Higher Mean Corpuscular Hemoglobin Research Articles

Photoperiod manipulation improves growth performance, haematological indices and economic returns of Indian butter catfish, Ompok bimaculatus (Bloch, 1794).

Photoperiod manipulation is emerging as an effective approach for regulating physiological functions in fish. This study aimed to assess the impact of photoperiod on the growth performance, haematological responses, and economic returns of the endangered and highly valued Indian butter catfish, Ompok bimaculatus. Fish with an average body weight of 28.60 ± 4.78g were randomly placed in six FRP tanks, each measuring 120 × 45 × 60 cm3. Each tank contained 20 fish exposed to a light intensity of 1500lx under different photoperiods [24:0 light: dark (L: D), 15L: 9D, 12L: 12D, 9L: 15D, 0L: 24D and a natural photoperiod (control)], and fed at a daily rate of 2% of their body weight twice daily for 60 days. The fish in the 15L: 9D photoperiod exhibited the highest final weight (g), percentage weight gain, specific growth rate (SGR) and survival rate, while the lowest was displayed in 24L: 0D photoperiod group. The feed conversion ratio (FCR) was at its lowest in the catfish subjected to the 15L: 9D photoperiod. Regarding haematological parameters, the 15L: 9D photoperiod group showed higher total erythrocyte count, total leukocyte count, haemoglobin levels, and haematocrit values compared to the other groups. Conversely, the 0L: 24D group, which experienced prolonged darkness, exhibited the lowest values in these parameters. Moreover, the 24L: 0D, 9L: 15D, and 0L: 24D groups displayed a lower mean corpuscular volume (MCV) but higher mean corpuscular haemoglobin (MCH) and mean corpuscular haemoglobin concentration (MCHC) when compared to the control group. The economic analysis revealed that O. bimaculatus reared in a moderate photoperiod (15L: 9D) displayed better growth, feed utilization, and overall health. This finding suggests that adopting a 15L: 9D photoperiod can lead to enhanced production and improved economic returns for farmers culturing this high-value catfish in the future.

The Impact of Blood Morphological Parameters on Treatment Outcomes in Tennis Elbow Patients Receiving Platelet-Rich Plasma (PRP) Therapy: A Prospective Study.

Platelet-rich plasma (PRP) therapy holds substantial promise for the treatment of tennis elbow, a complex and challenging musculoskeletal condition. The aim of the study was to assess whether there are correlations between the levels of individual morphotic elements determined in whole blood and the outcomes of tennis elbow treatment with PRP injection, as measured using patient-reported outcome measures (PROMs) such as the Visual Analog Scale (VAS), Quick Disabilities of the Arm, Shoulder, and Hand (QDASH), and Patient-Rated Tennis Elbow Evaluation (PRTEE). A prospective analysis was conducted on 107 patients (132 elbows) undergoing lateral epicondylitis treatment with (PRP) injections. Patients completed VAS, PRTEE, and QDASH questionnaires on the day of PRP administration and at established checkpoints (2, 4, 8, 12, 24, 52, and 104 weeks). Minimal clinically important difference (MCID) was employed to assess the treatment effects. Then, correlations were measured within each PROM, and the impact of the concentration of individual blood parameters on the MCID outcomes was assessed. Analyzing the relationships between the MCID+ and MCID- groups, significant correlations for the VAS and QDASH scales were observed. The level of individual morphotic elements in the blood may have influenced the treatment outcome, as measured using specific patient-reported outcome measures (PROMs). Regarding the VAS scale, factors favoring a positive treatment outcome included higher values of eosinophils (EOS) and basophils (BASO). For the QDASH scale, these factors were a lower value of mean corpuscular volume (MCV) and a higher mean corpuscular hemoglobin (MCH). The levels of certain blood parameters, such as EOS and BASO, in the current study influenced the classification of patients into MCID+ or MCID- groups, based on the VAS and QDASH scales.

