Higher Hematocrit Levels Research Articles

A Real-World Study on the Short-Term Efficacy of Amlodipine in Treating Hypertension Among Inpatients.

Hospitalized hypertensive patients rely on blood pressure medication, yet there is limited research on the sole use of amlodipine, despite its proven efficacy in protecting target organs and reducing mortality. This study aims to identify key indicators influencing the efficacy of amlodipine, thereby enhancing treatment outcomes. In this multicenter retrospective study, 870 hospitalized patients with primary hypertension exclusively received amlodipine for the first 5 days after admission, and their medical records contained comprehensive blood pressure records. They were categorized into success (n=479) and failure (n=391) groups based on average blood pressure control efficacy. Predictive models were constructed using six machine learning algorithms. Evaluation metrics encompassed the area under the curve (AUC), accuracy, sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV). SHapley Additive exPlanations (SHAP) analysis assessed feature contributions to efficacy. All six machine learning models demonstrated superior predictive performance. Following variable reduction, the model predicting amlodipine efficacy was reconstructed using these algorithms, with the light gradient boosting machine (LightGBM) model achieving the highest overall performance (AUC = 0.803). Notably, amlodipine showed enhanced efficacy in patients with low platelet distribution width (PDW) values, as well as high hematocrit (HCT) and thrombin time (TT) values. This study utilized machine learning to predict amlodipine's effectiveness in hypertension treatment, pinpointing key factors: HCT, PDW, and TT levels. Lower PDW, along with higher HCT and TT, correlated with enhanced treatment outcomes. This facilitates personalized treatment, particularly for hospitalized hypertensive patients undergoing amlodipine monotherapy.

Effect of magneto-thermal conditions on blood viscosity: An experimental study

The effects of the combined magneto-thermal conditions on blood viscosity and the underlying mechanisms of the key factors were elucidated. An integrated magneto-thermal experimental apparatus was devised to measure the viscosity of blood samples sourced from healthy blood donors subject to various non-thermal alternating magnetic fields (AMF), temperature, and magneto-thermal conditions. Mechanisms governing the influence of different factors on blood viscosity were further probed by assessing the viscoelastic modulus of red blood cells (RBCs) and observing RBC morphology. Results show that the hierarchy of significance of three main factors in magnetic hyperthermia on blood viscosity is as follows: temperature > AMF intensity > AMF frequency. Both heightened AMF field strength and elevated temperature led to a nonlinear decrease in blood viscosity, particularly in blood samples with higher hematocrit levels. This is associated with enhanced rheological characteristics of RBCs at increased temperatures and alterations in the repulsive forces between RBCs owing to changes in the cell surface charge induced by AMF. These changes ultimately reduce the flow resistance. However, when the temperature exceeded 46 °C, the deterioration of spectrin on the RBC membrane, coupled with the formation of spicules on the cell membrane surface and subsequent RBC rupture, contributed to increased blood viscosity at higher temperatures.

Impact of Haemoglobin and Haematocrit on the Incidence of Thrombosis in the Individuals Exposed to High-Altitude

Impact of Haemoglobin and Haematocrit on the Incidence of Thrombosis in the Individuals Exposed to High-Altitude

Pseudosubarachnoid hemorrhage sign in a patient with tetralogy of Fallot

Subarachnoid hemorrhage (SAH) constitutes a common neurosurgical emergency. Non-contrast computerized tomography (NCCT) head has very high specificity and sensitivity in detecting SAH. However, in certain conditions, the computed tomography (CT) may be falsely positive, termed as pseudo-SAH. We hereby report a rare case of pseudo-SAH in a patient with tetralogy of Fallot and discuss the possible etiopathogenesis and the pertinent literature. We present here a case of a 15-year-old male patient, who was diagnosed with tetralogy of Fallot (TOF) physiology. He presented to the cardiology outpatient clinic with complaints of dyspnea on exertion, headache, and drowsiness. The NCCT head revealed diffuse hyperdensity in the basal cisterns and sulcal spaces, which were suggestive of diffuse SAH. However, in the setting of negative CT and magnetic resonance angiography along with high hematocrit levels (84%), diagnosis of pseudo-SAH was considered. The patient was appropriately managed with beta-blockers, intravenous fluids, and serial phlebotomies. The patient underwent a palliative shunt connecting the ascending aorta to the main pulmonary artery (central shunt), following which his saturation improved, and hematocrit decreased (40%) leading to significant symptomatic improvement. Knowledge of pseudo-SAH signs is essential for the treating physician and plays an important part in the management of this patient population.

