Mean Platelet Count Research Articles

Effect of mean platelet volume and platelet count on the prognosis of branch atheromatous disease.

The purpose of this study was to investigate the predictive value of mean platelet volume (MPV) and platelet count (PC) in branch atheromatous disease (BAD). This retrospective study included 216 patients with BAD-stroke within 48h of symptom onset. These patients were divided into good and poor prognosis groups according to their 3-month modified Rankin scale scores after discharge. Multiple logistic regression analysis was used to evaluate independent predictors of poor prognosis in BAD-stroke patients. Receiver-operating characteristic (ROC) analysis was used to estimate the predictive value of MPV and PC on BAD-stroke. Our research showed that a higher MPV (aOR, 2.926; 95% CI, 2.040-4.196; p<.001) and PC (aOR, 1.013; 95% CI, 1.005-1.020; p=.001) were independently associated with poor prognosis after adjustment for confounders. The ROC analysis of MPV for predicting poor prognosis showed that the sensitivity and specificity were 74% and 84.9%, respectively, and that the AUC was.843 (95% CI,.776-.909, p<.001). The optimal cut-off value was 12.35. The incidence of early neurological deterioration (END) was 24.5% (53 of 163), and 66% of patients in the poor prognosis group had END (33 of 50). Multiple logistic regression analyses showed that elevated MPV and PC were associated with the occurrence of END (p<.05). Our results suggested that an elevated MPV and PC may be important in predicting a worse outcome in BAD-stroke patients. Our study also demonstrated an independent association of MPV and PC with END, which is presumably the main reason for the poor prognosis.

Thrombocytosis Is a Poor Prognostic Factor in Those Treated With Chemoradiation for Advanced Cervical Cancer [ID 2683596

INTRODUCTION: Prior to the addition of chemotherapy to radiation, thrombocytosis was seen as a poor prognostic factor for women with advanced cervical cancer. The objective of this study was to see in the chemoradiation era whether thrombocytosis was still a prognostic factor. METHODS: An IRB-approved study was performed analyzing all patients with cervical cancer receiving primary chemoradiation (cisplatin) as therapy over a 10-year period. Minimum follow-up was 30 months. Records were examined for initial platelet count at diagnosis, stage, grade, histology, and survival. Only patients receiving chemoradiation with stage IIa–IVb cervical cancer were studied and included in the final analysis. RESULTS: Two hundred nine with cervical cancer were diagnosed with 173 treated with primary chemoradiation. The most common stage was IIIb (88; 50.9%). The mean platelet counts of those receiving chemoradiation were significantly higher (396k/mL; 95% CI, 376–416k) than those with lower-stage disease (313k/mL; 292–334k) (P&lt;.001). Of the 173 patients, 42 (24.3%) had a platelet count &gt;450k/mL and 24 (13.9%) had a platelet count &gt;500k/mL. Patients who died of disease had significantly higher initial platelet counts (mean 433k/mL; 95% CI, 407–458k) than those who were alive at the completion of follow-up (mean 326k/mL; 95% CI, 303–350k). None of the patients with an initial platelet count greater than 500k/mL was alive at the time of follow-up. CONCLUSION: High platelet count at initial diagnosis is a poor prognostic factor in those with cervical cancer treated by primary chemoradiation.

Comparison of platelet count by automated hematology analyzer and peripheral blood smear in thrombocytopenic patient

Platelet count estimation is one of the common as well as important laboratory investigations to diagnose many diseases like dengue, malaria etc. Different methods for platelet estimations are automated haematology analyzer, peripheral blood smear examination method etc. Most common causes of inaccurate platelet count by automated analyser are the presence of giant platelets, platelet clumps etc. leading to erroneous result like false low platelet count etc. We aimed to compare platelet count estimation by automated haematology analyzer and the peripheral blood smear examination in thrombocytopenic patients. A comparative cross-sectional study was conducted on 100 blood samples of patients which came thrombocytopenic on automated haematology analyzer. Each case was also analyzed by peripheral blood smear examination and compared with its corresponding automated haematology platelet count value. Our study included 63% males and 37% females, with the mean age of 38.8 years. Most of the patients belonged to the age group of 30-40 years (34%). The mean platelet count on automated analyzers was 85.46 ± 38.81 x 103/uL whereas on peripheral smear was 92.13 ± 38.30×103/uL with a significant difference between the two groups (p-value &lt;0.0001).Pseudo-thrombocytopenia was observed in 10% of patients, with giant platelets observed in 29% of the cases on blood smear. In view of false low platelet count by automated analyser, we concluded that manual examination by peripheral blood smear examination should always be considered whose platelet count is low by automation.

