Complete Blood Count Analysis Research Articles

Is there Any Relationship Between Long-Term Mortality of Acute Pulmonary Embolism and Complete Blood Count Analysis?

Purpose:Acute pulmonary embolism (PE) is a challenging disease as the third most common cause of cardiovascular death. Despite various scoring systems and blood parameters, more simple and practical predictors are being investigated. The objective of this study is to investigate the relationship between hospital and long-term mortality and complete blood count parameters, neutrophil-to-lymphocyte ratio (PLR) and platelet-to-lymphocyte ratio (PLR) in patients with acute PE. Patients and Methods:The present study is a retrospective observational study. Between June 2016 and June 2018, patients hospitalised in our chest diseases clinic with evident PE were included. Demographics, baseline complete blood count, D-dimer (mg/L) and C-reaktif protein (mg/L) values were recorded. In-hospital mortality and long-term mortality were investigated and predictors of mortality were analyzed. Results:Of all the 74 pateints, 36 (49%) were male and the mean age was 65±18 (20-89). Embolus was localised in main pulmonary artery in 51%, right heart dysfunction were noted in 8 (10%) patients. Baseline NLR was significantly higher in patients who died in hospital (9.8±7.1 vs. 5.3±4.8, respectively) (P=0.037). Additionally NLR was found as a predictor of long-term mortality (P=.,047). The other predictors for long-term mortality were male gender (P=0.002), advanced age (P=0.023) and lower hemoglobin (P=0.013) values. Conclusion:Acute PE may lead mortality and require close follow-up of patients. Higher NLR values relate both in-hospital and long-term mortality and may be used as a cheap, simple and useful prognostic predictor in patients with PE.

A rare urea cycle disorder in a neonate: N-acetylglutamate synthetase deficiency

Urea cycle disorders (UCD), are genetically inherited diseases that may have a poor outcome due to to profound hyperammonemia. We report the case of a baby girl diagnosed as N-acetylglutamate synthase (NAGS) deficiency. The patient was evaluated due to diminished sucking and hypotonicity. Physical examination showed hepatomegaly. Complete blood count, biochemical values and blood gas analyses were normal, acute phase reactants were negative. Further laboratory analyses showed no ketones in blood and highly elevated ammonia. Metabolic tests were inconclusive. Emergency treatment was initiated immediately and she was discharged on the 15th day of admission. NAGS deficiency was confirmed by DNA-analysis. She is now without any dietary restriction or other medication, except N-carbamylglutamate (NCG). NAGS deficiency is the only UCD which can be specifically and effectively treated by NCG. Early recognition of disease will lead to early treatment that may prohibit devastating effects of hyperammonemia.

28 Steroid hormones are differentially abundant in sows with elevated risk for pelvic organ prolapse during late gestation

Abstract Sow mortality, as the result of pelvic organ prolapse (POP), has increased during recent years in the U.S. swine industry and continues to worsen. The objective of this study was to identify putative biological factors associated with POP risk. We hypothesized sows differing in POP risk would differ in serum factors and steroid hormone profiles. Perineal scores (PS) were assigned to sows (n=2865) during late gestation (days 107-116) to assess POP risk. Sows assigned a PS1 had a presumed low risk of POP while those assigned a PS2 or PS3 had a presumed moderate or high risk of POP, respectively. Subsequently, 1.0, 2.7, and 23.4% of sows scored as PS1, PS2, or PS3, experienced POP, respectively. Blood samples were collected on a subset of sows (n=215) identified as PS3 along with parity-matched PS1 sows at the time of scoring and whole blood was subjected to complete blood count (CBC) analysis. Serum from a subset of these (n=110) samples were also subjected to a 17-panel hormone analysis. Additionally, serum biomarkers of inflammation, C-reactive protein and haptoglobin, were analyzed in PS3 sows that subsequently experienced POP and parity matched PS1 sows that did not experience POP. The CBC analysis revealed a 4.3, 7.8 and 5.9% decrease (P < 0.05) in mean platelet volume, lymphocytes, and monocytes, respectively, in PS3 compared to PS1 sows. Deoxycortisol, androstenedione, androsterone, estrone, β-estradiol, and testosterone were greater (P < 0.05) in PS3 compared to PS1 sows. Circulating haptoglobin was unaffected (P = 0.35) by PS, although C-reactive protein was 24.6% greater (P = 0.02) in PS3 sows. Collectively, serum differences in hormone profiles and biomarkers consistent with inflammation in sows differing in POP risk. This project was supported by the National Pork Board and the Foundation for Food and Agriculture Research.