Investigation of Zinc on hemorheological parameters in a rat model of diabetes

Diabetes mellitus (DM) is a complex, chronic metabolic disorder characterized by impaired regulation of blood glucose levels. Zinc (Zn) is an essential trace elements that plays a role in various physiological processes within the body, including those related to diabetes. The current study was investigated the effect of Zn supplementation on hemorheological parameters in a rat model of DM. After induction of DM, 32 male Wistar albino rats were divided into four groups: control, Zn, DM, and Zn+DM. Whole blood viscosity (WBV) was determined by using digital cone and plate viscometer and plasma viscosity (PV) was determined by a Coulter Harkness capillary viscometer. The rats in the DM Group showed a decrease in both Zn levels and body weight, as well as an increase in glucose levels when compared to the control group. Diabetic rats supplemented with Zn displayed lower blood glucose levels and higher concentrations of Zn compared to the DM Group. The higher PV and lower hematocrit level were measured in DM Group than control group and lower PV, higher hematocrit level were measured in Zn+DM group than DM Group. The WBV was measured at four different shear rates (57.6–115.2 - 172.8–230.4 s −1). A statistically significant increase was observed in the DM group compared to the control group. Additionally, a statistically significant decrease was observed in the Zn+DM Group compared to the DM Group at a shear rate of 230.4 s−1. Erythrocyte rigidity index (Tk) and oxygen delivery index (ODI) were computed under conditions of high shear rate. The rats in the DM group exhibited a reduction in ODI and an elevation in Tk in comparison to the control group. Conversely, the diabetic rats supplemented with Zn exhibited decreased Tk and increased ODI compared to the DM Group. Zn supplementation seems to have a potential beneficial effect for protecting adverse affect of diabetes on hemorheogical parameters and for maintaining vascular health.

Two Novel Genetic Variants Involved in the Oxygen Sensing Pathway in JAK2-unmutated Erythrocytosis.

JAK2-unmutated erythrocytosis or non-polycythemia vera erythrocytosis is a rare condition comprising both acquired and hereditary forms. Although acquired erythrocytosis has been well-studied, hereditary erythrocytosis remains poorly studied. Genetic alterations associated with hereditary erythrocytosis include mutations in erythropoietin receptor and erythropoietin (EPO), altered oxygen affinity mutations, and variants associated with the oxygen-sensing pathway. We established a molecular diagnostic approach based on these genes and retrospectively evaluated. Peripheral blood from 56 erythrocytosis patients, lacking JAK2 mutation, were screened for oxygen-sensing pathway abnormalities. Two novel mutations were identified in the EGLN1 gene: NM_022051.2:c.712G > C (p.Gly238Arg) and NM_022051.2:c.122A > C (p.Tyr41Ser) in two patients separately. Notably, both reported heterozygous mutations were absent in the population database. Predictions using multiple computer software indicated that these two missense mutations were harmful and induced a highly conserved amino acid change in EGLN1. Patients with the two mutations exhibited normal serum EPO levels and high hemoglobin and hematocrit levels. Additionally, three other variants of genes were identified in the oxygen-sensing pathway, including endothelial PAS domain protein 1 (EPAS1) rs184760160(2/56), and EGLN1 rs186996510(2/56), rs555121182(2/56). These variants were categorized as benign or likely benign. Our findings provide a framework for etiological research and highlight the importance of screening for genetic mutations associated with erythrocytosis in clinical practice.

