Blood Bilirubin Levels Research Articles

Novel Design and Evaluation of an Automatic and Portable Phototherapy Device Using for Newborn Jaundice Treatment

Jaundice in infants is one of the most common diseases at birth. In preterm infants, the risk is more than 80%, and in term infants, the rate is reduced to about 60%. One of the most effective and low-risk ways to treat neonatal jaundice is the use of light therapy or phototherapy. Fluorescent lamps, tungsten halogen lamps, LEDs, optical fibers and etc are used in these devices. Bilirubin reacts to green light and blue light. The green light's wavelength is in the range of 570-495 nm. The blue light has a wavelength of 495-450 nm and an absorption range of 450 nm. Studies have found that the best light for phototherapy devices is a light that has the wavelength of 400 to 520 nm, and because the blue light absorption rate is about 450 nm, so it is used in phototherapy. In addition to its proper absorption rate, it also has antimicrobial activity against bacteria. It is difficult to determine the exact duration of the phototherapy, because each infant has his/her specific conditions and the exact duration cannot be determined generally. Phototherapy should be continued until the bilirubin level in the baby's blood is sufficiently reduced, monitored by the supervision, and does not pose a threat to the baby. Phototherapy devices have different types, each with advantages over their predecessors. In existing models, because of their unique features like high sensitivity to bilirubin reduction, higher power, and efficiency, lighter, lower heat generation, lower cost and longer life devices, LED light sources are widely used in phototherapy devices. According to all the studies, we are looking for a device with proper coverage, portability, and moving the baby with the device without separating the baby from the baby as well as providing a quiet space for the mother and baby away from the hospital environment.

PSX-15 Hepatic function characteristics in pregnant Saanen goats depending on month of pregnancy

Abstract In recent economical situation goat farming is a promising field accompanied by high price and demand of goat milk, meat and wool. Saanen goats is a dairy breed, the mean yield per lactation is 600–700 kg (1320–1540 lb). This breed is widespread in North-Western region of Russian Federation. Nowadays the deep research of Saanen goat metabolism in different physiological states is important and relevant. This study is aimed to study blood markers of hepatic function in Saanen goats depending on month of pregnancy. The experiment was conducted in the north-western region of Russian Federation, in laboratory of biochemistry and physiology department, FSBEI of Higher Education «SPbSAVM». The experimental group included 30 pregnant Saanen goats, 1–4 years of age, selected using matched pairs method; control group included 30 non-pregnant Saanen goats, same age. The blood samples were taken 5 times during pregnancy – each month. The blood markers of hepatic function (serum ALT, AST, ALP activity and total bilirubin) were assessed by standard methods. The results are displayed in table 1. After analyzing the received data of hepatic function markers there were revealed signs of hepatic toxic damage in pregnant goats during the whole period of pregnancy. Increase of hepatic enzymes activity (AST, ALT) and total bilirubin blood level in pregnant goats when compare with non-pregnant is also notable. Thus during the whole period of pregnancy there were signs of hepatic function disturbances because of intoxications. This is characterized by hepatic function markers elevation. This endogenic intoxication can potentially lead to hepatic damage. Received data allows taking into consideration preventive measures to minimize endogenic intoxication during the second half of pregnancy in goats.

Diagnostic accuracy of hyperbilirubinemia in preoperative diagnosis of acute perforated appendix

Background: Delayed diagnosis of perforated appendicitis is a life threating condition. All these cases warrant expeditious surgical intervention. Hyperbilirubinemia can play a vital role in early diagnosis of perforated appendix and thereby reduce mortality, morbidity and prolonged hospital stay. The aim of this study is to compare the levels of bilirubin in simple appendicitis and perforated appendicitis.Methods: This was a single center retrospective study of 100 patients who attended Surgery OPD with right iliac fossa pain during the period between July 2017 and June 2018.Results: During the period of study, 100 patients were selected of which 18 (18%) subjects were diagnosed having perforated appendix and 82 (82%) cases were having non-perforated appendix. The mean serum bilirubin levels were 1.65±0.83 among subjects diagnosed having perforated appendix whereas it was 0.82±0.36 among subjects having non-perforated appendix. Further raised levels of bilirubin levels in blood were detected among 20 cases, of which 17 cases were diagnosed having perforated appendix. Out of total 20 cases in whom hyperbilirubinemia was observed, only 3 cases were having non-perforated appendix. Of total 80 cases in which normal Bilirubin levels in blood were detected, only 1 case had perforated appendix.Conclusions: Preoperative serum bilirubin levels are promising tool with high diagnostic accuracy in preoperative diagnosis of acute perforated appendix when used together with clinical correlation.