Tissue Lead and Cadmium Levels and Associated Haematological Changes in Goats Slaughtered at The Bodija Abattoir, Ibadan

Heavy metal environmental contamination consequent of anthropogenic factors has become a global concern with cadmium and lead constituting a major public health, livestock and ecological threat. This study, therefore, uses goats (as sentinel animals) raised in 2 different regions based on their mining history (previous and existing) to evaluate exposure to cadmium and lead and their consequent toxicities and pathological changes. A total of 130 goats (composed of 88 goats which constitute the suspected exposure (SE) group and 44 goats, the suspected unexposed (SU) group) were sampled. Blood and tissue samples (liver, kidney and muscles) were analysed for lead and cadmium levels using Atomic Absorption Spectrophotometer along with the complete blood count analysis. The mean blood lead levels (BLLs) and cadmium levels (BCLs) in the goats from the SE groups were 14.59 and 3.12 µg/dl respectively, which were significantly higher than the SU groups (9.23 and 0.46 µg/dl respectively) A significantly higher frequency of goats in the SE (93.18%) also had an elevated BLLs compared to the SU group (78.57%). The levels of tissue lead and cadmium in both the SE and SU groups were found significant and higher than the FAO/WHO maximum limits. The packed cell volume, red blood cell count, and haemoglobin concentration were found significantly lower, and the platelet count and some leucocyte parameters (total white blood cell, neutrophil, eosinophil, and monocyte count) were found significantly higher in the SE group. The elevated cadmium and lead level in both groups further highlight the ubiquitous spread of cadmium and lead environmental contamination in both study regions and the direct risk of exposure to human and animals in Nigeria. The relative differences in the observed pathological changes in the two study groups also suggest the influence of the environmental heavy metal pollution and exposure levels on health.

Differential microRNA expression in childhood B-ALL with trisomy 8: A case report

B-Cell Acute Lymphoblastic Leukemia account for approximately 80% of leukemia cases in children and adolescents. Numerical chromosomal changes are important prognostic factors. Trisomy 8 is one of the most frequent numerical aberrations in acute myeloid leukemia but is rarely found in lymphoid malignancies. Here, we share our findings in a childhood acute lymphoblastic leukemia patient with trisomy 8, referred for diagnostic assessment. Physical examination, myelogram, complete blood count, cytogenetic, and RT-PCR analysis for TEL-AML1 and E2A-PBX1 rearrangements were carried out. Microarray methodology was used to assess the miRNA expression profile. We highlight 36 miRNAs differentially expressed (p < 0.001, fold change >2.0) comparing with mononuclear cells from five subjects without leukemia. Among the miRNAs differentially expressed in our patient, only two have been described in B-ALL, namely miR-133b and miR-181b-5p. Some miRNAs which was downregulated in our patient as miR-495 and miR-127 have tumor suppressor function. None of the miRNAs located on chromosome 8 were significantly upregulated. The relationship between the altered miRNA expression profiles and leukemogenesis can be associated with global changes in gene expression and regulation patterns caused by acquired trisomy 8, influencing the patient's response to treatment and prognosis.

Abstract 14991: Mitochondrial Transplantation by Intraarterial Injection Ameliorates Acute Kidney Injury

Introduction: Acute kidney injury (AKI) is a common clinical disorder and one of the major causes of morbidity and mortality during the postoperative period. In this study, we investigated the safety and efficacy of autologous mitochondrial transplantation by intra-arterial injection for renal protection in a swine model of bilateral renal ischemia-reperfusion injury (IRI). Methods: Female Yorkshire pigs (n=12) underwent percutaneous bilateral temporary occlusion of the renal arteries with balloon-catheters. Following 60 minutes of ischemia, the balloon catheters were deflated and animals received either autologous mitochondria suspended in vehicle (n=6) or vehicle alone (n=6), delivered as a single bolus to the renal arteries. Results: Injected mitochondria were rapidly taken up by the kidney and were distributed throughout the tubular epithelium of the cortex and the medulla. Evaluation of plasma electrolytes, acid-base status, complete blood count and biochemical analysis did not reveal evidence of any adverse effects associated with mitochondrial transplantation. After 24 hours of reperfusion, eGFR and urine output were significantly increased (p&lt;0.01) while plasma creatinine and BUN were significantly decreased (p&lt;0.01) in pigs receiving mitochondria compared to vehicle (Figure 1). Gross anatomy, histopathological analysis, acute tubular necrosis scoring and transmission electron microscopy showed that the renal cortex of vehicle group had extensive coagulative necrosis of primarily proximal tubules, while mitochondrial transplanted kidneys showed only patchy mild acute tubular injury. Renal cortex IL-6 expression had a 3.5-fold significant increase (p&lt;0.05) in vehicle kidneys compared to kidneys receiving mitochondrial transplantation. Conclusions: Mitochondrial transplantation by intra-arterial injection provides renal protection from IRI, significantly enhancing renal function and ameliorating AKI.

