Mean Red Cell Volume Research Articles

COVID-19 Disease - Temporal Analyses of Complete Blood Count Parameters Over Course of Illness, and Relationship to Patient Demographics and Management Outcomes in Survivors and Non-Survivors: A Longitudinal Descriptive Cohort Study

Background: More detailed temporal analyses of complete (Full) blood count (CBC) parameters, their evolution and relationship to patient age, gender, co-morbidities and management outcomes in survivors and non-survivors with COVID-19 disease could help identify prognostic clinical biomarkers. Methods: From 29 January 2020 until 28 March 2020, we performed a longitudinal cohort study of COVID-19 inpatients at the Italian National Institute for Infectious Diseases, Rome, Italy. Nine CBC parameters as a continuous variable were studied [neutrophils, lymphocytes, monocytes, platelets, mean platelet volume, red blood cell count, haemoglobin concentration, mean red blood cell volume and red blood cell distribution width (RDW %)]. Model-based punctual estimates and difference between survivors and non-survivors, overall, and by co-morbidities, at specific times after symptoms, with relative 95% CI and P-values were obtained by marginal prediction and ANOVA-style joint tests. All analyses were carried out by STATA 15 statistical package. Main Findings: 379 COVID-19 patients [273 (72% were male; mean age was 61.67 (SD 15.60)] were enrolled and 1,805 measures per parameter were analysed. Neutrophil counts were on average significantly higher in non-survivors than in survivors (P60 years(p=0.001). Age (p=0.042), obesity (p=0.002), chronic renal failure (p=0.002) and cardiovascular diseases (p=0.009) were independently associated with poor patient clinical outcome at 30 day after symptom onset. Interpretation: Increased neutrophil counts, reduced lymphocyte counts, higher median platelet volume, anemia with anisocytosis, in association with obesity, chronic renal failure, COPD, cardiovascular diseases and age >60 years predict poor prognosis in COVID19 patients.Funding Statement: Ricerca Corrente e Finalizzata Italy Ministry of Health, AIRC (IG2018-21880); Regione Lazio (Gruppi di ricerca, E56C18000460002).Declaration of Interests: The authors declare no competing interest.Ethics Approval Statement: This study was approved by the IRB of Italian National Institute for Infectious Diseases “Lazzaro Spallanzani” (INMI), in Rome (Italy).

Microcytosis as a risk marker of cancer in primary care: a cohort study using electronic patient records.

Microcytosis (smaller than normal red blood cells) has previously been identified as a possible early risk marker for some cancers. However, the role of microcytosis across all cancers has not been fully investigated. To examine cancer incidence in a cohort of patients with microcytosis, with and without accompanying anaemia. Cohort study of patients aged ≥40 years using UK primary care electronic patient records. The 1-year cancer incidence was compared between cohorts of patients with a mean red cell volume of <85 femtolitres (fL) (low) or 85-101 fL (normal). Further analyses examined sex, age group, cancer site, and haemoglobin values. Of 12 289 patients with microcytosis, 497 had a new cancer diagnosis within 1 year (4.0%, 95% confidence interval [CI] = 3.7 to 4.4), compared with 1465 of 73 150 without microcytosis (2.0%, CI = 1.9 to 2.1). In males, 298 out of 4800 with microcytosis were diagnosed with cancer (6.2%, CI = 5.5 to 6.9), compared with 940 out of 34 653 without (2.7%, CI = 2.5 to 2.9). In females with microcytosis, 199 out of 7489 were diagnosed with cancer (2.7%, CI = 2.3 to 3.1), compared with 525 out of 38 497 without (1.4%, CI = 1.3 to 1.5). In patients with microcytosis but normal haemoglobin, 86 out of 2637 males (3.3%, CI = 2.6 to 4.0) and 101 out of 5055 females (2.0%, CI = 1.6 to 2.4) were diagnosed with cancer. Microcytosis is a predictor of underlying cancer even if haemoglobin is normal. Although a benign explanation is more likely, clinicians in primary care should consider simple testing for cancer on encountering unexplained microcytosis, particularly in males.

