Complete Blood Count Samples Research Articles

1 Million Segmented Red Blood Cells With 240 K Classified in 9 Shapes and 47 K Patches of 25 Manual Blood Smears

Around 20% of complete blood count samples necessitate visual review using light microscopes or digital pathology scanners. There is currently no technological alternative to the visual examination of red blood cells (RBCs) morphology/shapes. True/non-artifact teardrop-shaped RBCs and schistocytes/fragmented RBCs are commonly associated with serious medical conditions that could be fatal, increased ovalocytes are associated with almost all types of anemias. 25 distinct blood smears, each from a different patient, were manually prepared, stained, and then sorted into four groups. Each group underwent imaging using different cameras integrated into light microscopes with 40X microscopic lenses resulting in total 47 K + field images/patches. Two hematologists processed cell-by-cell to provide one million + segmented RBCs with their XYWH coordinates and classified 240 K + RBCs into nine shapes. This dataset (Elsafty_RBCs_for_AI) enables the development/testing of deep learning-based (DL) automation of RBCs morphology/shapes examination, including specific normalization of blood smear stains (different from histopathology stains), detection/counting, segmentation, and classification. Two codes are provided (Elsafty_Codes_for_AI), one for semi-automated image processing and another for training/testing of a DL-based image classifier.

Role of neutrophils to lymphocytes ratio in identification of bacterial infection in adult population

Background: Bacterial infection are difficult to distinguish from viral infection. Neutrophils are the first cells mobilize to infectious site caused by bacteria and also apoptosis of lymphocytes in response to cell mediated immunity hence raised in neutrophils and decrease in lymphocyte count. The goal of this study is to determine the neutrophil to lymphocyte ratio in patient with positive blood culture for bacteria in patients admitted in hospital.
 Patients and methods: This cross-sectional study was conducted at Department of Pathology, Hamdard University Karachi, Pakistan from 1st January to 31st June 2022. Total 123 adult patients with positive blood cultures admitted in ward or ICU were enrolled in the study. CBC Samples were collected from patients admitted in ward or ICU and blood culture were already sent due to clinical condition, the organism isolated in blood culture were recorded As blood culture is a gold standard investigation to detect bacterial infection .In this study we will record neutrophil to lymphocyte ratio in patients admitted with positive blood culture for bacteria. Age less than 15 years, pregnant female, OPD patients, negative blood cultures and patients on antibiotic therapy were excluded. Complete blood count (CBC) was performed in Beckman coulter model DxH 520 made by Germany. Age and ward of patient, organism isolated from blood culture, CRP.
 Results: A total of 123 patients with positive blood culture were enrolled in the study. Out of 123 patients 61.8% (n=76) were male and 38.2% (n=47) were female. Mean NLR was 5.9± 13.1. Total 45.5% patients presented with high NLR. Mean CRP was 58.5± 68.7. 
 Conclusion: High NLR was seen in 45.5% which shows NLR is an important indicator of bacterial infection. More studies are needed to define true significance of NLR in all ages and negative blood cultures. 

An Overview of Complete Blood Count Sample Rejection Rates in a Clinical Hematology Laboratory Due to Various Preanalytical Errors.