Mean Corpuscular Hemoglobin Optimizes the Thrombocytosis Risk Stratification in Polycythemia Vera: A Retrospective Multi-Center Study

Thrombosis was a common complication and the main cause of mobility of polycythemia vera (PV) with a lifetime incidence of 22%. Thrombosis risk was correlated with age, prior thrombosis, hypertension, red blood cell distribution width (RDW), leukocytosis, and JAK2V617F allele burden in previous studies, but only age≥65 years and prior thrombosis were included in thrombosis risk stratification. Finding independent thrombosis factors is significant to depict the landscape of PV and decrease the probability of thrombosis. Here, we aimed to find potential predictors to optimize the thrombocytosis risk stratification. Retrospectively reviewed 763 patients diagnosed with PV according to the 2016 WHO criteria from 17 hematology center in China from Jan 1, 2010, to July 1, 2023. Analyzed clinical characteristics and genetic features of thrombosis risk and compared the potential predictor in different risk stratification. The patients' clinical features are in table A.A total of 508(66.8%) subjects were male, the median age was 62 years (IQR, 53-70 years). The media follow-up was 45 months (IQR, 25-77 months). 84 (11.1%) subjects had thrombotic event pre-diagnosis, 25 (3.3%) of which were venous and 59 (7.9%) were arterial. 72 (9.6%) subjects had thrombotic events after diagnosis, 10 (1.3%) of which were venous and 62 (8.3%) were arterial (Figure B). Univariable analysis found thrombosis was associated with the thrombosis risk stratification (P=0.011), hypertension (P=0.017), diabetes (P=0.010), leukocytosis (P=0.026), mean corpuscular hemoglobin (MCH) (P=0.001), triglyceride (P=0.025), cholesterol (P=0.022), and splenomegaly (P=0.000). Thrombosis risk stratification (HR=1.74 [1.00, 3.02], P=0.026) and MCH (HR=0.92, [0.86, 0.98], P=0.010) were independently risk factors in multivariable variable analysis. We divided by MCH with cut-off point of 28.5pg, patients with MCH<28.5pg were associated with worse thrombosis-free survival (TFS) (Figure E). We further analyzed the effect of MCH in different thrombosis risk stratification. Results showed MCH <28.5pg was also meaningful in both low (P=0.0164) and high risk groups (P=0.0014) (Figure F, G). High risk stratification and MCH<28.5pg showed higher probability of thrombosis during the follow-up period (Figure C, D). In our study, potential risk factors from other studies such as JAK2V617F allele burden, hyperlipidemia, hypertension, leukocytosis, and RDW were not significant independent predictors of thrombosis. However, we found MHC<28.5pg was correlated with worse TFS both in low thrombosis risk stratification group and high thrombosis risk stratification group. Our study suggested that MCH< 28.8pg was an independent predictor and can increase the accuracy of predicting thrombosis. Acknowledgement: This research was funded by the Key R&D Program of Zhejiang, No. 2022C03137; Public Technology Application Research Program of Zhejiang, China, No. LGF21H080003; Zhejiang Medical Association Clinical Medical Research special fund project, No. 2022ZYC-D09. Correspondence to: Dr Jian Huang, Department of Hematology, The First Affiliated Hospital of Zhejiang University School of Medicine. househuang@zju.edu.cn

Systemic factors associated with 10-year glaucoma progression in South Korean population: a single center study based on electronic medical records

Glaucoma is a multifactorial disease where various systemic features are involved in the progression of the disease. Based on initial systemic profiles in electronic medical records, this study aimed to develop a model predicting factors of long-term rapid retinal nerve fiber layer (RNFL) thinning over 5 years in 505 patients with primary open-angle glaucoma. Eyes with faster or slower RNFL thinning were stratified using a decision tree model, and systemic and ophthalmic data were incorporated into the models based on random forest and permutation methods, with the models interpreted by Shapley additive explanation plots (SHAP). According to the decision tree, a higher lymphocyte ratio (> 34.65%) was the most important systemic variable discriminating faster or slower RNFL thinning. Higher mean corpuscular hemoglobin (> 32.05 pg) and alkaline phosphatase (> 88.0 IU/L) concentrations were distinguishing factors in the eyes with lymphocyte ratios > 34.65% and < 34.65%, respectively. SHAP demonstrated larger baseline RNFL thickness, greater fluctuation of intraocular pressure (IOP), and higher maximum IOP as the strongest ophthalmic factors, while higher lymphocyte ratio and higher platelet count as the strongest systemic factors associated with faster RNFL thinning. Machine learning-based modeling identified several systemic factors as well as previously acknowledged ophthalmic risk factors associated with long-term rapid RNFL thinning.

