Low RBC Research Articles

Clinical, Laboratory, and Demographic Factors Contributing to COVID-19 Mortality Risk

Background: This study aimed to identify COVID-19 mortality risk factors and relevant laboratory markers to inform prevention and treatment strategies. Methods: This cross-sectional study was conducted in Iran, involving 1561 patients diagnosed with COVID-19 between 2019 and 2021. Demographic, clinical, and laboratory data were collected from hospital records and analyzed using a logistic regression model. Results: The mortality rate attributed to COVID-19 in this study was 24.7%. Identified risk factors for mortality included intubation, multiple chronic conditions, liver or kidney disease or cancer, low RBC levels, and abnormal creatinine (Cr) levels. The adjusted odds ratios (adjOR) and 95% confidence intervals (CIs) for these factors were as follows: intubation (70.75, 14.07:355.84), concurrent chronic diseases (24.29, 3.25:181.24), liver or kidney disease or cancer (5.13, 1.21:21.81), low RBC levels (5.21, 1.24:21.79), and abnormal Cr levels (5.09, 1.21:21.43). Conclusion: The findings from this study indicated that several factors, including intubation, multiple chronic conditions, liver or kidney disease or cancer, and low Cr levels were associated with a higher risk of death from COVID-19. These results highlight the significance of continuous monitoring and specialized care for patients exhibiting these risk factors to reduce the risk of COVID-19 mortality.

Red blood cell folate level is associated with periodontitis in American adults: results from the NHANES 2009–2014

BackgroundRed blood cell (RBC) folate is an indicator of long-term folate nutrition. Whether there is an association between RBC folate and periodontitis is unclear. This study aimed to use the NHANES database to determine whether RBC folate is associated with moderate/severe periodontitis.MethodsA cross-sectional analysis of 10,151 participants in the NHANES database from 2009 to 2014 was performed. Multivariate logistic regression was used to analyze the independent relationship between RBC folate and moderate/severe periodontitis. The generalized additive model (GAM), restricted cubic splines (RCS), smooth curve fitting, and threshold effect analysis were used to explore the dose–response relationship and the potential nonlinear relationship between RBC folate and periodontitis. Finally, subgroup analysis and interaction tests were performed to determine the effect of covariates on the relationship between RBC folate and moderate/severe periodontitis.ResultsAfter adjusting for all confounders, there was a negative association between RBC folate concentration and moderate/severe periodontitis. The lowest fraction Q1 (< 360 ng/mL) of RBC folate concentration was used as the reference group, multivariable-adjusted ORs and 95% CIs of the second (360-463 ng/mL), third (464-569 ng/mL), fourth (570-732 ng/mL), and the highest quintile (> 733 ng/mL) categories were 0.88 (0.77, 1.01), 0.83 (0.72, 0.96), 0.77 (0.67, 0.90), 0.65 (0.56, 0.77) respectively. Additionally, a threshold nonlinear association was found between RBC folate (ng/mL) log2 transformation and moderate/severe periodontitis.ConclusionThis cross-sectional study revealed a negative relationship between RBC folate and moderate/severe periodontitis within a certain threshold range. Dentists and policymakers should pay closer attention to oral hygiene and health care for people with low or high RBC folate levels. Further causal and longitudinal research mechanisms are needed to validate our findings.

100 What Are We Transfusing? A Prospective Trial Evaluating the Quality of Intraoperatively Salvaged Red Blood Cells in Spinal Deformity Surgery

