Full Blood Count Parameters Research Articles

Cord blood full blood count parameters in Lagos, Nigeria.

IntroductionFull blood count (FBC), one of the most frequently requested for laboratory investigations, is a simple, fast and cheap test and is a reliable indicator of health. Due to its usefulness in the assessment of health status of individuals, its parameters in cord blood, a major source of haemopoietic stem cell transplantation and an ideal source for laboratory investigations for newborns were determined to provide a useful guide to local neonatologists and stem cell transplant physicians.MethodsThree millilitres of umbilical cord blood was collected from 130 normal birth weight newborns (69 males and 61 females) whose cord were clamped immediately after delivery, at a teaching hospital in Lagos, Nigeria and full blood count parameters were determined using Sysmex autoanalyzer, model KX-21N. Consented mothers of the newborns were selected based on, age between 18 and 45 years; uneventful pregnancy and delivery and haemoglobin (Hb) concentration ≥ 10 g/dL.ResultsThere were no statistical gender differences in the mean values of Hb concentrations (M = 13.27 ±1.60 g/dL; F = 13.32±1.61g/dL; p = 0.93), total white cell count (M = 3.16±5.43 × 109/L; F = 13.07±4.98 × 109/L; p= 0.92), platelet count (M= 223.64± 64.21 × 109/L; F = 226.69±80.83 × 109/L; p = 0.81) and other parameters.ConclusionMean values of full blood count parameters obtained in this study are comparable to reports from other studies in developing countries and could be a useful guide for neonatologists and stem cell transplant physicians in our geographical location.

Authorising bortezomib treatment prior to reviewing haematology results: a step toward home administration

Bortezomib treatment requires four visits to a chemotherapy unit in each 21-day cycle. Analysis of the Day 1 full blood count could allow clinicians to predict the risk of Grade 4 thrombocytopenia, thus negating the need to review the full blood count prior to each dose. The freedom to administer bortezomib without reviewing full blood count results on each treatment day could minimise appointment times and be a step toward home administration. A prospective study of treatment authorisation following a full toxicity assessment and full blood count results from the previous treatment day was undertaken. The full blood count results from 27 patients, receiving 381 doses revealed 12 treatment episodes where bortezomib was administered in the presence of Grade 4 thrombocytopenia. One instance of bleeding and two episodes of neutropenic sepsis were detected during toxicity assessments and treatment was not administered. Only one instance of Grade 4 thrombocytopenia was reported on any other treatment day when the Day 1 platelet count was greater than 75 × 10(9) units/l. From this data, Day 1 full blood count parameters were derived, which minimise the risk of Grade 4 haematological toxicity on subsequent treatment days, allowing clinicians to identify suitable patients for administration of bortezomib prior to reviewing full blood count results. When platelet counts on Day 1 are greater than 75 × 10(9) units/l and neutrophil counts are greater than 1.0 × 10(9) units/l, the administration of bortezomib can be authorised without the need for review of the full blood count on subsequent days of that cycle.

The use of the full blood count and differential parameters to assess immune activation levels in asymptomatic, untreated HIV infection

A feature of HIV/AIDS is chronic immune activation, which results in a number of complications including inflammation-related disorders and blood cytopaenias. Immune activation status is not routinely tested in HIV infection. However, the full blood count (FBC) is a commonly performed test. We hypothesised that FBC parameters would be significantly different in HIV-infected v. -uninfected individuals, and that some of these parameters would correlate with markers of immune activation (i.e. percentage CD38 expression on CD8(+) T cells (%CD38onCD8)) and disease progression (i.e. CD4(+) counts) in HIV infection. This was a cross-sectional study with 83 HIV-infected adults who were antiretroviral therapy-naive and clinically well, and 51 HIV-uninfected adults. The %CD38onCD8 and CD4(+) counts were determined by flow cytometry and the FBC was performed on a Siemens ADVIA 2120 system. FBC parameters investigated were total white cell count (WCC), haemoglobin (Hb) concentration, platelet count, absolute neutrophil count, absolute lymphocyte count, and percentage of large unstained cells (%LUCs). Significant differences were found between the HIV-infected and -uninfected groups for total WCC, Hb, neutrophil count, lymphocyte count and %LUCs. The mean ± standard deviation (SD) for the total WCC (5.3±1.3 v. 6.9±2.2; p≤0.001) and the %LUCs (2.5±0.9 v. 2.0±0.9; p=0.001) both showed correlations with CD4(+) counts and %CD38onCD8. The total WCC and %LUCs showed significant differences in HIV-infected individuals and correlated with markers of immune activation and disease progression. This suggests the potential use of these parameters as markers of immune activation in HIV infection.