Malnutrition Predisposes to Endotoxin-Induced Edema and Impaired Inflammatory Response in Parenterally Fed Piglets.

Poor nutrition status is common among hospitalized children and children in low-income countries and may be associated with increased susceptibility to edema and infections. We hypothesized that poor nutrition status, established with a suboptimal composition of parenteral nutrition (PN), predisposes to endotoxemia-induced edema, oxidative stress, and dysregulated immune responses. Using a 2 × 2 factorial design, 3-day-old piglets (n = 40) were given either optimal or suboptimal composition of PN for 7days and then infused with either saline or lipopolysaccharide (LPS) for 9hours to induce an acute-phase reaction. Abdominal tissue edema and blood markers of immunity, inflammation, and oxidative stress were assessed. Piglets receiving suboptimal nutrition showed signs of malnutrition with restricted growth, signs of inflammation (elevated C-reactive protein [CRP], interleukin-6, and serum amyloid A levels), oxidative stress (lower erythrocyte glutathione/hemoglobin and α-tocopherol/cholesterol ratios), and liver dysfunction (increased liver weight and blood bilirubin levels). Perirenal edema was more excessive in malnourished LPS-infused animals, relative to healthy LPS-infused control animals (P<.01). Malnutrition reduced the inflammatory response to LPS (lower CRP, tumor necrosis factor-α, haptoglobin, and neutrophil to lymphocyte ratio) but did not influence LPS-induced oxidative stress markers. We conclude that endotoxemia and malnutrition in combination lead to acute-phase hyporesponsiveness and perirenal edema in piglets. This finding may have implications for pediatric patients that suffer from malnutrition, as their response to bacterial infections may differ substantially from patients of normal nutrition status.

Utility of cord blood bilirubin as a predictors of significant neonatal Hyperbilirubinemia in healthy term neonate

Background: Clinical jaundice is evident in more than two-third neonates in their early neonatal life. Early identification of neonates at risk might allow early intervention and prevent complication. Objective of the study was to assess the cord blood bilirubin level as a tool to screen the risk of development of subsequent significant neonatal hyperbilirubinemia in term neonates.Methods: A prospective observational study was conducted over a period of 2 years on 1040 healthy term neonates. Demographic profile, relevant maternal and neonatal information were recorded. Measurement of cord blood bilirubin, blood group/Rh typing and serum bilirubin at the end of 24 &amp; 72 hours was done to predict significant hyperbilirubinemia.Results: Incidence of significant hyperbilirubinemia was 11.53%. Gender, gestational age, mode of delivery and birth weight had no correlation with development of significant jaundice. 800 (76.93%) neonates had cord blood bilirubin level ≤3.0mg/dl and 240 (23.07%) neonate had cord blood bilirubin level &gt;3.0mg/dl. Out of 240 (23.07%) neonates with higher cord bilirubin (&gt;3.0 mg/dl), 108 (45%) had significant hyperbilirubinemia at the end of 24 hours with sensitivity 90.00%, specificity 85.65%, positive predictive value 45.00% and negative predictive value 98.50% while 110 (45.83%) neonates were observed with serum bilirubin &gt;17mg/dl at the end of 72 hours with cord blood bilirubin &gt;3mg/dl with sensitivity 91.67%, specificity 84.52% positive predictive value 45.83% and negative predictive value-98.61% and this difference was statistically significant.Conclusions: Neonates with cord blood bilirubin level ≤3mg/dl can be safely discharged early whereas neonates with bilirubin &gt;3mg/dl will need close follow up to check for development of subsequent significant jaundice. Hence cord blood bilirubin levels help to determine and predict the possibility of significant jaundice among healthy term neonates.

The Effect of Pediatric Living Donor Liver Transplantation on Neurocognitive Outcomes in Children.

