Complete Blood Count Parameters Research Articles

Evaluation of Sensitivity and Specificity of High Fluorescence Lymphocyte Count Percentage of Sysmex XN Analyzer in Diagnosis of Dengue

BACKGROUND: The Sysmex XN-series hematology analyzers provide newer parameters including high fluorescence lymphocyte cell percentage (HFLC%) which correlates with the presence of atypical lymphocytes in peripheral blood. We aimed to analyze the sensitivity and specificity of HFLC% as a diagnostic tool and its association with serological status in diagnosed dengue patients and thereby establish a cutoff of HFLC% based on serology. Besides, we also wish to correlate HFLC% with thrombocytopenia in these patients. MATERIALS AND METHODS: A total of 1500 serum samples were subjected to serological evaluation for dengue. After excluding hematological malignancies and autoimmune disorders, the same day complete blood count parameters including HFLC% and platelet counts were collected retrospectively for 292 serologically positive dengue cases and 76 seronegative controls. RESULTS: Our result shows that in nonstructural 1 antigen-positive cases, a cutoff of >5.2% HFLC can have a sensitivity of 79.5% and specificity of 98.6%. We found a different cut off of HFLC% >3.2% (sensitivity 83.4%, specificity 98.6%) for the cases with only immunoglobulin M positivity and a cut off of HFLC% >2.6% (sensitivity 86.1%, specificity 96%) in the dual positive cases (immunoglobulin M with nonstructural 1 antigen). Besides, high HFLC% also shows a strong correlation with platelet count with a Spearman correlation coefficient of −0.6. CONCLUSIONS: The result of our study shows that a specific cutoff of HFLC% can not only help us to suspect dengue fever but also predict the risk of thrombocytopenia in already diagnosed dengue patients. The sensitivity and specificity of HFLC% varied with the serological status of the patients which depend on the days of fever on presentation.

Relationship between the Hematological Indices and COVID-19

Background: Recently, the novel coronavirus disease-2019 (COVID-19) has a wide spread around the world. Clinically, it was responsible for respiratory illness ranged from mild to life-threatening infection. The study aimed to investigate the link of gender, age, ABO blood groups, and hematological indices with COVID-19 infection. Methods: One hindered COVID-19 cases, as confirmed using reverse transcription–polymerase chain reaction test, were checked for some sociodemographic features, blood group, and hematology parameters. A blood sample was collected from each person in an EDTA container and immediately tested for blood group using commercial antisera, in addition to complete blood count parameters using of a semiautomated hematology analyzer (Mindray BC-3200). Results: Of 100 COVID-19 patients, 52% were male and 48% were female. About 33% and 31% of the study participants were of age group 15–31 and 32–49 years, respectively. The majority (37%) of COVID-19 patients carried blood group O+ve, followed by A+ve (24%). A+ve blood group was significantly more reported in males (32.7%) than females (14.6%). Notably, 61% of participants showed low Hb level. Erythropenia was detected in 41% of the participants, while thrombocytopenia was observed only in 19% of the patients. Moreover, lymphocytopenia was detected in 82%, low packed cell volume in 66%, decreased mean corpuscular volume in 20%, and declined mean corpuscular hemoglobin concentration in 8% of the participants. In contrast, leukocytosis and neutrophilia were found in 69% and 73% of the participants, respectively. Conclusion: Taken together, the study findings highlighted the link of COVID-19 with age, gender, blood groups, and hematology parameters, which is important in diagnosis, prognosis, and management of illness.

Prognostic value of hematological parameters in childhood respiratory tract infections

Introduction. Respiratory tract infections (RTIs) represent a growing burden among pediatric populations, as their potential progression towards acute respiratory insufficiency (ARI), which requires hospitalization and can be light-threatening without adequate supportive measures. Several recent studies have tried to investigate the role of non-invasive depictable parameters, such as those easily determined through a complete blood count (CBC), in the prediction of potentially complicated RTIs. The aim of the current study is to assess whether changes in hematological parameters can predict the development of respiratory insufficiency in children with RTIs. Material and methods. A retrospective study was conducted on 80 patients hospitalized for RTIs, divided into two groups based on their complication by ARI: children with RTI and ARI (group 1-30 patients) and children with RTI, uncomplicated with ARI (group 2-50 patients). Patients with a previously known chronic or hematological disorder were excluded from the study. A CBC was carried out in each patient and C-reactive protein (CRP) values were also determined. Moreover, RT-PCR testing for SARS-COV2 infection was carried out in each child. Results. There were no significant differences in most of the hematological parameters analyzed between the two groups, with the exception of mean corpuscular hemoglobin concentration (MCHC), which exhibited lower values in study group 1. Insignificant differences in parameters of CBC were also found when performing a separate analysis on the subgroup of patients infected with SARS-COV2. However, significantly higher CRP values were found in subjects with RTIs complicated by ARI. An important decrease in hemoglobin levels, under 10 mg/dl, was not positively associated with a complicated outcome of RTIs. Conclusion. Hematological parameters, with the exception of MCHC, are not predictive of ARI in children diagnosed with RTIs. A separate analysis on cases diagnosed with SARS-COV2 infection revealed similar, insignificant results. Further studies, conducted on larger populations, could provide more data regarding the role of hematological parameters in the prediction of RTIs’ severity.