Hematological Indices Reference Intervals for Healthy Arab Population in Qatar: Effect of Age, Gender, Geographic Location and ABO Blood Group

Introduction: The majority of physicians' medical judgments are based on clinical information supported by laboratory reports . The availability of a reference interval for different lab values facilitates the process of interpretation . Complete blood count (CBC), testing is one of the most frequently performed hematology test in any clinical setting. Analysis of CBC by hematology analyzers is an indispensable means in the evaluation of many acute and chronic disorders including traumatic, infectious, immunological, and hematological diseases. Establishment of a normal reference interval is essential for accurate clarification of the disease diagnosis as well as for follow up. CBC techniques have improved significantly, and the accurate automated methods have now substituted manual methods. In addition, various novel blood cell parameters have been developed alongside to aid in diagnosis and management of several blood disorders . However significant differences exist in the reference intervals based on age, gender, ethnicity, genetic differences, environmental factors, and geographical location.. Dietary habits and occupational exposures are factors that have been shown to affect reference interval . Therefore, there is a requirement for each country to establish its own reference intervals. Country-specific reference intervals for CBC of adult peripheral blood have been established in many countries around the world; however, there have been no specific comprehensive studies in Arab population in Qatar based on age, gender, geographic location and ABO blood groups. To the best of our knowledge, this is the first study in Qatar that investigated CBC reference intervals in relation to age, gender, and blood grouping which can now be used as a reference when evaluating patient samples in Qatar. Methods: Venous blood specimens were collected from 720 healthy randomly selected individuals aged 18 to 69 years from 2018 to 2019 and analyzed by Sysmex NX-10 and NX -20 automated hematology analyzers. Results were statistically analyzed and compared by gender, age, and ABO blood group. Arab adults were divided into African Arabs (Egypt, Libya, Tunisia, Morocco) and Asian Arabs (Syria, Lebanon, Jordon, Palestine, Qatar). The lower and upper reference limits of the hematology reference intervals were established at the -2 SD and +2SD respectively. Results: Reference intervals were calculated for all the hematology parameters which included red blood cell, white blood cell and differential count, and platelet parameters. Arab males had significantly higher Hb, Hct, RDW, ANC, lymphocytes and monocyte counts compared to adult females. Asian-Arab males had significantly higher Hb concentration and higher WBC, lymphocytes and eosinophil counts compared to African- Arab males. Asian Arab young males had significantly higher Hb level and lymphocyte count and lower monocytes counts compared old males. African Arab young males had significantly higher lymphocyte and lower monocytes counts compared to old males. Asian- Arab young females had higher WBC, ANC counts compared to old Asian Arab females. No statistical difference in the studied hematological parameters was detected among the three groups with different ABO subgroups Conclusions: Data from this study established specific reference intervals which could be considered for general use in the Arab world. The differences in hematology reference intervals in respect to age, sex and geographical location highlights the necessity to establish reference intervals for venous blood parameters among the healthy population in each country or at least in each region. Disclosures No relevant conflicts of interest to declare.

Metabolomic Characterization of Red Blood Cell Differentiation

Background: Erythropoiesis is the highly coordinated multi-step process by which multipotent hematopoietic stem cells differentiate into mature enucleated red blood cells (RBCs). As erythroid cells become more terminally differentiated, they undergo changes in morphology and gene expression, start synthesizing hemoglobin, commit to an irreversible loss of proliferation, and eventually expulse their nuclei and other cytoplasmic organelles. Thus, RBCs must rely on their proteome and metabolome for proper function. The RBC proteome is estimated to contain 2,800 proteins, including a variety of receptors and transporters that allow RBCs to uptake xenobiotics or endogenous metabolites as they circulate for ∼120 days. Furthermore, they are metabolically active with glycolysis, nucleotide catabolism, and glutathione metabolism as the major pathways supporting cell survival and function. However, it is unclear how the metabolome is altered during erythropoiesis, what role metabolites play in normal erythropoiesis, and if dysregulation of metabolites contributes to diseases of ineffective erythropoiesis, such as sickle cell anemia and thalassemia. Methods: Four models of erythropoiesis were used in this study. 1) Mice were treated with phenylhydrazine (Phz) to induce acute hemolysis followed by erythropoietic recovery, leading to an increase in circulating reticulocytes. 2) Mice were lethally irradiated and transplanted with wild-type or sickle cell bone marrow, leading to anemic profiles in sickle cell chimeras. 3) The mouse erythroleukemic (MEL) cell line was treated with DMSO to induce differentiation. 4) The human erythroleukemic (K562) cell line was treated with sodium butyrate to induce differentiation. For the in vivo mouse models, blood was collected from control and treated animals, and complete blood count (CBC) analysis was performed. For the in vitro cell culture models, the mRNA levels of β-globin were measured by Q-RT-PCR in control and differentiated cells, and the degree of hemoglobinization was determined visually and via staining for heme. In addition, metabolites were extracted from the collected RBCs and erythroleukemic cell lines, and a Snapshot LC/MS metabolomic platform was used to identify commonly altered metabolites. Results: We first validated our four models of erythropoiesis. Treatment with Phz decreased the number of total RBCs while increasing the RBC distribution width, indicating an increased number of reticulocytes (more immature RBCs) in circulation. Similar results were seen in the sickle cell chimeras. Treatment of MEL and K562 cells with DMSO and sodium butyrate, respectively, resulted in increased expression of β-globin, increased levels of heme, and increased red color. Then, using our Snapshot metabolomic platform, we identified global changes in RBC metabolism during erythropoiesis. Analyses of the commonly altered metabolites in the in vitro and in vivo models revealed an increase in amino acid, mitochondrial, and urea cycle metabolism during erythropoiesis. L-aspartate levels were particularly upregulated, especially in DMSO-treated MEL cells. We are now investigating the role of aspartate in the regulation of erythropoiesis. Conclusions: We defined how the metabolome was altered in multiple in vitro and in vivo models of erythropoiesis and identified global changes in RBC metabolism between the different models. Specifically, we found that L-aspartate was upregulated during RBC differentiation in all four models. Aspartate is an amino acid that plays a role in many processes in cells, including nucleotide biosynthesis, redox homeostasis, and amino acid biosynthesis. We hypothesize that aspartate metabolism is critical for RBC differentiation and that its dysregulation exacerbates disease of ineffective erythropoiesis, such as sickle cell anemia and β-thalassemia. We are currently testing its role in inducing hemoglobinization and in regulating the commitment of erythroid progenitor cells to an irreversible loss of proliferation. Overall, we believe that understanding the precise mechanisms by which cellular metabolism plays a role in proper RBC differentiation may lead to better therapies for diseases of ineffective erythropoiesis, such as sickle cell anemia and thalassemia. Disclosures No relevant conflicts of interest to declare.

