Blood Count Research Articles

Combating paediatric pneumonia: the dynamic duo of cinnamon-clove steam and physiotherapy

IntroductionPaediatric community-acquired pneumonia (CAP) is a prevailing respiratory infection that impacts children in non-medical settings, giving rise to substantial morbidity and mortality, especially in less developed areas. The current study was aimed at finding a holistic approach for improving the management and treatment of paediatric CAP. For that purpose, a comparative interventional study was conducted to investigate the effectiveness of chest physiotherapy (CPT) combining with Cinnamon varum and Syzygium aromaticum steam therapy in paediatric CAP. MethodsA total of 60 paediatric patient hospitalised with CAP were assessed. The study included both male and female participants aged between three and 14 years. The study was conducted at Children Hospital and Institute of Child Health in Faisalabad, Pakistan. The subjects were divided into three equal groups: group 1 received CPT, group 2 underwent CPT accompanied with nebulization, and group 3 received CPT along with steam therapy using C. varum and S. aromaticum. Each participant received the assigned therapy twice a day for seven consecutive days. The study was approved and registered by Ethics Review Committee, Government College University, Faisalabad, Pakistan (Reference number GCUF/ERC/214). ResultsAmong the three groups studied, those who received the combined therapy exhibited improved outcome by improving the complete blood count (CBC), spirometer index, arterial blood gases (ABGs) and Systolic blood pressure, Multilobar infiltrates, Albumin, Respiratory rate, Tachycardia, Confusion, Oxygen and pH severity score for pneumonia. ConclusionsThe antimicrobial, anti-inflammatory and mucolytic properties of cinnamon and clove, along with the positive effects of CPT, resulted in reduced lung inflammation, enhanced respiratory performance, and improved vital signs.

The potential predictive value and relationship of blood-based inflammatory markers with the clinical symptoms of Han Chinese patients with first-episode adolescent-onset schizophrenia.

Inflammation is associated with the pathophysiology of schizophrenia. The blood markers for systemic inflammation include neutrophil-lymphocyte ratio (NLR), systemic immune-inflammation index (SII), lymphocyte-monocyte ratio (LMR), system inflammation response index (SIRI), and platelet-lymphocyte ratio (PLR). However, these inflammation markers and their relationships with clinical phenotypes among Han Chinese patients with first-episode adolescent-onset schizophrenia (AOS) is unclear. This investigation aimed to elucidate the impact of inflammation on Han Chinese AOS patients as well as the association of blood-based inflammation markers with clinical symptoms. Altogether, 203 Han Chinese individuals participated in this study, 102 first-episode AOS patients and 101 healthy controls. The assessment of inflammatory indices was based on complete blood cell count. Furthermore, schizophrenia-related clinical symptoms were evaluated using the five-factor model of the Positive and Negative Syndrome Scale (PANSS). In Han Chinese first-episode AOS patients, levels of SIRI, PLR, SII, and NLR were significantly increased (p < 0.001), while LMR decreased (p < 0.001) compared to healthy controls. Furthermore, multivariate logistic regression showed that LMR, NLR, SII, and SIRI (all p < 0.05) were independently associated with AOS. Moreover, Receiver operating characteristics assessment indicated that NLR, SIRI, LMR, and SII could effectively distinguish AOS patients from healthy controls. Their areas under the curves were 0.734, 0.701, 0.715, and 0.730 (all p < 0.001). In addition, Correlation analysis revealed that LMR was negatively correlated with the PANSS total, negative, and cognitive factor scores (all p < 0.05); NLR was positively correlated with the cognitive factor score (p < 0.01); SII was negatively correlated with the positive factor score and positively with the negative and cognitive factor scores (all p < 0.05); SIRI was positively correlated with the PANSS total and cognitive factor scores (all p < 0.01). This research established the involvement of peripheral blood inflammatory markers (LMR, NLR, SII, and SIRI) with the clinical manifestations and pathophysiology of schizophrenia, and these can serve as screening tools or potential indices of the inflammatory state and AOS symptoms severity.

Increased packed cell volume alters point of care viscoelastic clotting parameters in horses.