P1557: DISTINGUISHING OF IRON REFRACTORY IRON DEFICIENCY ANEMIA FROM IRON DEFICIENCY ANEMIA AND THALASSEMIA TRAIT BY SYSMEX RESEARCH RED CELL PARAMETERS

Background: Iron refractory iron deficiency anemia (IRIDA), iron deficiency anemia (IDA), and Thalassemia trait (TT) are the most common causes of microcytic anemia. It is possible to discriminate between IDA and TT by routine complete blood count (CBC), hemoglobin (Hb) electrophoresis and iron parameters; however, it is very difficult to distinguish IRIDA from IDA and TT using only routine CBC and iron parameters. Aims: The aim was to distinguish IRIDA from IDA and TT using Sysmex research red cell parameters. Methods: The study included a total of 25 patients (n=10, TT; n=10, true IDA; n= 5, genetically confirmed IRIDA). Traditional [mean corpuscular volume (MCV), mean corpuscular hemoglobin (MCH), mean corpuscular hemoglobin concentration (MCHC), red blood cell count (RBC), and red cell distribution volume (%RDW)] and new red cell parameters [percentage hypochromic RBCs (%Hypo-He); percentage microcytic RBCs (%Micro-R)] were measured in a Sysmex-XN®2000 (Sysmex Corporation, Kobe, Japan), along with iron parameters. Participants’ disorders were categorized based on patients’ ferritin, Hb electrophoresis, genetic results, and CBC values. Results: Compared with the IDA patients, IRIDA patients had significantly higher mean levels of ferritin, RBC, %Hypo-He, %Micro-R and significantly lower mean levels of serum iron level MCV, MCH, and MCHC values (p<0.05 for all). Compared with TT patients, IRIDA patients had significantly higher mean levels of ferritin, %Hypo-He and %RD,W and significantly lower mean levels of serum iron level and MCH values (p<0.05 for all). The RBC, Micro-R, Hypo-He, MCV and MCH cut-off values for discriminating IRIDA from IDA patients were 4.9µL, %60, 50%, 60fL, and 16.0pg, respectively. The RDW, Hypo-He, and MCH cut-off values for discriminating IRIDA from TT patients were %19, %30, and 17.0pg, respectively. Summary/Conclusion: This first study has examined the utility of new red cell parameters in patients with IRIDA. Our findings should be confirmed in larger studies; however, we believe that higher percentage of hypochromic microcytic erythrocytes with an elevated RBC value may be useful predictors for distinguishing IRIDA from IDA patients. As well, a moderate percentage of hypochromic erythrocytes with high RDW value can guide physicians in discriminating IRIDA from TT patients

Does blood type have an effect on the course of COVID-19?

Introduction &#x0D; Predictive parameters that can affect the course of this infection have been the main topic of research since the beginning of the COVID-19 (Coronavirus disease 2019) pandemic. Since the discovery of blood groups, the effect of these on infectious diseases has always been of interest.&#x0D; Objectives &#x0D; To analyze the effect of ABO blood group on mortality, hospitalization duration and hematological and cytokine storm parameters in patients with COVID-19. &#x0D; Patients and methods: This retrospective study was conducted on 140 patients diagnosed with COVID-19. Demographic characteristics, laboratory parameters including ABO blood group, complete blood count (CBC) parameters, biochemical tests, cytokine storm parameters, duration of hospitalization, and final status (discharge or death) were recorded.&#x0D; Results: The 140 patients included in the analysis comprised 72 (51.4%) males and 68 (48.6%) females with a mean age of 66.3±14.0 years. . Age and gender, hospitalization duration and mortality rates were similar in all blood group types. Only D-dimer levels were found to be higher in blood group A compared with other blood groups.&#x0D; Conclusion: Although no difference in mortality was determined between groups, the D-dimer level was statistically significantly higher in COVID-19 patients with A blood group. Larger studies are needed to reflect D-dimer levels on the clinical course of infection, and thus on daily practice.