Study of Platelet Indices as a Predictive Parameter for Diabetic Complications in Type II Diabetes Mellitu-A Cross Sectional Study

Introduction: Diabetes Mellitus is a prothrombotic state with enhanced platelet activity. The enhanced platelet activity may result in the development of microvascular and macrovascular complications. Platelet indices i.e. Mean Platelet volume (MPV), Platelet Distribution Width (PDW) are routinely available in alllaboratories and can be used to study as a prognostic marker for the patients. Aim: To evaluate platelet indices in patients with type 2 diabetes mellitus. Methods and Material: Cross sectional study was conducted in the Department of Pathology at a tertiary care centre over a period of 18 months. Samples of 120 patients of type 2 diabetes with and without complicationswere investigated. Haematological (platelet count and platelet indices i.e. Mean platelet indices and Platelet distribution width) and biochemical parameters (Fasting blood sugar and HbA1c) were compared between diabetic patients with and without complications. Platelet indices were measured using automated haematology analyser. Statistical evaluation was performed using SPSS version 16.0. Results: In DM with complication17 (28.33%) out of 60 cases were between the age group of 51-60 years, 14 (23.33%) out 60 belonged to the age group of 61-70 years and 12 (20%) patients were &gt;70 years of age. The mean platelet volume was 12.74±3.076 and 8.65±1.58 for diabetes with and without complications. The mean platelet distribution width was 15.54 and 13.94±2.66 for diabetes with and without complications. The mean HbA1c was 8.33 and 6.75 for diabetes with and without complications. The mean platelet count was 3.12 Lac/mm3 and 2.45 Lac/mm3 for diabetes with and without complications. The mean fasting blood sugar was 219.65 and 109.96 for diabetes with and without complications. Conclusion: Diabetes is responsible for endothelial dysfunction and platelet hyperactivity. In our study, diabetic patients with uncontrolled glycaemic index and raised fasting blood sugar level had raised platelet indices in comparison to patients without complication where the platelet count, platelet indices level and glycaemic index were within normal limits. These indices can also be used as a prognostic tool.

Nonlinear relationship between platelet count and 30-day in-hospital mortality in intensive care unit stroke patients: a multicenter retrospective cohort study.

Evidence of the relationship between platelet count and 30-day in-hospital mortality in ICU stroke patients is still scarce. Therefore, the purpose of this study was to explore the relationship between platelet count and 30-day in-hospital mortality among ICU stroke patients. We conducted a multicenter retrospective cohort study using data from 8,029 ICU stroke patients in the US eICU-CRD v2.0 database from 2014 to 2015. Utilizing binary logistic regression, smooth curve fitting, and subgroup analyses, we examined the link between platelet count and 30-day in-hospital mortality. The 30-day in-hospital mortality prevalence was 14.02%, and the mean platelet count of 223 × 109/L. Adjusting for covariates, our findings revealed an inverse association between platelet count and 30-day in-hospital mortality (OR = 0.975, 95% CI: 0.966, 0.984). Subgroup analyses supported the robustness of these results. Moreover, a nonlinear relationship was observed between platelet count and 30-day in-hospital mortality, with the inflection point at 163 × 109/L. On the left side of the inflection point, the effect size (OR) was 0.92 (0.89, 0.95), while on the right side, the relationship was not statistically significant. This study establishes an independent negative association between platelet count and 30-day in-hospital mortality in ICU stroke patients. Furthermore, a nonlinear relationship with a saturation effect was identified, suggesting that maintaining the platelet count around 163 × 109/L can reduce 30-day in-hospital mortality in these patients.