Introduction The Chughtai Laboratory collects blood samples for complete blood counts from various hospitals, emergency departments, ICUs, and through home sampling servicesall across the country. The preanalytical phase isan integral componentof laboratory medicine. A laboratory report has a key role in patient treatment and the clinician's decision in the management of the disease. Preanalytical errors are most frequently caused by the absence of a sample and/or inappropriate understanding of a test request, mislabeling, contamination from the sampling site, hemolyzed, clotted, insufficient samples, storage issues, and inappropriate blood to anticoagulant proportion or inappropriate choice of anticoagulant. Objective To identify the cause ofrejection rates ofthe complete blood countsamples and reduce the rejection rates by improving the accuracy of the results and loweringpre-analytical errors. Methods This cross-sectional study was done in the Hematology Department of Chughtai Laboratory's head office in Lahore between 19-06-2021 and 19-10-2021. Simple random sampling was applied to collect the data. About 3 ml of each blood sample was received in an ethylenediaminetetraacetic acid (EDTA) vial, inspected visually, run on Sysmex XN-9000 (Sysmex Corporation,Kobe, Hyogo, Japan), and was reviewed on peripheral smears. Results Out of 231,008 blood samples, 11,897 (5.15%) samples were rejected. The most common pre-analytical mistake was storage issues due to transportation delay (19.45%) followed by wrong medical records (19.16%), diluted samples (16.35%), incorrect tubes (16.01%), hemolyzed samples (15.13%), unlabeled samples (10.01%), and clotted sample (3.88%). Conclusion In the hematology department, the total rejection rate observed during the study period was 5.15%. Recognition of preanalytical errors and avoiding them will help uslower the sample rejection rateand raise the overall quality of laboratory management.

Extra Gastric Hematological Display of Helicobacter Pylori Infection

Objective: To scrutinize extra gastric associations of Helicobacter Pylori (H Pylori) infection with disorders those come under hematology domain. Design: Descriptive cross sectional Place and duration: Histopathology and hematology department of Bakhtawar Amin Medical & Dental College and Trust hospital, Multan from Jan 2021 to Dec 2021 Material and methods: Complete blood count (CBC) and peripheral blood microscopic examination were done in every histopathologically approved H Pylori positive patient to record hemoglobin (Hb %), mean corpuscular volume (MCV), mean corpuscular hemoglobin (MCH), mean corpuscular hemoglobin concentration (MCHC) and platelet count. Serum Iron, serum ferritin, serum Vitamin B 12 and folic acid levels were done in suspected cases only. Patients with low platelet count were checked in detail for immune thrombocytopenic purpura (ITP). The CBC samples were taken twice once at the time of delivery of histopathology report and second time after treatment of H Pylori infection to check reversal of counts and peripheral blood changes for authentication of H Pylori association with these blood changes. The test results along with the essential details like age, gender, nutritional history, previous medical history esp. related to these disorders and menstrual history in females were recorded on excel sheet and the proportions of all the variables were calculated to extract appropriate tables and figures. Results: Out of total 132 gastric biopsies received in Histopathology department Helicobacter Pylori prevalence noted to be 78.8 %. Eighty three (79.8 %) out of 104 H Pylori positive cases revealed extra gastric hematological manifestations and in 59 (56.7 %) of these patients the blood indices along with peripheral blood picture returned to normal on H Pylori eradication. Conclusion: A large number of H Pylori positive patients displayed hematological manifestations that reverted to normal on taking H Pylori treatment. H Pylori should be kept in mind especially dealing cases of unexplained iron deficiency, vitamin B12 anemia and Immune thrombocytopenia. Keywords: Helicobacter Pylori infection, iron deficiency anemia, histopathology, platelets, vitamin B 12 deficiency anemia, serology

Resident Perspectives 56–3

Resident Perspectives 56–3

Decreasing Complete Blood Count Clotting Rates: An Improvement Project in an Academic Neonatal Intensive Care Unit.

In premature and critically ill infants, a complete blood count (CBC) is commonly collected via the heel-stick method, which is preferred because of the ongoing requirements to preserve intravenous sites. However, because of sample clotting, these specimens are often rejected, leading to unnecessary repeat heel sticks, painful stimuli, and increased costs. The purpose of this quality improvement project was to decrease the rate of clotted CBC samples obtained from neonates admitted in the neonatal intensive care unit. The RE-AIM translation model, which stands for Reach, Effectiveness, Adoption, Implementation, and Maintenance, was adopted to decrease the rate of clotted CBC samples through staff education, randomized audits of the staff's heel-stick technique, and the development and implementation of a standardized capillary blood sampling protocol. The primary outcome measure was the rate of clotted CBC samples, which was defined as the proportion of clotted CBC samples. CBC clotted sample rates decreased by 27%, resulting in a cost saving of $1136, and overall CBC rejection rates decreased by 23%. All hospital units should provide staff with an evidence-based resource, recurrent education, and evaluation of skills to avoid unnecessary repeat heel sticks and prevent increased pain sensitivity, social hypervigilance, and avoidance behavior in early infancy. Future efforts should focus on the long-term benefits of routine education and its effects on clotted sample rates and whether samples drawn by laboratory phlebotomy staff versus registered nurses/patient care technicians result in disproportionate rejection rates.