Valores de referencia del hemograma completo en escolares de 8 a 12 años de edad residentes a 2.760 m sobre el nivel del mar

ObjectiveTo determine reference values for full blood count parameters in a population of children 8 to 12 years old, living at an altitude of 2760m above sea level. Material and methodsOur sample consisted of 102 individuals on whom a full blood count was performed. The parameters included: total number of red blood cells, platelets, white cells, and a differential count (millions/μl and %) of neutrophils, lymphocytes, monocytes, eosinophils and basophils. Additionally, we obtained values for hemoglobin, hematocrit, mean corpuscular volume, mean corpuscular hemoglobin, concentration of corpuscular hemoglobin and red blood cell distribution width. The results were statistically analyzed with a non-parametric test, to divide the sample in quartiles and obtain the lower and upper limits for our intervals. Moreover, the values for the intervals obtained from this analysis were compared to intervals obtained estimating+- 2 standard deviations above and below from our mean values. ResultsOur results showed significant differences compared to normal interval values reported for the adult Mexican population in most of the parameters studied. ConclusionsThe full blood count is an important laboratory test used routinely for the initial assessment of a patient. Values of full blood counts in healthy individuals vary according to gender, age and geographic location; therefore, each population should have its own reference values.

Pathogenetic treatment of the patient with splenic marginal zone lymphoma complicated by Evans syndrome

A case report of a patients with splenic marginal zone lymphoma, in whom clinical remission was initially achieved by 5 continuous courses of combined treatment with fludarabine 25 mg/m2 and cyclophosphamide 350 mg/m2 at days 1-3. Nevertheless, 6 months after patient developed a clinical picture of Evans syndrome, characterized by severe hemolytic anemia, thrombocytopenia and neutropenia. Corticosteroid treatment accompanied by blood transfusion was initiated, the effect was marginal and short-lasting. Switch to rituximab monotherapy allowed to archieve complete clinical and hematological remission with full blood count parameters reversal.

Determination of reference ranges for full blood count parameters in neonatal cord plasma in Hilla, Babil, Iraq

BackgroundThe health of an individual is known to vary in different countries, in the same country at different times, and in the same individuals at different ages. This means that the condition of individuals must be related to or compared with reference data. Determination of a reference range for the healthy term newborn is clinically important in terms of various complete blood count parameters. The purpose of this study was to establish a local reference range for full blood count parameters in neonatal cord plasma in Hilla, Babil, Iraq.MethodsA total of 220 mothers and their neonates were enrolled in this cross-sectional study from February 2011 to January 2012. Maternal inclusion criteria were age 15–45 years, an uneventful pregnancy, and hemoglobin ≥ 10 g. Neonatal inclusion criteria were full term (37–42 weeks) and normal birth weight. The umbilical cord was immediately clamped after delivery of the baby; 3 mL of cord blood was then taken from the umbilical vein and collected in a tube containing ethylenediamine tetra-acetic acid, its plasma was analyzed for full blood count parameters by standard Coulter gram, and the differential leukocyte count was done manually.ResultsMean neonatal hemoglobin was 13.88 ± 1.34 (range 11–17.3) g/dL and mean white cell count was 10.12 ± 2.8 (range 3.1–21.6) × 109/L. Mean platelet count was 267.63 ± 60.62 (range 152–472) × 109/L. No significant differences in red cell, white cell, or platelet counts were found between males and females, except for neutrophil count. The current study shows lower levels of hemoglobin, white cells, and red cells compared with other studies, and there is agreement with some studies and disagreement with others concerning platelet count.ConclusionMost results in the current study were within the reference range. The hematological reference values for Iraqi neonatal cord plasma need to be confirmed by larger numbers of blood samples and by collecting samples from different areas in Iraq.