BackgroundNeurocognitive dysfunction commonly occurs after solid organ transplantation and affects 15–30% of liver transplant recipients. The aim of this study was to evaluate the neurocognitive changes pre- and post-operation and the relative factors affecting those changes.Material/MethodsChildren with biliary atresia who underwent pediatric living donor-related liver transplantation before the age of 2 years were given Bayley Scale of Infant Development-II test (BSID-II), including Mental Development Index (MDI) and Psychomotor Development Index (PDI) the week before and again half a year after transplantation to assess the effect of transplantation on neurocognition. According to the test outcome, the children were divided into a normal group and an abnormal group. The association of clinical data with neurocognitive development between the 2 groups was analyzed by logistic regression analysis.ResultsThere was a certain degree of improvement in neurocognition half a year after surgery compared with preoperative. The BSID-II subscales were significantly lower than expected before and after transplantation. Preoperative blood ammonia and bilirubin levels were independent risk factors for MDI half a year after transplantation, and preoperative albumin and bilirubin levels were risk factors for PDI.ConclusionsLiver transplantation clearly improves children’s neurocognitive function. The postoperative neurocognition is closely related to pre-operation nutritional development.

Effect of L-carnitine on liver enzymes and biochemical factors in hepatic encephalopathy: A systematic review and meta-analysis.

We aimed to investigate the effect of L-carnitine on biochemical factors including ammonia, bilirubin, albumin, alanine aminotransferase, aspartate aminotransferase (AST), blood urea nitrogen (BUN), and creatinine (Cr) in patients with hepatic encephalopathy (HE). A systematic search was carried out in Web of Science, PubMed, Scopus, and Cochrane Library databases to find articles related to the effect of L-carnitine supplementation in patients with HE, up to 7 February 2019. There was no language and time limitation. Meta-analyses were carried out using both the random and fixed effects models where appropriate, and I2 index was used to evaluate the heterogeneity. Search yielded 3462 publications. Nine randomized clinical trials with 779 patients were eligible. L-carnitine supplementation significantly reduced blood levels of ammonia. Furthermore, our results indicated that L-carnitine supplementation significantly reduced blood levels of bilirubin, AST, BUN, and Cr in patients with HE. Subgroup analysis demonstrated that L-carnitine significantly reduced ammonia in patients with all the ages, long and short duration of the supplementation, doses less or higher than 4000mg/day, any route of treatment (intravenous or oral), and in patients with any grade of the symptoms of HE. Moreover, we found that L-carnitine significantly increased circulating levels of albumin in HE patients. Present systematic review and meta-analysis revealed that L-carnitine supplementation significantly reduced blood levels of ammonia, bilirubin, AST, BUN, and Cr in HE patients. Moreover, we found that L-carnitine significantly increased circulating levels of albumin. However, further large-scale randomized clinical trials are needed.

Lymphocyte counts may predict a good response to mesenchymal stromal cells therapy in graft versus host disease patients.

Steroid-resistant GvHD is one of the most significant causes of mortality following allogeneic Hematopoietic Stem Cell Transplantation (HSCT). Treatment with mesenchymal stromal cells (MSC) seems to be a promising solution, however the results from clinical studies are still equivocal. Better selection of candidate patients and improving monitoring of patients following MSC administration can increase treatment effectiveness. In order to determine which characteristics can be used to predict a good response and better monitoring of patients, blood samples were taken prior to therapy, one week and one month after therapy, from 26 allogeneic HSCT patients whom contracted GvHD and were treated with MSCs. Samples were examined for differential blood counts, bilirubin levels and cell surface markers. Serum cytokine levels were also measured. We found that the level of lymphocytes, in particular T and NK cells, may predict a good response to therapy. A better response was observed among patients who expressed low levels of IL-6 and IL-22, Th17 related cytokines, prior to therapy. Patients with high levels of bilirubin prior to therapy showed a poorer response. The results of this study may facilitate early prediction of success or failure of the treatment, and subsequently, will improve selection of patients for MSC therapy.