Hematological Changes in Blood of Smokers of Cigarettes and Nargyle

The current study aimed at determining the effect of smoking cigarette and Narghile at some of bloody variables and Vitamin D in a sample of young smokers aged 20-35 in Ramadi.The study included complete blood count (C.B.C) tests including:Total White Blood Cell and Red Blood Cell Count, determination of the concentration of total hemoglobin and calculation of Platelet Count.Calculation of RBC Indicators: “mean corpuscular hemoglobin” (MCH), “Mean Corpuscular Hemoglobin Concentration” (“MCHC”) and Mean red blood Cell Volume (MCV). The study also evaluated the concentration of vitamin D. Results showed that: A rise in the number of white blood cells and red blood cells, as well as a high concentration of hemoglobin and platelet count in smokers.An increase in the volume of red blood cells, mean hemoglobin concentration, and Mean Corpuscular Hemoglobin Concentration in smokers’ blood. Decreased concentration of vitamin D .

Preoperative anaemia in patients undergoing open intra-abdominal surgery at a South African tertiary hospital

Background: The prevalence of preoperative anaemia (PA) in mixed surgical populations is as high as 47.8%. PA in mixed surgical populations is associated with increased postoperative mortality (PM). It is likely that the prevalence of PA and the associated risk of PM might be higher in open intra-abdominal surgery (OIAS) populations, such as laparotomy patients, due to the underlying disease pathologies in this group. An investigation of PA in OIAS patients can inform future improvements in the perioperative management of this high-risk surgical group. Method: This was a sub-analysis of data from a pre-existing registry of 435 laparotomy patients who attended a South African tertiary hospital. The registry collected data on preoperative haemoglobin (Hb), patient characteristics, and PM. Identified PA was graded according to World Health Organization definitions. Established mean red cell volume (MCV) thresholds were used for the morphological classification of PA. Results: The prevalence of PA was 71.0% (95% confidence interval [CI]: 66.8–75.3%). Overall, PA was associated with a three-fold higher risk of PM (odds ratio 3.35, p &lt; 0.001). Postoperative mortality was higher in patients with moderate and severe anaemia than in those without anaemia, while there was no difference in PM between patients with mild anaemia and non-anaemic patients. Conclusion: PA is common in OIAS patients and is associated with increased PM. Identification of OIAS patients with PA, and appropriate preoperative management of these patients is recommended.

Chemiluminescence study of the effects of Router radiation on red blood cell volume and Erythrocyte sedimentation rate in Human blood human blood

It is in vitro study to examine the effect of electromagnetic radiation from router on human blood samples rheological factors, such as mean red blood cell volume (MCV) and erythrocyte sedimentation rate (ESR). Samples were irradiated for one, ten, twenty four hour, and three with 500 milli-watt. The measurements were done directly after the irradiation, chemilumenscence (CL) signal. MCV and ESR decresed after irradiation for ten hours by 20.6%, 0.41%and 5.3% respectively. This because the effect of radiation on the composition of the plasma that finally effect in ESR of whole blood.

A "One-Stop" Screening Protocol for Haemoglobinopathy Traits and Iron Deficiency in Sri Lanka.