Practical parameters that can be used for nutritional assessment in patients hospitalized in the intensive care unit with the diagnosis of chronic obstructive pulmonary disease: Prognostic nutritional index, neutrophil-to-lymphocyte, platelet-to-lymphocyte, and lymphocyte-to-monocyte ratio.

Malnutrition is an important condition in patients diagnosed with chronic obstructive pulmonary disease (COPD). There is a need for practical and objective nutritional assessment methods in patients hospitalized in the intensive care unit with the diagnosis of COPD. In this study, it was aimed to determine the parameters that can practically evaluate the nutritional status of these patients. It was aimed to determine the relationship between prognostic nutritional index (PNI), and nutritional risk screening (NRS)-2002, nutrition risk in the critical ill (Nutric) Score and to determine a cut-off value for PNI, neutrophil-to-lymphocyte (NLR), platelet-to-lymphocyte ratio (PLR), lymphocyte-to-monocyte ratio (LMR), and other complete blood count parameters.Hemogram values, albumin values, NLR, PLR, LMR, NRS-2002, PNI and modified Nutric Score calculations of the patients hospitalized in the intensive care unit due to COPD were recorded. The relationship between PNI and NRS-2002 and modified Nutric Score, as well as the relationship between NLR, PLR, LMR, hemogram parameters and PNI were analyzed using statistical methods.The PNI cut-off value for nutritional assessment in patients hospitalized in the intensive care unit due to COPD was determined as 38.5 (area under curve = 0.891, sensitivity 80.8%, specificity 88.1%, positive predictive value 92.9%, negative predictive value 88%). High-risk group according to PNI compared to low-risk group, lymphocyte count (P < .001), basophil count (P = .004), red blood cell (P < .001), hemoglobin (P < .001), hematocrit (P < .001), and LMR (P = .001) were statistically significantly lower, while NLR (P < .001) and PLR (P = .001) were statistically significantly higher. Cut-off values for lymphocyte count, basophil count, NLR, PLR, and LMR were found to be 1.18, 0.035, 7.97, 291.10, and 2.606, respectively.Nutritional risk assessment can be made in a practical way by using PNI in patients hospitalized in intensive care unit due to COPD. For this, the PNI cut-off value was determined as 38.5 in our study. In addition, NLR, PLR, LMR, basophil and lymphocyte values, which can be calculated using complete blood count parameters, may also be useful in the evaluation of nutritional status in these patients. In our study, the cut-off values determined for NLR, PLR, LMR, basophil and lymphocyte were 7.97, 291.10 and 2.606, 0.035 and 1.18, respectively. We think that the results we have obtained can provide preliminary information for future research.

Coagulation Abnormalities and Risk Assessment in Acute Promyelocytic Leukemia: An Experience From a Resource-Constraint Country.

IntroductionThe objective of the study was to assess the impact of coagulopathy in risk-stratified acute promyelocytic leukemia (APML) patients irrespective of bleeding manifestation.Patients and methodsThis was a cross-sectional study design conducted at the National Institute of Blood Diseases and Bone Marrow Transplantation (NIBD & BMT) from November 2019 to December 2021. A total of 62 patients between three years to 74 years of age of either gender and treatment-naive cases of APML were included in the study. Morphological diagnosis was made on bone marrow samples, and confirmation was done by karyotyping/fluorescence in situ hybridization (FISH) and/or polymerase chain reaction (PCR). Complete blood count (CBC), prothrombin time (PT), activated partial thromboplastin time (APTT), D-dimer, and fibrinogen levels were done for bleeding risk assessment. Cases other than APML and cases on treatment were excluded from the study.ResultsA total of 85 APML patients were registered at our institute. Among them, 62 (73%) were included in the analysis as per the inclusion criteria of the study. The median age was 32 (3-74) years, with a male predominance of 34 (55%). According to the Sanz score, 18 (29%) patients were noted to have low risk; however, 22 (35.4%) patients were found to have an intermediate-risk disease and 22 (35.4%) patients had high-risk disease. There was positive bleeding history among 44 (71%) patients, followed by fever in 28 (45%) patients. Raised PT, APTT, and D-dimer were found in 46 (74%), 38 (61%), and 52(83.8%) patients, respectively. Low fibrinogen levels were observed among 16 (26%) patients. The association of risk stratification and bleeding history with CBC and coagulation parameters was observed. Platelet count and total leucocyte count were noted to be significantly associated with risk stratification. However, there was no association observed between the rest of the parameters with risk stratification and bleeding.ConclusionThe results of our study suggest that regardless of bleeding symptoms, coagulation parameters must be investigated at the time of diagnosis in patients with suspected APML, and in addition to all-trans-retinoic acid (ATRA), transfusion of fresh frozen plasma should be done. It has clinical value, and adding it to the algorithm of treatment would be beneficial to the patients in the developing world, where resources are already meager.

