Hematologic Analytes Research Articles

Actualización de las especificaciones de la calidad analítica 2014. Consenso de las Sociedades Científicas nacionales

The aim of this study is to calculate minimum quality specifications (MQS) in urine biochemistry, blood glycosylated hemoglobin and several hematological analytes, and to compare these specifications with those from other countries, as well as to update the values for the 80 analytes studied. Materials used in this work are the results from laboratories participating in the external quality assurance programs organized by four Spanish scientific societies, and obtained in the time period 2007-2010. A total of 13,054 results were obtained for glycosylated hemoglobin, and from 14,180 (albumin) to 20,594 (creatinine) for urine biochemistry, and for hematology, from 1,839 (fetal hemoglobin) to 6,961 (antithrombin).The conclusions found were: to achieve the MQS for glycosylated hemoglobin does not ensure meeting clinical requirements, whereas MQS for urine biochemistry also meet the requirements based on biological variation. The MQS studied in this work could not be compared with those from other countries (there are no published values), and some of them could require calculations stratified according to several concentration levels.

Population-Based Pediatric Reference Intervals in General Clinical Chemistry: A Swedish Survey.

SummaryVery few high quality studies on pediatric reference intervals for general clinical chemistry and hematology analytes have been performed. Three recent prospective community-based projects utilising blood samples from healthy children in Sweden, Denmark and Canada have substantially improved the situation. The Swedish survey included 701 healthy children. Reference intervals for general clinical chemistry and hematology were defined.

COMPARISON OF SELECT HEMATOLOGY AND SERUM CHEMISTRY ANALTYES BETWEEN WILD-CAUGHT AND AQUARIUM-HOUSED LAKE STURGEON (ACIPENSER FULVESCENS)

Hematology and serum chemistry analytes were compared between wild-caught and aquarium-housed lake sturgeon (Acipenser fulvescens) to potentially improve understanding of medical issues in lake sturgeon. Blood samples were taken from 30 lake sturgeon exhibited in 11 institutions in the United States and from 23 experimentally stocked lake sturgeon caught in gill nets in the lower Genesee River in Rochester, New York, USA. For hematology, only segmented neutrophil count was significantly different, with wild-caught fish having a higher number of circulating neutrophils. For clinical chemistry analytes, chloride, uric acid, calcium, phosphate, glucose, aspartate aminotransferase, triglycerides, and creatine kinase were significantly different between the two cohorts. These differences are likely not clinically significant and are attributable to handling stress, variability in environmental parameters, or differences in nutritional status. This is the first report of hematology and serum chemistry values in aquarium-housed lake sturgeon and provides useful reference intervals for clinicians.

HEMATOLOGY AND PLASMA BIOCHEMISTRY ANALYTES IN FIVE AGE GROUPS OF IMMATURE, CAPTIVE-REARED LOGGERHEAD SEA TURTLES (CARETTA CARETTA)

Abstract: Blood samples of 85 immature, apparently healthy, captive-reared loggerhead sea turtles (Caretta caretta) were analyzed for 13 hematologic variables and total solids of 5 age groups (8, 20, 32, 44, and 56 mo old) and for 20 plasma biochemical analytes of 4 age groups (20 to 56 mo old). Each individual turtle was sampled under similar conditions during a blood collection period of 3 days. Hematologic analytes included packed cell volume, white blood cell (WBC) counts, WBC estimates, and leukocyte differentials. Biochemical analysis included albumin, alanine aminotransferase, alkaline phosphatase, amylase, aspartate aminotransferase, blood urea nitrogen, calcium, chloride, cholesterol, creatine kinase, creatinine, gamma glutamyltransferase, globulins, glucose, phosphorous, potassium, sodium, total bilirubin, total protein, total solids, and uric acid. In due consideration of small sample size in all five age groups, the results of hematologic and biochemical analysis were used to determine ranges for these analytes and to compare values among consecutive age groups. Several significant differences in some hematologic and biochemical variables were identified and need to be considered in the interpretation of blood work of immature, growing sea turtles in human care.