Introduction: The high frequencies of carriers of severe haemoglobinopathies and of iron deficiency in Southeast Asia require reliable and affordable tests to improve on current screening procedures.Objectives: We evaluate a “one stop” approach using the THALCON dichlorophenolindophenol (DCIP) and one-tube osmotic fragility (OF) tests and measurement of Zinc Protoporphyrin (ZPP) to detect and distinguish HbE and β-thalassaemia traits from iron deficiency. We compare findings with current screening practice in Sri Lanka that relies on the identification of low mean red cell volume and/or mean red cell hemoglobin for this purpose.Methods: Between November 2017 and May 2018, we undertook a cross-sectional survey of secondary school students in Gampaha district, Sri Lanka. The THALCON–DCIP and OF tests were compared to capillary electrophoresis (CE), used as a gold standard to detect haemoglobinopathies. ZPP was measured in whole blood. Plasma ferritin and C-reactive protein (CRP) were measured in students with a raised ZPP concentration.Results: We collected venous blood samples from 1,324/1,332 (99.4%) students. The median age of the students was 17 (IQR 16–18) years, all were Sinhalese and 814/1,324 (61.5%) were female. CE identified 3 students with HbE trait and 26 students with β-thalassaemia trait. The THALCON–DCIP test was positive only in the 3 students with HbE (sensitivity 100%, 95% CI 29.2–100.0; specificity 100%, 95% CI 99.7–100.0). The THALCON–OF test identified all 26 students with β-thalassaemia trait (sensitivity = 100%, 95% CI 86.8–100.0) and 287 students with a normal CE result (specificity = 77.9%; 95% CI 75.5–80.1). It was also positive in 2/3 (66.7%) students with HbE trait. Iron deficiency (ZPP > 70 μmol/mol heme) was present in 118/1,240 (9.5%) students with a normal hemoglobin genotype, all of whom had plasma ferritin <15 ng/ml and CRP <5 mg/L.Conclusion: This one–stop approach offers reliable and affordable population screening for both haemoglobinopathy traits and iron deficiency in resource-limited settings where these conditions are common and ensures that iron supplements are targeted only to those who require them. Further work is warranted to refine the OF test to reduce the number of false positive results.

Organ accumulation and carcinogenicity of highly dispersed multi-walled carbon nanotubes administered intravenously in transgenic rasH2 mice.

PurposeMultiwalled carbon nanotubes (MWCNTs) have been known to enter the circulatory system via the lungs from inhalation exposure; however, its carcinogenicity and subsequent accumulation in other organs have not been adequately reported in the literature. Moreover, the safety of MWCNTs as a biomaterial has remained a matter of debate, particularly when the material enters the circulatory system. To address these problems, we used carcinogenic rasH2 transgenic mice to intravenously administer highly dispersed MWCNTs and to evaluate their carcinogenicity and accumulation in the organs.MethodsTwo types of MWCNTs (thin- and thick-MWCNTs) were intravenously administered at a high dose (approximately 0.7 mg per kg body weight) and low dose (approximately 0.07 mg per kg body weight).ResultsMWCNTs showed pancreatic accumulation in 3.2% of mice administered with MWCNTs, but there was no accumulation in other organs. In addition, there was no significant difference in the incidence of tumor among the four MWCNTs-administered groups compared to the vehicle group without MWCNTs administration. Blood tests revealed elevated levels in mean red blood cell volume and mean red blood cell hemoglobin level for the MWCNTs-administered group, in addition to an increase in eotaxin.ConclusionThe present study demonstrated that the use of current technology to sufficiently disperse MWCNTs resulted in minimal organ accumulation with no evidence of carcinogenicity.

The value of red blood cell distribution width in the evaluation of patients with obstructive sleep apnea hypopnea syndrome

Objective:To investigate the relationship between red blood cell distribution width (RDW) and severity of obstructive sleep apnea hypopnea syndrome (OSAHS). Method:A total of 112 patients with OSAHS who were diagnosed by PSG monitoring were selected as OSAHS group, and 61 healthy subjects with matched age, gender and BMI were selected as the control group. The peripheral venous blood of all subjects was collected in the morning, and relevant hematological indexes such as RDW, white blood cell count, red blood cell count, hemoglobin, mean red blood cell volume, and platelet count were obtained. Result:The RDW level in the OSAHS group was significantly higher than that in the control group. The RDW value increased gradually with the severity of OSAHS and was positively correlated with AHI(r=0.259), the mean SaO₂ (r=-0.279), the lowest SaO₂( r=-0.328), BMI(r=0.203) and negatively correlated with sleep time(r=-0.204). Conclusion:The elevated level of RDW may be an indicator of the severity of OSAHS. Since RDW is usually included in the complete blood count, it can provide an economical and practical indicator to initially assess the condition of OSAHS patients and prioritize polysomnography monitoring.