Evaluation of critical cord blood bilirubin level as a predictor of significant hyperbilirubinemia in term newborns

Evaluation of critical cord blood bilirubin level as a predictor of significant hyperbilirubinemia in term newborns

Evaluation of the Severity and Duration of Thrombocytopenia following Exchange Transfusion in neonatal hyperbilirubinemia

Background: Infant jaundice is one the most common causes of hospitalization in infant in the first month of birth, which is defined an abnormal increase in blood bilirubin levels. Exchange transfusion is the recommended treatment for neonatal jaundice who do not respond to phototherapy and experience dangerous complication of jaundice and signs of kernicterus. However, this treatment may lead to complications such as thrombocytopenia. This study aimed to investigate the severity and duration of thrombocytopenia following the exchange transfusion in neonatal jaundice. Material and Methods: This cross section study was performed on 217 infants. Infants with a gestational age of 35 to 42 weeks and bilirubin levels of above 17 mg/dl, who were undergoing treated with exchange transfusion, entered in this study. This study was conducted from 2012 to 2018 in the Ghaem Hospital (Mashhad, Iran). The samples were selected by convenience sampling. The platelet count was measured before exchange transfusion, right after exchange transfusion, 6 hours after exchange transfusion, and platelet count continued until platelet level was normal. At the time of discharge, platelet levels were re-measured. Results: Among the samples, 104(53.8%) were males and 89 (46.2%) females. Of the infants who were transfused, 15 % had thrombocytopenia. After the exchange transfusion, 80 % of infants had thrombocytopenia. The mean platelet count before the exchange transfusion was 299,180 per mm3 of blood, and it was 105.140 per mm3 of blood after the exchange transfusion. With respect to severity of this complication, 86 % of the thrombocytopenia after exchange transfusion was mild to moderate. Conclusion: In this study, nearly one-sixth of the infants who needed exchange transfusions had thrombocytopenia that most of them had platelet of more than 100000. Thrombocytopenia is associated with jaundice and can be exacerbated by phototherapy.

Comparison of Total Bilirubin Values Measured with ABL 735 Blood Gas Analyzer and Roche Cobas C8000 Chemistry Analyzer in Age-Segregated Pediatric Patients

Abstract Aim: Measurement of blood bilirubin levels is a crucial analysis because of the toxic effects of bilirubin on brain tissue, particularly in preterm neonates. The aim of this study was to investigate the consistency of the total bilirubin values obtained by the blood gas analyzer and the autoanalyzer. Material and Methods: In this study, we used total bilirubin data of 407 pediatric patients from Kocaeli University Medical Faculty Education and Research Hospital Central Laboratory System. Total bilirubin data, provided that it was measured simultaneously, was obtained from ABL 735 blood gas analyzer and Roche Cobas C8000 chemistry analyzer. Pediatric patients (neonates, infant and children under 17 years old) were selected retrospectively by year between 2015-2017. Results: Under a cut-off value (14.6 mg/dL) ABL 735 blood gas analyzer and Roche COBAS C8000 chemistry analyzer had strong correlation (r = 0.939) for total bilirubin measurements. It was found that 2-15 days old neonates give more scattered total bilirubin data by Bland Altman analysis in two measurements. Statistical analysis performed to compare whole total bilirubin data identity between two measurements: correlation coefficient was found r = 0.949 a statistically significant positive correlation (p &lt; 0.001). Conclusion: According to our analysis which was supported by previous studies in the literature, we can say that the compatibility between the blood gas analyzer (multi-wave-length spectrophotometric technique) and the chemistry analyzer becomes weaker when the total bilirubin levels exceed 14.6 mg/dL.

Detection of Neonatal Jaundice by Using an Android OS-Based Smartphone Application

Background: Neonatal jaundice resulting from raised blood bilirubin levels is one of the most common clinical conditions that needs medical attention. To initiate appropriate management that can both prevent and treat severe neonatal jaundice, screening methods that measure bilirubin level are warranted. Methods: In this study, we present an Android OS-based application for detecting neonatal jaundice. We used the application to detect jaundice in 113 neonates. Our smartphone-based estimation of bilirubin levels depends on a smartphone, a color calibration card, and a 100X zoom microscope clip. Our application was designed to acquire images of the newborn’s forehead skin in a standardized manner, estimate the average R, G, B scores of the images that have been taken from the forehead skin and calibration card, and then convert them to hue, saturation, intensity (HSI) parameters. All these are performed offline; in this application, we used offline machine learning and regression techniques for analysis Results: Our smartphone-based estimation of bilirubin levels had a sensitivity of 68% and specificity of 92.3% for estimating the bilirubin levels of less than 10 mg/dL and sensitivity of 82.1% and specificity of 100% for estimating the bilirubin levels of less than 15 mg/dL. Our application-based estimation of bilirubin levels had the correlation of 0.479 with the total serum bilirubin values. Conclusions: Our results suggest that our smartphone-based application can serve as a promising screening tool for neonatal jaundice, and it can aid in determining neonates requiring a blood draw for measuring total serum bilirubin level.

