Mean Red Blood Cell Research Articles

Acute Toxicity Effect of Mulsate (Glyphosate) Herbicide on Behaviour and Haematological Indices of African Catfish (Clarias gariepinus Burchell 1822) Juvenile

A semi-static bioassay method was used to study the toxicity effect of acute exposure of a commercial formulation of glyphosate herbicide (Mulsate) on the behaviour and haematological profile of Clarias gariepinus juvenile. Sample fish were exposed to lethal concentrations of mulsate at 0.00mg/l, 55.00mg/l, 65.00mg/l, and 75.00mg/l for 96 hours. Behavioural characteristics observed in exposed fish include respiratory distress, erratic swimming, loss of equilibrium, lethargies and sudden fish death. These varied greatly with differences in concentration of the toxicant. Mortality increased with an increase in concentration of the toxicant. The differences observed in the mortalities of C. gariepinus at varying concentrations were significant (P<0.05), an indication that mortality could be a factor of concentration and time of exposure. After 96 hr of exposure, the LC50 for mulsate glyphosate herbicide was found to be 44.67mg/l. Furthermore, the toxicant led to significant reduction (P<0.05) in haematological parameters as the toxicant concentration increased. Mean Red Blood Cells (RBC), Haemoglobin content (Hb), Packed Cell Volume (PCV), reduced as the concentration of toxicant increased. Mean corpuscular volume (MCV), mean corpuscular haemoglobin (MCH), and mean corpuscular haemoglobin concentration (MCHC) were significantly different (P <0.05) between the treated and control fish. Our results indicate that the commercial formulation of glyphosate herbicide (Mulsate) is toxic to C. gariepinus. The herbicide must hence be applied with care in our environment particularly close to water bodies to avoid ecotoxicological consequences.

The relationship between food quality score with inflammatory biomarkers, and antioxidant capacity in young women.

Diet has the potential to decrease oxidative stress and inflammation and this may be beneficial in several diseases. This study investigated the association between food quality score (FQS) with antioxidant and inflammatory properties in 171 apparently healthy young women. This cross-sectional study was conducted using a validated food frequency questionnaire to determine the dietary intake of participants. FQS was calculated by summing all the scores obtained from healthy and unhealthy food groups. The total antioxidant capacity and free radical scavenging activity of serum and urine were quantified using the ferric reducing/antioxidant power (FRAP) and α, α-diphenyl-β-picrylhydrazyl (DPPH) methods, respectively. Malondialdehyde (MDA) was measured using the formation of thiobarbituric acid reactive substances (TBARS). White blood cell (WBC) and neutrophil counts, mean platelet volume (MPV) and red blood cell distribution width (RDW), were measured. Neutrophil: lymphocyte ratio (NLR), platelet: lymphocyte ratio (PLR), and RDW: platelet ratio (RPR) were also calculated. A high food quality (rich in fruit and vegetables, nuts, whole grain, and low intake of sweetened beverage, potato chips and fried food from outside the home) was related to lower hematological inflammatory biomarkers including WBC count, RDW, NLR, and PLR. Multivariable-adjusted odds ratios (95% CIs) demonstrated that higher FQS group (third tertile vs. first tertile) was associated with a significant lower levels of urinary FRAP (ORadj =0.82; 95%CI: 0.70 to 0.97), and DPPH. High food quality was associated with reduced of markers of inflammation and oxidative stress in Iranian young girl.

Glucose-6-Phosphate Dehydrogenase Deficiency in Icteric Newborns at the Essos-Yaoundé-Cameroon Hospital

Background: Glucose-6-phosphate dehydrogenase deficiency is an enzymopathy characterized by insufficient production of reduced glutathione (GSH), a molecule known for its antioxidant role. This lack of GSH leads to a deficit in the elimination of peroxide ions from the red blood cells, causing thereby hemolytic accidents, which can be fatal if not properly managed. In neonates, the clinical picture is most often that of neonatal jaundice. Objectives: This study aimed to determine the place of G6PD deficiency as a cause of neonatal jaundice at Essos Hospital Centre. Methods: We conducted a prospective descriptive study over three months. Blood samples taken from newborns aged 0 to 28 days were analyzed in the medical analysis laboratory of the Essos Hospital Centre in Yaoundé. We carried out a determination of the enzymatic activity of G6PD, a blood count and the determination of the bilirubin level. The results obtained were analysed using R statistical software version 4.1.1. Linear regression analyses were used to assess correlations between the variables of interest. Results: Sixty-nine icteric neonates constituted our study population, with a total of 40 boys (58%) and 29 girls (42%) with a sex ratio of 1.37 in favour of boys. The prevalence of G6PD deficiency in icteric children was 50.72%. The mean hemoglobin was 15.3 ± 3.08 g/dL and the mean red blood cell count was 4.52 ± 1.01 × 106/mm3. The mean total bilirubin was 122 ± 48.3 mg/L with a maximum of 308 mg/L and the mean free bilirubin was 104 ± 46.6 mg/L with a maximum of 292 mg/L. Furthermore, after linear regression analysis, we obtained a positive and significant correlation between G6PD enzymatic activity and hemoglobin level (r = 0.33; p ≤ 0.001), G6PD red blood cell level (r = 0.26; p Conclusion: Neonatal jaundice in G6PD-deficient children is a real public health problem and the prevention of hemolysis in children requires an early diagnosis of the enzyme disorder and good follow-up of the children.