Thrombocytopenia after sutureless and standard stented aortic valve replacement: a retrospective analysis of risk factors, clinical course, and early outcome

ObjectivesThrombocytopenia following Perceval aortic valve replacement has been described previously with variable outcome. Studies have lacked a robust analysis of platelet fluctuation and factors affecting it. We aimed to statistically describe the trend in thrombocyte variability as compared with conventional aortic valve replacement, and to assess predictors as well as impact on associated outcomes.MethodsOne hundred consecutive patients with first-time Perceval were retrospectively compared to 219 patients after Perimount Magna Ease valve replacement. The primary outcome was the serial thrombocyte count on day 0–6. Generalized estimating equations were used to analyse the data using fixed-effect models: for the effect of the post-operative day on platelet count, and random-effect models estimating both time-variant (platelets) and time in-variant variables (valve type, age, LV function, pre-op platelet level).ResultsPerceval patients were older (72 ± 1 vs 68 ± 1 years, p < 0.01) with higher NYHA status (3(2–3) vs 2(1–2), p < 0.001). Mean platelet count in the sutureless group was lowest on day 2 (91.9 ± 31.6 vs 121.7 ± 53.8 × 103 µl−1), and lower on day 4 (97.9 ± 44) and 6 (110.6 ± 61) compared to the conventional group (157.2 ± 60 and 181.7 ± 79) but did not result in a higher number of transfusions, bleeding or longer hospital stay (p > 0.05). Reduced platelet count was a strong predictor of red cell transfusion in the conventional (p = 0.016), but not in the sutureless group (p = 0.457). Age (Coef -1.025, 95%CI-1.649—-0.401, p < 0.001) and CPB-time (Coef 0.186, 95%CI-0.371—-0.001, p = 0.048) were predictors for lower platelet levels.ConclusionConsidering the older patient profile treated with Perceval, postoperative thrombocytopenia does not impact on outcome in terms of transfusions, complications or hospital stay.

THE SIGNIFICANCE OF MINIMAL RESIDUAL DISEASE IN ACUTE LYMPHOBLASTIC LEUKAEMIA: A SINGLE CENTRE STUDY

In Acute lymphoblastic Leukemia (ALL) assessment of molecular response to treatment, assessing minimal residual disease (MRD) is a major independent predictor of treatment outcome. Consequently, MRD is implemented in all ALL-treatment protocols to fill up or to redefine stratification of multifactorial risk with optional intensity of customized treatment. Aim: to specify the significance of MRD in the assessment of remission in children with ALL with results discordant between morphology and flow cytometry at the end of induction phase of therapy. Materials and Methods: A descriptive cross-sectional study was conducted at Jin Oncology Center from March 2019 through November 2023. Data were taken out of the records of 58 patients who had ALL less than 16 years old. All patients were less than 16 years old and treated by ukall. They were diagnosed using peripheral blood morphology, bone marrow study and/or flow cytometry when lymphoblasts in peripheral blood or bone marrow aspirate are ≥20% and was confirmed by flow cytometry. On 29th day of induction therapy, bone marrow was examined for morphology and flow cytometry. The presence or absence of MRD was determined, and CD19, CD10 and tdt were tested. By morphologic assessment they were divided patients into: Category 1, C1 (&lt;5% blasts), Category 2, C2 (5-20% blasts), and Category 3, C3 (&gt;20% blasts). Statistical analysis was made using SPSS version 25. P value of less than 0.05 was considered significant. Results: The study involved 58 patients who had ALL. with a median age of 6.5 years, male to females ratio of 1.76:1, mean platelet count of 96.6 x 10⁹/L ,mean hemoglobin of 8.6 g/dL, mean leucocyte count of 74.3 x 10⁹/L), 48 cases (82.7%) of B-cell lineage and 10 cases (17.3%) of T-cell lineage, 94.6% of the B-cell cases were of the common B-ALL and the rest Pro-BALL type, 54.6% of the T-cell ALL was cortical T-ALL and 44.4% Early T-cell ALL. They were tested for MRD by morphology and flow cytometry on day 29. By morphology, 46 patients had remission but by flow only 24 cases. Seventeen cases had residual blasts &gt;5%. In 19 cases there was a discrepancy between the results of morphology and flow. Twenty-five cases (52.08% of B-cell cases) were positive for MRD by flow results. Eight of the ten cases of T-ALL (80%), were positive for MRD by flow cytometry. Among 48 cases of B-ALL, 36 were in C1 category (morphologically in remission), 11 cases were in C2 category and one case in the C3 category. Of cases in C1 category, 17 were MRD +ve and 19 were MRD –ve by flow cytometry. In the C2 category, only 2 out of the 11 cases (18.18%) had discordant results between morphology and flow results. The correlation between morphology and flow results was 100% in the C3 category. Conclusion: MRD should not be the surrogate of morphology but to be used in conjunction in order to give us a more accurate representation of status of remission.