Diagnostic markers in acute appendicitis

Objective The objective of the study was to determine the value of white cell count (WBC), C-reactive protein (CRP), and bilirubin as diagnostic markers in acute appendicitis. Background Appendicitis is a frequent reason for hospital admissions. Elevated CRP, white blood cell count, and serum bilirubin have been suggested as individual markers for appendicitis and appendicular perforation. Patients and methods This prospective observational study was conducted on patients admitted with clinical suspicion of acute appendicitis at Menoufia University and Bolak El-Dakror Hospitals in the 6 months period starting from June 2017 involving 150 patients. Results A total of 150 patients were operated under suspicion of appendicitis. From these, 65.3% of patients had simple appendicitis, 18.7% had normal appendix, and 16% of patients had complicated appendicitis. Complicated appendicitis was accompanied with higher WBC level with significant correlation (P = 0.03); complicated and simple ones were accompanied with a higher level of total bilirubin than normal appendix with significant differences (P Conclusion Combining blood markers was useful in predicting appendicitis and perforated appendicitis, in addition to CRP and WBC, and blood levels of bilirubin.

Predicting mortality and adverse events in patients with advanced pancreatic cancer treated with palliative gemcitabine-based chemotherapy in a multicentre phase III randomized clinical trial: the APC-SAKK risk scores.

Background:The prognosis of advanced pancreatic cancer (APC) is poor and differs considerably among patients. Therefore, it is clinically relevant to identify patients with APC who are more likely to benefit from palliative chemotherapy with reduced risk of toxicity. To date, there is no prognostic score universally recommended to help clinicians in planning the therapeutic management.Methods:Using individual patient data from 319 cases of APC treated with gemcitabine-based chemotherapy and enrolled in the SAKK 44/00-CECOG/PAN.1.3.001 randomized trial, several baseline variables, including inflammatory markers, were analysed post hoc as predictors of mortality and/or grade 3 or 4 chemotherapy-related toxicity and separate risk scores were developed.Results:Median survival of the study patients was 7.9 months (interquartile range 3.7–13.3 months). Independent predictors of mortality included increased Aspartate transaminase (ASAT), low performance status, increased derived neutrophil to lymphocyte ratio, increased Carbohydrate Antigen 19-9 (CA 19-9), low haemoglobin, presence of pain, presence of metastasis and increased alkaline phosphatase (ALP). During the study, 117 patients experienced at least one grade 3 or 4 adverse event. Independent predictors of toxicity included white blood cells, ALP, renal function and bilirubin levels at baseline. Both models displayed moderate levels of discrimination (C-statistic 0.68 and 0.64 for mortality and toxicity, respectively) and adequate calibration.Conclusions:We developed simple-to-use prognostic scores for mortality and severe toxicity for patients with APC. These scores can be useful in daily practice to identify patients with increased risk of death or toxicity and to plan the most appropriate therapeutic strategy to improve survival and quality of life. Further prospective studies to validate such scores are needed.