HEMATOLOGY PROFILES AND DISEASE SEVERITY OF PEDIATRIC DENGUE VIRUS INFECTION AT A TERTIARY HOSPITAL IN SURABAYA, INDONESIA

Highlights Dengue virus infections exhibit a spectrum of clinical manifestations, ranging from asymptomatic cases to severe disease, with the potential for fatalities if not managed effectively. Hematology factors significantly contribute to the severity of dengue virus infection. Abstract Background: The escalating incidence of dengue cases in Surabaya, Indonesia, underscores the imperative to comprehend the hematology profiles and disease severity in pediatric patients affected by dengue virus infections (DVI). As the prevalence of DVI continues to surge, understanding the nuanced clinical manifestations becomes paramount for effective management and mitigation of the disease burden. Objective: This study aimed to characterize the hematology profiles and the disease severity of dengue virus infections (DVI) among pediatric patients hospitalized at Dr. Soetomo General Academic Hospital, Surabaya, Indonesia throughout 2019. Material and Method: A retrospective descriptive cross-sectional study was conducted using secondary data from medical records. Pediatric patients aged six months to 18 years were enrolled. A total sampling method comprised 67 patients meeting the inclusion criteria. Result: Severe thrombocytopenia was most commonly observed in dengue hemorrhagic fever (DHF) III cases (36.4%), while leukopenia was predominant in DF cases (42.2%). High hematocrit levels were more prevalent in DHF III cases (27.3%), and high hemoglobin levels were most frequently identified in DHF II and DHF III cases (33% in each case). Significant differences in DVI severity were observed in platelets and hemoglobin levels (p=0.0002 and p=0.0066, respectively) but not in leukocyte and hematocrit levels. Conclusion: Mild thrombocytopenia was prevalent in Dengue Fever (DF), while severe thrombocytopenia was most prevalent in Dengue Hemorrhagic Fever (DHF) grade III. Leukopenia was prominent in DF patients, and platelets and hemoglobin levels varied across severity of DVI. These findings provide insights for improved clinical management and diagnostic criteria refinement.

Spontaneously Ruptured Hepatocellular Carcinoma Treated by Transarterial Embolization Compared with Conservative Treatment: Survival Outcome and Prognostic Factors

Objective: To report the survival outcome and prognostic factors in the patients with spontaneously ruptured hepatocellular carcinoma treated by transarterial embolization compared with conservative treatment. Materials and Methods: A retrospective review of 89 patients who had spontaneous rupture of hepatocellular carcinoma (HCC) at Siriraj Hospital between January 2011 and February 2017 were enrolled. Ruptured HCC patients are diagnosed by clinical presentations of abdominal pain/distension, anemia/shock with dynamic liver computed tomography findings as: hemoperitoneum, focal discontinuity or tumor protrusion of the hepatic surface and/or active contrast material extravasation. We compared the survival outcome and prognostic factors of the ruptured HCC patients who received two treatment methods; conservative treatment and transarterial embolization (TAE). Results: The cumulative median survival time of the ruptured HCC patients was significantly higher in the TAE group (81 days) than in the conservative treatment group (29 days) with p-value = 0.006. There were two significant predictors for post-treatment mortality. First, treatment modality in the TAE group showed a significantly lower mortality rate than in the conservative treatment group with a hazard ratio (HR) 0.454 (p-value = 0.003). Second, a pre-treatment high hematocrit level was a significant predictive factor for lower mortality than a low hematocrit level with a hazard ratio (HR) 0.946 (p-value = 0.016). Conclusion: TAE results in a good clinical outcome and increased survival rate in the patients with ruptured HCC. A pre-treatment high hematocrit level was a good prognostic factor for the survival in ruptured HCC patients.

Novel Anti-TMPRSS6 Monoclonal Antibody Provides a Potential Therapeutic Approach for the Treatment of Polycythemia Vera