Association with Platelet Distribution Width and New-Onset Atrial Fibrillation After Coronary Artery Bypass Grafting

Objective: The platelet distribution width (PDW) is one of the parameters of platelet activation. The PDW directly measures the variability in platelet size. However, there has been a limited number of data reported thus far on PDW and postoperative AF in patients undergoing CABG. We aimed to investigate the relationship between the PDW and postoperative AF in patients undergoing CABG. Methods: 124 consecutive patients with sinus rhythm who had undergone CABG between July 2011 and December 2013 were evaluated. AF was defined as any episode of AF lasting longer than 30 seconds. Complete blood count samples were analyzed according to the results obtained within 48 hours of the preoperative and postoperative period. Results: The preoperative PDW levels were significantly lower in patients who had developed AF than in the control group (56.5±14.8 vs. 50.9±10.0, p=0.015). There was no correlation between the postoperative PDW levels and AF. The preoperative white blood cell (WBC) and the neutrophil/lymphocyte ratio (NLR) were found to be similar between the two groups, while the postoperative WBC (13.9±5.7 vs. 10.5±3.6, p=0.000) and NLR (14.4±9.4 vs. 9.0±8.4, p: 0. 001) levels were higher in the group of patients who had AF. An NLR of 8.5 predicted post-CABG AF with a sensitivity of 73% and a specificity of 63%, and a WBC of 10 predicted post-CABG AF with a sensitivity of 77% and a specificity of 48%. Conclusion: These results support the hypothesis that preoperative PDW level predicts new-onset AF after CABG, but suggest that other factors are also important.

Evaluation of protein Z plasma level in beta-thalassemia major patients in Ahvaz city in Iran

Thrombotic episodes occurred frequently in beta-thalassemia major (BTM) patients, leading to hypercoagulability of plasma. Protein Z (PZ) is a vitamin-K-dependent anti-coagulation factor that plays a role in the human homeostatic process. The objective of the current study is to investigate the distribution pattern of PZ plasma concentrations between BTM patients and the normal population in Ahvaz city, the center of Khuzestan province, southwest of Iran. Forty confirmed BTM patients and 40 healthy volunteers were evaluated for complete blood count (CBC) indices and PZ plasma levels. CBC samples were measured using an automated cell counter, and PZ was assayed with an immunoassay method. Statistical analysis was conducted using SPSS software. The ROC curve and binary logistic regression estimated the sensitivity, specificity, and Odd’s ratio for PZ measurement. The mean±SD of the PZ plasma level in normal individuals was 1.68±0.63 μg/mL, and in BTM patients, it was 1.10±0.52 μg/mL. This shows a significant reduction of PZ in BTM patients statistically (CI = 0.99; p<0.001). Further, the mean±SD of the PZ plasma levels in BTM patients who received washed red blood cells was not significantly different from that of patients undergoing packed red blood cell therapy (CI = 0.95; p = 0.320). The area under the curve (AUC) for PZ was 0.759 (p = 0.00). The cut-off value = 1.4 μg/mL of the PZ plasma level had at least 70% sensitivity and specificity in BTM patients. Several epidemiologic studies have shown thromboembolism episodes in BTM patients. In the current study, PZ was reduced significantly in BTMs. We noticed that BTMs have lower plasma PZ concentration might be predisposed to BTM.