Nutritional Content and a Phase - I Safety Clinical Trial of a Herbal-Nutritional Supplement (Imuniti) With Putative Immune-Modulating Properties

The relationship between HIV and AIDS and poor nutrition has been well established. Poor nutrition hastens the progression of HIV infection to AIDS. The rising pandemic of HIV and AIDS and high toxicity associated with anti-retroviral use are major factors that have compelled research to explore traditional herbal medicines as potential alternatives or supplements to anti-retroviral agents. A Phase I clinical trial was conducted on IMUNITI Wellness Pack, a herbal product with putative immune-modulating properties. The product is a combination of 7 herbal preparations, minerals, vitamins, and a specially formulated soya-maize meal porridge and a bottle of water purifier. The aim was to evaluate the safety and tolerability of IMUNITI, with a purpose of developing it for use in HIV-infected patients. The phase I study was conducted at the MRC clinic in Botha's hill and the study lasted 5 weeks from date of participant dosing. The study was a randomised blinded placebo-controlled phase I clinical trial conducted on 48 healthy males. The participants were randomly divided into 4 groups of 12. The 3 groups received different escalating doses of IMUNITI while the forth group received placebo tablets. Participants consumed IMUNITI daily for a period of 5 weeks. Assessments were done at baseline, week 1 and week 5 to determine the safety parameters in all participants. In this study, IMUNITI did not show any safety concerns. In all study participants, there were no significant changes above the upper limit of the reference ranges of the laboratory tests for full blood count, INR, renal and biochemical safety parameters. IMUNITI was well tolerated. Furthermore, the nutritional content analysis of IMUNITI showed that it is a high kilojoule, high protein content product which contains a mixture of sugars, vitamins, traces of calcium, phosphorus and minerals.

Systemic inflammatory response is a predictor of outcome in patients undergoing preoperative chemoradiation for locally advanced rectal cancer

Current management of locally advanced rectal cancer includes neoadjuvant chemoradiation in selected patients to increase the chance of a tumour-free circumferential resection margin. There is uncertainty over the role of and selection criteria for additional systemic therapy in this group of patients. In this retrospective study we investigate the association between markers of systemic inflammatory response (SIR) and outcome from treatment. One hundred and fifteen patients with locally advanced rectal cancer undergoing preoperative chemoradiation had recording of full blood count parameters including neutrophil/lymphocyte ratio (NLR) and platelet/lymphocyte ratios (PLR). Postoperative surgical margins (R status) and pathological stage were documented. Outcome measures were overall survival (OS), time to local recurrence (TTLR) and disease-free survival (DFS). Cox regression analysis was performed to identify predictors of outcome. Only NLR and R status were significant predictors for all outcome measures on univariate and multivariate analysis. Elevated NLR (≥5) was associated with decreased OS, [hazard ratio (HR) and 95% CI, 7.0 (2.6-19.2)], decreased TTLR [HR 3.8 (1.3-11.2)] and shorter DFS [HR 4.1 (1.7-9.8)]. Median survival for patients with an elevated NLR was 18.8 months compared with 54.4 months without an elevated NLR (P<0.001). In addition to postoperative R-status, an elevated NLR is also a valuable prognostic marker in patients undergoing chemoradiation for locally advanced rectal carcinoma. It is associated with worse OS, TTLR and DFS. An elevated NLR may be a useful additional tool in guiding the decision-making process for adjuvant or neoadjuvant therapies.