Systemic Immune Inflammation Index as a Reliable Disease Activity Marker in Psoriatic Arthritis

To assess the utility of systemic immune inflammation index (SII) in predicting disease activity in psoriatic arthritis (PsA) patients.A descriptive study.Dışkapı Yıldırım Beyazıt Research and Training Hospital, Ankara, Turkey, from October 2020 to September 2021.This study included 106 PsA and 103 age and gender-matched healthy individuals. Neutrophil to lymphocyte ratio (NLR), platelet to lymphocyte ratio (PLR), monocyte to lymphocyte ratio (MLR), and SII were calculated from complete blood count parameters. The PsA disease activity was assessed by using disease activity score-ESR and DAS-CRP based on 28 joints and the Disease Activity in Psoriatic Arthritis (DAPSA) scores. The receiver operating characteristic (ROC) curve was performed to evaluate the utility of SII in determining disease activity in PsA patients.The NLR, PLR, MLR, and SII were significantly higher in PsA patients compared to healthy control (p=0.013, p=0.019, p=0.012, and p=0.002, respectively). There were statistically significant positive correlations between the DAS28-ESR, DAS28-CRP, and DAPSA and SII (p<0.001, p<0.001, and p<0.001 respectively). The SII values were significantly higher in PsA patients with moderate to severe disease activity according to DAPSA scores when compared to patients with remission or low disease activity (p<0.001). The cut-off value of 800x109/L was found for predicting disease activity in PsA.SII may be an easy, practical, economical, and readily accessible tool for monitoring disease activity and the efficacy of treatment in PsA patients.Blood cell count, Psoriatic arthritis, Systematic immune inflammation index (SII).

Complete blood cells count abnormalities in COVID-19 patients and their prognostic significance: Single center study in Makkah, Saudi Arabia.

Objectives:To evaluate the role of different peripheral blood count parameters as a cheap and rapid test in determination of coronavirus disease -19 (COVID-19) severity and patients’ outcome.Methods:The data of 462 confirmed COVID-19 patients who attended at the Security Force Hospital, Makkah, Saudi Arabia, from October 2020 to March 2021 was retrospectively reviewed and C. Patients with viral infection and respiratory diseases other than COVID-19 were excluded from the study. Complete blood count parameters were compared in accordance with the severity of the clinical presentation, age, and disease outcome.Results:A total of 277 (60%) were male and 185 (40%) female. Clinically, 32 (6.9%) had severe illness and 430 (93.1%) showed moderate clinical disease. Organ failure occurred in 2.8% of the patients. There was significant leucocytosis, neutrophilia, lymphopenia, high neutrophil-lymphocyte (N/L) ratio, and anemia in patients with severe COVID-19 diseases as well as in non-survivors’ cases (p<0.001). Similarly, the inflammatory markers (C-reactive protein [CRP] and serum ferritin) were significantly elevated in the above-mentioned 2 groups (p<0.001). Significant decrease of the platelets count was detectable in clinically severe cases and non-survivors (p<0.01). Older age (>60 years) was associated with high leucocyte, neutrophil count, lymphopenia, anemia, organ failure, and poor outcome.Conclusion:Leucocytosis, neutrophilia, lymphopenia, and high N/L ratio together with elevated serum level of ferritin and CRP are eminent features of COVID-19 severity. The inclusion of these parameters in the regimens for patients’ categorization on admission will enable early effective intervention and proper decision making during clinical case management.