Molt-associated Changes in Hematologic and Plasma Biochemical Values and Stress Hormone Levels in African Penguins (Spheniscus demersus)

Handling, including blood collection, has often been discouraged in molting penguins because it is considered an additional stress imposed on birds already experiencing major physiologic stress associated with molting. To evaluate the degree of physiologic stress posed by molting, we compared the hematologic and plasma biochemical values and hormone levels of molting and nonmolting African penguins, Spheniscus demersus. Five male and 5 female penguins randomly chosen were given complete physical examinations, were weighed, and blood samples were taken at 7 time points before, during, and after the molt. Data were analyzed by linear mixed-model analysis of variance. Throughout the study, behavior and appetite remained normal. Catecholamine levels were highly variable within and among subjects, whereas mean corticosterone levels were significantly different between baseline, molt, and postmolt values. Significant differences from baseline values were observed in many of the hematologic analytes; however, only decreases in hematocrit and red blood cell count values were considered clinically significant. Anemia due to experimentally induced blood loss as a possible cause of the significant hematologic changes was ruled out based on results of a follow-up control study during the nonmolt season, which showed no significant changes in hematocrit level or total red blood cell counts when using similar sampling protocols, which indicates that these changes were associated with molt.

Estimating reliable paediatric reference intervals in clinical chemistry and haematology

Very few high-quality studies on paediatric reference intervals for general clinical chemistry and haematology analytes have been performed. Three recent prospective community-based projects utilising blood samples from healthy children in Sweden, Denmark and Canada have substantially improved the situation. The present review summarises current reference interval studies for common clinical chemistry and haematology analyses.

Monitoring the health status of free-ranging tammar wallabies using hematology, serum biochemistry, and parasite loads

Population differences in body condition, parasitic burden, hematology, and serum biochemistry of free-living tammar wallabies (Macropus eugenii) are presented and compared to studies reporting values in captive tammar wallabies. The nutritional distinction in the composition and quality of the available vegetation on Garden Island produces 3 sub-populations that differ in their human disturbance, body condition, rates of reproduction, and survival, providing unique opportunities to examine condition-related health parameters in free-living wallabies. Our results show several hematology analytes (in particular, mean corpuscular hemoglobin and mean corpuscular hemoglobin concentration), all the measured serum biochemistry analytes (urea, creatinine, triglycerides, and albumin), and total gastrointestinal parasite burden are significantly associated with body condition (body mass index), providing reliable indices of wallaby condition and habitat quality. The means and standard errors for hematology analytes (in particular, hemoglobin, mean corpuscular hemoglobin, and mean corpuscular hemoglobin concentration) and all serum biochemistry values for free-ranging wallabies lie below and outside of reference ranges for captive wallabies, despite the naval base sub-population benefiting from human modified habitats with a consistent availability of food. This indicates that free-ranging tammar wallabies may be suffering from some challenges that captive wallabies do not face. The hematology and serum biochemistry values coupled with body condition indices suggest wallabies in the south bush sub-population are under greater nutritional stress and suffering from prolonged malnutrition. Examining all parameters in a single year and across years would be beneficial to further investigate habitat differences driving this change to help distinguish if vegetative structure and associated nutritional deficiencies and/or disease are limiting this population. Health monitoring is an integral part of the management of both captive and free-living populations and the data presented here will serve as an effective management tool in assessing the health status of free-living tammar wallabies. © 2013 The Wildlife Society.

Hematological and serum biochemical analytes reflect physiological challenges during gestation and lactation in killer whales (Orcinus orca)

Gestation and lactation result in metabolic alterations of the dam because of varying demands of the fetus and offspring during the different stages of development. Despite killer whales (Orcinus orca) having one of the longest gestations and highest birth weights of all mammals in human care, these metabolic alterations, and their impact on the physiology of the dam have not been measured. The objectives of this analysis were to determine if physiologic demands on the killer whale during pregnancy and lactation have measurable effects on hematology and biochemical analytes and if detectable, to compare these changes to those which are observed in other mammalian species. Forty hematologic and biochemical analytes from seven female killer whales (22 pregnancies, 1,507 samples) were compared between the following stages: (1) non-pregnant or lactating (control); (2) gestation; and (3) the first 12 months of lactation. Decreased hematocrit, hemoglobin, and red blood cell counts were indicative of plasma volume expansion during mid and late gestation. The killer whales exhibited a progressively increasing physiologic inflammatory state leading up to parturition. Gestation and lactation caused significant shifts in the serum lipid profiles. Gestation and lactation cause significant physiologic changes in the killer whale dam. The last 12 months of gestation had greater physiological impact than lactation, but changes associated with and immediately following parturition were the most dramatic. During this period, killer whales may experience increased susceptibility to illness, and anthropogenic and environmental disturbances.