Calcium-binding protein, S100b, in the blood as a biochemical marker of the neurological state of men in warzones

Acute and chronic stress are two of the most challenging issues faced by men situated in warzones. According to the main concept of G. Selye, stress response is the most important link during the adaptation of an organism to environmental factors. However, excessively intense or prolonged exposure to stress creates the threat of sustained homeostasis disorder. At present, the primary indicators in clinical studies are the general biochemical parameters of blood alanine aminotransferase, aspartate aminotransferase, bilirubin, creatine, urea, total protein, and glucose levels. But these indicators are not classical markers for determining the state of the nervous system itself and cannot reflect a patient's mental state. In this regard, we tested for a different biomarker; we made an attempt to determine the neurospecific S100b protein in the blood serum by analyzing the correlation between classical and specific methods for diagnosing the state of the nervous system. For this study, blood was collected from 20 patients aged 25 to 45 years old. Participants were divided into two groups: one group of provisionally healthy men and another group of patients who were admitted to the Department of Neurology of the I. Mechnikov Regional Clinical Hospital after military operations (from the territory of the ATU). The standard test kits of PrAT Reagent Company (Dnipro) were used to assess biochemical indicators in accordance with the given instruction in the supplier’s protocol. The activity of each of alanine aminotransferase, aspartate aminotransferase, direct and total bilirubin content, creatine, urea, total protein levels, and astrocyte-specific protein S100b was examined. The level of alanine aminotransferase in the men from the warzone was 23.9 ± 3.9 μmol/l, compared with the healthy men 31.2 ± 0.7 μmol/l. The level of aspartate aminotransferase in the group of men at the neurological department was similar to that in the healthy group. The content of direct bilirubin in the patients at the neurological department increased by 28.0%, compared with the healthy men. The concentration of creatinine, total protein, urea, and glucose levels did not significantly change, compared with healthy volunteers and were in the range of the standard reference data. The content of astrocyte-specific protein, S100b, in the blood of the patients was 0.011 μg/ml, 36.0% more than in the conditionally healthy men 0.007 μg/ml. Prolonged stress could, therefore, induce profound changes in blood brain barrier and registration of neurospecific protein in the blood of men in warzones. These changes could become chronic if or when these men develop other social and economic problems that can be monitored with the specific marker for S100b.

Clinical analysis of invasive natural killer cell leukemia with focal bone marrow lesions and hemophagocytic syndrome

