in patients with lymphoid hemopathies (15%). Comorbidities (P < 0.0001), lymphoid hemopathies (P < 0.0001), and the severity of COVID-19 (P < 0.0001) had a positive impact on death occurrence in univariate analysis. CONCLUSION: The association between SARS-CoV-2 and hemopathy is not uncommon and is dominated by benign hemopathies. Malignant hemopathies are at-risk underlying conditions justifying a hospital follow-up of mild forms, allowing better survival. Particular attention must be paid to SCT with comorbidities and those with sickle cell disease of disease.

Early detection, reactivation of cytomegalovirus DNA & immediate early (IE)-mRNA expression in hematopoietic stem cell-transplant patients

BackgroundHuman cytomegalovirus (HCMV) reactivation is a major cause of morbidity and mortality among stem cell transplant recipients post-transplantation. AimHCMV immediate-early messenger RNA (IE-mRNA) was evaluated as marker of post-transplant HCMV reactivation in bone marrow transplant recipients. Methodology: An in-house real-time reverse transcriptase PCR targeting IE-mRNA was developed to estimate HCMV mRNA levels post-transplantation. Blood samples collected in K2-EDTA tubes from patients (n = 162) admitted with Department of Clinical Hematology were transported in cold condition for routine HCMV DNA screening. For HCMV IE-mRNA quantification, peripheral blood mononuclear cells (PBMCs) were separated from whole blood and stored in RNA later at −70 °C until testing. Samples were collected weekly once for first 3 weeks post-transplantation and thereafter from week 4–12, samples were collected twice weekly. A total of 2467 samples were collected from 162 study participants. ResultsThirty five patients (21.6 %) had post-transplant HCMV reactivation. Twenty five patients with complete follow-up were selected for monitoring HCMV DNA. HCMV IE-mRNA PCR was performed for 15 patients and 7(46.6 %) patients had detectable mRNA levels. HCMV IE-mRNA was detected in all patients with increasing HCMV DNA levels except for one patient in whom IE-mRNA appeared 3 days before HCMV DNA was detected. One patient had detectable HCMV IE-mRNA during declining HCMV DNA level. However the patient showed an increased HCMV DNA one week later, indicating the importance of HCMV mRNA in predicting HCMV replication. ConclusionQuantification of HCMV IE-mRNA may be a valuable tool to predict progression of HCMV infection post-transplantation, with further prospective studies needed for validation.

Haematology and biochemistry in healthy llamas at sea level.

In the last years, there has been an increasing interest in llamas, not only as part of a productive system, but mostly as companion animals. Most reports regarding clinical biochemistry and haematology include few llamas and details about their health status are not available. The present study aims to provide haematological and biochemical parameters for llamas of known health status. Twenty-three non-pregnant females and seven males that live in Buenos Aires, Argentina (34°36'S, 58°22'W, at sea level) were studied. Llamas were clinically healthy, in good nutritional status. Animals were kept at grass and were fed hay bale or pellets and water ad libitum. Blood samples were collected by jugular venipuncture in spring. Packed cell volume, leucocyte count, differential white cell count, platelets count, urea, creatinine, total proteins, albumin, alkaline phosphatase, aspartate aminotransferase, alanine aminotransferase, glucose, calcium and phosphate were assessed. No significant differences were observed between males and females, except for platelet count and calcium, which was greater in males (P˂0.01). Values obtained for the different parameters were similar to those previously reported, except for monocytes, alkaline phosphatase, glucose and calcium, that were lower and lymphocytes and platelets count, that were higher in this study. In conclusion, different ambient and methodological conditions might affect some parameters. The parameters hereby presented are representative of llama's population living at sea level in South America.

Negative impact of immunoparesis in response to anti-SARS-CoV-2 mRNA vaccination of patients with multiple myeloma.

Multiple myeloma reduces cellular and humoral immunity. Optimal prediction of antibody response to anti-severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccine in patients with MM and related disorders is essential to prevent coronavirus disease 2019 (COVID-19) during the SARS-CoV-2 pandemic. This study analyzed the humoral response to the anti-SARS-CoV-2 messenger ribonucleic acid (mRNA) vaccine and its associated factor in 83 patients from June to November 2021 at seven member institutions of the Kyoto Clinical Hematology Study Group. SARS-CoV-2 neutralizing antibody (nAb) was measured from 12 to 210days. The result revealed that 40 (48.2%) patients with MM and 59 (100%) healthy controls became seropositive after vaccination. Receiver operating characteristic curve analysis identified serum immunoglobulin (Ig) M of > 18mg/dL at vaccination as the optimal threshold level associated with seropositivity in the whole cohort. Moreover, the multivariate analysis identified serum IgM of > 18mg/dL as the independent predictor for a favorable response. Serum IgA level was positively associated with vaccine response in a sub-cohort. Our findings indicate a significant association between immunoparesis and impaired humoral response against mRNA vaccination, including that against SARS-CoV-2, and that serum non-M-protein Ig levels can serve as surrogate biomarkers of nAb production ability.