HEMATOLOGICAL BIOMARKERS ASSOCIATED WITH INFLAMMATION AND CARDIOVASCULAR RISK IN PSORIASIS SEVERITY

Objective: Psoriasis is a chronic inflammatory disease charactered by abnormal proliferation of keratinocytes and infiltration of immune cells and is associated with increased cardiovascular risk. Psoriasis Area and Severity Index (PASI) is a clinical tool used to assess the severity of psoriasis. Circulating biomarkers, such as those of complete blood count (CBC) derived ratios such as platelet-lymphocyte (PLR) and lymphocyte-monocyte (LMR), have been shown to be associated with autoimmune diseases and have been identified as indicators of systemic inflammation surrogate biomarkers. This study aims to evaluate the impact of CBC biomarkers on psoriasis and their clinical severity (PASI). Design and method: Sixty-three psoriasis patients with a mean age of 52.50 ± 12.81 years. Sociodemographic, hemodynamic and routine blood laboratory data were collected. Patients were stratified based on PASI: &lt; 5 (Group I) and &gt; or equal to 5 (Group II). Biochemical parameters were determined in serum according to standardized methods. For statistical analysis SPSS program was used and a significant value for p &lt; 0.05. Results: Compared patients between the group I and II it were observed higher levels in this last group of: hemoglobin (p = 0.049), mean corpuscular hemoglobin concentration (p = 0.027), leukocytes (p = 0.012), neutrophils (p = 0.006), erythrocyte sedimentation rate (p = 0.032), Gamma-glutamyltransferase (p &lt; 0.001), alkaline fosfatase (p = 0.046), triglicerides (p = 0.038), PLR (p = 0.012) and lower values of: ymphocytes (p = 0.010), LMR (p = 0.018), chloride (p = 0.035), cholesterol-HDL (p = 0.003) and tumour Necrosis Factor alpha (p = 0.030). Conclusions: Routine CBC, derived indices and biochemical parameters related to inflammation and cardiovascular risk appear to be inexpensive and easily accessible biomarkers to psoriasis severity.

КЛИНИЧЕСКИЙ АНАЛИЗ КРОВИ ПРИ ДИФФЕРЕНЦИАЛЬНОЙ ДИАГНОСТИКЕ ТУБЕРКУЛЕЗА ЛЕГКИХ И ВНЕБОЛЬНИЧНОЙ ПНЕВМОНИИ У ПАЦИЕНТОВ С ВИЧ-ИНФЕКЦИЕЙ

Abstract. Introduction. Nowadays, methods for detecting Mycobacterium tuberculosis are being improved, but at the same time, general clinical methods of laboratory diagnostics, which include a complete blood count, included in the diagnostic minimum of tuberculosis screening, do not lose their significance. Aim. The aim of the study is to evaluate the value of a complete blood count in the differential diagnosis of pulmonary tuberculosis and pneumonia in patients with HIV infection. Material and methods. The parameters of the complete blood count were studied in 159 patients in the pulmonology department who were at the stage of differential diagnosis with tuberculosis. For analysis, indicators of erythrocyte sedimentation rate, leukocytes, lymphocytes and hemoglobin were selected. According to the diagnostic results, the diagnoses of pulmonary tuberculosis (n=119) and pneumonia (n=40) were verified. Statistical processing was carried out using the statistical software package IBM SPSS Statistics 22.0. Results and discussion. In a comparative analysis of the complete blood count parameters of a group of patients with a confirmed diagnosis of tuberculosis and pneumonia, statistically significant differences were found in the average hemoglobin level (by 13.25 g/l more in tuberculosis, p&lt;0.001) and the average level of leukocytes (by 4.44*109/l less with tuberculosis, p&lt;0.001). When studying the dependence of changes in the main indicators of a clinical blood test in HIV-infected patients on the level of CD4+ T-lymphocytes, a direct correlation (r=0.451) between the number of CD4+ T-lymphocytes and the level of hemoglobin (p&lt;0.001) was established, the lower the number of CD4+ T-lymphocytes the lower the hemoglobin level. Conclusion. A complete blood count does not differentiate between pneumonia and tuberculosis in patients with HIV infection, but can be used in the algorithm for forming a risk group for tuberculosis in a pulmonology department. Being the most important laboratory test, it can evaluate the changes characteristic of inflammatory (infectious) lung diseases.