Polycythemia vera (PV) is a myeloproliferative neoplasm (MPN) triggered by activating mutations in JAK2, an important kinase in the principal signaling pathway of the erythropoietin receptor. Most of the clinical manifestations of PV are caused by increased erythrocyte count, leading to increased risk of pulmonary hypertension and thrombosis. The mainstay of therapy for PV is therapeutic phlebotomy to reduce the hematocrit (HCT) level and minimize the risk of thrombosis, however, the effect of phlebotomy is transient until patients become iron deficient. Therefore, systemic iron restriction could be effective in treating PV patients. Transmembrane serine protease 6 (TMPRSS6) is a negative regulator hepcidin, the master regulator of iron homeostasis. Increasing genetic, preclinical and clinical evidence has demonstrated that inhibition of TMPRSS6 can potently elevated hepcidin levels, thereby achieving systemic iron restriction. Previously, we reported the generation of anti-TMPRSS6 antibody MWTx-003 and its efficacy in reducing iron overload and improving ineffective erythropoiesis in a mouse model of β-thalassemia. In this study, we explored therapeutic application of MWTx-003 in PV using a Jak2 V617F bone marrow transplantation mouse model. The mouse model exhibits typical PV phenotypes of erythrocytosis and elevated HCT levels. In the PV mice, treatment with MWTx-003 (2-10 mg/kg, i.p., every 4 days for 3 weeks) led to significantly reduced HCT levels, red blood cell (RBC) counts and hemoglobin (HGB) concentration that were comparable to that of wildtype control mice. These effects were evident in a dose-dependent manner and observed as early as two weeks into treatment. It is worth noting that in the 10 mg/kg dose group, a worsening splenomegaly and expansion of early erythroid progenitors were observed after 3 weeks of treatment, and these findings are typical of iron-restricted erythropoiesis in mice. Taken together, the anti-TMPRSS6 antibody offers a promising therapeutic approach in the management of PV, where erythrocytosis and high HCT levels are associated with poor outcomes. A Phase I clinical trial with MWTx-003 in healthy volunteers has been initiated in China.

Risk of deep vein thrombosis (DVT) in lower extremity after total knee arthroplasty (TKA) in patients over 60 years old

PurposeThere is a significant risk of DVT after TKA. We aim to evaluate the potential risk factors for postoperative DVT in the lower extremities in TKA patients over 60 years of age and provide a reference for the effective prevention of DVT.MethodsThis retrospective study included patients older than 60 who underwent TKA surgery in our hospital from May 2015 to May 2022 and compared and analyzed patients' personal characteristics and clinical data with or without postoperative DVT. Logistic regression analysis was performed to determine the potential risk factors for DVT after TKA. The sensitivity and specificity of each risk factor in the diagnosis of DVT were compared by the ROC curve, and the value of this model in the diagnosis of DVT was further investigated using a multivariable combined diagnosis ROC curve model.ResultsA total of 661 patients over 60 who underwent TKA were included. Preoperative Hematocrit (HCT), platelet count, anesthesia mode, postoperative D-dimer, ESR, diabetes mellitus, and other aspects of the DVT group and non-DVT group were statistically significant after TKA (P < 0.05). Multivariate logistics regression analysis showed that preoperative HCT, anesthesia mode, and diabetes were independent risk factors for DVT in patients over 60 years old after TKA. Compared with the univariate ROC model, the multivariable combined ROC curve analysis model has a higher diagnostic value for the diagnosis of DVT.ConclusionDVT is common in patients over 60 years of age after TKA, and there is a multivariable influence on its pathogenesis. For patients over 60 with diabetes, neuraxial anesthesia is recommended for patients with high preoperative HCT levels, which may reduce the incidence of postoperative DVT.

Pathophysiological features of neuroendocrine tumors in cyanotic congenital heart disease: a systematic review