Comparison of Full Blood Count Parameters Using Capillary and Venous Samples in Patients Presenting to the Emergency Department

Full blood count (FBC) analysis is a common investigation done in the emergency department (ED). The aim of this study was to determine the accuracy of bedside FBC analysis using capillary blood samples from a finger stab at point of care (POC) compared to a conventional venous blood sample analysis. A total of 314 consecutive patients presenting to the ED were recruited. After consenting, a sample of the patient’s venous (V) blood was obtained via venepuncture and sent to the haematology laboratory for analysis as standard practice. This was followed immediately by collection of a capillary (C) blood sample from a finger stab which was analysed at site using an automated FBC analyser at POC. Agreement between the paired samples for blood parameters including the total white cell count, hemoglobin, and platelet count was assessed by the statistical method of Bland and Altman using V sample as the gold standard. The results showed a statistically significant deviation between capillary and venous samples only for platelet counts (P&lt;0.001) and haemoglobin (P&lt;0.001). However, the magnitudes of this difference 7.3 × 109/L and 0.5 g/dL respectively, were not clinically significant. The study suggest that the analysis of capillary samples for FBC parameters is a reliable and acceptable alternative to conventional methods with the benefits of being a rapid, convenient, and minimally invasive technique.

Hematological parameters in association with outcomes in sickle cell anemia patients0

Sickle cell disease (SCD) has a wide range of clinical presentation. We evaluated hematological parameters, which are widely evaluable and assessable, as indices of clinical outcome in SCD. These parameters, although largely established as indices of clinical outcome in other SCD populations, have not been widely evaluated in African patients. One hundred and thirty six consecutive stable SCD patients who presented in the sickle cell clinic of a teaching hospital were studied retrospectively using a questionnaire. Hematological parameters of full blood count (FBC) for each patient were obtained using a cell counter. FBC parameters such as White blood cell count (WBC) were then statistically correlated with complications such as ankle ulcers, osteomylitis and others. A Chi-square text was used to compare frequencies and generate P values. The presence of sickle cell complications was significantly associated with raised white blood cell count (WBC) above 11 × 10(9)/l (P = 0.03).The WBC of the patients increased with increasing numbers of complications (P = 0.07). Mean packed cell volume (PCV) and WBC tended toward the reference range for age and sex (in apparently normal individuals) as the age at diagnosis of SCD increased. This trend was significant for PCV (P = 0.01). Our data provide additional support that widely evaluable and assessable hematological parameters such as PCV and WBC can be used as indices to predict SCD outcome in African patients. This is likely to impart positively on individualized therapy.

A Descriptive Study of Blood Films of Patients Serologically Positive for Dengue in Hospital Tengku Ampuan Afzan, Kuantan

Introduction: Dengue is one of the commonest infections in Malaysia and it is a notifiable disease. Even though the diagnosis of classical dengue fever and dengue haemorrhagic fever can be recognized clinically, the diagnosis remains a challenge in areas where it could not be differentiated with other febrile illnesses. The aim of this study was to focus on the specific and consistent morphological features observed in blood films of dengue infection. Materials and Methods: In all 400 cases of dengue infection serologically diagnosed in the Tengku Ampuan Afzan Hospital (HTAA) during May to October 2007, only a total of 27 cases had blood films examined, and thus were included in this study. These blood films were re-examined by two pathologists from HTAA. The full blood count parameters were also retrieved and studied. Results: We consistently found typical reactive lymphocytes [n= 23 (85%)] and thrombocytopenia [n=21, (77.8%)] in the cases. However, leucopenia was present only in 9 cases (33%). Conclusion: The presence of typical reactive lymphocyte is a consistent finding in dengue fever and thus could have a significant role in supporting the diagnosis of dengue infection.