The potential value of red blood cell distribution width in patients with invasive hydatidiform mole.

BackgroundRed blood cell distribution width (RDW) has attracted increasing attention in cancer. The aim of this study was to assess the changes of RDW in patients with invasive hydatidiform mole and analyze the relationship between RDW and invasive hydatidiform mole.MethodsA retrospective analysis was performed on 102 patients diagnosed as invasive hydatidiform mole in the First Affiliated Hospital of Guangxi Medical University from January 2009 to March 2018. A total of 120 healthy subjects were used as a control group. The Mann‐Whitney U test was used for comparison between the invasive hydatidiform mole and control groups. Comparison of RDW with other blood parameters was performed using Spearman's. The area under the ROC curve (AUC) and 95% confidence interval (95% CI) were also determined.ResultsThe RDW, platelet‐lymphocyte ratio (PLR), neutrophil‐lymphocyte ratio (NLR), and absolute lymphocyte count were significantly elevated in the invasive hydatidiform mole group compared with control group. The hemoglobin (Hb) concentration, mean red blood cell volume (MCV) and platelet count (PLT) were significantly lower in invasive hydatidiform mole group than control group. Grade III and above invasive hydatidiform mole patients had higher levels of RDW than grade I and II patients. Correlation analysis showed that RDW was negatively correlated with Hb, MCV, NLR, and neutrophil count, but positively correlated with PDW and different stages of invasive hydatidiform mole. The ROC curve showed that the AUC of the RDW was 0.660 (95% CI 0.581‐0.740; P < 0.01).ConclusionThis study reveals the potential value of RDW in invasive hydatidiform mole.

Etiologyical Analysis of 133 Patients with Elderly Macrocytic Anemia and Diagnostic Significance of Laboratory Tests

To study the etiology of macrocytic anemia in elderly patients and to evaluate the diagnostic significance of laborotory tests. 133 elderly macrocytic anemia patients, whose age>60 years old, hemoglobin<100 g/L, mean red cell volume(MCV)>100 fL, and bone marrow cell test was performed, and these patients were grouped according to diseases, and the bilirubin, lactate dehydrogenase, folic acid, vit B12 and serum ferritin were tested, then the results of tests were compared and analyzed. The majority of the cases were diagnosed as megaloblastic anemia (MA), myelodysplasia syndrome (MDS), acute leukemia/multiple myeloma (AL/MM) and hemolytic anemia (HA). Usually HA was a simple anemia, while others were accompanied by decrease of other 1 or 2 series. HA patients were often with significant high level of well volume (MCV), red cell distribution width(RDW), reticulocytes (RC) and indirect bilirubin (IBIL) (P<0.01). However, MA patients were often with high level of LDH. Serum ferritin (SF) level was significantly higher in both MDS and AL/MM groups (P<0.01). Common causes of macrocytic anemia in elderly patients are MA, MDS, AL/MM and HA. The combination detection of MCV, RDW, RC, LDH, IBIL and SF contributes to enhancing the accuracy of diagnosis.