Abstract Background Patients with cyanotic congenital heart disease (CCHD) have an increased risk to develop pheochromocytomas or paragangliomas (PPGL), which are rare neuroendocrine tumours molecularly driven by the activation of the hypoxia-inducible factor 2-alpha (HIF-2α ). Purpose To define the clinical characteristics of CCHD-PPGL patients. Methods An international multicentre CCHD-PPGL consortium from 8 countries was stablished. The group performed a systematic review of clinic-pathological features of 149 CCHD-PPGL cases and compared to 1559 CCHD non-PPGL patients. Results CCHD-PPGL were predominantly women (56.4%) with univentricular heart (UVH) (55.0%), followed by tetralogy of Fallot (23.5%). Most patients remained unoperated (28.6%) or had only undergone a palliative procedure (25.8%), and the mean saturation at diagnosis was 84.0%. The median age at PPGL diagnosis was 27.0 yo [20-38]. Pheochromocytoma (PCC) occurred in 36.9% of patients, abdominal or thoracic paraganglioma (TA-PGL) in 40.3%, carotid body paraganglioma (CB-PGL) in 14.7% and a combination in 8.0%. Most CB-PGLs were non-secreting, non-symptomatic tumors while PCC and TA-PGL were mostly noradrenalin-secreting and symptomatic tumors. Metastatic disease was documented in 10.3% of non-CB and none in CB-PGL . Comparing to patients with PCC or TA-PGL, CB-PGL patients were predominantly female (81.8% vs 52.0%), older at time of diagnosis (43 yo [36.0 – 52.0] vs 25.0 yo [19.0-35.0], p&amp;lt;0.01) and with a longer period of cyanosis at diagnosis (37.0 [23-47] vs 23.0 [13-46], p&amp;lt;0.01). Patients with Fontan procedure were mostly men (63.3%) who developed a noradrenalin-secreting PCC or a TA-PGL (42.0% and 58.0% respectively) at an earlier age than non-Fontan patients (22.0yo [18.0-27.0] vs 29.0yo [21.0-41.0], p&amp;lt;0.01). Patients with Eisenmenger physiology were female patients (100%) who developed mostly CB-PGL, non-secreting tumors (54.5%) and were older at diagnosis (48.0 yo [42-58]). Compared to a cohort of 1599 CCHD non- PPGL patients, CCHD-PPGL were predominantly women (57.7% vs 44.8%, p&amp;lt;0.01), with forms of UVH (53.7% in CCHD-PPGL vs 14.1% in CCHD, p &amp;lt;0.01 ) and were mainly unoperated and palliated patients (27.1% and 26.4% respectively vs 10.0% and 5.3% in CCHD, p &amp;lt;0.01). CCHD-PPGL patients showed lower levels of oxygen saturation (80.0% [76.0-85.0] vs 84.0% [80.0-88.0], p&amp;lt;0.01) and higher haematocrit levels (60.0% [52.0-66.5] vs 53.3% [46.3-62.0], p&amp;lt;0.01) than CCHD without PPGL. Conclusions Patients with CCHD and lifelong cyanosis, and especially those with Eisenmenger physiology, probably develop CB-PGL as an adaptive response to chronic systemic hypoxemia, present a good clinical course, and usually do not require an initial surgical approach. In patients with Fontan circulation, the risk of developing a sympathetic thoracic-abdominal PPGL persists, despite correction of hypoxemia, possibly due to the initial hypoxemia during adrenal medulla post-natal development.

Extrauterine Placental Perfusion and Oxygenation in Infants With Very Low Birth Weight

An extrauterine placental perfusion (EPP) approach for physiological-based cord clamping (PBCC) may support infants with very low birth weight (VLBW) during transition without delaying measures of support. To test whether EPP in resuscitation of infants with VLBW results in higher hematocrit levels, better oxygenation, or improved infant outcomes compared with delayed cord clamping (DCC). This nonblinded, single-center randomized clinical trial was conducted at a tertiary care neonatal intensive care unit. Infants with a gestational age greater than 23 weeks and birth weight less than 1500 g born by cesarean delivery between May 2019 and June 2021 were included. Data were analyzed from October through December 2021. Prior to cesarean delivery, participants were allocated to receive EPP or DCC. In the EPP group, infant and placenta, connected by an intact umbilical cord, were detached from the uterus and transferred to the resuscitation unit. Respiratory support was initiated while holding the placenta over the infant. The umbilical cord was clamped when infants showed regular spontaneous breathing, stable heart rates greater than 100 beats/min, and adequate oxygen saturations. In the DCC group, cords were clamped 30 to 60 seconds after birth before infants were transferred to the resuscitation unit, where respiratory support was started. The primary outcome was the mean hematocrit level in the first 24 hours after birth. Secondary prespecified outcome parameters comprised oxygenation during transition and short-term neonatal outcome. Among 60 infants randomized and included, 1 infant was excluded after randomization; there were 29 infants in the EPP group (mean [SD] gestational age, 27 weeks 6 days [15.0 days]; 14 females [48.3%]) and 30 infants in the DCC group (mean [SD] gestational age, 28 weeks 1 day [17.1 days]; 17 females [56.7%]). The mean (SD) birth weight was 982.8 (276.6) g and 970.2 (323.0) g in the EPP and DCC group, respectively. Intention-to-treat analysis revealed no significant difference in mean hematocrit level (mean difference [MD], 2.1 percentage points; [95% CI, -2.2 to 6.4 percentage points]). During transition, infants in the EPP group had significantly higher peripheral oxygen saturation as measured by pulse oximetry (adjusted MD at 5 minutes, 15.3 percentage points [95% CI, 2.0 to 28.6 percentage points]) and regional cerebral oxygen saturation (adjusted MD at 5 minutes, 11.3 percentage points [95% CI, 2.0 to 20.6 percentage points]). Neonatal outcome parameters were similar in the 2 groups. This study found that EPP resulted in similar hematocrit levels as DCC, with improved cerebral and peripheral oxygenation during transition. These findings suggest that EPP may be an alternative procedure for PBCC in infants with VLBW. ClinicalTrials.gov Identifier: NCT03916159.