Polycythaemia and coagulopathy are identified risk factors for non-survival in critically ill horses. Assessment of coagulation is recommended for critical care monitoring but may be affected by concurrent polycythaemia. To evaluate the effects of induced polycythaemia on coagulation parameters as measured by a point-of-care viscoelastic coagulation device (VCM Vet™). Prospective interventional study. Healthy adult horses (n = 7) were given 6 mcg/kg of phenylephrine IV over 15 min to induce transient polycythaemia. Samples for packed cell volume (PCV), total solids (TS), complete blood count (CBC), activated partial thromboplastin time (PTT), prothrombin (PT) and VCM Vet™ viscoelastic testing were collected at baseline (T0), 5 min (T1) and 2 h (T2) post-phenylephrine infusion. Splenic volume was measured by transabdominal ultrasonography. VCM Vet™ and plasma-based coagulation parameters, splenic volume and haematologic values were compared within and between time points. Splenic volume decreased from T0 (11.5 ± 4.8 L) to T1 (6.1 ± 2 L, p = 0.04) and returned to baseline volume by T2 (12.1 ± 3.9 L, p = 0.8), consistent with phenylephrine-induced splenic contraction. PCV increased from T0 (37% ± 4%) to T1 (56.3% ± 5.3%; p < 0.001) and returned to baseline at T2 (41.6% ± 3.6%; p = 0.1). A10 and A20 (amplitude at 10 and 20 min, VCM units) were decreased from T0 (12.6 ± 1.6, 18.9 ± 5) to T1 (5.4 ± 1.9, 7.6 ± 2.4; both p < 0.001) and remained lower than baseline at T2 (9.3 ± 2.1, 12.7 ± 3; both p = 0.01). PT and PTT remained within reference ranges with no significant difference over time (p = 0.5 and 0.09, respectively). PCV was negatively correlated with CFT (R = -0.61, p = 0.003), A10 (R = -0.9, p < 0.001) and A20 (R = -0.87, p < 0.001). Small sample size, limited to healthy mares. Phenylephrine-induced polycythaemia was associated with hypocoagulable viscoelastic traces using the VCM Vet™ device without effect on plasma-based coagulation assessments or platelet number. Further investigation of viscoelastic testing is needed in horses with increased PCV due to clinical illness.

Investigation of the effect of oral ivermectin on systemic inflammatory response and quality of life in scabies patients.

Scabies is a prevalent ectoparasitic infectious disease, caused by the mite Sarcoptes scabiei. As a consequence of the infestation, localised cutaneous inflammation, pruritus and polymorphic skin lesions develop. The primary symptoms of scabies manifest as hypersensitivity-like reactions and immune responses, the precise mechanisms of which remain poorly defined. The objective of this study was to evaluate the effects of oral ivermectin treatment in patients with scabies on the systemic immune response and the patient's quality of life (QoL). Patients admitted to the dermatology outpatient clinic and diagnosed with scabies were administered oral ivermectin treatment following diagnosis at week 0 and 2. Laboratory tests were conducted to measure complete blood count (CBC), erythrocyte sedimentation rate (ESR), and C-reactive protein (CRP) levels before treatment and at week 4. The systemic immune-inflammation index (SII) was calculated using the platelet, neutrophil and lymphocyte counts. Additionally, data pertaining to the Dermatological Life Quality Index (DLQI) were recorded. In 119 patients (51 males) diagnosed with scabies, increases in ESR, CRP, and SII values and decreases in inflammatory cell counts and DLQI scores were observed one month after treatment with oral ivermectin. The results of the study showed that the use of oral ivermectin, a scabicidal agent, triggered the inflammatory response and improved the QoL of the patients.

Back to Basics: The Diagnostic Value of a Complete Blood Count in the Clinical Management of COVID-19.

Since the beginning of the COVID-19 pandemic, scientists have struggled significantly to understand the complexity of COVID-19 pathophysiology. COVID-19 has demonstrated a notoriously unpredictable clinical course. This unpredictability constituted a significant obstacle to clinicians in predicting the disease course among COVID-19 patients, more specifically, in predicting who would develop severe cases and possibly die from the infection. This brief report aims to assess the diagnostic value of using a complete blood count (CBC) and applying high-dimensional analysis, i.e., principal component analysis (PCA), on it to differentiate between patients with mild and severe COVID-19 infection. The data of 855 patients were retrieved from multiple centres in Saudi Arabia. Descriptive statistics, such as counts, percentages, and medians (interquartile ranges) were used to describe patients' characteristics and CBC parameters. Analytical statistics, such as the Mann-Whitney U test, were used to compare between survivors and non-survivors. PCA was applied using the CBC parameters, and the results were compared between survivors and non-survivors. Patients in this study had a median age of 41, with an almost equal ratio of men to women. Most participants were Saudis, and non-survivors were 13.22% of the total cohort. The median values of all CBC indices were within reference ranges; however, some statistically significant differences were observed between survivors and non-survivors. Non-survivors had lower hemoglobin levels and lower hematocrit, lymphocyte, and eosinophil counts but higher WBC and neutrophil counts compared to survivors. PCA on the CBC results of survivors yielded a significantly different profile than non-survivors, indicating the possibility of its use in the context of COVID-19. The diagnostic value of CBC in the clinical management of COVID-19 should be utilized in clinical guidelines for managing COVID-19 cases.