Reference interval studies: what is the maximum number of samples recommended?

Little attention has been paid to the maximum number of specimens for reference interval calculation, i.e., the number of specimens beyond which there is no further benefit in reference interval calculation. We present a model for the estimation of the maximum number of specimens for reference interval studies based on setting the 90% confidence interval of the reference limits to be equal to the analyte reporting interval. Equations describing the bounds on the upper and lower 90% confidence intervals for logarithmically transformed and untransformed data were derived and applied to determine the maximum number of specimens required to calculate a reference interval for 12 common chemistry and hematology analytes. Maximum sample sizes ranged from 126 to 18,171 and depended on the standard deviation of the population, any transformation involved and on the chosen reporting interval. This paper demonstrates the importance of the influence of reporting interval on reference intervals. Using this technique can reduce the cost of determining a reference interval by identifying the maximum number of specimens required.

VARIATION IN HEMATOLOGIC AND SERUM BIOCHEMICAL VALUES OF BELUGAS (DELPHINAPTERUS LEUCAS) UNDER MANAGED CARE

Blood analytes are critical for evaluating the general health of cetacean populations, so it is important to understand the intrinsic variability of hematology and serum chemistry values. Previous studies have reported data for follow-up periods of several years in managed and wild populations, but studies over long periods of time (> 20 yr) have not been reported. The study objective was to identify the influences of partitioning characteristics on hematology and serum chemistry analytes of apparently healthy managed beluga (Delphinapterus leucas). Blood values from 31 managed belugas, at three facilities, collected over 22 yr, were assessed for seasonal variation and aging trends, and evaluated for biologic variation among and within individuals. Linear mixed effects models assessed the relationship between the analytes and sex, age, season, facility location, ambient air temperature, and photoperiod. Sex differences in analytes and associations with increasing age were observed. Seasonal variation was observed for hemoglobin, hematocrit, mean corpuscular volume, monocytes, alkaline phosphatase, total bilirubin, cholesterol, and triglycerides. Facilities were associated with larger effects on analyte values compared to other covariates, whereas age, sex, and ambient temperature had smaller effects compared to facility and season. Present findings provide important baseline information for future health monitoring efforts. Interpretation of blood analytes and animal health in managed and wild populations over time is aided by having available typical levels for the species and reference intervals for the degree to which individual animals vary from the species average and from their own baseline levels during long-term monitoring.

Haematological and biochemical values in North American Scottish deerhounds

Sighthounds, including deerhounds, have unique physiological traits that result in laboratory test results that may lie outside reference intervals for the general dog population. Although reference intervals for most analytes are thought to be similar among sighthounds, breed-specific reference intervals are available mainly for greyhounds. The aim of this study was to establish reference intervals for haematology and serum biochemical profiles in deerhounds. Venous blood samples were collected from healthy deerhounds. Haematological and biochemical analytes were examined and reference intervals were established using the 5th and 95th percentiles. The reference intervals obtained from 96 dogs for platelets, reticulocytes, total thyroxine, chloride, gamma glutamyl transferase, bilirubin and glucose were lower than the general dog population. Reference intervals for mean cell volume, potassium, urea, alanine aminotransferase, aspartate aminotransferase, alkaline phosphatase and cholesterol were higher than the general dog population. Reference intervals for eosinophils and globulin were wider than that of the general population. These results confirm that differences in haematological and biochemical values exist in the deerhound. Some appear to be shared by all sighthounds but others may be unique to this breed.