A Novel Approach to Blood Smear Analysis Based on Specimen Topology: Implications for Human and Artificial Intelligence Decision Making

Complete blood count (CBC) analysis is one of the most commonly ordered laboratory tests and is a critical first step in patients' clinical evaluation. However, CBC analyzers are limited in their ability to positively identify several types of white blood cells (WBC), and cells with substantial clinical significance, such as immature granulocytes or blasts, are merely marked as flags. Also, CBC analyzers fall short of recognizing informative red blood cell (RBC) morphology, such as schistocytes, and often provide inaccurate platelets count. Flags and clinically non-sufficient CBC-derived data reflex to generation of blood smear (BS), and BS review comprises a substantial portion of the workload in routine hematology laboratories. For accurate identification and classification of WBC, BS analysis (BSA) requires detailed observation of cells with high-magnification objective (60-100X), which provides a relatively narrow Field of View (FOV). This physical limitation restricts current BSA to either low resolution/wide FOV or to high resolution/narrow FOV data generation (Fig. 1A). Hence, key issues of BSA such as the effects of the smearing process on the distribution of blood components, the effects of cells distribution on their morphology and further classification, as well as many other attributes, are addressed only qualitatively or empirically, leaving the real topology of the BS obscure. The computational imaging microscopy system presented herein uses a low resolution and wide FOV objective, and records a plurality of images under different illumination conditions, of the same sample area (Fig. 1B). An algorithm reconstructs a high resolution and aberration free image of whole specimens, as can be observed in the attached link (https://tinyurl.com/Scopio-Labs-X100-ASH-2020). High resolution images are critical not only for manual BSA, but also for artificial intelligence (AI)-derived BSA, since data quality is of prime importance for deep-learning processes, and to a large extent determine their outcome. Thus, the combination of high resolution/wide FOV turns each BS into a big data analytic field, rendering the measurement of yet undetermined cell characteristics. In order to elucidate the basic topology, 60 normal BS (28 females, 32 males) were subjected to analysis utilizing this novel computational imaging microscopy. For convenience of analysis and comparison with current BSA methodology, BS were segmented into strips according to RBC density (Fig. 1C, D). The average length of smear from females (F) was higher by nearly 28% compared with smear from males (M), and the presence of acute inflammation (A) resulted in a significant 33% increase in overall smear length compared to normal (N) average (Fig. 1E). As expected, RBC density formed a linear gradient (Fig. 1C) along the axis of sample smearing, however, RBC morphology was affected by location within the BS. For example, strips 4-5 contained RBC with the appearance of spherocytes (Fig. 1F; arrows), while in strips with increased RBC density, cells aggregated resembling rouleaux formation (Fig. 1F; arrowheads). Platelets distribution was non-linear, with only a few of them reaching the feathered edge of the smear (Fig. 1G). Since the variance of both RBC/FOV and platelets/FOV concentrations drops starting with strip 4, BS-derived platelets number estimates should not be performed in strips 1-3. On average, a normal BS contains 890+399 WBC in the scanned area (strips 1-8). Similar to RBC, the location of individual WBC throughout the BS may affect their morphology, and hence their classification. WBC in the feathered edge (strips 1-3) are generally more stretched, and often squeezed between RBC, rendering their classification by AI-based tools challenging (Fig. 1H). In strips 4-7, WBC morphology is optimal for a classification task, enabling favorable outcomes for either manual or AI cell analysis (Fig. 1H). These data indicate that BSA can be taken to a sensitivity level of at least 10-3 of WBC analysis, provided that a large portion of the BS is scanned. Our system provides a novel combination of computational imaging microscopy and AI-based classification tools to unravel the complex topology of blood smears, and upgrade the data obtained in BSA. This approach enables the establishment of quantitative rules to scientifically direct the objective analysis of cellular blood components both manually, and by AI-tools. Figure Disclosures Katz: Scopio Labs: Consultancy.