Hb Westmead (HBA2: c.369C>G): Hematological Characteristics in Heterozygotes with and without α0-Thalassemia

Hb Westmead (α122(H5)His>Gln) (HBA2: c.369C>G) is a common α-globin variant causing α-thalassemia (α-thal) in Mainland China. In this study, we report the hematological characteristics in Hb Westmead carriers in a Chinese population. There were 546 individuals carrying Hb Westmead based on their molecular diagnosis: 514 Hb Westmead heterozygotes and 32 compound heterozygotes for Hb Westmead and α0-thal. Compared to common deletional α+-thal, Hb Westmead was associated with higher mean corpuscular hemoglobin (Hb) (MCH) values. Compound heterozygotes for Hb Westmead and α0-thal showed significantly higher Hb, mean corpuscular volume (MCV) and MCH values than subjects with deletional Hb H disease. When compared to α0-thal carriers, compound heterozygotes for Hb Westmead and α0-thal showed similar Hb values, but significantly lower MCV and MCH values. Our results indicate that Hb Westmead is a silent nondeletional α+-thal, with a deficiency of α-globin chain milder than deletional α+-thal, and compound heterozygotes for Hb Westmead/α0-thal have a phenotype similar to simple α0-thal.

Prediction of outcome in breast cancer patients using test parameters from complete blood count.

The aim of this study was to evaluate the prognostic effect of test parameters from pretreatment complete blood count (CBC) for predicting outcome in breast cancer patients. A total of 162 patients with breast cancer and a long follow-up were enrolled in this study. Red cell indices (RCIs) and neutrophil-lymphocyte ratio (NLR) from CBC prior to treatment, as well as related clinical data, were retrospectively collected. We evaluated the association of RCI and NLR with tumor size, clinical stage, histological grade, estrogen receptor, progesterone receptor, and human epidermal growth factor receptor 2 status. We further performed survival analysis and Cox multivariate analysis, stratified by RCI and NLR median values, to evaluate their prognostic effects. In the disease-free survival (DFS) analysis, patients in the higher mean corpuscular hemoglobin (MCH) and NLR groups exhibited shorter DFS times compared with those in the lower MCH and NLR groups (P=0.017 for MCH and P=0.039 for NLR). The univariate analysis revealed that both MCH and NLR were significantly associated with DFS. The Cox multivariate analysis demonstrated that only MCH was an independent predictor associated with disease relapse (hazard ratio = 1.975, 95% confidence interval: 1.118-3.487, P=0.019), whereas no index was associated with overall survival. Our results suggest that MCH prior to treatment may be a predictive marker associated with DFS in breast cancer.

Bioaccumulation of heavy metals in blood and tissue of striped mullet in two Italian lakes.

Water and sediment from Faro and Ganzirri lakes were tested for cadmium, mercury, and lead. These heavy metals have been assessed in serum and muscles of Striped Mullet Mugil cephalus. A haemogram was performed to find effects of heavy metals on haematological variables. Student's t-test showed higher Pb levels in sediments of Ganzirri Lake than Faro Lake. Two-way analysis of variance showed higher Cd and Pb concentration in muscles samples of Striped Mullet from Ganzirri Lake than from Faro Lake. Significant differences were found among haematological parameters as well. Mullet from Ganzirri Lake had lower white and red blood cell and trombocyte counts and higher mean corpuscular haemoglobin and mean corpuscular haemoglobin concentration than those from Faro Lake. Our results indicate a significant presence of lead in the environmental produces an accumulation of this metal in fish muscles.