Improving the Outpatient Pain Management Plan for Patients with Sickle Cell Disease with Electronic Medical Record-Based Pain Action Plans

Background: Patients with sickle cell disease (SCD) experience recurrent vaso-occlusive crises (VOC) as a primary manifestation of their illness. The American Society of Hematology (ASH) best practice guidelines recommend that individuals with SCD have individualized care plans to effectively begin pain management at home prior to presenting to the emergency room. A needs assessment of the comprehensive sickle cell program at Rady Children's Hospital San Diego (RCHSD) identified the need for a standardized approach for the provision of Pain Action Plans (PAP). In 2022, an outpatient PAP Quality Improvement (QI) project was initiated at RCHSD with the global aim to improve outpatient pain management and quality of life for patients with SCD. SMART Aim: Within 6 months (January-June 2023), to increase the proportion of patients with SCD receiving a PAP during a comprehensive clinic visit from 0 to 50%. Methods: The QI project was conducted by an interprofessional team with clinical, QI, and information technology expertise. An initial approach utilizing the Med Action Plan function in EPIC had technical challenges and was not implemented. We identified an existing Epic Asthma Action Plan which could be adapted to a SCD PAP. Meetings with clinical informaticists, pulmonology (consultants), and hematology teams informed the QI tools (process mapping, key driver and Ishikawa diagrams) that we used to design our PDSA cycles. The PAPs were modeled after the existing Asthma Action Plan, with green, yellow, and red zones to indicate different levels of pain management. Patients were given laminated Youth Acute Pain Functional Ability Questionnaire (YAPFAQ) and a comfort measures sheet to complete prior to their visit with the provider to inform the PAP which included pain medication details and supportive care measures for each zone. PAPs were created within the clinic note at comprehensive clinic visits and then provided to the family as a printed letter in person and via MyChart (if activated). Our outcome measure was the percentage of patients who were provided a PAP at their SCD comprehensive clinic visit. Process measures included the percentage of patients who had documentation in the PAP of the YAPFAQ and comfort measures, percentage of patients who had a PAP routed to patient via MyChart, percentage of patients who confirmed receipt of their PAP, percentage of patients who had used their PAP by parental report after one week, and percentage of patients who had used their PAP after 3 months per Epic documentation. Balancing measures were the perceived burden of patient care/documentation for the PAP to be evaluated with pre and post surveys among providers. Results: Interventions were evaluated using PDSA cycles. PDSA Cycle 1 (January-March 2023) included development of the SCD PAP by adapting the existing Asthma Action Plan to a SCD PAP. This included the creation of medication templates, integrating comfort measures and pain triggers, creating EPIC smart phrases to document the YAPFAQ. We educated providers on the SCD PAP and documentation process and worked with the interdisciplinary team including case managers, nurses, child life specialists, and psychologist to incorporate YAPFAQ and comfort measures into the comprehensive clinic visit. PDSA Cycle 2 (April-June 2023) included additional education, training, and targeted e-mail reminders to hematology attendings. From May 2023 to July 2023, 94% percent (13/14) of patients seen at a comprehensive clinic visit received a PAP. One patient had the PAP created but did not receive the printed letter due to time constraints for family. Feedback from families indicated that they felt the PAP was a valuable tool to have at home during VOC, however none had yet utilized it in the week since they were seen in clinic. Early provider feedback has indicated that this functionality is easy to use and efficient during the comprehensive clinic visit. Conclusion: The adaptation of the Asthma Action Plan to the SCD PAP allowed for successful implementation of PAPs for our patients with SCD. Subsequent PDSA cycles will focus on optimizing implementation in the clinic and utilization for pain events. We will evaluate the clinical impact of the PAPs on pain management outcomes.

Clinical Chemistry and Haematology Values of a Captive Population of Humboldt Penguins (Spheniscus humboldti).