A practical approach to febrile cancer patients: Diagnostic stewardship in Oncology units

Introduction Cancer and cytotoxic chemotherapy used for its treatment predispose to severe and often fatal infections. Prompt diagnosis and timely antibiotic therapy are crucial, with delays in therapy initiation having high mortality. Complete blood count (CBC) is an inexpensive, standardized, and preliminary investigation for the management and follow-up of cancer patients with diagnostic and prognostic value. Method We studied the types of infections associated with various cancers treated with chemotherapy, their etiologies and susceptibility patterns, and the hematological profile of these patients as predictors of infection. Results A total of 21 patients (12 solid and 9 hematological malignancies) presented with 31 febrile episodes. White Blood cell count (2079 cells/cu. mm), percentage of neutrophils (52.9%), absolute neutrophil (137.5 cells/cu. mm), and platelet count (1,77,507 cells/cu. mm) were significantly lower in the 11 patients with febrile neutropenia. The absolute lymphocyte count (412.7 cells/cu. mm) was reduced with a strikingly low Neutrophil-to-lymphocyte ratio (NLR) (6.07) in patients with neutropenia. Laboratory and radiological evidence were present in 14/15 episodes of hematological malignancies (p-0.218) whereas unexplained clinical sepsis was common in solid malignancies (p-0.0202). The majority of documented infections were bacterial, caused by gram-negative bacilli, often showing multi-drug resistance. Infectious etiologies were identified in 71.4% of the patients with febrile neutropenia for &gt;5days. Bacterial infections developed within 2 days of neutropenia, whereas viral and fungal infections manifested in prolonged neutropenia. Multi-site infections and higher mortality rates were observed in patients with febrile neutropenia. (p&lt;0.04) Conclusion Febrile neutropenia is a common complication among patients receiving chemotherapy for cancer, with an increased risk of morbidity and mortality. Early, rapid, and accurate diagnosis is key to prompt intervention. Hematological parameters such as Total Leukocyte count, platelet count, NLR, and Platelet-to-lymphocyte ratio are promising biomarkers in conjunction with morphological changes in neutrophils, thus proving that CBC and peripheral smears are simple, easily available, cost-effective, and highly dependable screening tools, especially in resource-poor settings.

Delta Immature Platelet Fraction Is Associated With Mortality in Bacteremia Patients.

Immature platelet fraction (IPF) for differentiating bacteremia has been explored, whereas its prognostic correlation remains uncertain. This study aims to confirm the predictive capability of IPF for bacteremia and investigate its association with prognosis. Patients with complete blood count (CBC) on the blood culture day (D1) and the preceding day (D0) were retrospectively recruited and categorized into bacteremia and nonbacteremia groups. Immature platelet (IP) analysis, alongside CBC, was conducted. Delta IPF, defined by the absolute values of D1 minus D0 results was calculated. The ability to distinguish bacteremia from nonbacteremia patients, and the correlation with mortality were analyzed. From February to December 2020, a total of 150 patients were enrolled, with 75 having bacteremia. The specificity for delta IPF ≥3.4% to predict bacteremia was 97.3% (95% confidence interval [CI]: 90.7-99.7). When delta IPF ≥3.4% combined with procalcitonin ≥0.5 (ng/mL), the sensitivity was 90.5% (95% CI: 69.6%-98.8%). Within the bacteremia group, delta IPF and the proportion of patients with delta IPF ≥1.5% were significantly higher in nonsurvival, while delta platelet levels did not. Furthermore, delta IPF ≥1.5% was independently associated with 30-day mortality (adjusted odds ratio: 3.88, 95% CI: 1.2%-11.4%; p = 0.020). The 30-day survival curve demonstrated a significant difference between patients with delta IPF ≥1.5% and those without (p < 0.001). Delta IPF correlates with mortality in bacteremia patients. Our findings suggest IPF not only helps detect bacteremia but also predicts prognosis in the early stage.