Effect of sheep’s genotype and grazing site on haematological and redox status indicators

The aim of the study was to determine the effect of sheep’s genotype and grazing site on their hematological and redox status indicators. The experiment was carried out on sheep of the Świniarka and Uhruska breeds grazed in naturally valuable areas (xerothermic grasslands) and kept in a sheepfold. Several blood indices were determined by ABACUS Junior Vet, including the numbers of leukocytes, thrombocytes and erythrocytes, hemoglobin and procalcitonin concentrations, hematocrit, the mean red cell volume and the average hemoglobin concentration in red blood cells, the percentages of lymphocytes, monocytes and granulocytes, the degree of erythrocyte anisocytosis and the degree of variation in platelet volume. The concentrations of lipid peroxides and malonic dialdehyde, the activity of superoxide dismutase and catalase and total antioxidant potential were determined by spectrophotometric methods. The study showed that Świniarka sheep had a greater antioxidant potential and higher white blood cell counts than Uhrusian sheep. It was found that sheep’s grazing place had a significant influence on the antioxidant status and hematological indicators of their blood. An improvement in antioxidant potential and hematological blood parameters was achieved in sheep grazed in naturally valuable areas, that is, in the Stawska Góra nature reserve and on xerothermic grasslands in Gródek and Kąty, compared to sheep fed in a sheepfold

Effect of sheep’s genotype and grazing site on haematological and redox status indicators

The aim of the study was to determine the effect of sheep’s genotype and grazing site on their hematological and redox status indicators. The experiment was carried out on sheep of the Świniarka and Uhruska breeds grazed in naturally valuable areas (xerothermic grasslands) and kept in a sheepfold. Several blood indices were determined by ABACUS Junior Vet, including the numbers of leukocytes, thrombocytes and erythrocytes, hemoglobin and procalcitonin concentrations, hematocrit, the mean red cell volume and the average hemoglobin concentration in red blood cells, the percentages of lymphocytes, monocytes and granulocytes, the degree of erythrocyte anisocytosis and the degree of variation in platelet volume. The concentrations of lipid peroxides and malonic dialdehyde, the activity of superoxide dismutase and catalase and total antioxidant potential were determined by spectrophotometric methods. The study showed that Świniarka sheep had a greater antioxidant potential and higher white blood cell counts than Uhrusian sheep. It was found that sheep’s grazing place had a significant influence on the antioxidant status and hematological indicators of their blood. An improvement in antioxidant potential and hematological blood parameters was achieved in sheep grazed in naturally valuable areas, that is, in the Stawska Góra nature reserve and on xerothermic grasslands in Gródek and Kąty, compared to sheep fed in a sheepfold.

Study on the health effects of occupational exposure to lead exceeded

Objective: The main purpose of this study was to explore the health effects of occupational exposure to lead exceeded. Methods: We collected 114 inpatients who exposure to lead, and diagnosed lead toxicity by No. 5 Suzhou People's Hospital from January 2011 to May 2018. Samples were selected according to 1:4 of the lead exceeded group and the control group. The age and gender of the lead exce eded group were matchied, and balanced between the two groups. Lead exceeded group: 84 inpatients occupational exposure to lead, whose blood or urinary lead exceeded. Control group: 336 healthy checkup persons who did not contact with any toxic or hazardous substances. Results: The diastolic blood pressure of lead exceeded group was significantly higher than control group (P<0.05) . The red blood cell count, hemoglobin, mean red blood cell volume, mean hemoglobin content, mean hemoglobin concentration, the platelet count, and the lymphocyte count levels of lead exceeded group were significantly lower than control group (P<0.05) , while the average platelet volume level of lead exceeded group was significantly higher than control group (P<0.05) . The aspartate aminotransferase, glucose and the urea nitrogen levels of lead exceeded group were significantly higher than control group, while the creatinine of lead exceeded group was significantly lower than control group (P<0.05) . The total protein, albumin, cholesterol and low density lipoprotein levels of lead exceeded group were significantly lower than control group (P<0.05) . The abnormal rate of electrocardiogram and spleen B (24.4%, 8.33%) in lead exceeded group were significantly higher than control group (11.04%, 0.6%) (P<0.05) . The abnormal rate of liver B ultrasound, and gallbladder B ultrasound (23.81%、8.32%) in lead exceeded group were significantly lower than control group (41.32%、21.06%) (P<0.05) . Conclusion: Occupational exposure to lead exceeded not only has a significant impact on red blood cell related indicators, but also has a certain impact on cardiac function and liver and kidney functions. It is suggested that lead exprsure may have some effect on health of occupational population.