A Challenging Diagnosis of Acute Myeloid Leukemia with Myelodysplasia Related Changes in the Setting of Ayurvedic Supplements and B12 Deficiency

Abstract Introduction/Objective Bone marrow findings of myelodysplastic changes can be associated with vitamin or mineral deficiencies (B12, folic acid or copper), infections, inflammatory disorders, exposure to toxins, heavy metals, zinc excess, recent radio- or chemotherapy, or myeloid neoplasms including myelodysplasia (MDS) and acute myeloid leukemia (AML). We present a case of a 32 year old Indian woman who presented with fatigue and weakness. She has a history of vitamin B12 deficiency and has been taking Ayurvedic supplements. This clinical history is very important because studies have shown that vitamin B12 deficiency has led to incorrect diagnoses of AML and/or MDS. Additionally, Ayurvedic supplements can contain a variety of heavy metals which can contribute to myelodysplastic changes. Results A complete blood count and peripheral smear analysis showed pancytopenia with rare blasts. A bone marrow core biopsy with ancillary testing was performed to evaluate for a hematologic malignancy. Vitamin B12 testing and heavy metal analysis was necessary to reach a final diagnosis. Flow cytometric analysis of the marrow identified 19.5% CD34 positive myeloblasts. The aspirate and core are hypercellular with increased blasts (17% on aspirate and 20-25% on core biopsy) with trilineage dyspoiesis. AML panel by fluorescence in situ hybridization showed no abnormalities. Heavy metal analysis shows no increase in lead, cadmium, mercury and arsenic levels. Recent vitamin B12 tests show results within normal range secondary to successful replacement. Ultimately, chromosome analysis identifies t(3;12)(q26,p13) involving ETV6/MECOM characteristic of a very poor prognosis in MDS or AML. Molecular AML panel identified BCOR and PTPN11 gene mutations which are associated with more aggressive disease and a poor prognosis in myeloid neoplasms. Conclusion This case had multiple possible causes of myelodysplastic changes and it was necessary to exclude these factors before yielding the final diagnosis of Acute Myeloid Leukemia with myelodysplastic related changes which demonstrated a rare translocation t(3;12) ETV6/MECOM which has a poor prognosis.

Lysinuric protein intolerance: an overlooked diagnosis

BackgroundLysinuric protein intolerance (LPI) is an autosomal recessively inherited inborn error of metabolism (IEM) caused by the defect in the dibasic cationic amino acid transporter found on the basolateral membrane of the lung, small intestine, and kidney due to mutations in the SLC7A7 gene, which encodes the y+LAT1 protein. LPI may present as an acute hyperammonemic episode or as chronic symptoms. Major clinical symptoms are feeding problems, vomiting and diarrhea, failure to thrive, hepatosplenomegaly, and cytopenia. We present a delayed diagnosis of symptomatic LPI with a homozygous mutation in the SLC7A7 gene.Case presentationA 15-year-old girl was referred to our clinic due to growth retardation and diarrhea. Physical examination showed short stature, retarded puberty, and hepatosplenomegaly. Laboratory tests showed normal complete blood count and biochemical analyses except elevated aspartate aminotransferase, triglyceride, total cholesterol, and ferritin. Peripheral blood smear and hemoglobin electrophoresis were within normal limits. Bone marrow analysis showed hemophagocytic cells. Postprandial ammonium level was found elevated. Low lysine, arginine, and ornithine and elevated glycine and alanine in plasma amino acid analysis and high amount of lysine and slightly elevated arginine and ornithine excretion in urine were detected. Molecular genetic analysis of the SLC7A7 gene showed a previously reported homozygous mutation. Low protein diet, sodium benzoate, l-carnitine, low-dose l-citrulline, and calcium replacement were initiated. The patient is now in good condition still being followed up in our department.ConclusionsLPI is a metabolic disorder with multi-systemic involvement that may have severe consequences if left untreated. Initiation of early treatment is essential for the prevention of severe chronic complications. Also, confirmation of the genetic defect may provide the parents to have healthy offsprings in the future with the help of genetic counselling and preimplantation genetics.

Inflammatory Effects of Thickened Water on the Lungs in a Murine Model of Recurrent Aspiration.