Observetion of major organs deadaptation change after returning to lower altitude in Qinghai-Tibet railway construction population

High altitude deadaptation affects the health of population returned to the plain. We examined major physiological functions in 348 healthy control subjects and 626 Qinghai-Tibet railway construction workers who returned to the plain from the Qinghai-Tibet plateau. Blood indices, such as hemoglobin, hematocrit, mean corpuscular volume, mean corpuscular hemoglobin concentration and platelet larger cell ratio, of the returned group that had stayed at high altitude more than 3 years were significantly higher than those of the control group. Red blood cell distribution width and platelet were significantly lower in the returned group than in the control group. Compared to the control group, five years after returning to the plain, the returned group had higher mean corpuscular hemoglobin and lower red blood cell distribution width. Detection rate of hypotension and low pulse pressure were significantly higher in the returned group than in the control group at 20 months after the return, and cardiothoracic ratio was significantly higher in the returned group than in the control group at 40 months after the return. Short-term memory function was significantly lower in the returned group than in the control group. Total triiodothyronine and thyroid-stimulating hormone were significantly lower, but total thyroxine and free triiodothyronine were significantly higher in the returned group than in the control group. Sex hormones level returned to normal level in the returned group. Superoxide dismutase was significantly higher and malondialdehyde was significantly lower in the returned group than in the control group. Fatty acid binding protein was significantly higher in the returned group than in the control group, and this difference maintained with time after the return. We conclude that physiological functions of most organs in returned population after exposed to high altitude can not be completely restored to the normal level in a short period of time.

Low Mean Corpuscular Hemoglobin Level is a Predictor of Discontinuation of Antiplatelet Therapy in Patients with Acute Coronary Syndrome

Premature discontinuation of antiplatelet therapy (APT) increases the risk of thrombosis in patients who have undergone placement of a drug-eluting stent for acute coronary syndrome (ACS). The goal of the present study was to identify predictors of patients who would prematurely discontinue APT following stent implantation. One-hundred and sixty-one ACS patients who underwent percutaneous coronary intervention in our institution between November 2004 and September 2008 were enrolled in this study. Over the 12-month follow-up period, 18 patients (11.2%) discontinued APT. Among baseline demographic and laboratory variables, multivariate analysis revealed that mean corpuscular hemoglobin (MCH) level was an independent risk factor for APT discontinuation (OR: 0.738, p=0.017). Kaplan-Meier survival analysis showed that the incidence of APT discontinuation was significantly higher in patients with low MCH (<30.0 pg) than in patients with high MCH (≥30.0 pg) (p=0.0006). Low baseline MCH level was a predictor of APT discontinuation in ACS patients. Thus, careful consideration should be made before employing a drug-eluting stent in patients with low MCH levels.

Longitudinal Follow-up From Newborn Screening Reveals Deletional Hemoglobin H Disease and Hemoglobin H Constant Spring Disease Are Distinct Thalassemia Syndromes