Evaluations of the diurnal variations in the haematological profiles of domestic fowls

The diurnal fluctuation in the haematological parameters of the domestic fowls was investigated using twenty four (24) male Isa Brown chickens. Twenty four (24) apparently healthy Isa Brown chickens of average mean weight 1.99±0.12 kg (1.85-2.30kg) aged 18 weeks were used for this study. The Isa Brown chickens (24) were randomly assigned to four treatment groups (A to D) of six chickens per group in a completely randomized design (CRD). Group A: Early morning (6am), Group B: Afternoon (12pm), Group C: Evening (6pm) and Group D: Mid Night (12am). Blood samples were collected from the birds at 6:00 am, 12:00 pm, 6:00 pm and 12:00 am, during a 12-hour light and a 12-hour dark period at a six hourly intervals. The mean haemoglobin (Hb) concentration (10.40±0.09g/dl) and packed cell volume (31.00±0.41%) at 12am were significantly (P < 0.05) higher than the other diurnal periods of the day. The mean red blood cell count (RBC) at early morning (6am) was significantly (P < 0.05) higher than the values at 12pm but showed no significant (p > 0.05) difference when compared to the values at 6pm and 12am. The mean corpuscular volume (MCV) and mean corpuscular haemoglobin (MCH) concentrations at 12pm were significantly (P < 0.05) higher when compared to the 6am values. The mean total leucocyte count (TLC), lymphocyte count and monocyte count at 6am were significantly (P < 0.05) higher than the values at 6pm. There was however no significantly (p > 0.05) variations in the mean corpuscular haemoglobin concentrations (MCHC), heterophil count, eosinophil count, basophil count and heterophil/lymphocyte (H/L) ratio among all the diurnal periods investigated. In conclusion, the haemoconcentration produced in this study might be responsible for the higher haematological parameters during the night (12am) and early morning (6am) because the birds were neither feeding nor drinking water at this period of the day

Haematological And Inflammatory Markers Among Paediatrics With Sickle Cell Anaemia Attending Tertiary Health Institutions in Ekiti State, Nigeria.

Sickle cell anaemia is one of the life threatening health challenges bedevilling many developing countries like Nigeria and the management requires regular monitoring of the patients. The aim of this study was to determine haematological parameters and inflammatory markers among paediatrics with sickle cell anaemia. A total of 90 subjects were recruited for this study comprising of 45 confirmed sickle cell anaemia patients in steady state, 32 males and 13 females and 45 apparently healthy subjects with haemoglobin genotypes AA were used as the controls. Automated blood analyzer was used to analyze haematological parameters, erythrocyte sedimentation rate was estimated by Westergreen method and C-reactive protein was estimated using Enzyme Linked Immuno-Sorbent method. Total white blood cell count, white cell differential count, mean cell volume, mean cell haemoglobin, mean cell haemoglobin concentration, red cell distribution width, platelet count, platelet distribution width, erythrocyte sedimentation rate, C-reactive protein was higher in case compared to control. However, red blood cell count, haemoglobin, haematocrit, plateletcrit and mean platelet volume were lower in the case compared to the control subjects. There is no significant (p>0.05) difference in haematological parameters, erythrocyte sedimentation rate and C-reactive protein among the gender in both the case and the control except plateletcrit in the case and eosinophil and red cell distribution width in the control. There is similarity in haematocrit in both sex among the case. It is our anticipation that these findings will greatly assist physicians in the better management of Sickle cell patients in our locality.

Macrocytic anemia: Myelogram results in military hospital Avicenna in Marrakech

Anemia is one of the most common health problems in the primary care setting. Macrocytosis in adults is defined as a red blood cell mean corpuscular volum >95 fL. Macrocytic anemias are generally classified into megaloblastic or non-megaloblastic anemia. Retrospective descriptive study included 340 samples of myelogram received in the Hematology Labortory belonging to patients admitted to the Military hospital of Avicenna in Marrakech, over a period of 48 months (from January 2016 to January 2020), aimed to assess the etiological profile of macrocytic anemia in patients whose bone marrow smears were received in our laboratory. Out of 340 myelogram samples, 120 cases of macrocytic anemia were received. The male gender was predominant with a sex-ratio (M/F) at 3. The average age was 55 years old with extremes ranging from 29 to 91 years? The discovery of macrocytic anemia was fortuitous in 30% of cases. 47% of our population presented anemic syndrom, 14% hemorrhagic syndrome, 9% infectious syndrome. The hemoglobin varyied between 4,7 g/dL and 11,9 g/dL with an average of 7.2 g/dL. The mean corpuscular volume was 107 fL. The bone marrow smear confirmed megaloblastic anemia in 54,3% of cases of macrocytic anemia. The diversity and complexity of factors leading to macrocytic anemia preclude a single or uniform method of investigation. The investigative pattern must be tailored to the individual patient, giving importance to the clinical presentation.