Liquid thickeners are commonly recommended in individuals with dysphagia and recurrent aspiration as a strategy for pneumonia prevention. The goal of this study was to examine the effects of small amounts of aspirated liquid thickener on the lungs. Animal model. Prospective small animal clinical trial. Adult Sprague Dawley rats (n=19) were divided into two groups and underwent three intratracheal instillations of either xanthan gum-based nectar-thick water (0.1-0.25 mL/kg) or water-only control over the course of 8 days. Blood was collected from a peripheral vein on days 1 and 8 and submitted for complete blood count (CBC) analysis. Rats were euthanized 10 days after the last instillation, and the lungs were harvested. Histopathology was conducted on lung specimens by a blinded licensed veterinary pathologist and scored for evidence of lung injury and pneumonia. Fifteen animals (8 nectar-thickener group, 7 control group) survived until the endpoint of the study (day 18). Serum CBC did not show abnormalities at any timepoint in either group. Histological evidence of lung inflammation and edema were significantly greater in the nectar-thick group compared to controls (P< .05). Signs of inflammation included aggregates of foamy macrophages, expansion of bronchiolar lymphoid tissue, and large numbers of eosinophilic intraalveolar crystals. Histiocytic and neutrophilic pneumonia was noted in one animal that received thickened liquids. Recurrent aspiration of small amounts of thickened water resulted in significant pulmonary inflammation in a murine model of aspiration. Results of this study support the need for further investigation of liquid thickener safety and its efficacy in reducing the pulmonary complications of swallowing disorders. NA Laryngoscope, 131:1223-1228, 2021.

Blood routine test in mild and common 2019 coronavirus (COVID-19) patients.

The new 2019 coronavirus disease (COVID-19), according to the World Health Organization (WHO), has been characterized as a pandemic. As more is being discovered about this virus, we aim to report findings of the complete blood count (CBC) of COVID-19 patients. This would serve in providing physicians with important knowledge on the changes that can be expected from the CBC of mild and normal COVID-19 patients. A total of 208 mild and common patients were admitted at the Dongnan Hospital located in the city of Xiaogan, Hubei, China. The CBCs of these patients, following a confirmed diagnosis of COVID-19, were retrospectively analyzed and a significant P<0.05 was found after a full statistical analysis was conducted using the Statistical Package for the Social Sciences (IBM SPSS). CBC analysis revealed changes in the levels of red blood cells (RBCs), hemoglobin (HGB), hematocrit (HCT), mean corpuscular volume (MCV), and C-reactive protein (CRP). Clinicians should expect similar findings when dealing with the new COVID-19.

Methylphenidate has mild hyperglycemic and hypokalemia effects and increases leukocyte and neutrophil counts.

Various psychotropic drugs may affect the hematological and biochemical profiles of plasma and its metabolism. Carbamazepine, the most well-known psychotropic drug, can cause substantial hyponatremia. Methylphenidate, a piperidine derivative structurally related to amphetamines, acts as a central nervous system stimulant. The current study evaluated whether methylphenidate affects hematological and biochemical parameters of patients diagnosed with attention deficit hyperactivity disorder.Patients undergoing treatment for attention deficit hyperactivity disorder at our Adolescent Psychiatric Clinic were enrolled in the study. Blood samples for complete blood count and common biochemical analyses were collected before patients started methylphenidate and after 3 months of continuous treatment.Participants included 64 patients comprised the study cohort. There were 48 (75%) males and 16 (25%) females, with a median age of 16 years (range 11–31). The total median potassium level decreased by 0.6 mg/dL (P < .0001), while glucose rose by 15 mg/dL (P < .0001), sodium decreased in 0.7meq/L, (P = .006). The white blood count rose by 1350 cells/μL (P < .033) due to neutrophilia, lymphocytosis and eosinophilia. Hemoglobin rose slightly by 0.1 (P = .041). Changes in calcium, phosphorus, protein, albumin, and liver enzyme levels were not significant.The results indicate that methylphenidate may cause hypokalemia and elevated glucose, leukocyte, neutrophil, lymphocyte and eosinophil counts.

Complications and risk factors regarding the outcomes of canine babesiosis in Central Europe - A retrospective analysis of 240 cases.

The purpose of this study was to investigate retrospectively the prevalence of the complicated and uncomplicated forms of babesiosis and to evaluate various laboratory and clinical parameters of dogs infected with Babesia canis in order to assess their prognostic value regarding the outcomes of the disease. Medical records, complete blood count and serum biochemical analysis from the animal hospital information system of 240 dogs were reviewed and evaluated retrospectively. Binary logistic regression analysis was used to ascertain correlations between alterations in the obtained parameters and survival probability. The results showed that creatinine levels of more than 5 mg/dL and phosphate levels of more than 3 mmol/L have a highly significant link to death (P ≤ 0.001). Albumin levels of <2.2 g/dL (P = 0.003) and a rectal body temperature below 38 °C (P ≤ 0.001) may also serve as prognostic markers for the severity of the disease. If renal involvement was present, 33.9% of the dogs died, while 40.0% of the dogs died in the presence of pancreatitis. The parameters creatinine, phosphate, albumin and rectal temperature serve as reliable predictive markers of an increased risk of death in the case of an infection with B. canis.