Reference intervals for clinical chemistry and haematology analytes are essential for the interpretation of blood results, but limited data are available for Humboldt penguins (Spheniscus humboldti) in zoological collections as well as in the wild. The aim of the present study was therefore to establish reference intervals for a series of clinical chemistry and haematology analytes in a single zoological population of Humboldt penguins. Furthermore, possible variations of the analytes influenced by the age and sex of the individuals were investigated. Lithium heparinized plasma and whole blood samples from 39 animals were analysed and statistically evaluated. The following clinical chemistry analytes were significantly higher in females: glutamate dehydrogenase (p = 0.0003), alanine transaminase (p = 0.0005), alkaline phosphatase (p = 0.0245), aspartate aminotransferase (p = 0.0043), creatine kinase (p = 0.0016), lactate dehydrogenase (p < 0.0001), inorganic phosphorus (p = 0.0223), and sodium (p = 0.0415). No significant differences between males and females were found for any haematology analyte. Cholesterol (p = 0.0233; -0.39), white blood cell count (p = 0.0208; -0.40), and absolute heterophiles (p = 0.0148; -0.42) had significant negative correlations with the age of the penguins. The results indicate that the factors of sex and age should be considered when interpreting the results of haematological and clinical biochemistry assays, and further studies are needed to determine whether there are more differences in other age groups or seasons.

Abstract 15468: Factor VII Induced Coronary Thrombosis

Case Description: 69-year-old male with a history of factor VII deficiency and coronary artery disease (CAD) with a stent in the distal left anterior descending (LAD) artery, underwent diagnostic laparoscopy for suspected appendiceal carcinoma. He is a non-smoker, has good exercise tolerance and takes aspirin only three times a week, due to epistaxis. Post-surgery, he complained of 10/10 substernal chest pain. Initial troponin (TnI) was 0.11 ng/dL, peaking at &gt;80 ng/dL in 2 hours. EKG was compatible with an anterior wall STEMI. An emergent coronary angiogram showed a patent distal LAD stent and a 99% occlusive lesion in the mid-LAD, which was treated with a drug-eluting stent. With careful clinical judgment and hematology consultation, dual antiplatelet therapy was continued despite a history of coagulopathy. On probing, it was discovered that the patient received two doses of recombinant factor VII (rVII) prior to the surgery to reduce operative bleeding. Discussion: Recombinant factor VII is known to cause serious arterial and venous thromboembolic events. This risk increases to almost 10% in patients who are elderly with concomitant vascular disease. In our patient with prior history of CAD and in the setting of acute surgical stress, exogenous factor VII unbalanced the coagulation system leading to a STEMI. Surgical teams should be aware of the detrimental consequences of administration of rVII in high cardiovascular risk patients and seek alternative hemostatic strategies. Prothrombotic agents should be used with caution and close monitoring for acute coronary syndromes, especially in patients with a high risk of CAD.

Quantitative Measurements of Red Blood Cell Indices Using Spectroscopic Differential Phase-Contrast Microscopy.

Red blood cell (RBC) indices serve as clinically important parameters for diagnosing various blood-related diseases. Conventional hematology analyzers provide the highly accurate detection of RBC indices but require large blood volumes (>1 mL), and the results are bulk mean values averaged over a large number of RBCs. Moreover, they do not provide quantitative information related to the morphological and chemical alteration of RBCs at the single-cell level. Recently, quantitative phase imaging (QPI) methods have been introduced as viable detection platforms for RBC indices. However, coherent QPI methods are built on complex optical setups and suffer from coherent speckle noise, which limits their detection accuracy and precision. Here, we present spectroscopic differential phase-contrast (sDPC) microscopy as a platform for measuring RBC indices. sDPC is a computational microscope that produces color-dependent phase images with higher spatial resolution and reduced speckle noise compared to coherent QPIs. Using these spectroscopic phase images and computational algorithms, RBC indices can be extracted with high accuracy. We experimentally demonstrate that sDPC enables the high-accuracy measurement of the mean corpuscular hemoglobin concentration, mean corpuscular volume, mean corpuscular hemoglobin, red cell distribution width, hematocrit, hemoglobin concentration, and RBC count with errors smaller than 7% as compared to a clinical hematology analyzer based on flow cytometry (XN-2000; Sysmex, Kobe, Japan). We further validate the clinical utility of the sDPC method by measuring and comparing the RBC indices of the control and anemic groups against those obtained using the clinical hematology analyzer.