Reevaluation of risk factors for aneurysmal subarachnoid hemorrhage associated epilepsy

BackgroundSymptomatic epilepsy is a common complication of aneurysmal subarachnoid hemorrhage (aSAH) associated with poor outcome. We sought to analyze the risk factors leading to post-SAH epilepsy. MethodsAll consecutive aSAH cases treated between 01/2003 and 06/2016 were retrospectively included. Post-aSAH period was followed up to 03/2020 for the occurrence of epilepsy. Demographic characteristics and previous medical history of the patients, parameters of initial severity, performed treatments, certain early and late complications of aSAH, as well as routine laboratory and vital parameter measurements were collected. Functional outcome was assessed at discharge and 6 months after aSAH using the modified Rankin scale (mRS). ResultsDuring the post-aSAH follow-up (median: 8.93 months/patient), 85 of 948 individuals (9%) in the final analysis developed symptomatic epilepsy (median: 3.43 months). In the majority of cases, epilepsy was diagnosed >3 weeks after aSAH (n = 67, 78.8%) and in survivors with poor outcome at discharge (mRS = 4–5, 15.8% vs. 5.3%, p < 0.0001). Of over 150 analyzed potential risk factors, the following parameters were independently associated with the risk of symptomatic epilepsy after aSAH: thyroid dysfunction (aHR = 1.81, p = 0.029), need for decompressive craniectomy (aHR = 2.32, p = 0.011) and shunt placement (aHR = 1.94, p = 0.022), prolonged tachycardia (≥4 days, aHR = 2.06, p = 0.025), as well as anemia signs (mean red blood cell count <3.6 × 1012 /L [aHR = 2.4, p = 0.015] and mean hematocrit <31% [aHR = 2.13, p = 0.044]) during first 2 weeks after aSAH. ConclusionSymptomatic epilepsy occurs predominantly in individuals with poor outcome at discharge and after the acute phase of aSAH. Knowledge of risk factors associated with aSAH-related epilepsy might help in early identification and treatment of compromised individuals, and therefore, help to improve their outcome.

505: FACTORS ASSOCIATED WITH INTENSIVE CARE UTILIZATION AFTER ADULT SPINAL DEFORMITY SURGERY

Introduction: Adult spinal deformity surgery (SDS) has a higher morbidity and mortality relative to other elective spinal procedures, and patients often require post-operative intensive care unit (ICU) admission. The goal of this study is to describe the type and frequency of ICU-specific needs after SDS and identify risk factors for these interventions. Methods: This was a single center, retrospective analysis of adult patients admitted to the ICU after elective SDS over a 6-year period. Demographics and ICU interventions (vasoactive medications, mechanical ventilation (MV), etc.) were recorded. Chi-square test and two sample t-tests were performed to determine risk factors for ICU needs. Results: 236 patient records were analyzed (mean age 68 + 9 years; 65% women). The most common surgery was long-segment thoracolumbar fusion for scoliosis (86%). Mean ICU and hospital lengths of stay (LOS) were 1.6 and 6.2 days, respectively; 2 (0.85%) patients died in the ICU. 42 (18%) required vasoactive medications and 17 (7%) needed MV (15 returned from the operating room (OR) intubated, 1 was re-intubated in the OR, 1 was re-intubated in the ICU for bronchospasm); all patients were extubated safely within 24 hours of ICU admission. Post-operative blood product transfusion was common (65%); 140 (59%) patients received red blood cells (mean units 1.28 + 1.4, max 8). Other ICU events included symptomatic arrhythmias in 14 (6%), acute kidney injury in 8 (3.4%), and acute pulmonary edema in 11 (4.7%). 75% of patients used continuous analgesic or sedative infusions. Age and gender were not significantly different in those requiring ICU interventions versus those who did not. Estimated blood loss (EBL) was associated with post-operative MV (p< 0.0001) and vasopressors (p = 0.04), while length of segmental fusion was associated with MV (p = 0.0001) only. Conclusions: ICU interventions (MV, vasopressors) were required in 53 (22%) patients undergoing SDS, suggesting that ICU destination after SDS is warranted. Intensivists should expect a moderate number of patients to need critical care interventions in the absence of intra-operative complications, however, most patients have a short ICU LOS. In this study, EBL and spinal fusion length was associated with the need for ICU-specific care.

Multifactorial analysis of renal anemia-associated substandard hemoglobin levels and prevalence of anemia in patients on maintenance hemodialysis in Liaoning Province: a cross-sectional study

In hemodialysis (HD) patients, anemia is greatly improved due to regular weekly use of iron and erythropoietin (EPO), but a large number of patients still show persistent anemia. We do a survey to elucidate the influencing factors that contribute to the failure of hemoglobin (Hb) to meet the standard and provide epidemiological data reference for promoting the recognition of renal anemia and improving the treatment effect of renal anemia. The clinical data of End-Stage Renal Disease (ESRD) HD patients in 22 tertiary hospital HD centers in Liaoning Province from September 2021 to June 2022 were collected by convenient sampling. According to the 2012 Kidney Disease: Improving Global Outcomes (KDIGO) anemia diagnostic criteria. The standard of Hb compliance: Hb ≥110 g/L is considered as Hb compliant, and Hb <110 g/L as Hb non-compliant. The factors influencing Hb up-to-standard in ESRD HD patients and their correlations were analyzed by comparison between the two groups. The results of this study showed that among the 1,652 ESRD patients investigated in Liaoning Province, the prevalence rate of anemia was 89.29% (1,475/1,652), and the Hb compliance rate was 46.25% (764/1,652). The Hb compliance rate in maintenance hemodialysis (MHD) patients with different primary diseases was statistically significant (P<0.05). Compared with the Hb non-standard group, the gender, dialysis access, HD frequency, concurrent infection, primary disease of ESRD patients, red blood cell (RBC) count, hematocrit (HCT), mean RBC Hb concentration, mean RBC Hb content, platelet (PLT), albumin (ALB), total protein (TP), serum creatinine (Cr), serum calcium (Ca), serum potassium (K), ferritin (Fer), serum iron (SI), and transferrin (TRE) saturation were significantly different between both groups (P<0.05). Adrenaline was an independent risk factor affecting Hb failure in ESRD patients (OR =1.001, 95% CI: 1.000-1.002); dialysis frequency (OR =0.726, 95% CI: 0.601-0.878), ALB (OR =0.959, 95% CI: 0.929-0.990), TP (OR =0.982, 95% CI: 0.968-0.996), serum Cr (OR =0.959, 95% CI: 0.929-0.999), and SI (OR =0.961, 95% CI: 0.940-0.982) were protective factors affecting Hb failure in ESRD patients (P<0.05). Pearson correlation analysis showed that ALB, TP, serum Cr, serum Ca, serum K, SI, and TRE saturation were positively correlated with Hb (P<0.05). The anemia rate of ESRD patients treated with MHD in Liaoning Province is high. Based on the results, increasing the frequency of dialysis can improve anemia. Parathyroid hormone levels need to be controlled.