Label-free hematology analysis using deep-ultraviolet microscopy

Hematological analysis, via a complete blood count (CBC) and microscopy, is critical for screening, diagnosing, and monitoring blood conditions and diseases but requires complex equipment, multiple chemical reagents, laborious system calibration and procedures, and highly trained personnel for operation. Here we introduce a hematological assay based on label-free molecular imaging with deep-ultraviolet microscopy that can provide fast quantitative information of key hematological parameters to facilitate and improve hematological analysis. We demonstrate that this label-free approach yields 1) a quantitative five-part white blood cell differential, 2) quantitative red blood cell and hemoglobin characterization, 3) clear identification of platelets, and 4) detailed subcellular morphology. Analysis of tens of thousands of live cells is achieved in minutes without any sample preparation. Finally, we introduce a pseudocolorization scheme that accurately recapitulates the appearance of cells under conventional staining protocols for microscopic analysis of blood smears and bone marrow aspirates. Diagnostic efficacy is evaluated by a panel of hematologists performing a blind analysis of blood smears from healthy donors and thrombocytopenic and sickle cell disease patients. This work has significant implications toward simplifying and improving CBC and blood smear analysis, which is currently performed manually via bright-field microscopy, and toward the development of a low-cost, easy-to-use, and fast hematological analyzer as a point-of-care device and for low-resource settings.

Clinical conundrums: Developing a strategy for discerning TP53-associated chip and coherent clinical care.

1514 Background: Germline TP53 mutations are associated with Li-Fraumeni syndrome (LFS). However, approximately 20% of commercial laboratory multigene panel test (MGPT)-detected pathogenic TP53 variants represent aberrant clonal expansion (ACE), rather than a germline finding, and are often detected in individuals that lack classic features of LFS. Clonal hematopoiesis (CH) is a form of ACE, and in the absence of an abnormal hemogram is termed Clonal hematopoiesis of indeterminate potential (CHIP). CHIP is often associated with a pathogenic variant (PV) in hematopoietic pathway gene(s) at a variant allele frequency (VAF) less than expected for a heterozygous germline finding. The prevalence increases with age and exposure to chemotherapy. The presence of a skewed VAF is usually noted in a comment on a genetic test result, however, clinicians without genetic training often lack understanding of the comment and need strategies to discern the difference between germline findings, CHIP, and post-zygotic mosaicism. Our studies illuminate possible strategies for discernment for clinicians. Methods: Among 113 cases with MGPT-detected TP53 PVs, enrolled in the Clinical Cancer Genomics Community Research Network registry, we obtained additional tissues, family history and complete blood count (CBC) reports on 42 cases. DNA extracted from formalin fixed paraffin embedded (FFPE) tumor/normal tissues, blood, saliva, eyebrow plucks, was analyzed using a previously validated custom myeloid and CH gene (n = 79) amplicon-based QIAseq panel. PVs with VAF &gt; 2% were included in analyses. Results: Germline status was confirmed for 6 cases (one with a CH PV), post-zygotic mosaicism was supported for 5 cases and 2 were indeterminant. 12 had results supporting ACE/CH, with additional CH-associated PV(s) identified in 5/12 (41%); n = 2 of each TET2, ATM, TP53; and increasing VAF over time for the driver TP53 PV was noted in 2. Of these 2 one was identified to have a hematopoietic malignancy identified through analysis of the CBCs and bone marrow biopsy in parallel with the increasing VAF. Additional results are pending for 7 cases. Conclusions: With the use of our multi-tissue NGS strategy, serial sampling of suspected ACE/CH cases, family history and CBC analyses we were able to discern the status of most TP53 genetic findings. This work has direct translational impact, refining risk estimation and improving the clinical care of patients with TP53 PVs, while avoiding unnecessary LFS-related care and enabling appropriate care for those with ACE.

Effect of SNPs in BCL11A gene on the clinical heterogeneity of patients with HbE/beta-Thalassemia in Bangladesh