Objective To investigate clinical characteristic and prognosis of aggressive natural killer cell leukemia (ANKL) with focal bone marrow lesions and hemophagocytic syndrome. Methods On 29 August 2016, a case of ANKL with focal bone marrow lesions and hemophagocytic syndrome who were admitted to Department of Hematology, Huai′an First People′s Hospital was included in this study. The patient was diagnosed based on clinical features and related examinations. The patient refused to receive chemotherapy. Dexamethasone 10 mg/d×12 d was given intravenously to control hemophagolysis; sodium foscarinate sodium chloride 2.4 g/time×2 times/d×4 d was given intravenously for antiviral treatment; cefoperazone sodium sulbactam sodium 1.5 g/time×3 times/d×3 d was given intravenously. The anti-infective effect was not good, and the replacement drug was teicoplanin 400 mg/time×2 times/d on the first day, and then 400 mg/d×7 d from the second day; imipenem sodium butyrate 1 g/time×3 times/d×3 d was given intravenously. At the same time, 5 U of the infusion red blood cell preparation, 2 U of the platelet preparation, and 325 mL of fresh plasma were administered. The laboratory test results, diagnosis, therapeutic effect and other clinical data of ANKL patients with focal bone marrow lesions and hemophagocytic syndrome were analyzed retrospectively, and the research progress on diagnosis and treatment of ANKL was discussed in combination with relevant literature. Results ① After admitted, patients′ abnormal index of blood routine examination showed that white blood cell count was 2.28×109/L, neutrophil count was 1.32×109/L, red blood cell count was 2.75×109/L, hemoglobin (Hb) level was 68 g/L, platelet count was 89×109/L, monocyte count was 0.42×109/L, and lymphocyte count was 0.52×109/L. Abnormal index of coagulation function test showed that international normalized ratio (INR) was 1.18, prothrombin activity (PTA) was 77%, activated partial prothrombin time (APTT) was 46.2 s, and other indicators were within the normal reference range. EB virus (EBV) quantitative test results were 8.74×103 copies/mL (normal reference value range <3.00×103 copies/mL). Cytomegalovirus (CMV) detection result was negative. Results of liver function tests showed that level of lactate dehydrogenase (LDH) was 293 U/L, and other indicators were within the normal reference range. Abdominal CT results showed splenomegaly. Ultrasound examination showed that the liver and spleen were large. The smear of the patient′s bone marrow (right anterior iliac) on 30 August 2016 showed a ratio of 4% of ANKL cells. Bone marrow cell immunophenotyping results showed 2 subpopulations, P1 with a ratio of 8.4% and P2 with a ratio of 3.8%. P1 antigen included myeloperoxidase (MPO) (0.1%), cCD3 (81.7%), CD2 (79.6%), CD5 (80.3%), CD7 (70.2%), CD56 (5.9%); P2 antigens included MPO (0.1%), CD2 (98.2%), CD7 (97.8%), CD56 (92.0%), human leukocyte antigen (HLA)-DR (98.4%). Thirty-three common leukemia fusion genes and 4 myeloid gene mutations were negative. TCR/IGH gene rearrangement was also negative. On 1 September 2016, the smear of the bone marrow (left posterior sputum) showed a ratio of ANKL cells (tissue cell-like) of 1.5%. No obvious abnormalities caught in bone biopsy results. On 5 September 2016, the results of smear examination of bone marrow (left anterior) showed that the proportion of ANKL cells was 70.5%, and result of peroxidase (POX) staining was negative with hematopoietic cells. Results of immunophenotypic analysis showed that proportion of 1 subpopulation cells was 50.1%, and the antigens included MPO (0.1%), CD2 (92.6%), CD7 (92.2%), CD56 (82.2%), HLA-DR (85.9%), CD38(85.1%). Karyotype analysis results show that 46XX, add(4)(q35), add(13)(q34)[1]/46, XX[19]. In addition, the patient repeatedly suffered from high fever with a heat peak of 39 ℃ for more than one week. ② The patient was diagnosed as ANKL with focal bone marrow lesions accompanied by hemophagocytic syndrome. ③After treatment, on 8 September 2016, Hb level, platelet count, and red blood cell count of the patient decreased progressively; on 12 September 2016, white blood cell count, bilirubin level, aminotransferase level, and LDH level increased progressively. On 15 September 2016, re-examination of fibrinogen level was 1.61 g/L, and this suggested abnormal coagulation function; on 13 September 2016, EBV quantitative test results were 8.74×103 copies/mL; multiple lymph nodes were enlarged; liver and spleen progressively enlarged. On 16 September 2016, the patient developed respiratory failure, and pulse oxygen decreased with cardiac dysfunction. The patient′s family gave up further treatment, and the patient died. Conclusion ANKL with focal bone marrow lesions and hemophagocytic syndrome has an invasive clinical course, and disease deteriorates in a short period of time with poor prognosis. Key words: Leukemia, large granular lymphocytic; Epstein-Barr virus infections; Diagnosis; Prognosis; Bone marrow with focal type

Cord serum bilirubin as a predictor of neonatal hyperbilirubinemia in healthy term and late preterm neonates

Background: Icterus neonatorum is the most common neonatal illness occurring in the first 7 days of life. It is the most important cause for hospital readmissions during the early neonatal period and also the cause for neonatal morbidity. In this study our main objective is, to find out that whether detecting umbilical cord blood bilirubin levels soon after birth, will help to identify the development of significant jaundice in early neonatal period which requires immediate interventionMethods: This was a prospective observational study carried out among 150 term and preterm babies. Their cord bilirubin level were estimated. Jaundice was determined by using yellowish appearance of eyes, skin and Kramer score. Statistics employed include Chi-square test and receiver operator characteristic curveResults: Study participants enrolled into the study was 150. Cord serum bilirubin was significantly associated with Kramer score and yellowish discoloration of eyes and skin and not significantly associated with sex, mode of delivery, gestational age and birth weight. When cord serum bilirubin was compared against the occurrence of clinical jaundice, sensitivity was found to be 58.33%, specificity was 96.49% positive predictive value was 84% and negative predictive value was 88%. Receiver operator characteristics curve indicated that the area below the curve was 0.842.Conclusions: Cord serum bilirubin can be used as a screening tool to identify the neonatal jaundice in both term and late preterm babies. Present study has shown increased specificity than sensitivity which warrants further exploration.

Factors predicting hyperkalemia in patients with cirrhosis receiving spironolactone.