AbstractAbstract 4260 Background:Alpha thalassemia disorders are rapidly increasing in North America. This has resulted in proposals for universal newborn screening (NBS) for hemoglobin H disease. However, the institution of routine newborn screening and construction of guidelines for early intervention requires longitudinal clinical data before setting national goals. Since 1995, California has performed universal screening for alpha thalassemia disorders. The longitudinal follow up of data from patients with hemoglobin H disorders diagnosed in the asymptomatic period provides essential information needed for formulating public health policy. Methods:Hemoglobin H disorders were diagnosed by high performance liquid chromatography with multiplex GAP-PCR assay to determine deletional hemoglobin H disease (deletion of 3 α globin genes, HbH) and the non-deletional hemoglobin H Constant Spring (α0 thalassemia with Constant Spring mutation, HCS). Longitudinal clinical data for all patients from the Northern California Thalassemia Center were analyzed. Ethnicity, growth data, clinic visits, hospitalizations, complications including splenectomy, transfusion, and iron overload were monitored. Quantitative liver iron concentration was determined by ferritometer. Results:86 patients predominantly diagnosed through NBS were longitudinally followed. Out of these, 60 (70%) had HbH, 23 (27%) had HCS and 3 (3%) had other forms of hemoglobin H disease. The parental ethnicity in HbH was 79% Asian, 6% Hispanic, and 15% African-American (in one or both parents). All patients with HCS were of Asian ethnicity. Longitudinal data for hemoglobin revealed that anemia was more severe in HCS at all ages (p<0.001). Mean hemoglobin in HbH increased from 8.8 g/dL (6.9-10.6 g/dL) at 6 months to 9.4 g/dL (7.9-11.5 g/dL) at 5 years (p<0.001). However, mean hemoglobin in HCS remained unchanged from 7.4 g/dL (5.8-9.9 g/dL) at 6 months to 7.2 g/dL (3.8-8.7 g/dL) at 5 years (p=ns). There was no hemoglobin value <6.7 g/dL in 237 patient-years of observation of 60 patients with HbH. Compared to HbH, red blood cells in HCS had higher mean corpuscular hemoglobin (18.6 versus 16.6 pg, p<0.001) and mean corpuscular volume (65.2 versus 54.0 fL, p<0.001). The mean absolute reticulocyte count was 88.2 ×103/μL in HbH versus 235.1 ×103/μL in HCS (p<0.001), while the mean serum bilirubin was 0.56 mg/dL and 2.60 mg/dL, respectively (p<0.001).Clinical severity and complications were markedly worse in HCS in contrast with HbH. Growth was delayed in HCS with mean weight-for-age Z-score -0.91 compared with -0.06 in HbH (p<0.001). The mean height-for-age Z-score was also lower in HCS (-1.29) compared with HbH (-0.43, p<0.001). The striking susceptibility to acute worsening of anemia with infections requiring urgent blood transfusion was observed in HCS, but not in HbH. The probability of receiving one or more blood transfusion by 20 years was 3% in HbH and 82% in HCS (p<0.001). Transfusions in HCS were required for 13% infants and median transfusion-free survival was 6 years. Splenectomy improved hemoglobin by 2.9 g/dL (0.4 to 4.0 g/dL, p=0.012) and reduced transfusions in HCS. Iron overload, measured by serum ferritin and liver iron concentration, developed during the first decade in HCS and increased during follow up. Median ferritin in HCS between 12 –17 years was 330 ng/mL (66-1420 ng/mL). Serum ferritin in HbH did not increase between 0–18 years (median 40 ng/mL, range 5–182 ng/mL), but older patients showed strong positive correlation between age and ferritin (p<0.001). In patients with HbH or HCS undergoing ferritometer examination, the degree of serum ferritin elevation underestimated the liver iron concentration. Conclusions:Our data support the utility of a universal NBS program, particularly in areas where αCS mutation is prevalent, since young infants with HCS can develop life-threatening anemia. HCS is a serious disease that needs close follow-up by a specialty thalassemia center to plan for emergency and elective transfusions, measure iron overload, monitor growth failure and evaluate the need for splenectomy. In contrast, HbH is asymptomatic during infancy and childhood; its complications are age-dependent, and monitoring for hemosiderosis and growth failure is more important in older children. In summary, HCS should be recognized as a thalassemia syndrome distinct from HbH with a different screening and treatment approach. Disclosures:No relevant conflicts of interest to declare.

Anti-Sports Anaemia Effects of Verbascoside and Martynoside in Mice

This paper aims to investigate the effects of verbascoside and martynoside isolated from PEDICULARIS DOLICHOCYMBA on sports anaemia. Forty mice were divided into four groups: Group R (control group, nonsupplemented and maintained at rest), Group E (nonsupplemented and undergoing exercise), Group VE (supplemented with verbascoside 10 mg/kg per day and undergoing exercise), and Group ME (supplemented with martynoside 10 mg/kg per day and undergoing exercise). After 5 weeks intensive swimming exercises, we measured the RBC count, the hemoglobin concentration, the hematocrit (Hct), the mean corpuscular hemoglobin concentration (MCHC) and the mean corpuscular hemoglobin (MCH). We studied the shapes of RBC and measured the plasma malonyldialdehyde (MDA). We found Group E showed lower RBC, hemoglobin and Hct levels, higher MCHC, MCH, plasma MDA levels and the abnormally shaped RBCs percentage than Groups R, VE and ME. Group ME showed lower RBC and Hct levels, higher MCH, plasma MDA levels and the abnormally shaped RBCs percentage than Group VE. The results indicated that verbascoside and martynoside have the potential of antagonizing sports anaemia, the mechanism of this effect might be related to preventing RBC from free radical damage. Moreover, verbascoside was found to be more active than martynoside.