Relationship Between Retinopathy and Mean Platelet Volume

OBJECTIVE: Platelet activation is thought to play a role in the angiogenesis process involved in the pathophysiology of retinopathy of prematurity (ROP). We planned this study to investigate whether the mean platelet volume (MPV), used to assess platelet activation, could be used as a biomarker in the diagnosis and treatment of ROP. STUDY DESIGN: In our study, we evaluated infants who underwent ROP examination among infants born at 32 weeks or less and/or 1500 grams or less as well as infants who had more than these values but experienced a bad neonatal period. These patients were divided into two groups as those with and without ROP, and in those with ROP group, as requiring treatment and not requiring treatment. We recorded the patients’ identity, maternal characteristics, antenatal/natal/postnatal features, and complications during follow-up, ROP control times, and complete blood count parameters (platelet count, MPV, platelet count/MPV). Primarily, we evaluated the differences of platelet parameters, especially the MPV values, between treatment requiring ROP and non-treatment requiring ROP groups and secondarily, we evaluated the correlation between scanned parameters and ROP development. RESULTS: Of the 144 patients included in the study, 49 patients (34%) had ROP and 25 patients (16.6%) had ROP requiring treatment. There were statistically significant differences between patients who were diagnosed with ROP and who were not, in terms of gestational age, birth weight, respiratory distress syndrome, surfactant use, duration of oxygen use, intraventricular hemorrhage, patent ductus arteriosus, neonatal sepsis, number of blood transfusions, necrotizing enterocolitis, bronchopulmonary dysplasia and time to catch up birth weight. However, there was no significant difference in terms of MPV, platelet count and platelet/MPV ratio. The gestational week, invasive ventilation day and duration of oxygen use, BPD and time to catch up birth weight were found to be statistically high in treatment-requiring rather than non-treatment-requiring ROP groups. There was no significant difference in MPV, platelet count, platelet/MPV ratio among these groups. A statistically significant difference was found in the most advanced stage ROP and plus existence in the treatment requiring ROP group. CONCLUSION: As a result of our study, we could not find enough data to say that MPV is a marker that can be used in the diagnosis of ROP and in measuring the severity of retinopathy. We suggest that more studies should be done on this subject.

Validation of a Classification Model Using Complete Blood Count to Predict Severe Human Adenovirus Lower Respiratory Tract Infections in Pediatric Cases.

BackgroundHuman adenovirus (HAdV) lower respiratory tract infections (LRTIs) are prone to severe cases and even cause death in children. Here, we aimed to develop a classification model to predict severity in pediatric patients with HAdV LRTIs using complete blood count (CBC).MethodsThe CBC parameters from pediatric patients with a diagnosis of HAdV LRTIs from 2013 to 2019 were collected during the disease’s course. The data were analyzed as potential predictors for severe cases and were selected using a random forest model.ResultsWe enrolled 1,652 CBC specimens from 1,069 pediatric patients with HAdV LRTIs in the present study. Four hundred and seventy-four patients from 2017 to 2019 were used as the discovery cohort, and 470 patients from 2013 to 2016 were used as the validation cohort. The monocyte ratio (MONO%) was the most obvious difference between the mild and severe groups at onset, and could be used as a marker for the early accurate prediction of the severity [area under the subject operating characteristic curve (AUROC): 0.843]. Four risk factors [MONO%, hematocrit (HCT), red blood cell count (RBC), and platelet count (PLT)] were derived to construct a classification model of severe and mild cases using a random forest model (AUROC: 0.931 vs. 0.903).ConclusionMonocyte ratio can be used as an individual predictor of severe cases in the early stages of HAdV LRTIs. The four risk factors model is a simple and accurate risk assessment tool that can predict severe cases in the early stages of HAdV LRTIs.

Age-related changes in mean corpuscular volumes in patients without anaemia: An analysis of large-volume data from a single institute.

Although the mean corpuscular volume (MCV) has been associated with various diseases, these associations in relation to the age‐related trends in MCV remain unclear. Therefore, we used a dataset with over one million values to identify the relationship between ageing and MCV changes. All laboratory data obtained between November 1998 and November 2019 at Chungbuk National University Hospital were retrospectively collected. After excluding cases with missing values for individual complete blood count parameters, outlier MCV values, and ages less than 1 year and more than 88 years, 977,335 MCV values were obtained from 309,393 patients. Principal component analysis of blood components with ages and analysis of the median value changes for each blood component across decade‐wise age groups were conducted to identify relationships between ageing and changes in blood components. The median values of MCV showed gradual increments with age. The linear relationship for patients aged 1–25 years had a larger slope than that for patients aged 26–88 years. For MCV, the equation for patients aged 1–25 years was 0.40*(age) + 81.24 in females and 0.45*(age) + 79.58 in males. The equation for patients aged 26–90 years was 0.04*(age) + 88.97 in females and 0.06*age + 88.30 in males. Among patients aged >40 years, the MCV value was higher in men than in women. Analysis of a large dataset showed that the MCV gradually increased with age and the linear relationship differed between patients aged 1–25 and 26–88 years.

Associations of Complete Blood Count Parameters with Disease-Free Survival in Right- and Left-Sided Colorectal Cancer Patients.