Changes in red blood cell volume during transition of heart failure status: a reflection of cellular hydration status?

This study examined how changes in heart failure (HF) status induce changes in the index of erythrocyte hydration based on mean red blood cell volume (MCV). Data from 47 HF patients (32% men; 78.2 ± 9.7 years) that experienced worsening and recovery of HF were analysed. Blood tests included measurements of MCV, albumin, serum solutes and b-type natriuretic peptide (BNP). Among a total of 47 worsening HF events, changes in MCV were positively correlated with changes in body weight (r = 0.31, p = .034), serum sodium (r = 0.417, p = .0036), and chloride (r = 0.457, p = .0012), and negatively correlated with changes in blood urea nitrogen (r= −0.389, p = .0069) and creatinine (r= −0.494, p = .0004). At recovery from worsening of HF by conventional diuretic therapy, change in MCV was positively correlated with the change in body weight (r = 0.457, p = .0012), serum sodium (r = 0.466, p = .001) and chloride (r = 0.484, p = .0006). Multivariate regression analysis demonstrated an independent association between the increase in serum chloride and MCV from stability to worsening of HF (odds ratio [OR] 6.02, 95% confidence interval [CI] 1.09–33.2, p = .039) and the increase or absence of change in serum chloride concentration and preserved MCV after decongestion (OR 11.5, 95% CI 1.53–85.9, p = .017). In conclusion, this study demonstrates that the changes in MCV under transition in HF status do not reflect a change that occurs in parallel with changes in HF-related markers, such as body weight and serum BNP level, but is independently associated with a change in the serum chloride concentration. Whether changes in MCV actually reflect the bodily cellular hydration status warrants further research.

Corelaţiile parametrilor sanguini uzuali cu incidenţa cariei dentare la un lot de pacienţI cu hepatită cronică alcoolică

Objectives. To investigate the correlations between the frequency of dental caries, assessed as cariogenic index, and a series of blood parameters in patients diagnosed with chronic hepatitis of alcoholic etiology. Materials and method. The study was conducted on a total of 25 patients diagnosed with chronic hepatitis of alcoholic etiology. The following blood parameters were determined: blood count (erythrocyte count, total hemoglobin, hematocrit, mean red blood cell volume, mean red blood cell hemoglobin, mean erythrocyte hemoglobin concentration), platelet count, white blood cell count (leukocyte count, neutrophils ratio, lymphocytes ratio, monocytes ratio, eosinophils ratio, basophils ratio) and glucose, urea and creatinine concentrations. Results. The mean values were: cariogenic index 1.8±0.96, erythrocytes 4.66±0.51x106/mm3, total hemoglobin concentration 14.67±1.26 g/dL, hematocrit 44.45±3.75%, mean erythrocyte volume 95.6±6.03 fL, mean erythrocyte hemoglobin 31.6±1.86 pg, mean erythrocyte hemoglobin concentration 33.01±1.02 g/dL, platelet count 2.7±0.61x105/mm3, leukocytes 8,812±2,065.66/mm3, neutrophils ratio 63.32±8.75%, lymphocytes ratio 26.32±8.48 %, monocytes ratio 7.99±2.02 %, eosinophils ratio 1.87±1.6%, basophils ratio 0.5±0.31%, glycemia 91.52±8.38 mg/dL, urea concentration 32.12±8.44 mg/dL and creatinine 0.92±0.19 mg/dL. Conclusions. We have been able to establish statistically significant correlations between the cariogenic index and total hemoglobin, hematocrit, mean erythrocyte hemoglobin concentration and glycemia.