Critical evaluation of peripheral smear in cases of anemia with high mean corpuscular hemoglobin concentration in children: A series of four cases

Mean corpuscular hemoglobin concentration (MCHC), a parameter that is reported as a part of a standard complete blood count by automated analyzer, is a measure of the concentration of hemoglobin in a given volume of packed red blood cell. Values of MCHC significantly above reference range are not physiologically possible due to limitations on solubility of hemoglobin. The high MCHC can give us a clue to certain type of hemolytic anemia and necessitate critical evaluation of peripheral smear to reach a definitive diagnosis. Here we are presenting a series of four cases with raised MCHC, emphasizing the importance of systematic and meticulous examination of the peripheral smear to render a definitive diagnosis.

Clinical features and molecular analysis in Thai patients with HbH disease

We studied the alpha-globin gene abnormalities, the clinical features, hematologic values, growth assessment, transfusion therapy, and serum ferritin levels of patients with hemoglobin H (HbH) disease in southern Thailand. HbH disease in 83 of the 147 patients was the deletional type of HbH. The remaining 64 patients was the nondeletional type of HbH disease. All 83 patients with the deletional type were double heterozygotes of alpha(0)-thalassemia and alpha(+)-thalassemia. The Southeast Asian type of alpha(0)-thalassemia accounted for 98% of the Thai patients with HbH disease and the Thai type of alpha(0)-thalassemia made up the rest. A 3.7-kb deletion accounted for 91% of alpha(+)-thalassemia, and a 4.2-kb deletion made up the rest of the deletional type. In patients with nondeletional type of HbH disease, the Constant Spring variant was the majority of the disease. Newborns with a nondeletional genotype had higher mean corpuscular volume, had higher mean corpuscular hemoglobin, had higher red blood cell distribution width, had lower mean corpuscular hemoglobin concentration, and had higher proportions of Hb Bart's than those with a deletional genotype. Twenty-one percent of children with HbH disease had growth deficiency. A genotype-phenotype correlation was found; patients with the nondeletional type of HbH disease had more symptoms at a younger age, more severe hemolytic anemia, more growth deficiency, more dysmorphic facial features, larger spleens, larger livers, and higher serum ferritin levels and required more transfusions than patients with deletional HbH disease.

Hemoglobin Variability in Dialysis Patients

Hemoglobin variability is the extent to which multiple measured hemoglobin values differ from each other. Variability may be assessed within the same patient or between patients in a group; in the context of clinical practice, it is generally the variability within a patient that is important,

Hemoglobin variability in epoetin-treated hemodialysis patients

Understanding the clinical variability of hemoglobin measurements in epoetin-treated hemodialysis patients is important, particularly when this therapy is aimed at maintaining patient hemoglobin levels within a narrow range, such as the 11 to 12 g/dL range recommended in National Kidney Foundation Kidney Dialysis Outcomes Quality Initiative (NKF-K/DOQI) guidelines. This study examines hemoglobin variability under conditions of standard clinical practice in epoetin-treated hemodialysis patients. We studied 987 hemodialysis patients participating in an observational retrospective study that evaluated anemia management practices from October 1, 1996 to December 31, 1997 at 11 United States dialysis centers that were randomly selected from a pool of nearly all United States dialysis facilities. Each participating facility maintained its own anemia management protocols without specific anemia management recommendations or interventions made as part of this study. Hemoglobin variability was determined by calculating the 1-month and 2- to 6-month rolling average hemoglobin for each patient. The range of mean hemoglobin values that included the middle 50% (25th to 75th percentile), 80% (10th to 90th percentile), and 90% (5th to 95th percentile) of values were determined. The hemoglobin ranges that included 1 standard deviation (SD) (67%) of the study values and 2 SD (95%) of the study values for each time period were calculated. The mean hemoglobin was between 10.9 and 11.2 g/dL throughout the study. The hemoglobin range encompassing 50%, 80%, and 90% of values from a single month was 1.7, 3.3, and 4.4 g/dL, respectively. A progressive narrowing in the range of hemoglobin values encompassed by each percentile grouping (i.e., hemoglobin variability) was observed as longer rolling intervals were averaged. The hemoglobin range within the 25th to 75th percentile was 1.7 g/dL using single-month hemoglobin values and 1.1 g/dL using a 6-month rolling average. The range of hemoglobin values that encompassed 90% of patients was 4.4 g/dL using single-month values, 3.7 g/dL using 3-month rolling averages, and 3.2 g/dL using 6-month rolling averages. Fewer than 50% of patients had hemoglobin values within the 1.0 g/dL NKF-K/DOQI recommended range, even when a 6-month rolling average was applied. When hemoglobin values were measured for 1 month, 1 SD was 1.4 g/dL; for the 3-month rolling average, 1 SD was 1.1 g/dL; and for the 4-, 5-, and 6-month rolling averages, 1 SD was 1.0 g/dL. Greater hemoglobin variability correlated with higher mean corpuscular hemoglobin (P = 0.003) and serum ferritin (P = 0.047), and inversely correlated with age (P = 0.006) and serum albumin (P = 0.0001). Substantial variability occurs in hemoglobin values in epoetin-treated hemodialysis patients. The NKF-K/DOQI recommended hemoglobin range appears to be too narrow in clinical practice. Expanding the target range and use of rolling average hemoglobin intervals of 3 to 6 months as a clinical and quality assurance measure avoids clinical variability inherent with the use of isolated hemoglobin values or single-month hemoglobin averages.