Investigating Platelet Count in Children With Chronic Idiopathic Thrombocytopenic Purpura

Objectives: Idiopathic thrombocytopenic purpura (ITP) is an immune-mediated disease associated with immune dysregulation and autoantibody production. Numerous studies have shown that vitamin D has a protective effect against autoimmune diseases. As vitamin D deficiency has been identified in the majority of children with chronic ITP, this study evaluates the effects of vitamin D supplementation on the platelet count of such children. Methods: This was a quasi-clinical trial study and the study population consisted of children with chronic ITP who were referred to Afzalipur Hospital in Kerman City, Iran, from August 2020 to September 2021. All patients' vitamin D levels were measured and subjects with levels below 30 mg/dL were treated while the remaining children received the standard vitamin D supplementation. Subsequently, after a 3 and 9-month interval, patients’ vitamin D levels and platelet counts were assessed. Results: As a result, the mean serum vitamin D level increased significantly from 21.34±5.87 mg/dL to 34.25±5.64 mg/dL throughout the study. The mean serum platelet count was 18085.71±1292.10 µL at the start of the trial, 26628.57±1727.72 µL after 3 months, and 32114.28±1127.77 µL after 9 months, which showed a significant increase. Discussion: In conclusion, vitamin D boosts platelet count in chronic ITP patients. Thus, all children with chronic ITP should be evaluated and treated for vitamin D insufficiency.

Growth performance, Haematological and Serum biochemistry of broilers fed diets containing Vitex doniana leaf meal

This experiment was conducted to investigate the growth performance, haematological and serum biochemistry indices of broilers fed diets containing Vitex doniana leaf meal (VDLM). A total of 120 unsexed broilers were allocated to four treatments of T1, T2, T3 and T4 and replicated three times with ten birds per replicate in a Completely Randomized Design. The birds in each treatment were fed with diets containing 0.0, 2.5, 5.0 and 7.5% VDLM respectively. Growth performances, packed cell volume, red blood cell count, haemoglobin, white blood cell count, lymphocytes, neutrophils, mean corpuscular volume, mean corpuscular haemoglobin concentration, platelet count, aspartate amino transaminase, alanine amino transaminase, alkaline phosphate, high density lipoprotein, low density lipoprotein, cholesterol, albumin, globulin, urea, glucose, total protein and creatinine were evaluated. Growth performance results showed that there were significant differences (P&lt;0.05) in all the measured parameters except feed cost. The result of the experiment showed that there were significant differences (P&lt;0.05) in all the heamatological and serum biochemistry parameters at starter and finisher phases, except for haemoglobin and mean corpuscular haemoglobin concentration which were not significantly different (P&gt;0.05) at the starter phase. Growth performances of broilers fed control diets were better than the other treatment diets. Mean corpuscular haemoglobin, platelet count and low density lipoprotein decreased progressively while mean corpuscular volume, neutrophils, alanine amino transaminase, aspartate amino transaminase and creatinine increased progressively with increase in the inclusion of VDLM at the finisher phase. At the finisher phase, haemoglobin, packed cell volume and glucose decreased progressively while high density lipoprotein increased progressively with increase in VDLM. The results show that VDLM reduced the growth performance but improved the heamatological and serum biochemistry of broiler at lower levels of inclusion.

Effect of phototherapy on haematologic indices in neonatal hyperbilirubinemia

Objective: The purpose of this study was to investigate the clinical significance of the platelet to lymphocyte ratio (PLR) and the neutrophil to lymphocyte ratio (NLR) in term neonates and its impact on management of neonatal hyperbilirubinemia on phototherapy Materials and Methods: This observational study was conducted with 20 term neonates diagnosed with neonatal hyperbilirubinemia, and recieved phototherapy. Exclusion criteria were prematurity, post- maturity, small or large for gestational age according to week of pregnancy, babies born to mothers with GDM or pre-eclampsia and congenital defects. Results: We observed that there was an increase in the lymphocyte counts from 12650 cells/mm3 before phototherapy to 10360 cells/mm3 after phototherapy with a p-value 0.03*. The mean platelet count also decreased from 209×103 cells/mm 3 to 258×103 cells/mm 3 with a p-value of 0.045 which was significant. Rest of the blood cell counts seem to be unaltered by phototherapy. Conclusions: NLRs and PLRs were reduced due to phototherapy in term neonates, and these ratios can be used to aid in management in term neonates with hyperbilirubinemia on phototherapy.