Influence of temperature and storage duration on measurement of activated partial thromboplastin time, D‐dimers, fibrinogen, prothrombin time and thrombin time, in citrate‐anticoagulated whole blood specimens

We report the effect of temperature and storage duration on a range of haematological analytes: activated partial thromboplastin time (APTT), D-dimers, fibrinogen (Fbg), prothrombin time (PT) and thrombin time (TT). All analytes were measured using a Sysmex CA7000 System with SIEMENS reagents. One hundred and sixty patients were divided into two groups: samples from group A (80 patients) were used to assess the effect of storage at room temperature (RT) (0, 4, 8 and 24 h), and samples from group B (80 patients) were used to determine the effect of storage at 4 °C. Percentage changes compared with baseline results (T = 0 result) were calculated, and clinically relevant differences were defined as a percentage change of >10%. Changes in APTT, D-dimer, Fbg, PT and TT results following 4, 8 and 24 h storage were statistically significant at RT and 4 °C. For D-dimer, Fbg, PT and TT at both RT and 4 °C, the mean percentage changes after all storage periods were <10%, but for APTT, the mean percentage change following 24 h storage was >10% and exceeded the analytical within-batch imprecision. We demonstrate that a storage time interval up to 24 h for D-dimers, Fbg, PT, and TT, and 8 h for APTT at either RT or 4 °C is acceptable.

Biological variation and reference change values of common clinical chemistry and haematologic laboratory analytes in the elderly population

Biological variation (BV) and reference change values (RCVs) have been widely described for the general population, but the use of these data derived from adults in the elderly population is a controversial issue. We determined the within- and between-subject BV and RCV in both elderly and young people and compared them with previously published analyses. Samples were collected from 135 volunteers over 80 years of age at weekly intervals over 4 weeks. Eighteen biochemical and eight haematological analytes were measured. The Fraser and Harris methods were used to calculate the components of BV and RCV. To perform a comparative analysis, a reference group of 118 young subjects was studied under the same conditions. The obtained coefficients of BV showed statistical differences in many cases, but in general, both the elderly and young patient data fall within the ranges previously described for the general population. The indexes of individuality for the analytes investigated did not exceed 1.4 in any case and were <0.6 for some analytes. The RCVs derived from elderly subjects were similar to those published in the young population, both in healthy and diseased individuals. The strong individuality observed supports the preferential use of RCVs rather than population-based reference intervals in elderly people. For most of the analytes studied, data from the young population can be applied to elderly people, but the specific elderly coefficients of BV and RCVs are a recommended option.

Analysis of Laboratory Repeat Critical Values at a Large Tertiary Teaching Hospital in China

ContextAs a patient safety measure, laboratories are required to have a critical values policy by regulatory agencies. Unfortunately, little information is available on repeat critical values for the same analyte(s) on the same patient.ObjectiveTo investigate the occurrence and distribution of repeat critical values and the relationship between the frequency of such values and patient outcome to provide information for hospitals on improving reporting policies.MethodsEleven laboratory critical value lists, including chemistry and hematology analytes, were selected from a tertiary hospital in China in the year 2010. The distribution and interval time for each repeat critical value were calculated. Serum potassium and platelet count were used as examples to illustrate the relationship between the frequency of the repeat critical values and patient outcome.ResultsAll test items on the critical value list were prone to the occurrence of repeat critical values. On average, each patient who experienced critical values had 2.10 occurrences. The median interval time for each repeat critical value varied, with most being longer than 8 hours. For those patients who had repeat critical values of serum potassium and platelet count, along with the increased frequency, the patients had a longer hospital stay and a generally worse outcome.ConclusionsPatient can have a number of repeat critical values and the frequency of these values is closely related to patient outcome. A careful evaluation is warranted if a laboratory chooses to adopt a policy of not reporting each repeat critical value.

Population-based pediatric reference intervals for hematology, iron and transferrin

Reference intervals are crucial decision-making tools aiding clinicians in differentiating between healthy and diseased populations. However, for children such values often are lacking or incomplete. Blood samples were obtained from 689 healthy children, aged 6 months to 18 years, recruited in day care centers and schools. Hematology and anemia analytes were measured on the Siemens Advia 2120 and Abbott Architect ci8200 platforms (hemoglobin, erythrocyte volume fraction [EVF], erythrocytes, mean corpuscular volume [MCV], mean corpuscular hemoglobin [MCH], mean corpuscular hemoglobin concentration [MCHC], reticulocytes, leukocytes, lymphocytes, monocytes, neutrophils, eosinophils, basophils, platelets, iron, transferrin, transferrin saturation). Age- and gender-specific pediatric reference intervals were defined by calculating 2.5th and 97.5th percentiles. The data generated is primarily applicable to a Caucasian population, but could be used by any laboratory if verified for the local patient population.