INTRODUCTION: Intraoperative RBC salvage (aka Cell Saver) is widely employed in spinal deformity surgery. Unlike other surgical subspecialities wherein blood is immediately salvaged (with low potential RBC injury), modern approaches to spine surgery inherently result in collection of blood exposed to high-heat electrocautery, prolonged stasis, and abrasive pharmaceuticals, potentially resulting in RBC injury. However, this has not been studied in a scientific manner. METHODS: Patients undergoing spinal deformity surgery with Cell Saver were prospectively enrolled (N = 86). Comparison blood samples include baseline (arterial-line), allogenic (blood bank), and salvage (Cell Saver transfusate). Qualitative laboratory measures of RBC health and hemolysis were collected. Morphological assessment utilized Stimulated Raman Histology (SRH) and artificial intelligence based machine-learning algorithm. Functional RBC evaluation was measured via ektacytometry. RESULTS: Salvage blood differed significantly from baseline and allogenic blood, including an unpredictable range of RBC density (2.11-9.52 x 1000/uL), and significantly lower MCV (smaller RBCs) vs. baseline and allogenic samples (p = 0.015 and 4.05E-8, respectively). SRH revealed a high proportion (30.7%) of often irreversibly injured acanthocytes (shrunken and irregularly spiculated RBCs). Ektacytometry revealed that salvaged RBCs were poorly deformable and had impaired relaxation kinetics. Salvage blood samples had significantly higher intracellular components indicating active lysis: potassium (p = 0.019 and 8.2E-16), LDH (p = 3.3E-11 and 1.66E-6), and free-hemoglobin (p = 4.87E-7 and 0.001). The salvage blood mean hemolysis index (HI) was significantly higher than baseline (155x, p = 1.1E-10) and allogenic blood (7.23x, p = 2.29E-5). CONCLUSIONS: Intraoperative salvaged blood is composed of high proportions of irreversibly injured RBCs with HI even exceeding levels suitable for transfusion by US FDA and Council of Europe standards, properties that may decrease the suitability of salvaged RBCs as a blood replacement. Collection of postoperative laboratory data and perioperative outcomes are currently underway.

Exercise-induced hematuria exacerbated by improper hydration, low RBC MCV and dapagliflozin use

BackgroundDapagliflozin is a reversible, highly potent, and selective Sodium-Glucose Co-Transporter-2 inhibitor indicated for the treatment of type 2 diabetes. It is generally well tolerated, with a low risk of hypoglycaemia and diabetic ketoacidosis. Case presentationWe report a new adverse effect of dapagliflozin in a form of a transient hematuria, presenting in a 54-years-old male patient with type 2 diabetes after exercise and insufficient hydration. The process of hematuria in the patient is strongly linked with initial period of treatment. ConclusionDapagliflozin appears to have a rare adverse effect in the form of transient hematuria. Exercise, insufficient hydration, and low RBC MCV may play a role in such episodes.

Correlation of Haematological Parameters and Glycated Hemoglobin to Vitamin D level in Type II Diabetes Mellitus Patients Attend Thumbay hospital, Ajman, UAE

Objective: This study is designed to evaluate the relationship between the hematological parameter, vitamin D level along with HbA1C level in type 2 diabetic patients. Material and Methods: The current study is a cross-sectional study that included 150 patients with type 2 diabetes mellitus aged 20 to 79 years. Patients were given a questionnaire that included demographic information, family history, duration of diabetes, and the presence of associated complications. During data analysis, the Mann-Whitney U-test, correlation, and descriptive statistics were used. P-values less than 0.05 were considered statistically significant. Results: CBC parameters show low RBC, HCT, and Hgb count and increase in RDW value among T2DM individuals. WBCs and monocytes count were insignificant statistically (P= 0.925, P= 0.084), but showed a weak positive correlation which could be used as an inflammation marker. In addition, most of the T2DM were having vitamin D deficiency (&lt;20 ng/mL) around 72.7% and occurs more in patients suffering from the diabetic disease for more than 5 years. Conclusions: This study highlights that T2DM patients could have one or more diabetes related complications at the time of diagnosis. Anemia was common among T2DM patients, especially patients with poorly controlled HbA1c because of diabetic nephropathy that affects the production of EPO. The study results demonstrated that vitamin D deficiency is common among T2DM patients. Therefore, it is recommended to screen and treat vitamin D deficiency for individuals whose diabetes risk is increased.

Compartment 1 acidosis associated with hemorrhagic diathesis causing mortalities among racing camels in Oman.

Camels are adapted to digestion of dry rough forages for their nutrition, and sudden change to highly digestible feed during the racing season causes digestive disorders. The current study investigated the cause of death among racing dromedary camels within 3-7 days following a sudden onset of fever ≈ 41 °C, colic with tarry feces, and enlarged superficial lymph nodes. Marked leukopenia, low RBC count and thrombocytopenia, deranged liver and renal function tests, and prolonged coagulation profiles were reported. Compartment 1 fluid revealed a pH of 4.3-5.2 with absence or few ciliated protozoa and Gram-positive microbial flora. Widespread petechial to ecchymotic hemorrhages were observed in various organs including the gastrointestinal tract (compartment 3 and colon), lungs, and heart. Fibrin thrombi in arterioles, capillaries, venules, and medium-sized veins were observed especially in the pulmonary interstitium, submucosa of the large intestine (ascending colon), deep dermis, and renal cortex. Furthermore, widespread hemorrhages and necrosis were constant histopathological lesions in parenchymatous organs. Based on clinical signs, hematology, blood biochemistry, and gross and microscopical findings, the cases were diagnosed as compartment 1 acidosis associated with hemorrhagic diathesis and endotoxicosis. Finally, compartment 1 acidosis associated with hemorrhagic diathesis is a serious fatal disease on the Arabian Peninsula in racing dromedaries causing multi-organ dysfunction and coagulopathy and disseminated hemorrhages.