Pattern and burden of thrombocytopenia in chronic hepatitis C virus patients at a tertiary care hospital

Objective: To determine the frequency of thrombocytopenia in chronic Hepatitis C virus infection. Material and Methods: This Descriptive cross-sectional study was conducted at department of Hematology, King Edward Medical University, Lahore from February 2023 to October 2023. A total of 143 patients of either gender with chronic Hepatitis C virus infection were included in the study. For every patient, a fresh 3 ml blood sample was collected by syringe using aseptic technique in a vacutainer containing EDTA. A complete blood count was carried out using Automated Hematology Analyzer and peripheral blood smear was prepared using Wright Giemsa stain to establish whether thrombocytopenia was present or not. Thrombocytopenia was assessed by Neubauer chamber. Results: Age range in this study was from 18 to 65 years with mean age of 44.132±7.34 years, mean duration of HCV 12.685±4.53 months and mean platelet count was 238076.923 ± 100165.08/µL. Thrombocytopenia was seen in 37.1% patients. Conclusion: Our results show that chronic hepatitis C infection is related to high frequency of thrombocytopenia. The higher the duration of disease process, higher is the risk of thrombocytopenia in these patients. This study highlights that identification by screening, timely diagnosis and treatment of Hepatitis C infection can prevent thrombocytopenia and its complications. Serial hematological follow up can play a pivotal role in such patients. Keywords: Chronic hepatitis, Hepatitis C virus, Thrombocytopenia

DELINEATION OF HEMATOLOGICAL CHANGES OCCURRING IN STORED CITRATE PHOSPHATE DEXTROSE ADENINE CPDA-1 BLOOD

Objectives: To study the changes in red cell indices and counts over a period of 42 days in blood stored in blood bags. Materials and Methods: This research was done in Blood Bank, Khyber Teaching Hospital, Peshawar in collaboration with the main laboratory, Khyber Teaching Hospital, Peshawar. About 450 ml of whole blood was taken from 200 donors into Citrate Phosphate Dextrose Adenine blood bags. The storage temperature for the blood bags was maintained between 2–8°C. Blood samples were collected from blood bags. At days 1 and 42, using a haematology analyser, parameters including haemoglobin, RBC count, WBC count, haematocrit, mean corpuscular volume, mean corpuscular haemoglobin, mean corpuscular haemoglobin concentration and platelet counts were measured. Mean and standard deviation were used for quantitative variables. Frequency and percentages were used for qualitative variables. Results: Through days 1 to 42, Haemoglobin (Hb) level decreased from 13.4gm/dl to 12.78 gm/dl, white cell count (WBC) decreased from 6.03x109/l to 2.95 x109/l, platelets count fell from 207 x109/l to 121 x109/l, neutrophils decreased from 59.6% to 23.8% while lymphocyte count increased from 28.36% to 66.3%. Conclusion: There is a decrease in haemoglobin level and white cell count over a period of 42 days of storage of blood bags. Lymphocyte counts increased during the storage duration of blood bags.

Baseline and average platelet count can predict the outcome of patients with aneurysmal subarachnoid hemorrhage

BackgroundBaseline values and the change of platelet count (PLT) during disease were reported to be associated with prognosis of patients with cancer and intensive care treatment. We aimed to evaluate the association between PLT with the course and prognosis of aneurysmal subarachnoid hemorrhage (SAH). MethodsAdmission (AdmPLT) and the 14-days mean PLT (MeanPLT) values of 763 SAH patients treated between 01/2005 and 06/2016 were recorded and, for further analysis, divided into four categories: <150, 150–260, 261–400 and > 400 × 109/L. Primary endpoints were cerebral infarcts in follow-up computed tomography scans, in-hospital mortality and unfavorable outcome at 6-months follow-up defined as modified Rankin scale>3. Adverse events during SAH were assessed as secondary endpoints. ResultsHigher PLT values were independently associated with lower risk of cerebral infarction (MeanPLT: aOR = 0.65 per-PLT-category-increase, p = 0.001), in-hospital mortality (AdmPLT: aOR = 0.64, p = 0.017; MeanPLT: aOR = 0.23, p < 0.0001) and unfavorable outcome (AdmPLT: aOR = 0.70, p = 0.031; MeanPLT: aOR = 0.35, p < 0.0001). Moreover, individuals with poorer outcome were less prone to PLT increase during SAH (mean values: -+20.3 vs + 30.5 × 109/L for cerebral infarction; +9.3 vs + 32.8 × 109/L for in-hospital mortality; +14.4 vs + 31.1 × 109/L for unfavorable outcome). The following adverse events during SAH were related to AdmPLT and/or MeanPLT: non-aneurysm related secondary rebleeding, intracranial hypertension requiring conservative treatment or decompressive craniectomy, sepsis and acute kidney failure. ConclusionLow PLT at admission and their less prominent increase during SAH were strongly linked with poor outcome of SAH. Further analysis is required to clarify the background of this association and potential therapeutic implications.