Evaluation of erythrocytapheresis compared to phlebotomy in polycythaemia vera patients

IntroductionPolycythaemia vera patients can present with arterial or venous vascular occlusive events such as thrombosis or cardiovascular disease; disease-related symptoms may significantly impact on the quality of life. The aim of this study was to evaluate the efficacy and safety of erythrocytapheresis compared to phlebotomy in the treatment of polycythaemia patients. MethodsThis study reports the findings of a retrospective analysis of 40 polycythaemia vera patients diagnosed according to published guidelines and treated either with erythrocytapheresis or phlebotomy over a four-year period. The goal of treatment was to reduce blood volume and red blood cell count to near normal levels as both of which may attenuate the symptoms and complications associated with polycythaemia. Patients were treated by applying a mathematical model. ResultsUsing the model, 28 erythrocytapheresis procedures were performed. Blood laboratory values (red blood cell count, haemoglobin count and haematocrit level) were significantly reduced in patients treated with erythrocytapheresis. Moreover, among treated patients, erythrocytapheresis resulted in less work absenteeism and reduced costs due to lost production, with a lower overall procedure cost in comparison to phlebotomy. ConclusionThis model can assist in selecting the proper treatment modality for individual patients. Especially for those with high blood volumes and high achievable haematocrit levels (delta), erythrocytapheresis offers a more efficient method in red blood cell depletion compared to phlebotomy thereby, potentially reducing the number of treatment procedures required for the induction of polycythaemia vera patients as well as the interval between procedures during the maintenance phase.

Physiological impacts of chronic and experimental Plasmodium infection on breeding-condition male songbirds

While Plasmodium parasitism is common in songbirds, its impact on avian reproduction is unclear owing to conflicting reports in the existing literature. Particularly understudied is the impact of phase of infection on variation in host reproductive physiology in wild, breeding-condition birds. However, assessing the full impact of Plasmodium on reproductive success in the wild can be difficult because individuals experiencing severe effects of parasitism may not enter the breeding population and may be less likely to be captured during field studies. To address these factors, we quantified metrics of health and reproductive physiology in wild-caught, breeding-condition male dark-eyed juncos (Junco hyemalis hyemalis) before and after experimental Plasmodium inoculation in a captive setting. Metrics of health and reproductive physiology included activity rate, hematocrit, scaled body mass, testosterone and sperm production. Individuals already infected at capture (i.e., chronically infected) had higher levels of hematocrit than males without chronic infections. Experimentally infected males showed a larger reduction in hematocrit and activity rate as compared to controls. However, chronic infection status did not influence the extent of metric decline. Testosterone production did not vary by treatment and most birds produced sperm following inoculation. Broadly, our results suggest that male juncos exposed to Plasmodium during the breeding season likely experience declines in general health, but Plasmodium infections do not negatively impact reproductive physiology. We conclude that physiological tradeoffs in males may favor maintenance of reproductive function despite infection.