Performance of red blood cell indices for the detection of reticulocytosis in anemic and non-anemic dogs in Taiwan

Reticulocyte counts (RETIC) are considered the gold standard in detecting an erythroid bone marrow response (BMR) in anemic and non-anemic dogs. Reticulocytosis without anemia (RWA) is a potential indicator of disease. The prevalence of anemia or RWA, as well as the effectiveness of red blood cell (RBC) indices in identifying a BMR, may vary based on geographical locations and breed differences. The purpose of the study was to determine the prevalence of regenerative and nonregenerative anemia, and RWA in pet dogs of Taiwan, and to assess the sensitivity and specificity of combined increased mean cell volume and decreased mean cell hemoglobin concentration (iMCV+dMCHC) to detect reticulocytosis in this population.The final population analysis consisted of 149,076 dogs. A cross sectional, retrospective analysis of complete blood count (CBC) samples from a field of automated hematology analyzers in Taiwan from December 1, 2018 through December 31, 2020 was performed. Among 149,076 dogs, 11.8 % (n=17,600) had reticulocytosis (RETIC > 110K/µl) and 21.8 % (n=32,474) had anemia (HCT < 37.3 %). Of 32,474 anemic dogs, 17.8 % (n=5,789) had reticulocytosis. Of 116,602 dogs without anemia, 10.1 % (n=11,776) had reticulocytosis. Across all dogs, sensitivity/specificity of iMCV+dMCHC to detect BMR was 4.3 % and 99.4 %, respectively compared to RETIC. Among anemic dogs, sensitivity/specificity of iMCV+dMCHC to detect BMR was 9.8 % and 99.2 %, respectively. Among non-anemic dogs, sensitivity/specificity of iMCV+dMCHC to detect BMR was 1.6 % and 99.5 %, respectively. Therefore, most regenerative anemias and cases of RWA did not have a combined iMCV+dMCHC. To avoid overlooking potential illness, RETIC should be evaluated regardless of whether patients have anemia or not.

Inflammatory biomarkers and clinical adverse effects associated with Isotretinoin treatment: A prospective study

Background Isotretinoin is considered now one of the most important drugs in the treatment of different dermatological diseases. However, different body systems can be affected during the treatment due to isotretinoin induced apoptosis. Objectives To evaluate the clinical adverse effects and laboratory changes associated with isotretinoin used in the treatment of different dermatological diseases. Methods 73 patients on isotretinoin treatment fulfilled a questionnaire about side effects associated with isotretinoin. Complete blood count (CBC), fasting lipid profile, liver enzymes, and the inflammatory markers Monocytes/HDL ratio (MHR), Neutrophil/lymphocyte (NLR), and Platelets/lymphocyte ratios (PLR) were assessed before treatment and monthly during the treatment period. Results The commonest adverse effects were related to dryness of skin and mucus membrane. 32.9% complained of myalgia and 12.3% arthralgia. Headache was reported in 13.7%, mood alteration in 11%, and insomnia in 12.3%. 24.5% of studied females reported menstrual irregularities. There were no statistically significant changes in CBC. TG, cholesterol, AST, ALT, and MHR significantly increased while HDL, NLR and PLR ratios significantly decreased after isotretinoin treatment. Conclusion: isotretinoin affects different body systems by side effects that are reversible in most instances; however, some of them are serious and need regular monitoring especially in high- risk patients.

Systemic immune-inflammation index, and neutrophilto-lymphocyte and platelet-to-lymphocyte ratios can predict clinical outcomes in patients with acute coronary syndrome.

Inflammatory mechanisms play an important role in the pathogenesis of atherosclerosis and myocardial infarction. The clinical and prognostic importance of inflammatory parameters, such as neutrophil-lymphocyte (NLR) and platelet-lymphocyte ratios (PLR) in complete blood counts in acute myocardial infarction and other cardiovascular diseases has been demonstrated. However, systemic immune-inflammation index (SII) calculated from neutrophils, lymphocytes and platelets in the complete blood cell count has not been studied sufficiently and is thought to provide a better prediction. This study investigated whether haematological parameters such as SII, NLR and PLR were associated with clinical outcomes in acute coronary syndrome (ACS) patients. We included 1 103 patients who underwent coronary angiography for ACS between January 2017 and December 2021. The association between major adverse cardiac events (MACE) that developed in hospital and at 50 months of follow up and SII, NLR and PLR was compared. Long-term MACE were defined as mortality, re-infarction and target-vessel revascularisation. SII was calculated using the formula: NLR × total platelet count in the peripheral blood (per mm3). Of the 1 103 patients, 403 were diagnosed with ST-elevation myocardial infarction and 700 with non-STelevation myocardial infarction. The patients were divided into a MACE and a non-MACE group. In hospital and during the 50-month follow up, 195 MACE were observed. SII, PLR and NLR were found to be statistically significantly higher in the MACE group (p < 0.001). SII, C-reactive protein level, age and white blood cell count were independent predictors of MACE in ACS patients. SII was found to be a strong independent predictor of poor outcomes in ACS patients. This predictive power was greater than that of PLR and NLR.