IL-6 at the center of cytokine storm: Circulating inflammation mediators as biomarkers in hospitalized COVID-19 patients.

The management of hospitalized COVID-19 patients depends largely on controlling the intensified inflammatory response known as the cytokine storm. Candidate inflammatory cytokines can serve as new biomarkers for the management of hospitalized COVID-19 patients. Patients (80) were recruited into three groups: room air (RA), oxygen (OX) and mechanical ventilator (MV). Blood analysis was performed for RBC, WBC, Hb, Platelets, serum albumin and creatinine, INR, PTT, and hematocrit. ELISA was used to quantify a panel of inflammatory mediators including GM-SCF, IFN-α, IFNγ, IL-1β, IL-1R, IL-2, IL-2Ra, IL-6, IL-8, IL-10, IL-12p70, IL-13, MCP-1, MIP-1a, and TNF-α. Correlations between laboratory results and the levels of circulating inflammation mediators were investigated. Patients on MV had low RBC, Hb, albumin, and HCT and high WBC count, PTT, and INR when compared to RA and OX groups. A statistical positive correlation was found between WBC and the levels of IL-6 and MCP-1. RBCs correlated negatively with IL-6 and IL-10 and positively with IL-8. Higher TNF-α correlated with lower platelet counts while higher levels of IL-1Rα and IL-10 were associated with lower Hb levels. Increases in IFN-γ and TNF-α were indicative of compromised kidney functions as creatinine levels increased significantly. Most significant correlations were found between IL-6 and lab results, showing positive correlation with WBC and INR, and negative correlation with RBC, albumin, and HCT. Having the most significant correlations, IL-6 high levels in mechanically ventilated patients were shown to affect laboratory results, and, therefore, is suggested as a severity biomarker of COVID-19.

ASSESSMENT OF HEMATOLOGICAL PROFILE OF NEWBORNS BORN TO PREGNANCY INDUCED HYPERTENSION AND NORMOTENSIVE MOTHERS

Introduction: Hematological abnormalities in infants born to hypertensive mothers can lead to serious neonatal complications like sepsis, increased predisposition to infections and disseminated intravascular coagulation. This study was aimed to assess the hematological prole of newborns born to mother with pregnancy induced hypertension in comparison to normotensive mothers. Material &amp; Method: This prospective comparative study was conducted among the inborn of PIH and normotensive mothers in AVMC hospital. Total of 360 patients fullling inclusion criteria were included with 180 neonates born to mother with PIH and normotensive mothers. Written informed consent was obtained from the mothers and cord blood sample was collected from newborn to measure the hematological parameters. Analysis of the data was done using the SPSS v21 with p-value &lt;0.05 as statistically signicant. Results: In present study, total of 360 patients fullling inclusion criteria are included with mean age of 25.86±2.68yrs. The mean level of hemoglobin, RBC and MCVwere signicantly higher in newborn of hypertensive mothers and signicantly low leucocyte count and platelet count in newborn of hypertensive mothers (p&lt;0.05) Conclusion: The babies born to pre-eclamptic mothers are more prone for development of prematurity, low birth weight, leukopenia, thrombocytopenia and elevated RBC count .

Abstract WP30: Positive Covid-19 Cases Requiring Neurology Consultation: Review Of Death Status