Relation of erythrocyte and iron indices to oral cancer growth

Background and purpose: Anaemia is known to influence prognosis of head and neck cancer patients, but how anaemia and tumour growth influences each other is not clear. The present study investigates the relation of erythrocyte and iron indices of oral cancer patients to primary tumour size (Tsize), invasiveness and lymph node involvement. Materials and methods: The haemoglobin (Hb), erythrocyte count (RBC), packed cell volume (PCV), mean corpuscular volume (MCV), mean corpuscular haemoglobin (MCH), mean corpuscular haemoglobin concentration (MCHC), Serum iron (SFe), transferrin iron-binding capacity (TIBC) and transferrin saturation (%Fe) were evaluated in 217 untreated patients with epidermoid cancer of the bucco-gingivo-palatine area. The association of erythrocyte and iron indices with sex, tumour size groups, invasion of adjacent structures and lymph node involvement, as well as the relation of SFe to Hb were analyzed. Results: Most of the patients were anaemic in terms of Hb (63%), RBC (43%) and PCV (48.4%) but almost all had normal or higher MCH (97.3%) and MCV (93.3%) though MCHC was less than normal in 70.7%. Normal or higher SFe was seen in nearly 70% and TIBC in 45% of patients. Hb, RBC and PCV were significantly lower in women, but there was no difference between men and women in the case of MCV, MCH and MCHC. Primary tumour size showed negative association with Hb, RBC and PCV but positive association with MCH (<2 cm: 29.7 pg; 2–4 cm: 31.4 pg; >4 cm: 31. 7 pg; P=0.04) and MCHC (<2 cm: 29.9; 2–4 cm: 31.5; >4 cm: 32.1; P=0.006). MCV, SFe, TIBC and %Fe did not show any relation to primary tumour size. None of the indices had any relation to invasion of adjacent structures or lymph node involvement. MCH, MCHC and MCV were not different in men and women but women had significantly lower Hb, RBC and PCV. The SFe showed poor correlation with Hb. Conclusions: The negative association of Hb, RBC and PCV with tumour size is most likely due to chronic RBC destruction, probably tumour induced, with the products of haemolysis such as polyamines, glutathione, iron, etc., promoting tumour growth, and the positive association with MCH and MCHC reflects compensatory regeneration attempts by bone marrow. Lack of relation between the iron indices and tumour parameters and the poor correlation between SFe and Hb is probably due to utilization of iron by both bone marrow and tumours. Lack of difference in MCH and MCHC between men and women obviates the need of using separate cut-off values for the two sexes, unlike Hb, RBC and PCV. The study suggests that anaemia in oral cancer patients represents a tumour–host interaction and that evaluation of all erythrocyte indices should be part of research on cancer related anaemia.

Influence of valproate monotherapy on platelet activation and hematologic values.