Case 333.

A 61-year-old male patient without prior history of ophthalmologic problems presented with pain and redness in the left eye associated with slowly progressive proptosis over the previous 6 months. The patient also had diplopia in rightward and downward gaze. There was no vision loss. Mild fullness was seen in the periorbital tissues without any redness or fluctuance and with no purulent discharge from the left eye. The patient was otherwise healthy, with a 6-year history of diabetes mellitus and an 8-year history of hypertension managed well with medication. There was no history of trauma to the head or face. At clinical examination, conjunctival edema and redness with proptosis were noted. The cornea was clear. Evaluation of eye movements revealed restricted motion of the left eye in medial gaze and downward gaze. Ophthalmoscopic evaluation did not show any substantial abnormality. The retina and retinal vascularity were unremarkable. The right eye was unremarkable. Uncorrected visual acuity was 20/30 in the right eye and 20/40 in the left eye. Corrected visual acuity was 20/20 in both eyes. Complete blood cell count, as well as liver and kidney function test results, were within normal limits. The erythrocyte sedimentation rate and C-reactive protein level were normal. Thyroid function test results were normal. The patient subsequently underwent CT of the orbits without and with contrast enhancement (Fig 1) followed by further evaluation with MRI of the orbits without and with contrast enhancement (Figs 2-4).

Optimization of Complete Blood Count Results with Variations in Specimen Handling and Whole Blood Secondary Homogenization Techniques

Specimen homogenization and the addition of anticoagulants are pre-analytical steps that influence the accuracy of the test results. Complete blood count (CBC) is a screening test that supports disease diagnosis and aids in determining the appropriate therapy for patients. Inadequate specimens are inappropriate for subsequent testing, as they can lead to inaccurate results in the CBC examination. This study aims to determine the optimization of complete blood count results with variations in specimen handling and secondary homogenization techniques for whole blood. The type of research used is quantitative analysis using laboratory experimental methods. The study was conducted in May 2024 in the Clinical Pathology Laboratory of the Diploma-4 Medical Laboratory Technology Study Program, Faculty of Health Sciences, Muhammadiyah University of Sidoarjo, using 48 blood samples. The results of the MANOVA test indicate that the type of anticoagulant has a significant effect on the erythrocyte count (p=0.041) but does not have a significant impact on the leukocyte count (p=0.844) and platelet count (p=0.920). Meanwhile, the homogenization technique does not significantly affect the erythrocyte count (p=0.959), leukocyte count (p=0.991), or platelet count (p=0.867). This study concludes that the secondary homogenization technique has no significant effect. In contrast, the type of anticoagulant significantly impacts the results of the Complete Blood Count (CBC) test. This research suggests collecting whole blood specimens using Ethylene Diamine Tetra Acetate (EDTA) vacutainers as the anticoagulant and applying a secondary homogenization technique before performing the CBC analysis.

Pediatric Sickle Cell Disease Patients' Hematological Changes during Vaso-Occlusive Crises (VOCS) Versus Steady State

Background: The primary acute outcome of sickle cell disease (SCD) is a vaso-occlusive crisis (VOC) with extreme pain. More than three vaso-occlusive crisis (VOC) hospitalizations in a year increase the risk of early death. The objective of the study was to evaluate the hematological alterations in complete blood count (hemoglobin, red blood cell indices, white blood cell count, and platelets) and C-reactive protein levels during vaso-occlusive crises in patients with sickle cell anemia (HbSS) compared to a stable symptomatic state. Methodology: This study is a prospective descriptive study conducted in a hospital setting. During the period from February to June 2015, a Sudan Sickle Cell Anemia Center (SSCAC) in North Kordofan State, Sudan, treated a total of 100 patients with sickle cell anemia. Out of these patients, 74 had a vaso-occlusive crisis and 26 had a steady-state condition. All patients had measurements of their complete blood count (CBC) and C-reactive protein (CRP) levels. We calculated the average values of CBC and CRP level counts during vaso-occlusive crises and compared them to the values during steady state using independent t-tests. We analyzed the collected data using the Statistical Tool for Social Sciences (SPSS) software tool, specifically version 13. Results: The statistical analysis of the patient sample during vaso-occlusive crisis and steady state revealed that the concentration of hemoglobin (Hb) was 6.55 g/dl ± 1.3 and 9.8 g/dl ± 2.4, respectively, with a p-value of 0.000. The packed cell volume (PCV) was 20.4% ± 3.9 and 30.7% ± 7.1, respectively, with a p-value of 0.000. The red blood cell (RBC) count was 2.5×106/µl ± 0.57 and 3.9×106/µl ± 1.1, respectively, with a p-value of 0.000. A lot more white blood cells (WBC) were present in vasoocclusive than in steady state, with numbers 19.36 x 109/l ± 10.645 and 76.76 x 109/l ± 20.19, respectively, and a P-value of ≤0.000. There was a notable statistical disparity in the platelet count, with values of (357.108109/l ± 162.838) and (290.4610×9/l ± 124.40), with a P value of 0.05. In vaso-occlusive crises, the amounts of hemoglobin, packed cell volume (PCV), and red blood cells (RBCs) are lower than they are in the steady-state phase. Conversely, white blood cell (WBC) and platelet levels are much greater in patients experiencing vaso-occlusive crises compared to those in a steady state. The levels of C-reactive protein (CRP) were significantly different between patients experiencing vaso-occlusive crises and those in a stable condition.