Background and Purpose: Identify characteristics contributing to death in patients with Covid-19 and neurology consultation Hypothesis: We suspected many characteristics contributed to death in those with Covid-19 requiring neurologic consultation based on our clinical experience and prior descriptive study. Methods: A retrospective review of the characteristics of 200 patients with Covid-19 requiring neurology consultation from April 2020 to February 2021 were analyzed. Continuous variables were summarized by mean ± standard deviation and compared using the Student’s T-test of Wilcoxon rank-sum test. Categorical variables were summarized by frequency and percent and compared using Chi-squared or Fisher’s exact tests. Analyses were preformed with the use of SAS software (version 9.4). P-value &lt; 0.01 was considered statistically significant. Results: The patients who were deceased tended to be older compared to the patients who were alive (73.1 ± 12.4 vs. 64.7 ± 17.6, P-value = 0.001). Patients who were deceased had lower RBC (3.9 ± 1.0 vs 4.5 ± 1.7, P-value=0.006) and higher creatinine (2.3 ± 2.5 vs 1.4 ± 1.3, P-value = 0.003). Patients who were deceased were more likely to have impaired consciousness, coma, acute stroke, and encephalopathy compared to patients who were alive (83.1% vs 41.3%, 56.9% vs 16.9%, 48.3% vs 22.7%, and 86.2% vs. 62.3%). Among 58 with acute stroke, there was no statistically significant difference in type of stroke (38.5% vs 53.6%, P-value = 0.265) or intervention on stroke (15.4% vs 20.7%, P-value = 0.732) by death status. The patients with stroke who were deceased had lower platelets (180.4 ± 98.5 vs 276.6 ± 145.5, P-value = 0.004). Stroke patients who were deceased were more likely to have impaired consciousness and coma (78.6% vs 43.4%, and 53.6% vs 17.2%, respectively). Conclusion: Patients requiring neurologic consultation with Covid-19 have a higher likelihood of death in the setting of acute stroke, coma, encephalopathy, low RBC count, and elevated creatinine; and those with stroke had higher mortality with low platelet count. Further studies with early intervention to improve these factors may play a role in reducing morality.

Low RBC counts predict high on-treatment platelet reactivity in patients undergoing percutaneous coronary intervention and treated with clopidogrel.

Low RBC counts predict high on-treatment platelet reactivity in patients undergoing percutaneous coronary intervention and treated with clopidogrel.

Haematological indices in acute coronary syndromes: Could there be a hidden message?

Introduction and Aim: The routine markers of CAD show elevation after the development of acute manifestations. There exists a need for the establishment/validation of biomarkers that predict preclinical atherosclerotic changes. This study assesses the utility of haematological indices in the prediction and prognostication of CAD. Materials and Methods: This retrospective study includes 830 patient reports investigated for serum Troponin T retrieved from the laboratory information system. Reports were grouped into positive and negative categories. Relevant haematological and biochemical data were retrieved. Statistical analysis was carried out to estimate group differences, correlation, sensitivity, specificity, and AUC. Results: Troponin T positive group showed significantly elevated WBCs, neutrophils, CRP, NLR, PLR, and SII with significantly low lymphocytes, monocytes, basophils and RBC count. None of the lipid profile parameters, except serum triglyceride, showed significant differences between groups. Males showed a higher baseline but a blunter elevation CRP during acute coronary events. ROC showed maximum sensitivity (75.9%) and NPV (77.9%) for NLR, while PLR showed maximum specificity (76.4%). Conclusion: Haematological indices may have a better predictive value than conventional lipid profile and might serve as key markers in novel cardiac risk screening panels and aid in the risk stratification and management of coronary artery diseases.