Patients with High Hematocrit Undergoing Coronary Artery Bypass Graft Surgery: A Case Report and Literature Review

Patients undergoing coronary artery bypass graft (CABG) surgery with elevated hematocrit levels can face unique challenges related to increased blood viscosity, compromised tissue perfusion, and impaired oxygen delivery. This case report presents a 45-year-old male patient with very high hematocrit levels who underwent CABG surgery. Preoperative optimization, intraoperative monitoring, and postoperative management were implemented to mitigate the risks associated with high hematocrit. The patient’s hematocrit, blood gases, and cerebral saturation were continuously monitored during the procedure, demonstrating adequate perfusion. The patient had an uneventful postoperative course and was extubated the same day. A literature review revealed limited evidence regarding the management of high hematocrit patients undergoing cardiac surgery, emphasizing the need for further research. Tailored management strategies, including preoperative hematocrit optimization and individualized antithrombotic therapy, are crucial for optimizing outcomes in this patient population.

Music Box-Inspired Semi-Automatic Hematocrit Validation Device.

A high hematocrit (HCT) level is strongly associated with the risk of cardiovascular disease. For early diagnosis of cardiovascular disease, it is vital to regularly measure the HCT, which is typically achieved by centrifuging a blood sample to measure the percentage of red blood cells. However, the centrifugal modalities are usually bulky, expensive, and require a stable electric input, which restrict the availability. This research develops a semi-automatic and portable centrifugal device for HCT measurement. This torque-actuated semi-automatic centrifuge, which we call the tFuge, is inspired by a music box, allowing different operators to generate the same rhythm. It is electricity-free and can be controlled based on a constant torque mechanism. Repeatable test results can be received from among different users regardless of their age, sex, and activity. With the assistance of the Boycott effect on the tFuge, we proved that the HCT level is in high linearity to the length of the sedimentation of the blood cells in a tube (R2 = 0.99, sample HCT range 10-60%). The tFuge takes less than 4 min and requires no more than 10 μL of blood that can be obtained by a less-invasive finger prick to complete the testing procedure. Calibrated gradient numbers are printed onto the rotation disc for instant HCT results that can be read by the naked eye. We expect this proposed point-of-care testing device possesses the potential to replace the microhematocrit centrifuge in the regions with limited resources.

Variability of response on prophylactic prasugrel for endovascular treatment of intracranial aneurysms: Clinical implications.

Prophylactic prasugrel for endovascular treatment of intracranial aneurysms has been introduced and increased, but HTPR (high on-treatment platelet reactivity) or LTPR (low on-treatment platelet reactivity) of prasugrel is not uncommon in clinical circumstances. To investigate the predisposing factors of HTPR and LTPR on prasugrel premedication in the neurointerventional field and to determine its clinical implications. Between February 2016 and December 2020, 191 patients treated with coil embolization using prophylactic prasugrel in 234 intracranial aneurysms were the final candidates for this study. Patient and aneurysm characteristics, clinical status, and laboratory study values were carefully reviewed retrospectively. We performed risk factor analyses for HTPR and LTPR on prasugrel. Ultimately, 20 patients (10.5%) had HTPR, and 74 patients (38.7%) were categorized as having LTPR. In multivariable analyses, the factors related to HTPR were BMI (adjusted OR 1.21, 95% CI 1.04-1.41, p = 0.01), history of antithrombotics (adjusted OR 3.79, 95% CI 1.39-10.34, p = 0.01), and hematocrit (adjusted OR 0.91, 95% CI 0.84-0.99, p = 0.03). Low BMI was the only risk factor for LTPR (adjusted OR 0.84, 95% CI 0.76-0.94, p = 0.001). In the neurointerventional field, high BMI and prior use of antithrombotic agents were related to HTPR, and low BMI was associated with LTPR on prophylactic prasugrel. High hematocrit levels decreased the risk of HTPR. When preparing endovascular treatment for intracranial aneurysms, attention to patients with these clinical features is required to address the possibility of ischemic or bleeding complications.