Colorectal cancer (CRC) is a leading cause of cancer-related deaths worldwide. Some complete blood count (CBC) parameters are found to be associated with CRC prognosis. In this study, ninety-seven pretreated CRC patients were included, and the patients were divided into two groups: left-sided and right-sided, depending on the anatomical location of the tumor. Based on clinicopathologic features including tumor budding, disease stages, and tumor anatomical location, levels of CBC parameters were compared, and disease-free survivals (DFS) were determined. There were differences between patients with different tumor budding scores for only three parameters, including red cell distribution width (RDW), numbers of platelets, and mean platelet volume (MPV). Furthermore, numbers of WBCs, monocytes, and MPV in CRC patients with early disease stages were higher than those with advanced stages. However, levels of eosinophil in CRC patients with advanced stages were higher than those with early stages. Depending on the tumor anatomical location, we observed that numbers of red blood cells (RBCs), hemoglobin (Hgb), and hematocrit (Hct) in CRC patients with left-sided tumors were higher than those with right-sided tumors. We found that low levels of MPV were associated with shorter DFS. However, high levels of eosinophils were associated with shorter DFS in all CRC patients. When patients were divided based on the tumor anatomical location, higher levels of MPV, MCHC, and Hgb were associated with better DFS in the left-sided but not right-sided CRC patients. However, left-sided, but not right-sided, CRC patients with high levels of eosinophil and RDW had shorter DFS. Furthermore, right-sided, but not left-sided, CRC patients with high levels of platelets tended to have a shorter DFS. Our data show that MPV and eosinophils could serve as potential prognostic biomarkers in pre-treatment CRC patients, regardless of the tumor anatomical location. Additionally, lower levels of MPV, MCHC, and Hgb, and high levels of eosinophils and RDW could be negative predictive biomarkers in left-sided CRC patients.

Radiological evidence in clinical prevalence of hematological changes in multidrug resistant pulmonary tuberculosis

Background: Globally, tuberculosis is the leading cause of death. India accounts for the highest proportion of drug resistant tuberculosis among all other countries. Objectives: This study investigated the changes in hematological parameters with respect to radiological evidences in multidrug resistant tuberculosis patients. Materials and Methods: The study enrolled a total of 273 patients with the confirmative diagnosis of multidrug resistant tuberculosis. The radiological evidences were classified into mild, moderate and severe lung involvement. Results: The chest radiographs illustrated tracheal deviation (74), loss of lung volume (35), pleural effusion (25), lobar collapse and fibrotic manifestations. The defensive leucocytes, phagocytic neutrophils, anucleated platelet cells and platelet volume observed an increase with severe lung grading (p&lt;0.0001). Reduced lymphocyte count, mean platelet size observed with the intense lung involvement. Prevalence of normocytic, normochromic anemia, anisocytosis was prominent in these patients. The erythrocyte sedimentation rate observed no significant changes in the categorized radiological grades of lung. Radiological grading reported a weak positive correlation with the hematological parameters. Conclusion: The study noticed the changes in the complete blood count parameters with radiological signs and recommend monitoring of these investigations in determining the progression of the lung involvement in the multidrug resistant pulmonary tuberculosis patients.

The Implication of Aquaporin-9 in the Pathogenesis of Preterm Premature Rupture of Membranes.

This study aimed to detect aquaporin-9 (AQP9) concentrations in the serum of patients with preterm premature rupture of membranes (PPROM) and compare them with the healthy control group with intact membranes. We conducted this prospective case-control study from March 2021 to August 2021. Of the 80 pregnant patients included in the study, we enrolled 42 singleton pregnant patients with PPROM as the study group and 43 healthy gestational age-, and body mass index (BMI)-matched healthy pregnant women with intact fetal membranes as the control group. We compared demographic and clinical characteristics, complete blood count and biochemical parameters, and serum AQP9 concentrations of the participants. We constructed an ROC curve to illustrate the sensitivity and specificity performance characteristics of AQP9 and calculated a cutoff value by using the Youden index. Maternal serum AQP-9 concentrations were significantly higher in patients with PPROM (804.46±195.63 pg/mL) compared to the healthy pregnant women in the control group (505.97±68.89 pg/mL, p<0.001). When we examine the area under the ROC curve (AUC), the AQP-9 value can be reflected as a statistically significant parameter for diagnosing PPROM. According to the Youden index, a 654.78 pg/mL cut-off value of AQP-9 can be utilized to diagnose PPROM with 80.5% sensitivity and 100% specificity. Maternal serum AQP9 concentrations were significantly higher in PPROM patients than healthy pregnant women with an intact membrane. We suggest that AQP9 might be an essential biomarker of the inflammatory process and energy homeostasis in PPROM.