Hemoglobin E/beta-thalassemia is a blood disorder with highly variable clinical phenotypes related to increased production of fetal hemoglobin (HbF), which can influence the degree of severity in beta-thalassemia. The aim of this study was to find out the disease modifying effects of two SNPs, rs-4671393 &amp; rs-11886868 in BCL11A gene among HbE/beta-thalassemia patients. A total of 133 HbE/beta-thalassemia patients with mean of age 19.66 ± 10.22 years and 50 healthy controls with completely normal hematological parameters were recruited in this study and patients were classified as NTD/mild, moderate and severe, according to previously reported clinical scoring system. All the samples were subjected to Complete Blood Count analysis and Hemoglobin Electrophoresis. For SNP detection, Real-time PCR-based High Resolution Melt-Curve Analysis and Sanger Sequencing were performed. Statistical analysis including two-tailed unpaired T-test, one-way ANOVA test and Pearson Correlation were done using ‘Graphpad Prism version 7’. The allelic distribution of rs-4671393 in the BCL11A gene was 78.2% GG and 21.8% AG and for rs-11886868, there were 51.12% CC and 48.9% CT+TT. Both SNPs showed significant association with clinical severity score and induction of HbF (g/dl) (p= 0.03 and p= 0.02) in HbE/beta-thalassemia patients. In addition, HbF level was significantly higher (p&lt;0.0001) in NTD/mildly severe group compared to other two groups having significant correlation with transfusion interval (r= 0.5) and clinical score (r= -0.45), while showed comparatively less correlation with the age of first blood transfusion (r= 0.32). Nevertheless, having both SNPs (17% minor allele for rs-4671393 and 25% minor allele for rs-11886868), no induction of HbF was found among SNP positive healthy individuals. The SNPs of BCL11A, rs-11886868 and rs-4671393 have significant effects on both HbF and clinical score in HbE/beta-thalassemia patients. However, any of the two SNPs showed no HbF inductive effect in the absence of anemic condition.

Factors influencing treatment outcome in hepatitis C virus minority patients at an inner-city hospital: A STROBE-complaint article.

Chronic hepatitis C virus (HCV) infection disproportionately affects African-Americans (AAs) and is a major contributor to liver failure and mortality. Genetic factors may not be the only cause in outcome disparity. We retrospectively investigated whether genetic host factors, viral genotypes, and treatment compliance in AA patients impacted the efficacy and the sustained virological response (SVR) rate of the interferon (IFN)-based treatment regimen. The medical chart review included 76 African-American patients (age ranging from 26 to 76) with varying levels of hepatitis condition. Fifty-seven (75%) of them had a clinically verifiable HCV infection and were followed by a hepatologist for 2 years at Howard University Hospital in Washington, DC. Both comprehensive metabolic profile and complete blood count analyses were performed. Among the 57 patients whose viral and IL28B genotypes were determined, sixty-eight percent (68%) were infected with viral genotype 1 and 71% harbored the CT allele of the IL28B gene. Among the 12 patients who completed treatment with IFN-based dual or triple therapy, 58% had achieved SVR 12 weeks following completion of treatment; 33% had a partial response with under 6000 viral count after 16 weeks of treatment; and there was one patient with viral genotype 1a and CT allele who did not respond to the medications. The results of this study prove that the PEG IFN-based regimen was effective in treating HCV-infected AA patients despite the current availability of new direct-acting antivirals. The major obstacles contributing to a low reduction in HCV infection and outcome in the AA community were avoidance or lack of treatment or compliance; contraindications, medication side effects, non-adherence, and payer eligibility restrictions.

Topical treatment with SPHINGOLIPIDS and GLYCOSAMINOGLYCANS for canine atopic dermatitis

BackgroundSkin barrier dysfunction plays a key role in atopic dermatitis (AD). This impairment is related to altered composition and metabolism of epidermal sphingolipids and a deficiency of ceramides. Glycosaminoglycans (GAGs), and especially hyaluronic acid, could be useful in the management of AD. This study aimed to evaluate the effects of a novel topical treatment consisting of sphingolipids and GAGs extracts in dogs with AD. This formulation is different from previously tested products because the sphingolipid extract contained high amounts of sphingomyelin, a precursor of ceramides, and this has been shown to enhance endogenous synthesis of ceramides and to increase lamellar-related structures in vitro. Thus, it was hypothesized that this formulation could improve clinical disease and skin barrier function in patients with AD.ResultsTwelve house dust mite (HDM) allergic atopic beagle dogs were randomized into two groups: control (n = 6; no treatment) or treatment (n = 6; topical sphingolipids and GAGs twice weekly for 8 weeks). Dogs were challenged with allergen twice weekly and the severity of dermatitis was scored using the canine atopic dermatitis and extent severity index (CADESI-03) once weekly. Skin barrier function (measurement of transepidermal water loss) and severity of pruritus (both pruritus visual analog scale [PVAS] and pruritus timed episodes) were assessed at 0, 4 and 8 weeks of treatment. Assessments were done by personnel unaware of group allocation. Complete blood count, serum biochemistry and stratum corneum (SC) lipidomics analyses were done at baseline and at week 8.Compared to baseline, significant increases in CADESI (P = 0.0003) and PVAS (P = 0.041) were observed only in the control group, and SC polyunsaturated fatty acids increased significantly only with treatment (P = 0.039). Compared to control, treatment group had a significantly lower CADESI after 1 week (P = 0.0078) and a significantly lower PVAS after 8 weeks (P = 0.0448). Treatment was well tolerated.ConclusionsIn this study in dogs with AD, a new topical formulation containing sphingomyelin-rich sphingolipids plus GAGs extracts attenuated the clinical worsening induced by HDM, supporting its use in atopic patients, either as an adjunctive treatment or used as monotherapy in certain cases.