Immuno-Hematological and Biochemical Changes in Patients with Tuberculosis in Dessie Comprehensive Specialized Hospital, Dessie, Ethiopia.

Tuberculosis (TB) is a serious worldwide health issue, particularly in developing nations like Ethiopia. Patients with tuberculosis experience a range of hematological, immunological, and biochemical alterations. The purpose of this study was to evaluate immunological, hematological, and biochemical alterations of newly diagnosed TB patients at Dessie comprehensive specialized hospital, Dessie, Ethiopia. A comparative, cross-sectional study was carried out to evaluate the immuno-hematological and biochemical changes in patients with tuberculosis at Dessie comprehensive specialized hospital from January to July 2018. One hundred sixty-four (164) newly diagnosed TB patients, and 80 apparently healthy controls were included consecutively. The variables were expressed in frequency, percentage, and mean ± SD. To compare mean ± SD of the groups or within the groups, we used an independent sample t-test. Statistical significance was defined as a P value less than 0.05. Male TB patients had significantly high mean absolute WBC count, neutrophil count, lymphocyte, platelet count, and systemic immune-inflammation compared with male healthy controls (P=0.001, P=0.011 P=0.021, P=0.001, and P=0.018, respectively). The mean platelet count of female TB patients was significantly higher than that of the female control group (P=0.015). However, mean RBC counts, Hgb, HCT, and MPV of TB patients were significantly lower than those of male (p<0.001) and female healthy controls (P=0.022, 0.015, and 0.001, respectively). The TB patients had developed anemia (23.8%), WBC abnormalities (29.3%), thrombocytosis (11.6%), and thrombocytopenia (9.8%). The cases had significantly higher mean alanine amino transferase, total bilirubin, and glucose level, but the mean total protein, alkaline phosphatase, and total cholesterol of cases were significantly lower than healthy control groups. TB patients in this study showed significant alterations in a number of hematological and biochemical profiles. This indicates that hematological and biochemical profiles should be monitored and properly interpreted for the differential diagnosis of tuberculosis and evaluation of response to treatment.

Prognostic value of systemic immune-inflammation index in the diagnosis of preeclampsia

BackgroundPreeclampsia is a serious complication of pregnancy with negative consequences for the mother and fetus. It was aimed to investigate whether the systemic immune inflammation index is a parameter that will facilitate the diagnosis of preeclampsia. MethodsThis retrospective and single-center study included patients diagnosed with preeclampsia after admission to the emergency department and those who met the inclusion criteria. Vital parameters, demographic data, medical history, white blood cell count, platelet count, neutrophil count, systemic immune-inflammation index values, biochemical parameters, and gestational weeks were analyzed in each patient. ResultsA total of 40 patients with preeclampsia (preeclampsia group) and 40 normal pregnant women (control group) were included. Laboratory tests revealed that the mean WBC, neutrophil, and lymphocyte counts were significantly higher in the preeclampsia group than in the control group, whereas the preeclampsia group had a significantly lower mean platelet count than the control group (p < 0.001). The sensitivity and specificity for the cut-off value of 758.39 × 109/L systemic immune-inflammation index in pregnant patients with preeclampsia was 77.5% and 67.5%, respectively (AUC: 0.705; 95% CI: 0.587–0.823; p = 0.002). No significant difference was observed between the mean neutrophil-to-lymphocyte ratio in preeclampsia diagnosis. ConclusionThe systemic immune-inflammation index may be used as a marker to help in establishing the diagnosis of preeclampsia. We believe that this index is an important prognostic indicator because it concurrently evaluates neutrophil and lymphocyte values—which indicate the inflammation process—and platelet count, i.e., an indicator of coagulopathy.