Osteoid Osteoma of the Talus Misdiagnosed with Juvenile Idiopathic Arthritis: A Case Report

Osteoid osteoma is a primary benign bone tumor that consists of a central area (nidus), surrounded by sclerotic bone. The most relevant symptom is pain that increases during the night and improves after salicylates or nonsteroidal anti-inflammatory drug administration. Osteoid osteoma is frequently misdiagnosed because it mimics juvenile idiopathic arthritis, bone infection, or malignancy. A 14-year-old girl presented to our department with a history of chronic pain in her left ankle. Juvenile idiopathic arthritis was diagnosed and anti-inflammatory treatment was prescribed. Because of persistence of ankle pain, the patient underwent further examinations, in particular, bone scintigraphy and computed tomography. As a result, osteoid osteoma of the talar neck was diagnosed. The patient underwent surgical treatment and her condition improved. Osteoid osteoma should also be considered in patients with chronic ankle pain to avoid misdiagnosis and start adequate treatment. This condition should be suspected in a patient with chronic bone pain and normal complete blood count and inflammatory parameters.

Evaluation of the Relationship between Simple Hemogram Indexes and Disease Severity Scores in Pediatric Familial Mediterranean Fever

Aim: In recent years, it has been seen that simple complete blood count (CBC) parameters can be used to show subclinical inflammation in patients with familial Mediterranean fever (FMF). The aim of this study is to determine whether there is a difference in CBC parameters among FMF patient groups divided according to disease severity scores. Material and Methods: FMF patients followed up in our clinic between 2016 and 2019, were reviewed for medical records. They were divided into three groups as those with mild, moderate, and severe diseases according to the disease severity scoring systems by Pras et al., Mor et al., and International Severity Score of FMF (ISSF). Red cell distribution width (RDW), platelet, neutrophil, lymphocyte, RDW-platelet ratio (RPR), platelet-lymphocyte ratio (PLR), and neutrophil-lymphocyte ratio (NLR) of the patients were compared among the groups. Results: According to the scoring system of Pras et al., lymphocyte value was found significantly higher in the group with severe disease compared to the groups with mild and moderate diseases (p=0.031). PLR was significantly lower in the group with severe disease compared to moderate diseases according to the scoring system of Mor et al (p=0.008). According to ISSF, there was no difference among the groups in terms of CBC parameters. Conclusion: Different results were obtained according to all three scoring systems. Since the ISSF is the most common and suitable system for use in FMF patients, we can conclude that there is no relationship between disease severity and RDW, RPR, NLR and PLR.

Electrosprayed Nanoparticles Containing Hydroalcoholic Extract of Echinacea purpurea (L.) Moench Stimulates Immune System by Increasing Inflammatory Factors in Male Wistar Rats.

Purpose: Echinacea purpurea (L.) Moench is a member of the Asteraceae family and is traditionally used mainly due to its immunostimulatory properties. Various compounds including alkylamides and chicoric acid were reported as active ingredients of E. purpurea. Here, we aimed to prepare electrosprayed nanoparticles (NPs) containing hydroalcoholic extract of E. purpurea using Eudragit RS100 (EP-Eudragit RS100 NPs) to improve the immunomodulatory effects of the extract. Methods: The EP-Eudragit RS100 NPs with the different extract:polymer ratios and solution concentrations were prepared using the electrospray technique. The size and morphology of the NPs were evaluated using dynamic light scattering (DLS) and field emission-scanning electron microscopy (FE-SEM). To evaluate the immune responses, male Wistar rats were administrated with the prepared EP-Eudragit RS100 NPs and plain extract in the final dose of 30 or 100 mg/kg. The blood samples of the animals were collected and the inflammatory factors and complete blood count (CBC) were investigated. Results: In vivo studies indicated that the plain extract and EP-Eudragit RS100 NPs (100 mg/kg) significantly increased the serum level of tumor necrosis factor-α (TNF-α) and interleukin 1-β (IL1-β) whereas the EP-Eudragit RS100 NPs (30 mg/kg) significantly increased the number of white blood cells (WBCs) compared to the control group. Lymphocytes' count in all groups was increased significantly compared to the control group (P<0.05) whereas other CBC parameters remained unchanged. Conclusion: The prepared EP-Eudragit RS100 NPs by electrospray technique caused significant reinforcement in the immunostimulatory effects of the extract of E. purpurea.