597 Elevated Leukocyte Count Predicts Mortality in Infants with Neonatal Encephalopathy

Background and aims: An elevated peripheral leukocyte count has been associated with increased risk of neurological disability in asphyxiated term neonates. We aimed to examine the alternations in routine haematological indices in infants with severe asphyxia.Methods: 70 infants referred to the tertiary referral centre of Semmelweis University Budapest Ist Dept of Pediatrics with asphyxial encephalopathy and were randomized to either normothermia or hypothermia. Their serial full blood count parameters, clinical outcome and Bayleys assessments were evaluated.Results: There were 51 survivors and 19 nonsurvivors in this cohort. 60 infants received hypothermia therapy and the remainder were kept normothermic. There was a significant difference in the white cell count (WCC) in the first 8 hours of life between survivors and non-survivors (23+/-; 9 v 31+/-;11, respectively; p value=0.012). In addition the associated neutrophils were altered (Survivors:72+/-;12 v non-survivors:55+/-;5%). However CRP was not significantly different. Here was no correlation between Bayley score and initial WCC in surviving infants.Conclusions: Altered inflammatory markers may indicate infants at higher risk of death. Further exploration of early inflammatory markers may be useful in early decisions about the use of hypothermia.

The effect of storage on the clinical utility of the immature platelet fraction

The immature platelet fraction (%IPF) is a highly utilised new parameter in the full blood count (FBC) profile. It is a measure of the number of reticulated platelets and hence provides information on platelet transfusion requirements. It is common practice to measure %IPF values on blood samples that are several hours old, however unlike the well known good stability of other well established and more traditional FBC parameters such as haemoglobin and platelet counts, previous animal studies have shown that reticulated platelets are unstable. This study therefore assessed the validity of %IPF values obtained from stored patient samples. Our findings showed that %IPF values alter with storage; significant differences in %IPF values were obtained on stored samples compared with freshly analysed samples (p<0·001). It is therefore essential that in order to maintain the clinical utility of the %IPF, analyses should only be made on freshly drawn blood samples.

Long‐term follow‐up of metal‐on‐metal total hip replacement

Metal-on-metal articulations were reintroduced to reduce polyethylene particle-induced osteolysis. Elevated serum metal levels have been detected at short- and intermediate-term follow-up. There is little knowledge about long-term effects of increased ionic metal generation. Our study was undertaken to provide information about long-term survival, clinical outcome, radiographic appearance, and serum metal concentrations after a minimum 10 years follow-up with a metal-on-metal hip prosthesis: 105 cementless primary total hip prostheses with metal-on-metal articulating surfaces were implanted in 98 patients with a mean age of 56 years. Clinical data, radiographs, and blood samples were obtained at a follow-up visit 10 years after implantation. Serum cobalt and chromium levels were determined with use of atomic absorption spectrometry. General laboratory analyses included a full blood count and kidney function parameters. The Harris score was 92 points and the UCLA score 6 points after 10 years. Small osteolytic lesions and radiolucent lines were found in Gruen's zones 1, 7, 8, and 14. The probability of survival was 98.6%. The median serum cobalt concentration of the 22 patients with their hip replacement as the only source of cobalt was 0.75 microg/L (range, 0.3-50.1 microg/L). No patient was diagnosed with renal insufficiency during the study period. Five patients were diagnosed with a malignancy between surgery and the follow-up. We do not have evidence of an increased rate of primary malignancies nor could we detect renal failure in our study group. Serum metal levels did not differ from short- and intermediate term follow-up values.

Clinical Usefulness of the Simple Technique to Diagnose Thrombocytopenia Using Immature Platelet Fraction