Rituximab versus Splenectomy in Chronic Primary ITP: Experience of a Single Hematology Clinic.

Immune thrombocytopenia (ITP) is an acquired immune-mediated disease that lacks an underlying etiology. Steroids are the main first-line treatment of ITP, while the second-line treatment consists primarily of splenectomy and rituximab. This study aimed to assess and compare the response to rituximab and splenectomy. This retrospective comparative study reviewed ITP patients treated at a single private hematology clinic from 2007 to 2019. Seventy-four ITP patients were recruited, 27 were on rituximab, and 47 had undergone splenectomy. The initial platelet counts and bleeding symptoms were recorded, and initial and long-term responses to treatment were evaluated based on the American Society of Hematology guidelines. The mean age of the patients was 42.1 years with a male-to-female ratio of 1:1.8. The initial mean platelet count was comparable between the rituximab and splenectomy groups (p = 0.749). The initial complete response (CR) differed significantly between the rituximab and splenectomy groups (44.4% versus 83%, p = 0.002). The five-year response rate was significantly higher in the splenectomy than in the rituximab group (74% versus 52%, log-rank 0.038). Splenectomy was the only significant predictive factor for long-term response (OR = 0.193, p = 0.006). The overall response revealed that splenectomy appeared superior to rituximab as a second-line treatment of ITP. Splenectomy was the only positive prognostic indicator of sustained response.

Improved prediction of sepsis-associated encephalopathy in intensive care unit sepsis patients with an innovative nomogram tool.

Sepsis-associated encephalopathy (SAE) occurs as a result of systemic inflammation caused by sepsis. It has been observed that the majority of sepsis patients experience SAE while being treated in the intensive care unit (ICU), and a significant number of survivors continue suffering from cognitive impairment even after recovering from the illness. The objective of this study was to create a predictive nomogram that could be used to identify SAE risk factors in patients with ICU sepsis. We conducted a retrospective cohort study using the Medical Information Mart for Intensive Care IV (MIMIC-IV) database. We defined SAE as a Glasgow Coma Scale (GCS) score of 15 or less, or delirium. The patients were randomly divided into training and validation cohorts. We used least absolute shrinkage and selection operator (LASSO) regression modeling to optimize feature selection. Independent risk factors were determined through a multivariable logistic regression analysis, and a prediction model was built. The performance of the nomogram was evaluated using various metrics including the area under the receiver operating characteristic curve (AUC), calibration plots, Hosmer-Lemeshow test, decision curve analysis (DCA), net reclassification improvement (NRI), and integrated discrimination improvement (IDI). Among the 4,476 sepsis patients screened, 2,781 (62.1%) developed SAE. In-hospital mortality was higher in the SAE group compared to the non-SAE group (9.5% vs. 3.7%, p < 0.001). Several variables were analyzed, including the patient's age, gender, BMI on admission, mean arterial pressure, body temperature, platelet count, sodium level, and use of midazolam. These variables were used to create and validate a nomogram. The nomogram's performance, assessed by AUC, NRI, IDI, and DCA, was found to be superior to the conventional SOFA score combined with delirium. Calibration plots and the Hosmer-Lemeshow test confirmed the accuracy of the nomogram. The enhanced NRI and IDI values demonstrated that our scoring system outperformed traditional diagnostic approaches. Additionally, the DCA curve indicated the practicality of the nomogram in clinical settings. This study successfully identified autonomous risk factors associated with the emergence of SAE in sepsis patients and utilized them to formulate a predictive model. The outcomes of this investigation have the potential to serve as a valuable clinical resource for the timely detection of SAE in patients.

Dengue Cases Presenting to the Emergency Department of a Tertiary Care Hospital in Late 2021: A Cross-Sectional Study in Karachi.