Sex- and age-based reference intervals for capillary complete blood count parameters among urban preschoolers in southeast China based on a large community population

Background and aimPediatricians commonly use the complete blood count (CBC) of capillary blood to evaluate health status, guide diagnoses, and determine treatment strategies. This study aimed to establish sex- and age-specific reference intervals (RIs) for 23 capillary CBC parameters for urban preschoolers in Fuzhou, Southeast China. Materials and methodsCapillary blood CBC data of 18,369 healthy preschoolers who underwent annual physical examinations at Fujian Maternity and Child Health Hospital between January 01, 2022, and November 31, 2023, were analyzed retrospectively. To fully validate the new RIs, the data of all apparently healthy children within the same age cohort at the same institution were comprehensively analyzed in December 2023. The new RIs were assessed by comparing them with the RIs currently used in laboratories and those obtained from different regions, sample types, or methodologies. ResultsDynamic temporal changes that differ between males and females were observed in the blood system of 3-7-year-old children in this region. The new sex- and age-specific RIs for capillary CBC parameters were feasible to guide clinical decision-making in the local region. ConclusionsOur findings demonstrated the importance of establishing sex- and age-specific RIs for each region and underscored the necessity of continuous adjustment of clinical Rls based on statistical rules and clinical responses.

The treatment and diagnostic plan for chronic myeloid leukemia in Libyan oncology centers

Background: CML is one of the best understood diseases from the aspect of its cytogenetic abnormalities and the molecular mechanisms involved. CML was the first human disease in which a specific abnormality of the karyotype, the Philadelphia (Ph) chromosome, could be linked to a malignant disease. Later on, it was shown that the Ph chromosome results from a reciprocal translocation between the long arms of chromosomes 9 and 22, which produces the BCR-ABL fusion oncogene. Accordingly, in this study; we are going to determine whether the team workers in Libyan oncology centers actually following these steps of guidelines as it has been used internationally or there are some differences and special circumstances prevent them to apply the guidelines. Objectives: The present study aimed to explore the methods and plans used for diagnosis and treatment of CML patients in Libyan oncology centres and to confirm the most effective methods in diagnosis and treatment of CML by using a statistical analysing of some special data related to a well investigated cases by making a comparison between those plans. Methods: 173 and 153 CML patient files who has registered in Sabratha oncology institute and Misurata oncology institute -which are both considered as the main oncology centers in Libya- during the last sixteen years were investigated. Then, ten CML case files have randomly chosen from total CML patient files (51) and (78) cases from both oncology institutes which represents (35% and 45%) of all cases respectively (Male and Female, five from each institute). All results of laboratory investigations (CBC, biochemistry profiles, blood film, bone marrow, cytogenetic and molecular analysis) have been recorded and statistically analyzed to know the hematological, cytogenetic and molecular responses during the treatment period. CML patients chosen were at varying disease stages (chronic, accelerated, and blastic phases). The drugs used for treatment included 500 mg of Hydroxyurea, 400 mg, 600 mg and 800 mg of Glivec, and 600 mg of Tasigna in rare cases. Results and conclusion: The study has indicated the existence of a clear deficiency gap represented in a widespread lack of many capabilities such as the lack of some devices, equipments, operating materials and qualified experts. Moreover, the study has confirmed that the treatment plan has modified depending on the results of the complete blood count (CBC) only during all periods of the treatment without achieving other important investigation used for treatment follow up such as bone marrow aspiration, blood film examination, cytogenetic examination and molecular diagnostic. This study-as the first study dealing with this important topic- clarified many shortcomings of the diagnostic and treatment plan followed in both oncology institutes. As a recommendation, it is necessary to apply all international standard steps of the diagnosis and treatment in particular.