Relationship between the mean platelet volume values and tilt-table test results in patients with vasovagal syncope

Impaired sympathovagal balance, the main pathophysiological mechanism under the vasovagal syncope (VVS), may play a role on platelet sizes. Although it has been shown that mean platelet volume (MPV) is increased in patients with vasovagal syncope, its nature in syncope subgroups is unknown. Herein, we aimed to compare MPV values among patients with different head-upright tilt-table (HUTT) test results. Patients who underwent HUTT test were analyzed retrospectively. PatientsÂ’ demographic data and their complete blood count samples within the 24h of test were obtained from hospital data network. Patients were divided into 4 groups according to their HUTT test results; group I: cardioinhibitory type, group II: mixt type, group III: vasodepressor type and group IV: negative result. There were no statistical differences regarding the age and gender between the groups. There was statistically significant difference between groups, regarding the values of MPV, platelet distribution width (PDW), hemoglobin and hematocrit. In patients with vasodepressor type response, MPV was statistically significantly higher compared with control and other groups (p

Automated Specimen Receipt Recording to Reduce Turnaround Time of Complete Blood Count Samples

Automated Specimen Receipt Recording to Reduce Turnaround Time of Complete Blood Count Samples

Evaluation of the correlation of automated and manual results of complete blood count in oncologic patients

The aim of this study is to evaluate the performance of Sysmex XS-800i analyzer and compare its correlation with standard manual method in oncologic patients. The complete blood count (CBC) with differential leukocyte count is one of the most frequently requested hematologic tests. In oncologic patients, it is more important because primary diagnosis and treatment follow-up are depending on CBC results. Automated hematology analyzers are designed to perform CBC with acceptable precision and accuracy, but manual slide examination still is needed to complement the analyzer results. One thousand CBC samples of oncologic patients analyzed by Sysmex XS-800i analyzer and the corresponding slides were examined independently by a skilled hematology technician and a pathologist. Their results analyzed for finding the degree of correlation between them. Our instrument showed excellent performance with a correlation coefficient of >0.91 for platelet and leukocyte differential count (except for basophil with r = 0.592). Sensitivity and specificity of identifying abnormal cells was 82.7 and 92 %, respectively. The Sysmex XS-800i hematology analyzer results are as reliable as the standard manual method; however, manual microscopic blood examination should be used to complete the uncompleted results, to validate analyzer flags, and for counting the cells with a flag.

A novel predictive marker for the recurrence of nasal polyposis following endoscopic sinus surgery.

We aimed to determine the value of neutrophil-to-lymphocyte (NLR) ratio for prediction of recurrence in patients subjected to endoscopic sinus surgery. Higher neutrophil counts mean more chronic inflammation so the NLR value could show the inflammatory level resulting with higher incidence of recurrence. From January 2011 to March 2013, we performed a retrospective review of the complete blood count samples from 192 patients with chronic sinusitis who underwent endoscopic sinus surgery. The patients were divided into two groups based on the presence of nasal polyps. NLR and platelet-to-lymphocyte (PLR) ratios were analyzed. Receiver operating characteristic (ROC) curve analysis was performed to determine the cut-off value for significant differences in variables between the recurrence and non-recurrence groups. The ROC analysis results revealed an NLR cut-off of 3.13 and a PLR cut-off of 208.75. Our analysis revealed that NLR is an independent risk factor for recurrence of chronic sinusitis in patients subjected to endoscopic sinus surgery (p=0.006), whereas the PLR was not a predictive factor for recurrence (p=0.167). Our study revealed that the NLR could be used to predict disease recurrence before endoscopic sinus surgery. However, additional studies are needed to confirm these results.