S163: EFFICACY OF JAK 1/2 INHIBITION IN MURINE IMMUNE BONE MARROW FAILURE

Background: Immune aplastic anemia (AA) is a severe blood disorder characterized by cytotoxic T-lymphocyte mediated stem cell destruction. Therapies including hematopoietic stem cell transplant and immunosuppression are effective but entail costs and risks, and are not effective or possible in all patients. The Janus Kinase (JAK) 1/2 inhibitor ruxolitinib (RUX) suppresses cytotoxic T cell activation and inhibits production of interferon gamma and tumor necrosis factor alpha in models of graft-versus-host disease. Aims: Assess RUX in murine immune AA for potential therapeutic benefit. Methods: In a murine major histocompatibility complex mismatched C67BL/6(B6) to CByB6F1 lymph node (LN) cell infusion AA model, and a C.B10 minor histocompatibility antigen mismatched B6 to C.B10 LN cell infusion AA model, RUX was administered as a food additive (Rux-chow), which achieves therapeutic levels in 48-72 hours after administration. Control BMF mice received chow without RUX. Animals were fed with Rux-chow two days before LN cell infusion as a prophylaxis (BMF+RUXD-2), or two days after LN cell infusion as therapy (BMF+RUXD+2). Recipient mice were either bled and euthanized at day 14 following LN infusion to collect tissues or were kept for 56 days to record animal survival. Blood counts were measured biweekly. Samples for flow cytometry, histology, and gene expression assays were collected. Results: In both AA murine models, RUX attenuated bone marrow hypoplasia, ameliorated peripheral blood pancytopenia, and prevented mortality when used either prophylactically or therapeutically. Treated mice had significantly higher blood counts (neutrophils, red blood cells, hemoglobin, platelets) as well as bone marrow (BM) and RBM (residual BM, excluding T-cells), and cellularity relative to control BMF mice. RUX suppressed infiltration, proliferation and activation of effector T cells in the bone marrow and mitigated Fas-mediated apoptotic destruction of target hematopoietic cells. All mice who received RUX were alive at 56 days while control BMF mice all died (Figure 1). With the exception of two mice with low RBC at day 56, discontinuing Rux-chow at day 28 or day 42 did not affect animal blood counts measurements, nor survival. Gene expression in mice who received RUX revealed downregulated T cell function and JAK/STAT pathway-related genes (Stat1, Stat3, Stat4, Fas, Ly6a, Infg, Gzmb, Gzma, Gzmk, Infgr1, Il2rb, Il2rg, and Lag3). On network analysis of differentially expressed genes in downregulated pathways, Stat1 and Ifn-g genes were at the center of the network, connecting immune responses and cell cycle pathways. When toxicity was assessed, RUX exerted modest suppression of lymphoid and erythroid hematopoiesis in normal and irradiated CByB6F1 mice, but the drug showed impressive clinical efficacy despite this. Image:Summary/Conclusion: RUX showed striking therapeutic efficacy, improving blood counts and prolonging survival in two different BMF murine models. In patients, clonal T cell expansion and activation, IFN-g and TNF-α upregulation, and Fas mediated cell death, lead to severe BM destruction and the development of AA. Our study demonstrated that JAK 1/2 inhibition with RUX produced its suppressive effects by inhibiting T cell activation, reducing inflammatory cytokine secretion, and limiting FasL/Fas-mediated BM destruction. Given these results, JAK 1/2 inhibition with RUX is an exciting and novel potential therapy for BMF patients based on a well characterized mechanism of action.

Folate Deficiency Is Spatially Dependent and Associated with Local Farming Systems among Women in Ethiopia

ABSTRACTBackgroundFolate is essential for the synthesis and integrity of DNA, normal cell formation, and body growth. Folate deficiency among women of reproductive age (WRA) increases the risk of poor birth outcomes including neural tube defect (NTD)-affected pregnancies. Folate status is largely dependent on dietary intakes.ObjectivesWe aimed to explore the spatial distribution of biomarkers of folate status and their association with farming systems among nonpregnant WRA in Ethiopia.MethodsSerum and RBC folate concentration data were derived from the Ethiopia National Micronutrient Survey of 2015. The spatial dependencies of folate concentration of WRA were investigated and its relation with the dominant local farming system was explored.ResultsThe median serum folate and RBC folate concentrations were 12.3 nmol/L and 567.3 nmol/L, respectively. The national prevalence of folate deficiency using homocysteine concentration as a metabolic indicator based on serum and RBC folate concentration was 11.6% and 5.7%, respectively. The majority of women (77.9%) had low RBC folate concentrations consistent with increased risk of NTD-affected pregnancies. Folate nutrition was spatially dependent at distances of ≤ 300 km. A marked variability in folate concentration was observed between farming systems: greater RBC folate concentration (median: 1036 nmol/L) was found among women from the Lake Tana fish-based system, whereas the lowest RBC folate concentration (median: 386.7 nmol/L) was observed in the highland sorghum chat mixed system.ConclusionsThe majority (78%) of WRA in Ethiopia had low folate status potentially increasing the risk of NTD-affected pregnancies. These findings may help national and subnational nutrition intervention strategies to target the most affected areas in the country.

Analysis of clinical and anamnestic factors affecting endothelial glycocalyx condition in patients with active rheumatoid arthritis