Proposal for heart failure progression based on the 'chloride theory': worsening heart failure with increased vs. non-increased serum chloride concentration.

AimsChloride (Cl) is an established key electrolyte for the activation of the renin–angiotensin–aldosterone system. Recent studies have shown the serum Cl as a key electrolyte for the regulation of body fluid distribution in heart failure (HF) patients. The clinical differences of worsening HF status according to the changes in serum Cl concentration are unclear.Methods and resultsData from 47 chronic HF patients were analysed. Upon worsening HF, each patient exhibited at least two HF‐related signs. Blood tests included haemoglobin (Hb), haematocrit (Ht), mean red blood cell volume (MCV), albumin, serum solutes, and b‐type natriuretic peptide. The relative change in the plasma volume (%PV) from stable to worsening HF was estimated as follows: 100 × {Hb (stable) × [1 − Ht (worse)]}/{Hb (worse) × [1 − Ht (stable)]} − 100. When patients were divided into two groups based on changes in serum Cl concentration from stable to worsening HF, the pathophysiologic features of the patients with increased Cl (range 1–23 mEq/L; n = 31) included a greater increase in serum sodium (2.94 ± 4.15 vs. −0.69 ± 3.75 mEq/L, P = 0.005), higher vascular expansion (12 ± 11.1 vs. 4.81 ± 7.94%, P = 0.026), a tendency towards a greater MCV (1.23 ± 2.36 vs. −0.06 ± 1.88 fL, P = 0.065), and preserved renal function defined by the absence of an increase of serum creatinine (−0.24 ± 0.39 vs. −0.05 ± 0.12 mg/dL, P = 0.057) compared to patients with non‐increased Cl (range −9 to 0 mEq/L; n = 16). Clinically, the increased Cl group had fewer HF signs (2.65 ± 0.71 vs. 3.31 ± 0.79, P = 0.005) although the change in symptoms did not differ between groups (48% vs. 63%, P = 0.54).ConclusionsThe present study suggests a new clinical entity of worsening HF status, that is, HF with increased vs. non‐increased serum Cl concentration from clinical stability to worsening HF.

Hydroxyurea therapy in adult Nigerian sickle cell disease: a monocentric survey on pattern of use, clinical effects and patient's compliance.

The clinical prospects of hydroxyurea therapy in the management of sickle cell disease (SCD) require evaluation in the Nigerian setting to develop indigenous guidelines. This survey examines the pattern of hydroxyurea therapy, its clinico-haematologic benefits and safety profile in Nigerian SCD subjects. A cross sectional pilot survey was carried out among 60 adult SCD subjects over 3 months. Data on clinical phenotypes, relevant haematological parameters and details of hydroxyurea therapy were obtained using a structured questionnaire through an interview process and case file review. The median age was 30 years. Thirty-four (56.7%) of the subjects are aware of hydroxyurea therapy in SCD. Twenty-four (40%) SCD patients had previously used hydroxyurea. Only 4 subjects were fully compliant. Reasons for non-compliance included poor knowledge and lack of funds. In particular, hydroxyurea reduced leucocyte count and increased mean red cell volume (MCV) in compliant subjects. Hydroxyurea use is low among Nigerian SCD subjects despite its proven efficacy/clinical prospects in the developed nations. Large scale multicenter studies and clinical trials are needed to form a basis for developing standard local treatment protocol for its use.

Iron status in obese women.