Multiple Episodes of Transfusion Independence with Luspatercept Treatment and the Impact of Dose Escalation in Patients with Lower-Risk Myelodysplastic Syndromes from the MEDALIST Study

Introduction: In the phase 3 MEDALIST trial of luspatercept in lower-risk myelodysplastic syndromes (LR-MDS), 58 of 153 (37.9%) patients who received luspatercept achieved the primary endpoint of red blood cell (RBC) transfusion independence (RBC-TI) ≥ 8 weeks during weeks 1-24, versus 10 of 76 (13.2%) for placebo. Among the primary endpoint responders in the luspatercept arm, 17 (29.3%), 13 (22.4%), and 16 (27.6%) patients experienced 2, 3, or ≥ 4 separate RBC-TI ≥ 8 weeks response events during the entire treatment period, versus 3 (30%) and 1 (10%) patient in the placebo arm, who experienced 2 or 3 response events. (Platzbecker U, et al. Blood 2021;138:1524). The starting dose of luspatercept in the MEDALIST trial was 1.0 mg/kg with up-titration to 1.33 and 1.75 mg/kg allowed in the absence of RBC-TI after ≥ 2 doses at the same dose level, or after a loss of response following a dose reduction. Here, we report the effect of baseline transfusion burden (TB) and luspatercept dose level on response to treatment in patients with LR-MDS from the MEDALIST study. Methods: Eligible patients were ≥ 18 years of age, had LR-MDS requiring RBC transfusions, and were ineligible for, intolerant to, or refractory to erythropoiesis-simulating agents. Patients were stratified by mean baseline TB (mean RBC units/8 weeks assessed over the 16 weeks prior to initiation), as follows: low TB (LTB), > 0 to < 4 RBC units/8 weeks; intermediate TB (ITB), ≥ 4 to < 6 RBC units/8 weeks; and high TB (HTB), ≥ 6 RBC units/8 weeks. The number of individual periods of response (distinct episodes of RBC-TI ≥ 8 weeks) occurring during the entire treatment period was calculated. The treatment period lasted until the earliest of: the last dose date + 20 days; study discontinuation; data cutoff; or death. Time between RBC-TI responses was calculated as: start date of next response minus end date of current response plus 1. Results: As of November 26, 2020, RBC-TI ≥ 8 weeks was observed in 74/153 (48.4%) luspatercept patients and 12/76 (15.8%) placebo patients during the entire MEDALIST treatment period. Many patients experienced multiple distinct periods of RBC-TI ≥ 8 weeks; 52/74 (70.3%) luspatercept responders and 4/12 (33.3%) placebo responders experienced ≥ 2 episodes. The greatest number of response periods reported in a single patient was 10 with luspatercept and 3 with placebo. Overall, 30/39 (76.9%), 14/20 (70.0%), and 8/15 (53.3%) LTB, ITB, and HTB luspatercept responders, respectively, experienced ≥ 2 periods of response; 17/39 (43.6%), 10/20 (50.0%), and 5/15 (33.3%) LTB, ITB, and HTB luspatercept responders, respectively, experienced ≥ 3 periods of response; and 8/39 (20.5%), 3/20 (15.0%), and 0 LTB, ITB, and HTB, luspatercept responders, respectively, experienced ≥ 5 periods of response (Figure). The mean (SD) number of response periods with luspatercept was 3.0 (2.25) for LTB patients, 2.9 (2.0) for ITB patients, and 1.9 (1.03) for HTB patients. The greatest number of response periods reported with luspatercept in a single patient was 10 for LTB patients, 8 for ITB patients, and 4 for HTB patients. The mean (SD) time between RBC-TI response periods with luspatercept was 24.3 (63.16) days for LTB patients, 52.1 (55.91) days for ITB patients, and 32.1 (33.79) days for HTB patients. During the entire treatment period, rates of RBC-TI ≥ 8 weeks response at 1.0 mg/kg decreased with increasing baseline TB, with 94.9% of baseline LTB patients responding compared with 40.0% of baseline HTB patients. Patients who were ITB or HTB at baseline were more likely to respond when receiving 1.75 mg/kg luspatercept, with 50.0% and 46.7% responding, respectively, compared with 35.9% for LTB patients (Table). Conclusions: Patients who were LTB at baseline experienced more periods of RBC-TI response than ITB and HTB patients. LTB patients were more likely to respond to lower doses of luspatercept, whereas almost half of ITB and HTB patients required escalation to the maximum dose level to respond. ITB and HTB patients might be expected to wait longer for a second response to luspatercept than LTB patients. Importantly, many patients experienced multiple RBC-TI response periods with luspatercept, emphasizing the value of measuring cumulative response duration as well as the benefit of continuing luspatercept treatment. Figure 1View largeDownload PPTFigure 1View largeDownload PPT Close modal