Immature platelet fraction (IPF) is the percentage of reticulated platelet (RP) of total platelet count. We measured an IPF reference range using XE-2100 blood cell counter with upgraded software (Sysmex, Japan) and evaluated the clinical utility of this parameter for the laboratory diagnosis of thrombocytopenia due to an increase in peripheral platelet destruction. Peripheral blood samples collected into K2EDTA (Beckton Dickinson, USA) were analyzed at Chonbuk National University Hospital. One hundred forty-two samples from apparently healthy adults (all routine full blood count parameters including platelets within the healthy reference range) were used to establish a normal reference range for IPF. The patients were classified into 3 groups including hypoplastic (consisted of 22 patients undergoing chemotherapy with falling platelet counts and 14 with aplastic anemia), cirrhotic (40 with cirrhosis of liver), and idiopathic thrombocytopenic purpura (ITP) (14 with ITP) groups. An IPF reference range in healthy individuals was established as 0.4-5.4%, with a mean of 1.7%. A significant increase in IPF values was found in the ITP patient group. The cut-off value of IPF was 6.1% and its sensitivity and specificity were 92.9%, and 82.9% respectively. Reproducibility was good. A rapid, inexpensive automated method for measuring IPF is feasible and should become a standard parameter in evaluating thrombocytopenic patients.

Clinical Usefulness of the Simple Technique To Diagnose Thrombocytopenia Using Immature Platelet Fraction (IPF).

Background : It is defined that immature platelet fraction (IPF) is the percentage of reticulated platelet (RP) of total platelet count. We have measured an IPF reference range using XE-2100 blood cell counter with upgraded software (Sysmex, Kobe, Japan) and evaluated the clinical utility of this parameter for the laboratory diagnosis of thrombocytopenia due to increased peripheral platelet destruction.Materials and methods : Peripheral blood samples collected into K2EDTA (Beckton Dickinson, Franklin Lakes, NJ, USA) were analysed at Chonbuk National University Hospital. 142 samples from apparently healthy adults (all routine full blood count parameters including platelets within the healthy reference range) were used to establish a normal reference range for the IPF%. The patients are classified 3 group including hypoplastic (consisted of 22 patients undergoing chemotherapy with falling platelet counts and 14 with aplastic anemia), destructive (14 with ITP and 7 with infection), and cirrhotic (40 with cirrhosis of liver).Results : An IPF reference range in healthy individuals was established as 0.4~5.4%, with a mean of 1.7%. The significant increase in IPF values was found in destructive patient group. The cut-off value of IPF is 6.0%, its sensitivity and specificity are 95.2%, 82.9% respectively. Reproducibility was good.Conclusion : A rapid, inexpensive automated method for measuring the IPF% is feasible and should become a standard parameter in evaluating the thrombocytopenic patient.

Prediction of neonatal sepsis by thromboelastography.

The thromboelastogram (TEG) measures functional defects in coagulation, from fibrin formation through platelet aggregation to fibrinolysis. It is comparable with standard laboratory tests of coagulation; however, it provides additional useful qualitative information. This prospective study documents the TEG findings in 103 neonates: 60 were normal and healthy and provided a reference range; 12 surgical babies had established sepsis, 15 had early sepsis, and 16 were non-septic. TEG abnormalities were detected only in those patients with early and established sepsis. Abnormalities were found in all but 1 of this group of 27 patients (96%), whereas only 16 (59%) had thrombocytopenia, 2 (6%) had leukocytosis, and 6 had leukopenia. The TEG had a sensitivity for sepsis of 96% and a specificity of 96%. This exceeds the values for routine full blood-count parameters and other laboratory indicators of sepsis. It was found to be a simple, quick, and sensitive indicator of early sepsis that enabled the clinicians to manage septic newborns earlier.

Evaluation of the technicon H-1 hematology analyser

The Technicon H-1 is a new, random-access hematology instrument performing a full blood count with leukocyte differential including eosinophils and basophils. Technical assessment showed good linearity and precision. Comparison with a Coulter S-PLUS (II) showed close correlation for all full blood count parameters except MPV and MCHC on 149 unselected hospital inpatients over a wide clinical range. No significant carry-over was detected in hemoglobin, red cell, white cell and platelet estimations. Differentials agreed closely with Technicon H6000 results for neutrophils, lymphocytes, monocytes and eosinophils. Poorer correlation with 100-cell manual differentials for all cell types except neutrophils probably reflects the relative lack of precision in manual methods. Technological innovations on the H-1 include a laser-based optical system from which several new hematological parameters are derived. The contribution they make towards improved patient care awaits assessment.