A decreased concentration of iron, and consecutively haemoglobin, ferritin and decreased level of saturated transferrin, were observed in obese individuals more often than in healthy subjects. The purpose of this study was to determine whether iron, ferritin, transferrin saturation are significantly diminished in obese female patients compared to non-obese counterparts, and whether excess adiposity and inflammation were associated with depleted iron. Female patients (n=48) diagnosed with obesity (BMI > 30 kg/m2), aged 18-40 were accepted for the study. A control group (n=30) encompassed normal weight women, aged 18-30. All obese women obtained an individually adjusted dietary plan with an energy content of 1,500 kcal. Blood glucose, insulin, lipids, ferritin, TIBC and iron concentrations were assayed in serum twice, initially and after 8 weeks of dieting. The obese women at the initial evaluation, in comparison to non-obese control women, were characterized by a significantly lower mean red blood cell volume (MCV; 84.2±12.4 vs. 91.3±9.3 fL; p<0.0001), serum iron level (92.6±42.4 vs. 119.8±44.0 μg/dL; p<0.01), and transferrin saturation (TSAT; 25.9±12.7 vs. 38.8±15.7%; p<0.01), but by higher plasma level of the C-reactive protein (CRP; 7.0±6.7 vs. 1.2±1.3 mg/L; p<0.01). The obese women after 8 weeks of diet decreased their mean total body weight from 104.1±21.3 to 99.2±20.7 kg (p<0.0001). CRP level decreased slightly but significantly from 6.9±7.1 to 6.2±7.5 (p<0.05). Obese women exhibit an increased level of CRP which may affect iron homeostasis. Weight loss leads to decrease in the CRP level, but it does not change haematologic parameters in the period of 8 weeks.

The Beneficial Effects of Oral Cotrimoxazole upon Likely Biomarkers of Oxidative Stress in Advanced Fibrotic Lung Disease

Introduction: In cases of idiopathic pulmonary fibrosis, we have observed an elevation in mean red cell volume, serum gamma glutamyl transferase and peripheral monocyte counts, initially in a pilot study but also in new incident cases. These changes could not be explained by drug therapy, vitamin deficiency or other diseases. Method: We compared the peripheral blood abnormalities in 149 patients with lung fibrosis to 448 age and sex matched controls. We also examined the effect of cotrimoxazole treatment for 12 weeks on these abnormalities. From the pilot study of cotrimoxazole in lung fibrosis patients, the relationship of the peripheral blood monocyte count and serum cytokine transforming growth factor beta-1 was examined. Epstein Barr viral status was examined in a selection of patients in case it explained our observations. Results: The findings confirm the elevation in mean red cell volume, gamma glutamyl transferase and peripheral monocyte counts in patients compared with matched controls. Oral cotrimoxazole ameliorated these 3 blood abnormalities. Serological evidence of Epstein Barr viral infection was present in tested patients but active viral replication was absent. The monocyte count had a linear relationship with the serum transforming growth factor beta-1 levels, which increased by 600 pg/ml for every of 0.1 × 109/l increase in the monocyte count. Conclusion: These observations may reflect oxidative stress which was reduced by cotrimoxazole. A related sulphonamide “dapsone” is known to reduce oxidative stress through direct effects on neutrophil and monocyte function; similar effects may explain these findings and require a formal study.

Strategy for monitoring decompensated heart failure treated by an oral vasopressin antagonist with special reference to the role of serum chloride: A case report

Compared with conventional diuretic therapy, monitoring decompensated heart failure (HF) under treatment with a vasopressin antagonist is problematic because (1) use of this medication usually allows the patient free water intake to prevent drug-induced hypernatremia and (2) this medication often induces only minimal changes in the hemodynamics and blood concentration. In a 68-year-old female HF patient, use of tolvaptan did not induce much change in the urine output, presumably because of the low water intake due to a lack of thirst, but she did achieve a profound weight loss. Both the changes in chloride and sodium were negatively correlated with changes in the hemoglobin and serum creatinine, and positively correlated with changes in the mean red blood cell volume, but changes in the serum chloride were better correlated with each variable than were changes in the serum sodium.<Learning objective: The present case of heat failure therapy using a vasopressin antagonist highlights the importance of monitoring serum chloride concentration in relation to changes in the hemoglobin (to evaluate intravascular volume) and mean red cell volume (to estimate intracellular fluid status) in addition to changes in body weight.>