Valproate (VPA) has been linked to coagulation disturbances, with both impaired and exaggerated clotting, which has been attributed to an effect of VPA on platelets or hemostatic proteins. Additional thrombocytic function testing may help to identify patients at risk of increased bleeding caused by platelet dysfunction. We evaluated the influence of VPA on hematologic routine values and platelet activation by using immunostaining and flow cytometry in 30 patients receiving long-term VPA therapy and in 30 controls. The fraction of activated platelets was similar in both groups; however, the general extent of platelet activation was significantly lower in the patient group, with considerable interindividual variability. In addition, patients had a significantly lower platelet count, prolonged thrombin time, and higher mean corpuscular hemoglobin. Our data confirm the previously reported hematologic changes caused by VPA and additionally suggest that VPA impairs procoagulatory thrombocytic function, which is reflected by reduced platelet activation and increased thrombin time. Possible mechanisms of VPA-platelet interaction are discussed.

Identification of Heavy Drinkers Using a Combination of Laboratory Tests

Objective: This study derived and evaluated a model that used results of commonly performed laboratory tests to identify men who are heavy drinkers. Method: The results of 40 commonly available laboratory tests were obtained on a diverse sample of 426 heavy drinkers and 188 light drinkers. A logistic regression equation for identifying heavy drinkers was derived in a training data set of 411 subjects and tested in a validation data set of 203 subjects. Results: Ten laboratory measurements were included in the final regression equation: chloride, sodium, ratio of direct to total bilirubin level, blood urea nitrogen, high density lipoproteins, monocyte count, phosphorus, platelets, aspartate aminotransferase, and mean corpuscular hemoglobin. In the validation data this model correctly identified 98% of the 161 heavy drinkers and 95% of the 42 light drinkers. Other models reported in previous literature were applied to these subjects and did not perform as well. The model performed better for subjects of lower socioeconomic status. Conclusions: The laboratory tests in our model may help identify heavy drinkers. The performance of models to identify heavy drinkers depends on the demographic characteristics of the subjects.

Pulmonary entrapment of sickle cells: the role of regional alveolar hypoxia.

Pulmonary microvascular occlusion by abnormally adherent and/or nondeformable sickle red blood cells (SS cells) may contribute to the pathogenesis of acute chest syndrome of sickle cell disease. We hypothesized that regional alveolar hypoxia reduces SS cell deformability and, by causing regional vasoconstriction, slows regional perfusion, facilitating endothelial adhesion and mechanical entrapment of cells. In isolated rat lungs perfused at constant average flow with physiological salt solution, we separately ventilated the two lungs: one with 95% O2 and the other with 0, 2.5, 5, or 21% O2. We infused a bolus of 99mTc-labeled SS cells or normal human AA cells along with 113Sn-labeled 15-mu m microspheres as a perfusion marker, then sliced the lungs and counted 99mTc and 113Sn. Weight-normalized perfusion decreased with hypoxia (P < 0.02). Retention of AA cells (perfusion-normalized) averaged approximately 1% in lungs ventilated with 95% O2 and increased only twofold with 0% O2. In contrast, retention of SS cells averaged 3-fold higher than that of AA cells at 95 and 5% O2, 15-fold higher at 2.5% O2, and 25-fold higher at 0% O2 (P < 0.01). Histological examination demonstrated entrapment of individual SS cells in alveolar capillaries of hypoxic but not well-oxygenated lungs. Relief of hypoxia, but not increased perfusate flow, caused prompt efflux of most entrapped cells, which were primarily high-density (high mean corpuscular hemoglobin concentration) cells. Thus substantial retention of SS cells does not occur without hypoxia, but regional hypoxia and/or the resulting vasoconstriction causes extraordinary regional retention of dense SS cells, a phenomenon that appears to be due more to mechanical entrapment of nondeformable cells in capillaries than to endothelial adhesion.

Causal role of dense microspherocytes in the anemia of hereditary spherocytosis: Clinical importance of filterability measurements through 3-μm pores

through the 3-llm pore nickel mesh compared with that through the 5-llm pores. It is, therefore, likely that the impaired deformability of HS RBCs arises from the decrease in the cell surface area to volume ratio and the high mean corpuscular hemoglobin concentration. After splenectomy, the dense microspherocytes disappeared, and there was a marked improvement in RBC filterability through 3-llm pores. This suggests that dense cells were microspherocytes that received splenic conditioning in the walls of splenic sinuses. Correspondingly, splenectomy markedly improved clinical manifestations and ameliorated hemolysis. Thus, the laboratory measurement (i.e., the 3-llm filtration test) reflected the patient's clinical state. The use of