Background . Endothelial dysfunction (ED) involved in the pathogenesis of rheumatoid arthritis (RA) is more associated with the endothelial glycocalyx (EGC) condition. EGC thinning is an independent predictor of cardiovascular complications that is why it is important to determine the risk factors (RF) that most affect EGC in RA. Objective . To study the relationship between the endothelium condition and RF for an RA unfavourable course and cardiovascular risk (CVR). Design and methods . The study involved 103 patients aged 18 to 69 years of both sexes with active RA. A dark-field microscope was used to assess the EGC condition. In the microcirculatory bed, it allows you to evaluate the depth of erythrocyte perfusion in the EGC thickness (PBR), micro vessel density (VMD) and the number of erythrocytes in them (RBC Filling). An increase in PBR indicates EGC thinning and is a marker of ED. A decrease in RBC Filling and VMD indicates a decrease in the functioning vessels number. Circulating syndecan1 (Sdc1) was assessed as a laboratory EGC damage marker. As a result of a two-step cluster analysis, based on dark-field microscopy, two clusters were identified in the study cohort. They were compared in terms of RF for an unfavourable course of RA and CVR. Results . Patients belonging to cluster 1 had thinner EGC (high PBR), low perfusion (low RBC Filling) and density (low VMD) of microvessels, higher levels of Sdc1 than in cluster 2. This indicates a significant impairment of microcirculation in cluster 1. Among the studied RF for an unfavorable course of RA and CVR, cluster 1 differed only in a lower frequency of taking disease-modifying antirheumatic drugs (DMARDs) compared to the other cluster. In the future, it was associated with the 3,6-fold greater need for DMARD therapy modification. Conclusions . The lack of DMARD therapy, compared with the other RF for the unfavorable course of RA and CVR, makes the greatest contribution to EGC damage and microcirculation disorders in patients with active RA. The revealed changes confirm relationship between endothelial disorders and the pathogenesis of this disease and determine the leading role of DMARD therapy in the RA treatment.

A SCIENTIFIC DRUG REVIEW ON PUNARNAVA MANDUR

Punarnava Mandura a classical Herbo mineral formulation is available on the market either in tablet form or in Churna form and is frequently used for Anemia, Low Platelet count, Low RBC count, swelling around Joints, Generalized Swelling, Gout and other end toxins accumulation. It is also a diuretic and is useful in renal disorders. In renal failure, it is used with Mutrakrichantak Churna for getting good results. Used with it. This medicine is more commonly used in North Indian Ayurvedic practice. Clinical research involves investigating proposed med- ical treatments, assessing the relative benefits of competing therapies, and establishing optimal treatment combi- nations. It is the most fruitful line of approach for methods of diagnosis and treatment as described in Ayurvedic literature. Anaemia is the most common indicator used to screen for iron deficiency, the terms anaemia, iron defi- ciency, Pandu roga is known since Vedic period and Iron preparations for the treatment of Pandu Roga has also been well known since ancient times. Punarnava as name designates regeneration; it may help to decrease, the work of Kidneys as it has Mutral properties. Keywords: Punarnava Mandur, herbomineral, Anemia.

Ophthalmic Manifestations in Acute Leukemia Patients and Their Relation With Hematological Parameters in a Tertiary Care Center.

Background: Leukemia is a neoplastic disorder that affects blood and bone marrow and is characterized by white blood cells' abnormal proliferation. Leukemia patients may present with different ophthalmic manifestations. This study aims to provide an updated data about the prevalence and types of ocular manifestations in acute leukemia patients and their relation with the hematological parameters.Methods: This retrospective cross-sectional study included all acute leukemia patients diagnosed from 2015 to 2020 and underwent an ophthalmic examination during this period at King Abdulaziz Medical City in Jeddah.Results: Eighty-one patients met the inclusion and exclusion criteria and had ophthalmic examinations. Forty-three (53.1%) patients were males, and 38 (46.9%) patients were females. Acute lymphocytic leukemia (ALL) was diagnosed in 55 (67.9%) patients, while acute myelogenous leukemia (AML) was diagnosed only in 26 (32.1%). Ophthalmic manifestations were observed in 23 patients with a prevalence of 28.4%. AML patients had more manifestations with a rate of 38.5%. ALL had a rate of 23.6% (p=0.1). Retinal hemorrhage was the most commonly seen manifestation in six patients.Conclusion: Ophthalmic manifestations are not uncommon in acute leukemia patients. Low hemoglobin and RBC could give an idea about the type of ophthalmic manifestation, not the presence or absence. It is highly recommended to examine acute leukemia patients routinely prior, during, and after the treatment to prevent serious ocular damage and monitor the course of the disease.