Evaluation of adverse effects of lisinopril and rosuvastatin on hematological and biochemical analytes in wistar rats

Objective:Combination therapy of lisinopril and rosuvastatin may be an important concept in developing more effective strategies to treat and prevent atherosclerosis, coronary heart disease, and co-morbid metabolic disorders. The present study was designed to evaluate toxic effects of lisinopril and rosuvastatin alone or its combination therapy on hematological and biochemical analytes in Wistar rats.Materials and Methods:Forty-two rats were divided into seven groups, with each group comprising six rats. Rats were administered with lisinopril, rosuvastatin alone, or in-combination at two different doses. The blood samples were collected from rats after 21 days of oral administration of the drug/s and analyzed for various hematological and biochemical analytes.Results:Lisinopril alone and its combination treatment with rosuvastatin at high doses decreased hemoglobin and hematocrit. Rosuvastatin alone at high dose and its concomitant administration with lisinopril at two different doses showed increase in total white blood cells and absolute lymphocyte count and neutrophil count. Serum levels of aspartate aminotransferase (AST), alkaline phosphatase (ALP), and total bilirubin were significantly increased in rosuvastatin alone and its combination with lisinopril at both the doses. Besides this, lisinopril treatment decreased serum levels of sodium and increased the levels of potassium. Serum creatine kinase (CK) levels were increased in the animals treated with rosuvastatin at both the doses. However, increased serum CK level because of rosuvastatin became normal with co-administration of lisinopril at low doses.Conclusion:Our results indicate that administration of lisinopril with rosuvastatin does not ameliorate hepatotoxicity caused by rosuvastatin. However, combination treatment reduces serum CK levels elevated due to rosuvastatin, implicating protective effect of combination treatment on myopathy at low doses.

Clinical characteristics, haematology and biochemical analytes of primary omasal impaction in bovines

This study was conducted on 11 animals (7 buffaloes and 4 cows) diagnosed with primary omasal impaction. In all the cases, laparorumenotomy was performed and omasal impaction was confirmed based on the consistency of the omasal contents along with an empty abomasum. Signalment, history, clinical signs, clinic-pathologic findings, and treatment were determined. Clinical examination was found to be helpful in subjective assessment of omasal impaction but could not aid in definitive diagnosis. Pain on palpation of the omasal area along with rectal findings could be a diagnostic feature. Neutrophilic leukocytosis was observed in a majority of animals. Total bilirubin, glucose, lactate, BUN, and fibrinogen, as well as activities of aspartate aminotransferase, alkaline phosphatase, and gamma-glutamyltransferase were significantly high in the primary omasal impaction group compared to the control group. Albumin, fibrinogen ratio, calcium, and chloride were significantly low in the primary omasal impaction group. The negative prognostic signs were neutrophilic leukocytosis with marked left shift and toxic changes in neutrophils, chloride levels below 70 mmol/L, potassium below 2 mmol/L, lactate above 9 mmol/L, and highly distended omasum on rumenotomy. Primary omasal impaction should be included in the differential diagnosis of diseases associated with cessation of defecation and abdominal pain.

Determination of coverage interval of antioxidant vitamins (vitamin C & vitamin e) in plasma and serum of bengali population.

Reference interval of all haematological and biological analytes should be measured for every population because of the huge diversity in genetic make-up, dietary habits. The coverage interval of antioxidant vitamins (vitamin C and α-tocopherol) in the plasma and serum of reference Bengali population was determined and compared with the reference intervals of antioxidant vitamins in the established literature. Adult healthy volunteers from 18 to 68 years of age underwent extensive clinical and investigational procedure and were included in the study. Vitamin C and α-tocopherol were estimated using simple Spectrophotometric method. Of the 71 healthy Bengali volunteers participated, 31 were males and 40 were females. The mean concentration of plasma vitamin C was found to be 0.65 mg/dL. The mean α-tocopherol was found 6.35 mg/L (14.74 μmol/L) in the study population higher than the normal threshold value for α-tocopherol but lower than other populations. The study data enabled us to determine the gender nonspecific coverage interval of antioxidant vitamins, and the intervals were lower than the established reference interval in other populations.