Erythroferrone Overexpression Impairs Survival and Greatly Increases Tissue Iron Loading in a Mouse Model of β-Thalassemia

Beta-thalassemia, caused by mutations in the β-globin gene, is characterized by ineffective erythropoiesis, anemia and associated multi-organ dysfunction. Like in other anemias with ineffective erythropoiesis, the erythroid hormone erythroferrone (ERFE) is pathologically overproduced. ERFE functions by suppressing the master iron regulatory hormone hepcidin, and the chronic suppression of hepcidin in β-thalassemia results in excessive iron absorption and iron overload, even in patients who do not receive erythrocyte transfusions. A major obstacle in studying the role of ERFE in β-thalassemia has been the lack of a mouse model that represents the wide range of ERFE concentrations observed in human patients (Ganz et al, Blood 2017). Our lab generated ERFE-transgenic mice with a range of ERFE overexpression (Coffey et al, Blood 2022) and showed that they developed dose-dependent iron overload and relative hepcidin deficiency. In the current study, the mid-range ERFE-overexpressing E(M) mice were crossed with HbbTh3/+ (Th3) mice, a widely used model of β-thalassemia, to generate mice with a single copy of both transgenes (T-E(M)), as well as littermate controls (Th3, WT, E(M)), to analyze the effect of ERFE on the pathophysiology of ineffective erythropoiesis. The offspring had a noticeably skewed genotypic ratio, with T-E(M) pups making up only <9% of surviving pups compared to 25% expected for each genotype. At embryonic day 18.5, however, there was an equal distribution of all expected genotypes, suggesting that the mortality in T-E(M) pups is postnatal. Surviving T-E(M) mice were analyzed at 16 weeks of age. They had similar erythrocyte parameters to the Th3 littermates , with the expected decrease in red blood cell count, hemoglobin and mean corpuscular volume. Despite the similarities in blood counts, we discovered a synergistic effect of the ERFE and Th3 transgenes on ERFE production in the T-E(M) mice as indicated by increased serum ERFE levels (Figure 1a) and increased Erfe mRNA levels in the bone marrow and spleen compared with both E(M) and Th3 littermates. The dramatic increase in serum ERFE in T-E(M) mice may result from multiplicative effects of erythroblast expansion in Th3 mice and transgenic ERFE overexpression in individual erythroblasts of T-E(M) mice. The large range of ERFE concentrations in human patients may also reflect the combined effects of erythroblast number and ERFE overproduction by erythropoietin-stimulated thalassemic erythroblasts, both of which vary depending on patient genetics. T-E(M) mice also have significantly larger spleens compared to Th3 littermates, suggesting that ERFE overexpression contributes to increased extramedullary hematopoiesis in T-E(M) spleens. In addition, T-E(M) mice had significantly higher iron levels in the liver (Figure 1b) as well as serum and kidney compared to Th3 littermates. Coupled with the inappropriately low serum hepcidin levels (compared to liver iron levels) in T-E(M) mice, even when compared to E(M) and Th3 littermates, these data indicate that excessive ERFE further increases iron loading in a mouse model of β-thalassemia. Our data demonstrate that elevated ERFE levels contribute to the pathogenesis of β-thalassemia by decreasing postnatal survival, increasing iron overload, and increasing extramedullary hematopoiesis. These results suggest that neutralizing excessive ERFE levels may have therapeutic benefits for postnatal development and prevention of iron overload in β-thalassemia. Figure 1View largeDownload PPTFigure 1View largeDownload PPT Close modal

Pleiotropic Effects of Hydroxyurea on Red Blood Cell and Neutrophil Phenotype in Patients with Sickle Cell Disease; Data from the Notice Study