A cutaneous representation of parotid adenocarcinoma not otherwise specified

&lt;p class="abstract"&gt;Cutaneous manifestations of adenocarcinoma is a very rare entity. The patient reported to our institute with a complain of swelling on right parotid region that would bleed profusely merely on palpation. The hematological values revealed very low Hemoglobin, RBC and PCV counts indicating severe hemolytic anemia. The patient had palpable lymph nodes of level I and IIA which were enlarged. The patient underwent excision of the lesion along with modified radical neck dissection and reconstruction of the skin defect using pectoralis major myocutaneous flap.&lt;/p&gt;

Risk Factors Associated with Invasive Pulmonary Mycosis Among Severe Influenza Patients in Beijing City, China.

ObjectiveInfluenza co-infection with fungal infection increases the risk of death. Our study was to estimate risk factors associated with invasive pulmonary mycosis (IPM) among severe influenza patients at a single center in Beijing, China.MethodsA retrospective chart review was carried out of all patients with severe influenza admitted to respiratory the department including the respiratory intensive care unit (RICU) during the 2014 to 2019 influenza seasons in Beijing Chao-yang hospital, China. We compared the differences of characteristics and examination outcomes between IPM patients and non-IPM patients, and explored the predictors of IPM by a multivariate logistic regression.ResultsInfluenza associated IPM was found in 65 of 131 (49.62%) patients. The average age of IPM patients was 57.28±14.56 years and 70.77% were male. The mortality rate was much higher in the IPM group than the non-IPM group (34.85% versus 18.46%, P=0.026). Older age, hypoimmunity, liver disease, hypertension, positive serum GM test, steroids using, gasping, gastrointestinal symptoms, high APECHEII, low oxygenation index, other viruses co-infection, bacterial co-infection, low lymphocyte counts, low CD4+ T-cell counts, low CD8+ T-cell counts, low RBC, low hemoglobin, low platelets, high N%, low total protein, high CRP, low albumin, low fibrinogen, high BUN, positive serum GM test, more mechanical ventilation requirement, and more renal replacement requirement were risk factors of influenza IPM co-infection.ConclusionIPM is a severe complication of influenza hospitalizations. It is associated with increasing mortality, longer hospital stays, and higher hospital charges compared with non-IPM patients. Clinicians caring for patients with severe influenza should consider IPM.

Dyserythropoiesis Evaluated By Red Score and Hepcidin/Ferritin Levels Predicts Response to Epoetin Zeta in Lower Risk MDS