Reference intervals for select hematologic and plasma biochemical analytes of wild Lake Sturgeon (Acipenser fulvescens) from the St. Lawrence River in New York

Lake Sturgeon (Acipenser fulvescens) is a long-lived freshwater fish distributed throughout the Great Lakes region and is a threatened species in New York State. The species' unique life cycle makes it useful as an indicator of ecosystem health, and efforts to repatriate Lake Sturgeon to their historic range are underway. However, comprehensive hematologic and biochemical reference intervals that would be valuable for assessing the health status of individual animals have not been reported. The objective of this study was to determine normal hematologic and plasma biochemical reference intervals for healthy wild Lake Sturgeon. Blood samples were collected from 52 wild Lake Sturgeon caught in gill nets in the St. Lawrence River. Heparinized whole blood and plasma samples were analyzed using standard techniques. Reference intervals were calculated using the robust method following elimination of outliers and Box-Cox transformation of data. Hematologic reference intervals were as follows: PCV 17-38%, estimated WBC count 2740-23,150/μL, neutrophils 193-6121/μL, eosinophils 0-558/μL, other granulocytes/heterophils 0-488/μL, lymphocytes 1447-14,044/μL, and monocytes 55-1684/μL. Plasma biochemical reference intervals were as follows: aspartate aminotransferase 333-1746 U/L, calcium 1.85-2.80 mmol/L, chloride 95-123 mmol/L, creatine kinase 776-35,536 U/L, glucose 2.94-14.76 mmol/L, glutamate dehydrogenase 6-30 U/L, phosphate 2.03-5.81 mmol/L, potassium 2.34-4.24 mmol/L, sodium 122.9-151.1 mmol/L, total protein 2.0-4.4 g/dL, triglycerides 1.07-5.12 mmol/L, and uric acid 1-251 μmol/L. Reference intervals reported here will be useful for health assessment of wild and repatriated Lake Sturgeon.

Serum cardiac troponin I concentrations in dogs with leishmaniasis: correlation with age and clinicopathologic abnormalities

There is anecdotal evidence of myocardial injury in dogs with leishmaniasis due to generalized vasculitis and myocarditis. The aims of this study were to evaluate serum concentration of cardiac troponin I (cTnI) as an indicator of myocardial injury in dogs with leishmaniasis and to assess the relationship between cTnI concentration and age, serum antibody titer, and a variety of blood analytes. In this retrospective study, serum cTnI concentration was measured in dogs with leishmaniasis and in age-matched healthy dogs. Diagnosis was based on clinical signs and moderate-to-high seropositivity for Leishmania as measured by ELISA. Correlations between cTnI concentration and ELISA seropositivity, PCV, concentrations of serum creatinine, total protein, albumin, and globulin, albumin:globulin ratio (A/G), and urine protein:creatinine ratio (UPC) were investigated. The Mann-Whitney test was used to compare analytes between dogs with normal and increased (> 0.06 μg/L) cTnI concentration and to compare cTnI concentrations between dogs with and without anemia, azotemia, and proteinuria. In dogs with leishmaniasis (n = 40), median cTnI concentration was higher than in control dogs (n = 11) (P = .011). Sixteen dogs (40%) with leishmaniasis had increased cTnI concentration; cTnI was moderately to weakly correlated with decreased albumin concentration, decreased A/G, increased UPC, decreased PCV, positive Leishmania titer, and increased age. Dogs with leishmaniasis had significantly higher total protein and globulin concentrations and lower PCV, albumin concentration, and A/G than control dogs. Hematologic and biochemical analytes did not differ significantly between dogs with cTnI concentration within the reference interval and those with increased concentrations. Concentration of cTnI was higher in proteinuric dogs compared with nonproteinuric dogs (P = .017). A proportion of dogs with leishmaniasis have increased serum cTnI concentration, indicative of some degree of cardiac injury. Additional studies are needed to investigate the relationship between leishmaniasis and possible myocardial injury.