Prevalence of hemoglobinopathies detected by high performance liquid chromatography in tertiary care centre, Kota, Rajasthan

Background: Hemoglobinopathies are the most common heterogeneous group of monogenetic disorder in the world. Their prevalence varies with geographical regions. India is developing country and many studies have shown a significant burden of hemoglobinopathies in India. Our aim is to estimate prevalence of various hemoglobinopathies in our region. Methods: The present study was conducted at the department of pathology, Government Medical College, Kota on patients referred for antenatal or voluntary premarital checkup, patients with clinical history and complete blood count (CBC) suggestive of hemolytic anemia, and family members of known cases of hemoglobinopathies. Transfusion-dependent patients were also included. However, patients with history of blood transfusion within the last 1 month were excluded. EDTA samples were used for CBC using 6-part differential cell counter and high-performance liquid chromatography (HPLC) using BIORAD D10 analyzer. The results were tabulated and analyzed. Results: Of the 226 cases studied, 139 (61.5%) were females and 87 (38.5%) were males. Most common age group was 21 to 30 years. The number of thalassemia traits were 26 (11.5%), sickle cell traits were 7 (3.1%), sickle cell homozygous was 1 (0.4%), compound heterozygous for sickle cell and thalassemia were 2 (0.9%), while the remaining 190 patients (84.07%) were found to have normal HPLC, with presence or absence of nutritional deficiency. Conclusions: In our study, we found a high prevalence of hemoglobinopathies among patients. The most common disorder detected was beta thalassemia trait. Most of the hemoglobinopathies found in our study could be accurately quantified by HPLC which is a rapid, sensitive, and reproducible method for the detection of different hemoglobinopathies.

Baseline systemic inflammatory indices and clinicopathological features to predict the outcome of acute tubulointerstitial nephritis : Asingle-center retrospective study.

Acute tubulointerstitial nephritis (AIN) is an immune-mediated disorder that can cause acute kidney injury (AKI). We aimed to investigate the characteristics of patients with AIN and predictive factors for treatment response. In this study, thirty-one patients diagnosed with AIN on kidney biopsy between 2006 and 2021 were included. Baseline clinical, histopathological, and laboratory findings, including complete blood count (CBC), creatinine, erythrocyte sedimentation rate, C‑reactive protein, C3, C4, systemic immune inflammation index (SII), neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and urinalysis were evaluated. Treatment response, mortality, and creatinine levels at the time of last follow-up were also noted. The median age was 46 years and 80.6% were female. Median baseline creatinine and proteinuria levels were 4.1 mg/dL and 0.84 gram/day. The median follow-up period was 14months and 93.5% received immunosuppressives. End-stage kidney disease (ESKD) developed in five patients (16.1%). Renal recovery (creatinine < 1.4 mg/dL) was observed in 17 patients (54.8%). Higher degrees of interstitial fibrosis, tubular atrophy, granuloma formation, global glomerulosclerosis, and higher baseline hemoglobin levels, in addition to alonger interval between first symptom to initiation of immunosuppressives were associated with renal nonrecovery, statistically. Also, patients who progressed to ESKD had higher baseline hemoglobin (p = 0.033) and lymphocyte (p = 0.044) and lower PLR levels (p = 0.016), as well as higher degrees of global glomerulosclerosis (p = 0.014), interstitial fibrosis (p = 0.042), and tubular atrophy (p = 0.030). Treatment response rates are low for AIN, which may lead to ESKD. Besides chronicity in histopathology specimens, higher baseline hemoglobin levels and lower platelet-to-lymphocyte ratio might be prognostic. Further studies should be conducted on new markers for AIN.

Complete Blood Count-Based Biomarkers as Predictors of Clinical Outcomes in Advanced Non-Small Cell Lung Cancer Patients with PD-L1 < 50% Treated with First-Line Chemoimmunotherapy.