A Comparison of Hemoglobin Measured by Co-Oximetry and Central Laboratory During Major Spine Fusion Surgery

Many factors affect the accuracy of hemoglobin concentration values. In this study, we evaluated whether the hemoglobin concentration obtained by means of arterial blood gas (ABG) co-oximetry and complete blood count (CBC) central laboratory techniques clinically correlate when using simultaneous measurements of hemoglobin concentration obtained during complex spine fusion surgery. Three hundred forty-eight patients who underwent spinal fusion of >3 bony levels between September 2006 and September 2010, with concurrent ABG and CBC samples, were identified. The mean difference between pairs of measured hemoglobin values was determined using limits of agreement analysis. Error grid analysis was used to delineate correlation of samples in relation to hemoglobin values within the range considered for transfusion. The median difference (ABG-CBC) between the measured hemoglobin values was 0.4 g/dL (95% confidence interval [CI], 0.35-0.40 g/dL; P < 0.0001). Limits of agreement analysis correcting for repeated observations in multiple patients demonstrated that the mean difference between measured hemoglobin values (i.e., bias) was 0.4 g/dL (95% CI, 0.36-0.41 g/dL), and the 95% limits of agreement of the difference between paired measurements were -0.70 to 1.47 g/dL. The magnitude of the difference between the measured hemoglobin values was >0.5 g/dL in 44.5% of patients (95% CI, 42.2%-46.8%); however, 6.8% (95% CI, 5.8%-8.1%) of paired measurements had a difference of >1.0 g/dL. There was only fair-to-moderate agreement between the CBC and ABG values within the clinically significant range of hemoglobin values of 7 to 10 g/dL (Cohen κ = 0.39; 95% CI, 0.33-0.45). The hemoglobin values obtained from ABG and CBC cannot be used interchangeably when verifying accuracy of novel point-of-care hemoglobin measurement modalities or when managing a patient with critical blood loss.

The pneumatic tube system does not affect complete blood count results; a validation study at a tertiary care hospital

Effect of the pneumatic tube system (PTS) on sample quality is controversial. Herein we aim at evaluating the impact of sample transportation via the PTS on complete blood count (CBC) results. Duplicate CBC samples from normal donors and anemic patients were sent in parallel to the laboratory for testing through the PTS and the courier (CO). We used scatter plots, Bland-Altman plots, correlation coefficient (r), and coefficient of determination for the validation. A total of 115 samples (donors: 59, patients: 56) were tested. There was excellent correlation between both methods for red blood cell parameters (r range=0.9213-0.9958) and platelet count. White blood cell (WBC) count and differential count showed similar results (r range=0.8605-0.9821) for all, with exception of basophils which showed modest correlation (r=0.4827 for patients and 0.5758 for normal donors). Most of the differences in measurement of all CBC parameters were within the 95% confidence interval of the mean difference on Bland-Altman plots. Modern PTS can be safely used for transporting CBC samples.

Mean platelet volume in psoriasis and psoriatic arthritis

Mean platelet volume (MPV), an indicator of platelet activation, is a newly emerging risk factor for atherothrombosis. There is evidence of platelet activation in psoriasis and psoriatic arthritis (PsA). The association between psoriasis, PsA, and atherosclerosis is well documented, yet, the underlying mechanisms remain unclear. The aim of this study was to investigate the differences of MPV values in patients with psoriasis, PsA, and healthy subjects and the correlation between MPV and the clinical disease activity. A total of 106 patients with psoriasis were included in this study. The study population grouped as 48 patients with PsA (group 1) and 58 patients without PsA (group 2) and 95 healthy controls (group 3). MPV was measured in psoriasis and PsA patients. MPV values were collected from standard complete blood count samples. Clinical features and PASI scores in group 1 and 2 were also recorded. MPV in patients with psoriasis 8.7 +/- 0.9 fL was significantly higher than that of control subjects 7.3 +/- 0.8 fL (p < 0.001). There was also statistical difference between MPV levels of patients with (9.5 +/- 0.8) and without (8.0 +/- 0.7) arthritis (p < 0.001). MPV levels were positively correlated with psoriasis area and severity index score (p = 0.000, r = +0.735). MPV levels showed positive correlation with disease duration (p = 0.01, r = 0.518). MPV levels are increased in patients with psoriasis and PsA. MPV may be a marker for the severity of psoriasis. This study may confirm previous observation indicating increased platelet activation in psoriasis. Increased platelet activity could contribute to increasing the atherosclerotic risk in patients with psoriasis and PsA.