Objectives: Dengue Fever (DF) is an arboviral disease caused by the Dengue virus (DENV). This study aims to assess the association of dengue prevalence with patients' residential areas and hematological laboratory findings (Total platelet count, immunoglobulins, and dengue antigens) during COVID-19 pandemic. Methods: A retrospective study was conducted at the Emergency department of Jinnah Postgraduate Medical Center, Karachi from October to December 2021. All the patients irrespective of their ages presenting to the ED with either of the following complaints: fever; GIT problems; vomiting; body ache; bleeding were included in our study. Results: Our study comprised 189 patients in total in which the females (n = 172) outnumbered the males (n = 17). Out of all, 84.7% of the patients were febrile having a low-grade fever on average. Korangi district had the most dengue cases, while Keamari had the fewest. There was no significant association reported between mean platelet count, mean TLC, and mean hemoglobin levels with dengue positivity. Conclusion: There is a concerning rise in DF cases in Karachi, particularly in the Korangi district. Despite the COVID-19 pandemic, DF demands urgent attention.

Assessment of Platelet Indices as Biomarker for Neonatal Sepsis

Introduction: There is a need to increase the diagnostic capability of the traditional septic screen by adding additional markers. Platelet indices are one such marker that is readily available in routine hemogram reports. Materials and Methods: In this cross-sectional study, all newborn babies were recruited who had signs or symptoms of sepsis or had high-risk factors. Those who had clinical sepsis with positive cultures and/or a positive sepsis screen were classified under group “cases” ( n = 174), whereas all neonates suspected to have sepsis but who had a negative blood culture and a negative sepsis screen were classified under group “control” ( n = 126). Blood culture, sepsis screen, and platelet indices [platelet count, mean platelet volume (MPV), and platelet distribution width (PDW)] were performed on all babies. Babies with congenital or acquired causes of platelet abnormalities (including medication use by mothers with antiplatelet activity) were excluded from this study. Results: In this study, a total of 300 newborn babies were recruited for final analyses. Overall culture positivity was 38%. The mean platelet count was lower in the cases group ( P &lt; 0.001). MPV and PDW were higher in septic babies with statistically significant differences ( P &lt; 0.0001 and P = 0.012, respectively). Thrombocytopenia was the most sensitive marker (85.60%). However, it had low specificity (28.2%). On combining all three platelet markers, specificity increased to 48.4% (with a sensitivity of 64.5%) in detecting babies with neonatal sepsis. The sensitivity of the septic screen alone was 58% (with a specificity of 32.62%). When combining the sepsis screen and platelet indices, the specificity for the diagnosis of neonatal sepsis increased to 62.6%. On receiver operator curve analyses, thrombocytopenia had the highest area under the curve (0.692), followed by MPV (0.644). Conclusion: Platelet indices may be used as sensitive markers in combination with traditional sepsis screening to make an early diagnosis of neonatal sepsis.

Effect of Carica Papaya Leaves Juice on Plasma Leakage and Platelet Count among Children with Dengue Fever and Dengue Haemorrhagic Fever

Background: Over the last 10-15 years, dengue fever (DF) and dengue hemorrhagic fever (DHF) have become the leading causes of hospitalization and death among both children and adult. Carica papaya leaves juice is said to be increase platelet count and improve haematocrit. Objective: This study aimed to determine the effect of Carica papaya leaf juice on plasma leakage and platelet count in child patients with DF and DHF. Methods: This randomized controlled trial was conducted among 77 children with DF and DHF. Patients were purposively selected from the inpatient department of Dhaka Shishu hospital from July 2018 to December 2019. Patients were randomly allocated in group A and group B. Group A patients received standard treatment along with a bottle containing C. papaya leaves juice 10 ml single morning dose 15 minutes after breakfast for three consecutive days and group B patients received only standard management as per the National Guideline for Clinical Management of Dengue Syndrome, 2018. Three patients in group A and two patients in group B dropped out from the study. Results: There was no significant difference between the groups regarding age, sex, mean duration, type and severity of fever between the groups (p&gt;.05). In group A, the mean platelet count increased from 105000.00/ mL to 152428.57/mL after 48 hours and it reached to 212228.57/mL at 72hrs. In group B, the mean platelet count initially decreased from 129485.71/ mL to 91114.28/mL after 48 hours and then it increased to 96142.85/mL at 72 hours. There was highly significant statistical difference between group A and group B at 48 hours and at 72 hours regarding mean platelet count as p&lt;.001. Haematocrit values become significantly normal in group A then group B by 72 hours and p˂.05. There was highly significant statistical difference between group A and group B regarding mean hospital stay as p&lt;.001. Conclusion: Administration of Carica papaya leaf juice increase platelet count, maintain .......