Introduction The pathophysiology of sickle cell disease (SCD) is complex and goes beyond red blood cell (RBC) sickling alone. Neutrophils have been proposed to play an important role in SCD pathophysiology, but their exact contribution remains to be elucidated. Factors such as chronic hemolysis and oxidative stress can influence neutrophil adhesion, activity and aging. We designed a prospective study (Notice) to investigate a broad set of neutrophil characteristics in SCD patients. To correlate treatment effects of hydroxyurea (HU) on neutrophils with those on RBCs in SCD, we also studied RBC sickling and adhesion. Here, we will focus on the effects of hydroxyurea on RBC deformability and neutrophil adhesion, activity and aging. Aim: To assess the effects of HU on RBC deformability and neutrophil phenotypes with respect to adhesion, activation and aging. Methods Blood (EDTA) was collected from SCD patients with HbSS or HbSβ0 in steady-state. A subgroup of patients was included before and during treatment with HU. For measurement of antigen expression by flow cytometry, total leukocyte fraction after lysis of red blood cells (without Percoll gradient) was used and neutrophils were gated based on their forward and side scatter. For in vitro neutrophil adhesion, neutrophils were isolated using a Percoll gradient and lysis buffer, as previously described. (Kuijpers et al. Blood 2007) Neutrophils were labeled with calcein and placed in an uncoated 96-well MaxiSorp plate. After washing, adherent cells were lysed and fluorescence was measured. (Kuijpers et al. J Allergy Clin Immunol 2017). Adhesion of RBCs was measured by flowing whole blood (20x106/ml)over laminin-coated Ibidi slides for 30 minutes with visualization by microscope. Percentage of mean RBC adhesion was normalized to a healthy control (HC). Data were analyzed using SPSS and GraphPad Prism and are presented as mean ±SE or ±SD as appropriate. Conventional statistics were used. Results A total of 49 patients (median age 25.0 (IQR 20.0 - 32.5) years, 39% female) were included. Twenty patients (41%) used a stable dose of HU at baseline. In 10 patients, blood was drawn before and after starting HU treatment. HU treatment improved hemoglobin F and markers of hemolysis and was associated with a decrease in the point of sickling (PoS) of RBCs (from median 24.8 mmHg [IQR 16.0-28.2] to 16.8 [15.0-20.8], P=0.13). Adhesion of RBC was more than 3-fold higher in SCD patients than in HC. At baseline, there was no difference in RBC adhesion between patients with and without HU (P=0.86). After starting HU treatment, RBC adhesion decreased significantly from a median of 318% (normalized to control) to 149% (P=0.016, Figure 1a-b). Adhesion of neutrophils was significantly higher in patients compared to HC (median 18.3% versus 12.6% P <0.0001). No difference was observed between patients with and without HU at baseline. Neutrophil adhesion did not decrease after starting HU treatment (Figure 1c-d). Neutrophil surface expression of CD11b/CD18 was measured as markers of adhesion. While CD11b expression was comparable between SCD patients and HC, CD18 expression was significantly higher in SCD patients (mean MFI 12193 vs 10586, P=0.016; Figure 2b. After treatment with HU both CD11b and CD18 expression decreased, though the differences did not reach statistical significance (P=0.22 and 0.56, respectively). Neutrophils of SCD patients displayed a more aged phenotype compared to neutrophils of HC with lower L-selectin (median MFI 3108 vs 4656, P=0.021) and higher CXCR4 (median MFI 1150 vs 886, P=0.003) expression. Activation marker CD64 was also higher in SCD patients compared to HC (median MFI 1841 vs 1065, P=0.0006). HU treatment seemed to modify all markers more towards a HC phenotype although no statistically significant changes were observed. Conclusion Adhesion of both RBCs and neutrophils is increased in SCD patients compared to HC. HU treatment was associated with significantly improved RBC rheology as shown by decreased PoS and decreased adhesion to laminin. Despite a trend to improvement in expression of adhesion markers (CD11b/CD18), in vitro adhesion of neutrophils did not decrease. These findings could be due to the small sample size of patients starting with HU or by a difference in vitro behaviour of changed composition of neutrophil populations after treatment. Figure 1View largeDownload PPTFigure 1View largeDownload PPT Close modal

Effect of inulin, galacto oligosaccharides and iron fortification on iron deficiency anemia among women of reproductive age; a randomized controlled trial

Iron supplementation and fortification are the well-known approaches to treat iron deficiency anemia (IDA) in women of reproductive age. The objective of the current randomized controlled trial (RCT) was to evaluate the cumulative effects of prebiotics and iron fortification among women of reproductive age. For this purpose, a total of 75 iron deficient women of childbearing age were recruited and randomly divided into 5 groups (4 treatment groups and 1 control group). Four different types of fortified wheat flour were prepared using two iron fortificants (NaFeEDTA and FeSO4) and two prebiotics [inulin and galacto oligosaccharides (GOS)], while control group was treated with iron fortified flour without any prebiotics. Blood samples were collected from overnight fasted women on monthly basis up to 90 days. Hematological indices such as Hemoglobin (Hb), Hematocrit, Red Blood Cell (RBC) Count and Mean Corpuscular Volume (MCV), as well as iron biomarkers including serum iron, ferritin, transferrin, and Total Iron Binding Capacity (TIBC) were evaluated for analyses. The results showed a considerable positive improvement in all iron biomarkers as well as hematological indices among the treatment groups (P-value < 0.05), as compared to the control group. A maximum Hb (11.86 ± 0.24 mg/dL) and hematocrit value (35.06 ± 1.32%), was reported in group G3 which was treated with fortified wheat flour at a dose of 963 mg/kg GOS + 15 ppm FeSO4. On the other hand, highest mean values for RBC Count (4.73 ± 0.41 mil/mm3), MCV (81.41 ± 3.21 fL), serum iron (75.62 ± 2.79 μg/dL), serum transferrin (16.82 ± 0.30 mg/dL), and TIBC (403.68 ± 7.27 μg/dL) were observed in G4 group receiving the fortified wheat flour at a dose of 963 mg/kg GOS + 30 ppm FeSO4 level. The study concluded that prebiotic fortification along with iron salts helps to enhance iron absorption among iron deficiency anemic women of reproductive age.

The Effects of Honey Sulfonamides on Immunological and Hematological Parameters in Wistar Rats.