Thrombotic Events and Risk Factors for Thrombosis in Polycythemia in Senegal, West Africa

Objectives: We aim to identify thrombotic events and risk factors for thrombosis (RFT) comparing polycythemia vera (PV) and secondary polycythemia (SP) patients. Methods: We carried out a retrospective study of a cohort of 59 patients with PV (n=34) and SP (n=25) followed for a period of 14 years. Variables studied were the frequency and type of thrombosis, sociodemographic, clinical, and biological RFT. Statistical analysis was performed using SPSS software version 18. Multivariate analysis was performed to identify RFT. Results: Mean age in PV was 53 years (33 - 79) and 44.5 years (5 - 78) in SP (p=0.74). The sex ratio in PV was 1.12 and 2.57 in PS (p=0.52). Sixteen patients had thrombotic events (27.1%) including 12 PV (35.3%) versus 4 SP (16%) (p=0.09). Twenty-two thrombotic events were identified; 14 (63.7%) of arterial thrombosis and 8 (36.3%) of venous thrombosis. There were 18 thrombotic events (81.8%) in PV versus 4 (18.2%) in SP (p=0.02). Arterial thrombosis was more frequent in PV (55.6%). Thrombosis events were more frequent in female patients (59.1%). RFT in PV were age (40-59 years), hematocrit &gt;45% and thrombocytosis ≥ 600 G/L and in SP, RFT were hematocrit &gt;45% and hypercholesterolemia. After multivariate analysis, hematocrit &gt;45% was the only RFT independently associated with thrombosis occurrence. Conclusion: We show through this study, a frequent occurrence of arterial thrombosis in polycythemia. Main RFT is the high hematocrit level (&gt;45%). We insist on the interest of therapeutic bloodletting, sometimes associated with cytoreductive treatment in order to maintain a hematocrit level &lt;45%.

The possibility of automatic capillary blood testing in routine blood tests: an evaluation of the automatic mode of the Mindray BC-7500 CRP Auto Hematology Analyzer for capillary blood testing.

Capillary blood is a common specimen type used for infant blood routine tests. Until now, this specimen type could only be tested with the manual mode in hematology analyzers. Manual sample mixing and loading increases the amount labor force and can be more easily affected by human factors. This study was designed to investigate the proficiency of the automatic mode of the Mindray BC-7500 CRP Auto Hematology Analyzer for capillary blood testing. The complete blood count (CBC) results for capillary blood were compared between the automatic and manual modes. Special types of samples, including samples with high or low volume, thalassemia red cells, high fibrinogen, high hematocrit (HCT), or high triglyceride levels, were compared and evaluated. The intraclass correlation coefficient (ICC) was used to define the agreement between the 2 modes. The industry standard Analytical Quality Specifications for Routine Tests in Clinical Hematology (WS/T 406-2012), published by the National Health Commission of China, was used to evaluate the correlation between the results from the 2 modes. There was good correlation between the automatic and manual modes for every type of sample, and the ICCs were all higher than 0.9. Except for high HCT or high triglyceride samples, there were no differences found between the 2 modes based on the WS/T 406-2012 standard. This new automatic mode utilized in the Mindray BC-7500 CRP Auto Hematology Analyzer for capillary blood yielded the same results as the manual mode except in the case of samples with high HCT or triglycerides. Capillary blood might be routinely tested automatically with hematology analyzers in the near future, which might reduce the labor required and improve standardization.

Hematologic traits and primary biliary cholangitis: a Mendelian randomization study.

Hematologic abnormalities was observationally associated with the susceptibility of primary biliary cholangitis (PBC). However, the conclusion is still controversial and whether there exists a causal association remains elusive. Here we aimed to explore the causative role of hematological traits in the risk of PBC. We conducted two-sample and multivariable Mendelian randomization analyses based on summary statistics from previous large genome-wide association studies. Totally twelve red blood cell and six white blood cell traits were analyzed. Genetically determined higher hemoglobin level was significantly associated with a reduced risk of PBC (OR: 0.62, 95% CI: 0.47-0.81, P: 5.59E-04). Meanwhile, higher hematocrit level was nominally associated with reduced risk of PBC (OR: 0.73, 95% CI: 0.57-0.93, P: 0.01). These results could help better understand the role of hematological traits in the risk of PBC, and provide potential targets for the disease prevention and treatment.