▪INTRODUCTION: Erythropoiesis stimulating agents (ESA) are generally the first line of treatment of anemia in lower risk myelodysplastic syndrome (MDS) patients (pts) with a recent approval of epoetin alfa in this indication in EU. Predictive factors of response to ESA (E Hellström, BJH 2003, S Park et al, Blood 2008, V Santini et al, Blood 2013; O Kosmider et al., Haematologica 2016) include low RBC transfusion requirement, low serum EPO level, serum ferritin (SF) level<300ng/ml, low IPSS-R, and ≤2 somatic mutations. In a clinical trial using a biosimilar (epoetin zeta) in lower risk MDS pts, we investigated new biomarkers using flow cytometry (Ogata and Red Scores) (Mathis et al, Leukemia 2013), somatic mutations, GDF-15 and hepcidin levels.METHODS: Main inclusion criteria for this multicenter prospective trial involving 16 French centers from 2013 to 2017 were: (1) IPSS low or int-1 MDS (2) ESA naive, (3) with Hb level< 10g/dL, transfusion dependent (TD) or not (4) without unstable cardiovascular disease, renal failure, folates, vitamin B12 or iron deficiency or active inflammatory status. Pts received epoetin zeta 40000 IU/week for at least 12 weeks and erythroid response (HI-E, IWG 2006 criteria) was assessed at W12. sEPO level, iron homeostasis markers, Ogata and Red Score (RS), GDF15, hepcidin, and molecular analysis by NGS on a 39-gene panel were determined at baseline (T0), and Ogata and RS were reassessed at W12.RESULTS: 70 pts were included. Median age was 78 years (range 57-93), M/F: 31/39. At inclusion, WHO classification was 22 RCMD, 19 RCUD, 14 RARS, 4 RAEB, 6 CMML, 2 del 5q-, 3 unclassifiable, IPSS was 43 low (61.4%), 27 int-1 (38.5%), and R-IPSS was 13 very low (18.5%), 47 low (67%), 9 int (13%) and high (0.7%). Twenty (28.5%) pts were TD (median of 2 RBC/ 8weeks). ECOG was ≥1 in 30 pts.Median Hb level was 9.5g/dL (IQR 8.9-10), Transferrin Saturation (TS) 39% (IQR 28-56), SF 411 ng/ml (IQR 258-831), sEPO level 49 U/L (IQR 25-122). Median Ogata score was 1 (IQR 1-2) at T0 and 2 (IQR 1-2) at W12. Median Red score (RS) was 7 (IQR 5-7) at T0 (with 90% of pts having RS ≥3), and 5 (IQR 4.75-7) at W12.Median GDF15 level was 1971 pg/ml (IQR 1236-2860). GDF15 was lower in IPSS low vs int-1 pts, and correlated with TS (p<0.003). Hepcidin level was 27 ng/ml (IQR 14-42; normal 1.3-26.4). Median hepcidin/ferritin ratio (HFR) was 5.5 (IQR 1.9-11.85). HFR was inversely correlated with MCV, serum iron, TS, GDF15, and RS at T0 and at W12, and with the number of mutations.Before treatment, NGS was performed in 68 pts. Most frequent mutations involved SF3B1 (n=26), TET2 (n=18), ASXL1 (n=14), SRSF2 (n=9), DNMT3A (n=9), U2AF1 (n=7), IDH2 (n=6), and EZH2 (n=6). No, 1, 2, 3, 4 or 5 mutations were detected in 12, 12, 26, 10, 7 and 1 pts respectively, and 26% of pts had >2 mutations.The erythroid response (HI-E) rate was 47.6%. Median duration of response was 13 months. Three pts progressed to AML. Twelve pts had died. Median OS was 41 mo.Responders had significantly lower baseline RS (median 5 in responders vs 7 in non-responders, p=0.01), higher HFR (median 9 vs 4.8, p=0.04), lower IPSS (p=0.01). GDF15 tended to be lower in responders (1822 pg/mL) vs non-responders (2180 pg/mL; p=0.47). Age, sex, ECOG, blood cell count (ANC, platelets, Hemoglobin), number and type of mutations, IPSS-R, SF, sEPO level, T0 and W12 Ogata score, previous RBC transfusions, decrease of RS and of Ogata score between T0 and W12 were not significantly associated with response. In multivariate analysis, only RS≥5 at T0 was significantly associated with worse HI-E (p= 0.007, OR 19, 95% IC: 2.1-476). HI-E was 39% in pts with RS≥5 vs 75% in pts with RS<5.CONCLUSION: Erythroid response (HI-E) to epoetin zeta was 48% in lower risk MDS and was correlated with higher baseline hepcidin/ferritin ratio and lower Red score at T0. In multivariate analysis, only Red Score≥5 was associated with worse HI-E, in this population with very low median sEPO level. DisclosuresMaloisel:Pfizer/Hospira: Research Funding. Drenou:Alexion: Consultancy, Honoraria. Fenaux:Celgene: Honoraria, Research Funding; Amgen: Honoraria, Research Funding; Amgen: Honoraria, Research Funding; Celgene: Honoraria, Research Funding; Astex: Honoraria, Research Funding; Janssen: Honoraria, Research Funding; Novartis: Honoraria, Research Funding; Janssen: Honoraria, Research Funding; Novartis: Honoraria, Research Funding; Astex: Honoraria, Research Funding. Laribi:MUNDIPHARMA: Research Funding; NOVARTIS: Honoraria, Research Funding; ROCHE: Research Funding; TEVA: Research Funding; HOSPIRA: Research Funding; AMGEN: Honoraria; TAKEDA: Honoraria, Research Funding. Pegourie:Takeda, Novartis, Janssen, BMS: Consultancy. Wagner Ballon:Alexion: Consultancy, Honoraria. Park:Celgene: Research Funding; Novartis: Membership on an entity's Board of Directors or advisory committees, Research Funding; Hospira/Pfizer: Research Funding.

Reversible Hyperpigmentation: A Diagnostic Dilemma

Vitamin B12 deficiency presents as megaloblastic anemia with neurological, skin and other clinical manifestations. We present here an interesting case of anemia presenting with generalized weakness and nonspecific symptoms in a female who is a vegetarian. There was acral hyperpigmentation without any other clinical features, Investigations revealed megaloblastic anemia with low vitamin B12 and normal RBC folate levels. The patient improved after blood transfusion and intramuscular vitamin B12 injections and the skin lesions faded away suggesting vitamin B12 deficiency to be the cause of hyperpigmentation, which is an uncommon manifestation. The importance lies in the fact that this cause of reversible hyperpigmentation should be thought of by clinicians to start prompt treatment.