Sulfonamides are among the most used drugs in beekeeping due to their effectiveness, despite their long-term persistence in tissues. Bee honey containing such residues poses numerous risks to human health. The aim of the study was to evaluate the effects on immunological and hematological parameters of Wistar rats produced by sulfonamide residues in bee honey, through the evaluation of various blood parameters such as triiodothyronine and thyroxine levels, hematocrit, hemoglobin, red blood cell count and mean corpuscular hemoglobin concentration in a given volume of erythrocytes following administration of sulfonamide-containing honey. The hematological and immunological parameters showed significant variations in the group of rats that had been fed with honey spiked with sulfonamides compared to the control group. Changes in hematological indices were demonstrated in terms of a significant reduction in the number of erythrocytes, the amount of hemoglobin, and the value of hematocrit, thus confirming the induction of anemia in the tested group. Investigation of thyroid function through the analysis of triiodothyronine (T3) and thyroxine (T4) and their ratio showed a very significant decrease in plasma thyroxine levels in laboratory rats that were fed sulfonamide-spiked honey compared to the control group. The mean T3 concentration decreased from 0.70 ± 0.14 ng/dL to 0.34 ± 0.03 ng/dL, while the mean T4 concentration was reduced from 4.50 ± 0.30 μg/dL to 3.32 ± 0.21 μg/dL, thus demonstrating toxic effects on thyroid function. In sum, the presence of sulfonamides induced significant changes in the evaluated parameters indicating that the consumption of contaminated honey samples represents a high risk factor for thyroid dysfunction with potentially serious health impacts.

The multifactorial dynamic perfusion index: A predictive tool of cardiac surgery associated acute kidney injury.

cardiac surgery associated acute kidney injury (CSA-AKI) has a number of preoperative and intraoperative risk factors. Cardiopulmonary bypass (CPB) factors have not yet been elucidated in a single multivariate model. The aim of this study is to develop a dynamic predictive model for CSA-AKI. retrospective study on 910 consecutive adult cardiac surgery patients. Baseline data were used to settle a preoperative CSA-AKI risk model (static risk model, SRM); CPB related data were assessed for association with CSA-AKI. CPB duration, nadir oxygen delivery, time of exposure to a low oxygen delivery, nadir mean arterial pressure, peak lactates and red blood cell transfusion were included in a multivariate dynamic perfusion risk (DPR). SRM and DPR were merged into a final logistic regression model (multifactorial dynamic perfusion index, MDPI). The three risk models were assessed for discrimination and calibration. the SRM model had an AUC of 0.696 (95% CI 0.663-0.727), the DPR model of 0.723 (95% CI 0.691-0.753), and the MDPI model an AUC of 0.769 (95% CI 0.739-0.798). The difference in AUC between SRM and DPR was not significant (p = 0.495) whereas the AUC of MDPI was significantly larger than that of SRM (p = 0.004) and DPR (p = 0.015). inclusion of dynamic indices of the quality of CPB improves the discrimination and calibration of the preoperative risk scores. The MDPI has better predictive ability than the existing static risk models and is a promising tool to integrate different factors into an advanced concept of goal-directed perfusion.

A Vortex Method to Disaggregate Platelets for Correct Counting in Pseudothrombocytopenia.

Pseudothrombocytopenia (PTCP) refers to the aggregation of platelets in anticoagulant blood in vitro and causes a false lower platelet count (PLT). For the purpose to achieve an accurate PLT, we presented an alternative vortex method to disaggregate platelet clumps and consequently generate a reliable PLT without a second venous puncture for patients. PLT, mean-platelet-volume (MPV), red blood cells (RBCs), hematoglobin (Hb), hematocrit (Hct) and white blood cells (WBCs) were evaluated before and after vortex in 221 specimens with PTCP using vortex method, and the PLT was also compared with 85 specimens disaggregated by citrate method. Twenty control samples were used to investigate mixing effect on complete blood counts in normal samples. One thrombocytopenia specimen was used to evaluate reproducibility of vortex. The mean PLT, MPV, RBCs, Hb, Hct and WBCs of 20 control specimens pre-vortex were 260.7 ± 53.4 × 109/L, 11.65 ± 0.85, 4.87 ± 0.46 × 1012/L, 147.6 ± 13.8g/L, 45.31 ± 4.04, 6.46 ± 1.41 × 109/L, and results of post-vortex were 252.9 ± 50.2 × 109/L, 11.66 ± 0.92, 4.95 ± 0.48 × 1012/L, 149.1 ± 13.8g/L, 45.19 ± 4.03, 6.35 ± 1.36 × 109/L respectively. Specimens with platelet clumps using vortex mixer had higher PLT after mixing, the mean pre-vortex PLT was 54.3 ± 35.2 × 109/L, and after vortexing PLT increased to 157.5 ± 58.8 × 109/L (p < 0.05). MPV, RBCs, Hb, Hct and WBCs in 221 specimens were comparable before and after vortex mixing (all p > 0.05). Vortex method might disaggregate platelet clumps sufficiently in most PTCP specimens, and obtain a relatively reliable PLT without the need of a second venous puncture.