To evaluate the factors leading to hyperkalemia in patients with cirrhosis receiving spironolactone. An observational, analytical, case control study. The Aga Khan University Hospital. Six months. One hundred and fifty consecutive patients (100 males, 50 females) with cirrhosis of liver, hospitalized for decompensated disease and receiving spironolactone for at least two weeks before admission, were included in this study. Patients with hyperkalemia (n=67) having potassium level >5 mmol/l were compared with patients who had normal potassium level 5 mmol/l (n=83). The parameters taken into account were age, gender of the patients, type and dose of diuretics along with concomitant medicines, diastolic blood pressure, edema, ascites, blood urea nitrogen, serum creatinine, electrolytes, bilirubin, albumin, prothrombin time, Child class, and Child Pugh score. Patients with hyperkalemia (K > 5 mmol/l) had higher blood urea nitrogen, serum creatinine and bilirubin levels (p= 0.004, 0.001 and 0.044 respectively). Their serum sodium and albumin levels were lower (p= 0.000 and 0.017 respectively). They had advanced cirrhosis with high Pugh score (p= 0.003). These patients were on higher dose of spironolactone (p =0.001). Multivariate analysis showed that dose of spironolactone >100 mg /day, serum creatinine >1.3 mg/dl, persistence of ascites and edema, and female gender were important predictors of development of hyperkalemia. Patients with cirrhosis receiving high dose of the diuretic, having edema, ascites and high serum creatinine are at the greater risk of developing hyperkalemia during spironolactone therapy.

Is Cord Blood Bilirubin Level a Reliable Predictor for Developing Significant Hyperbilirubinemia?

We aimed to investigate whether cord blood bilirubin (CBB) level could be used to identify the newborns at a high risk of developing hyperbilirubinemia. Total and direct serum bilirubin level were evaluated from umbilical cord blood of newborns. We checked blood groups and Rh status of all mothers and determined blood groups and direct Coombs test (DC) of newborns born to mothers whose blood group was O type or Rh negative to determine the maternal-fetal blood group or Rh incompatibility. A total of 418 newborns were included, and phototherapy (PT) was required in 17 newborns. The cutoff value of CBB for predicting the occurrence of significant hyperbilirubinemia requiring PT was 1.67 mg/dL, with a sensitivity of 82% and specificity of 99%. The mean CBB level in babies receiving PT was 2.4 ± 0.9 mg/dL. When blood group, CBB level, DC, gender, and mode of delivery were assigned as possible risk factors, multıvariate analysis showed ABO, Rh incompatibility, and CBB level increased the risk of PT requirement. CBB could be useful to determine newborns at a risk of developing hyperbilirubinemia and prevent developing severe complications due to delay in diagnosis.

Risk Factors of Severe Hyperbilirubinemia in Neonates Undergoing Exchange Transfusion in Imam Reza Hospital Kermanshah- Iran, during 2012 to 2016

Background Jaundice is one of the most common problems in neonatal period. Although the efficacy of exchange transfusion in the treatment of neonatal jaundice is knownand quickly reduces blood bilirubin levels, but severe neonatal hyperbilirubinemia is associated with significant morbidity and mortality. We conducted this study to investigate the risk factorsof severe hyperbilirubinemia in neonates undergoing exchange transfusion in Imam Reza Hospital Kermanshah, Iran. Materials and Methods In this retrospective study, records of newborns with hyperbilirubinemia who were undergoing exchange transfusion to Imam Reza hospital in Kermanshah from of 2012 to 2016 were studied. Information were extracted from the patient case and recorded in the data collection form. Data analyzed using SPSS software (version 24.0). Results Birth weight of 42.1% of neonates was less than 2,500 gr and 43.1% were preterm. The most common causes of severe hyperbilirubinemia including: unknown causes (42.2%, n=38), ABO incompatibility (27.8%, n=25), and sepsis (12.2%, n=11). The most common complications of exchange transfusion in this study were thrombocytopenia (33.4%), hypocalcaemia (18.7%), hyperglycemia (12.3%), and hypoglycemia (12.3%). Conclusion According to the results, major risk factors for the occurrence of severe hyperbilirubinemia in neonates were birth weight less than 2,500 gram, gestational age below 37 weeks, age less than 5 days, and weight loss more than 10% of birth weight at the time of admission.