Background: The aim of the study was to investigate a series of complete blood cell count-based biomarkers of systemic inflammation as predictors of clinical outcomes in patients who underwent first-line chemoimmunotherapy for advanced NSCLC. Methods: Consecutive patients with pathologically diagnosed stage III/IV NSCLC and PD-L1 < 50% who underwent first-line chemoimmunotherapy were retrospectively enrolled. The clinical outcomes used for biomarker evaluation were Objective Response Rate (ORR) and Overall Survival (OS). Results: Non-responders had significantly higher values of neutrophil to lymphocyte ratio (NLR, median: 5.36; IQR: 2.78-10.82 vs. 3.31; IQR: 2.15-4.12, p = 0.019), neutrophil to monocyte ratio (NMR, median: 14.00; IQR: 8.82-21.20 vs. 9.20; IQR: 7.45-11.20, p = 0.013), and systemic inflammation index (SII, median: 1395; IQR: 929-3334 vs. 945; IQR: 552-1373, p = 0.025), but only NLR and NMR remained independently associated with clinical response in multivariate logistic regression. In the univariate analysis, white blood cells (OR:1.2202; 95% CI: 1.0339-1.4400, p = 0.019), neutrophils (OR:1.2916; 95% CI: 1.0692-1.5604, p = 0.008), NLR (OR:1.3601: 95% CI: 1.0949-1.6896, p = 0.005) and NMR (OR:1.2159; 95% CI: 1.00396-1.4221, p = 0.015) were significantly associated with survival; Cox regression models confirmed that neutrophils, NLR, and MLR were independently associated with survival; NLR, at a cut-off value of 4.0, showed the better AUC (0.749) in predicting OS. Conclusions: Baseline complete blood cell count biomarkers, especially the NLR, can predict clinical outcomes in patients with advanced NSCLC treated with first-line chemoimmunotherapy.

Effect of Vitamin D deficiency and some hematological parameters in Iraqi female patients with Systemic Lupus Erythematosus

Background: Systemic Lupus Erythematosus (SLE) is a chronic inflammatory autoimmune disease that affects multiple organs. Vitamin D deficiency is considered potential environmental factor triggering some autoimmune disorders, including SLE. This study was performed for determination of effect of vitamin D deficiency in SLE infection or disease worsening, and the relationship of ESR, HB, and WBCs with level of vitamin D in SLE disease, in addition to determine which of the previous parameter may describe the disease case of patients. Methods: This study included fifty three (53) SLE female patients and twenty six (26) healthy females were included. White blood count (WBC) and Heamoglobin (Hb) were determined in complete blood count (CBC) device, traditional Westergren method was used for Erythrocyte sedimentation rate (ESR) estimation, vitamin D was measured by using enzyme link immune-sorbent assay (ELISA) Kit. Results: The results showed a significant decrease in the hemoglobin levels in the SLE patients; significant increase was noticed in the ESR of SLE patients and significant increase was noticed in the WBC counts compared to the control group’s samples. A significant decrease in serum levels of vitamin D in patients compared to apparently healthy controls. Conclusions: Photosensitivity to sun in SLE patients contributed in decrease of vitamin D blood-levels. According to the ROC results, each of Hb, WBC, ESR and vitamin D may describe the disease case of patients.

Effect of rock bream iridovirus (RBIV) contained tissue intake on rock bream (Oplegnathus fasciatus) mortality and blood cell distribution

Rock bream (Oplegnathus fasciatus) is one of the highly priced cultured marine fish in Korea. Rock bream iridovirus (RBIV) outbreaks in aquaculture farms may involve environmental factors, co-infection with other pathogenic microorganisms and grounded (raw) fish feed. This study evaluated the effects of RBIV-containing tissue intake on mortality and oral transmission in rock bream. Virus-containing tissues administered to rock bream [50 mg (1.53 × 108/major capsid protein, MCP gene copies) to 2400 mg (7.34 × 109)] held at 23 °C lead to 100 % mortality by 27 days post administration. Interestingly, the mortality rates were not viral dose- or concentration dependent. Further, high MCP gene copy numbers were observed in the gill, liver, intestine, stomach, spleen, heart, kidney, brain and muscle tissues (viral load range of 3.03 × 106 to 4.01 × 107/mg, average viral load 1.70 × 107/mg) of dead rock bream. Moreover, a high viral load was detected in the intestine and stomach, where the virus was directly administered. This indicated that the intake of RBIV-containing tissue feed weakens the intestinal mucosal immunity and increases viral load in the intestine. Moreover, the levels of complete blood cell count (CBC) indicators, such as red blood cell (RBC), hemoglobin (HGB) and hematocrit (HCT) significantly decreased from 15 dpi with red blood cell distribution width (RDW), and white blood cells (lymphocyte, monocyte and granulocyte) significantly increased from the initial to later stage of infection. These results highlight the significance of blood-mediated indicators against RBIV infection in rock bream. We demonstrate the existence of an oral transmission route for RBIV in rock bream. Our findings indicate that pathogen-containing feed is an important risk factor for disease outbreaks in rock bream.