Malnutrition, anaemia and anisocytosis as public health problems among children ≤ 5 years living in malaria perennial transmission areas of Mount Cameroon: a cross sectional study

BackgroundAnaemia, anisocytosis, malnutrition (especially stunting) are common health problems in developing countries with children being the most vulnerable. These conditions have negative impacts on human performance, growth and development, and can further be complicated if comorbidity exists within a holoendemic stratum with strong and perennial malaria parasite transmission such as the Mount Cameroon area. The study aimed at determining the prevalence and severity malnutrition, anaemia and anisocytosis in children ≤ 5 years, living in the conflict hit malaria perennial transmission zone of the Mount Cameroon area.MethodA cross-sectional community-based survey involving 628 children ≤ 5 years was conducted. Malaria parasitaemia was confirmed by Giemsa-stained microscopy and the density was log transformed. Haemoglobin (Hb), mean cell volume and red blood cell distribution width were estimated using an auto-haematology analyser and defined according to WHO standards. Anthropometric indices were analysed and compared with WHO growth reference standards using WHO Anthro software.ResultsPlasmodium infection, anaemia, microcytic anaemia, anisocytosis and stunting were prevalent in 36.0, 72.8, 30.1, 54.1 and 29.0% of the children, respectively. The ≤ 24 months children were more moderately stunted (14.7%), with higher prevalence of microcytic anaemia (38.8%) and anisocytosis (68.8%) (P < 0.002 and P < 0.001, respectively) when compared with the older children. The mean Hb level in the study population was 10.04 g/dL with children ≤ 24 months having the least mean haemoglobin level (9.69 g/dL) when compared with their older counterparts at P < 0.001. The odds of having anisocytosis were highest among children who were malnourished (OR = 4.66, P = 0.005), those infected with malaria parasites (OR = 1.85, P = 0.007), and whose parents had a primary (OR = 3.51, P = 0.002) and secondary levels of education (OR = 2.69, P = 0.017).ConclusionMalaria, anaemia, anisocytosis and undernutrition still remain severe public health concerns among children ≤ 60 months in the Mount Cameroon area. This therefore emphasizes the need for the implementation of consistent policies, programmes and activities to avoid malaria, anaemia, anisocytosis and stunting in the paediatric age group.

Hematological Parameters in Newborns of Mothers with and Without Preeclampsia

Background: Pregnancy-induced hypertension, preeclampsia, and eclampsia syndrome are multisystem disorders associated with adaptive changes in the fetal circulation and cause a marked imbalance in the hemostatic system of the mother and fetus. Objectives: This study aimed to compare hematological parameters in newborns of mothers with and without preeclampsia. Methods: This prospective case-control study included 30 newborns of mothers with preeclampsia and 30 newborns with normotensive mothers matched for age and sex as a control group. Umbilical cord blood samples were collected from all newborns, and complete blood count and ferritin levels were measured. The data were analyzed using SPSS version 21, and the difference between the two groups was compared using the independent t-test and Mann-Whitney test. Results: The newborns of mothers with preeclampsia had higher mean corpuscular volume, mean corpuscular hemoglobin, red cell distribution width, mean platelet volume, and platelet distribution width but lower white blood cell counts, platelet counts, and ferritin level than those of the control group (P &lt; 0.05). Also, the mean red blood cell count, hemoglobin, and hematocrit was higher in the preeclamptic mothers’ newborns compared to those of the control group, although not significant (P &gt; 0.05). Conclusions: Newborns of mothers with preeclampsia should be carefully evaluated and monitored regarding hematologic abnormalities and early diagnosis of possible complications.

Simultaneous Bilateral Total Knee Arthroplasty May be Safe.

Objectives This study aims to analyze the safety of a simultaneous bilateral total knee arthroplasty (SBTKA) and to investigate patients' satisfaction with the procedure performed concomitantly. Methods In a prospective study, we evaluated 45 patients undergoing SBTKA performed by two surgical teams. The mean age of the patients was 66.9 years; 33 subjects were female (73.3%) and 12 (26.6%) were male. We followed a protocol of intra- and postoperatively measures to ensure the safety of this procedure. We evaluated the surgery time and blood loss by hematocrit (Ht) and hemoglobin (Hb) levels on the first postoperative day, the percentage of patients who received a transfusion of packed red blood cells, and the number of required units. We also recorded perioperative complications, and, at the end of 3 months, we asked patients about their preference between the simultaneous or staged procedure. Results The mean surgery time was 169 minutes. In the postoperative period, there was an average decrease of 28.2% in Htc and 27.0% in Hgb. A total of 16 patients (35.5%) received a transfusion of packed red blood cells (mean, 1.75 units per patient requiring a transfusion). There were 12 minor complications (26.6%) and 2 major complications (4.4%); furthermore, no patient had a clinical diagnosis of deep vein thrombosis, and there were no deaths. Conclusions: The SBTKA procedure may be considered safe if performed in selected patients and with a care protocol to prevent complications. This type of procedure was unanimously approved by patients.

APLICAÇÃO DO TREINAMENTO FÍSICO DOS JOGADORES DE FUTEBOL NA MELHORIA DA FUNÇÃO FÍSICA

ABSTRACT Introduction: Soccer is an intensely competitive sport. With its development and elevation in techniques, athletes’ higher demands for physical fitness, strategy, and tactics are presented. An excellent physical training protocol is essential to achieve these goals. Objective: To study how soccer players can improve their physical function in physical training. Methods: Soccer players from a school were selected as research subjects. Physical training interventions and follow-up tests were performed on soccer players during training. Physical training included a physical function test and a body composition test. Finally, SPSS16.0 software was used for statistical analysis of the obtained data. Results: The mean hemoglobin and red blood cell concentration mean values in the athletes’ final test increased slightly compared to the first test; the difference was insignificant (P&gt;0.05). However, the hematocrit index improved significantly (P&lt;0.01). Conclusion: Physical training can reduce the body fat content in the physical function of soccer players and reduce the weight of soccer players. This physical training mode can be used as a reference standard for the physical training of other high-level soccer teams. Evidence Level II; Therapeutic Studies - Investigating the result.