Red Blood Cell Indices Research Articles

Quantitative Measurements of Red Blood Cell Indices Using Spectroscopic Differential Phase-Contrast Microscopy.

Red blood cell (RBC) indices serve as clinically important parameters for diagnosing various blood-related diseases. Conventional hematology analyzers provide the highly accurate detection of RBC indices but require large blood volumes (>1 mL), and the results are bulk mean values averaged over a large number of RBCs. Moreover, they do not provide quantitative information related to the morphological and chemical alteration of RBCs at the single-cell level. Recently, quantitative phase imaging (QPI) methods have been introduced as viable detection platforms for RBC indices. However, coherent QPI methods are built on complex optical setups and suffer from coherent speckle noise, which limits their detection accuracy and precision. Here, we present spectroscopic differential phase-contrast (sDPC) microscopy as a platform for measuring RBC indices. sDPC is a computational microscope that produces color-dependent phase images with higher spatial resolution and reduced speckle noise compared to coherent QPIs. Using these spectroscopic phase images and computational algorithms, RBC indices can be extracted with high accuracy. We experimentally demonstrate that sDPC enables the high-accuracy measurement of the mean corpuscular hemoglobin concentration, mean corpuscular volume, mean corpuscular hemoglobin, red cell distribution width, hematocrit, hemoglobin concentration, and RBC count with errors smaller than 7% as compared to a clinical hematology analyzer based on flow cytometry (XN-2000; Sysmex, Kobe, Japan). We further validate the clinical utility of the sDPC method by measuring and comparing the RBC indices of the control and anemic groups against those obtained using the clinical hematology analyzer.

Abstract 11667: Red Cell Indices and Long-Term Prognosis of Heart Failure Patients

Introduction: It has been demonstrated that some properties of red blood cells also play a role in the etiology of cardiovascular diseases and their complications. Hypothesis: We determined to what extent red blood cell indices observed during hospitalization for heart failure (HF) affect the long-term prognosis of these patients. Methods: We followed 3697 patients [mean age 71.4 years (±SD10.1), 59.1% males] hospitalized for decompensated HF between 2010-20. In the multivariate model, we assessed the five-year all-cause mortality risk associated with red cell distribution width (RDW), mean corpuscular volume (MCV), mean corpuscular hemoglobin concentration (MCHC), and hemoglobin concentration (dichotomized by tertiles). Results: Kaplan-Meier survival curves comparing the tertiles of red cell indices are in Figure. Patients with RDW in the top tertile showed roughly two-fold higher 5-year mortality risk than those in the bottom tertile; increased risk we also observed in the middle tertile of RDW. This association remained significant even after complex adjustments for individual characteristics (age, gender, ejection fraction, HF etiology, history of malignancy, revascularization, hypertension, diabetes, LDL, atrial fibrillation, and glomerular filtration) as well as treatments (furosemide, beta-blockers, RAS blockers, MRA′s, statins). [HRR 1.83 (95% CIs: 1.53-2.18), p<0.0001, 3 rd versus 1 st ; 1.42 (95%CIs: 1.19-1.68), p<0.0001, 2 nd versus 1 st ] Similarly, we observed increased mortality risk in the bottom tertile of MCHC [HRR 1.34 (95%CIs:1.14-1.59), p=0.001, 1 st versus 3 rd ( fully adjusted)] or hemoglobin [HRR 1.37 (95%CIs: 1.15-1.62), p<0.0001]. In contrast, MCV did not show any additive mortality risk. Conclusions: High degree of anisocytosis and low red cell status of hemoglobin represents independent indicators of poor prognosis in heart failure patients, even long-term after an acute manifestation.

Ferritin Reference Ranges in an Adult Population of Working-Age Adults without Anemia

Introduction Considerable controversy has surrounded the creation of reference intervals for ferritin within tested populations. This is particularly true for women and has been attributed to a high prevalence of nonanemic iron deficiency due to physiologic blood loss during menses and physiologic iron transfer during pregnancy. The Quest Blueprint for Wellness (BFW) program is an annual health screening that provides a range of testing to Quest employees and families. Using deidentified data on 24,812 individuals (55% female; age range 18-80 years old) collected as part of this program, we studied the relationship between serum ferritin and characteristics of the study population, red blood cell parameters, and iron saturation in order to better define normal reference ranges for serum ferritin. Methods Test results of participants in the annual BFW screening program conducted between January 2022 and May 2023 were identified (26,535 [53% female]); tests included hematocrit, hemoglobin, RBC indices (including RDW), total serum iron and total iron binding capacity and CRP. Individuals with abnormalities of hemoglobin, hematocrit or RBC indices (including RDW); serum iron or serum TIBC; or elevated CRP were successively excluded, leaving 24,812 participants (55% female). None of these remaining individuals had a personal history of anemia or an identified ICD-10 code associated with anemia or other RBC disorder. This study population was used in subsequent analyses. Multimodal decomposition (MMD) in R (version 4.2.2) was used to calculate reference intervals based on the distribution of results associated with the healthy study subpopulation that was defined. To address the possibility that the TIBC saturation initially employed (20%) was too low, reference intervals were also determined when varying TIBC saturations from 20%-25%. Results As shown in Table 1, the lower limits of the ranges identified did not vary significantly as the TIBC saturation percent was increased from 20% to 25%. The lower limit for women below 50 years of age ranged from 11-13 ng/mL, which was substantially lower than the lower limits for men of the same age. Over the age of 50, the lower limit of the ferritin reference ranges for women increased, approaching but not equaling or exceeding the values observed for men until ages greater than 70. This may reflect the end of menses and the gradual repletion of iron stores. In contrast, the lower limits of the reference ranges for serum ferritin for men increased at ages 30-40 and then declined and fell below that of women in the eighth decade. Conclusions Comparing the lower range of ferritin values between men and women, these data suggest that iron deficiency may be present in a large proportion of working age women in the absence of anemia or abnormal RBC indices. These data also suggest that normal ferritin values are age dependent for both men and women. These conclusions are tempered by the unavailability of a physiologic reference standard able to demonstrate that iron deficiency is in fact present. The lower limit of the ferritin range for women under the age of 60 and for men over the age of 70 approximates the ferritin values associated with the absence of stainable bone marrow iron. While this test is the traditional “gold standard” it is rarely performed for the evaluation of iron status. The evaluation of iron deficiency at present lacks a physiologic indicator, analogous to the relationship between parathyroid hormone and calcium levels which permitted the definition of blood levels of 25 hydroxyvitamin D that represented sufficiency, or methylmalonic acid concentration in B12 deficiency. The broader availability of measures to assess the functional status of reticuloendothelial iron stores available to support erythropoiesis, such as measurements of hepcidin, would facilitate such an assessment.

Diagnostic Performance of Red Blood Cell Indices, Serum Erythropoietin, and JAK2 Mutation Testing for the Evaluation of Polycythemia Vera at High Altitude

Introduction: Polycythemia vera (PV) is a clonal myeloproliferative neoplasm associated with mutation of Janus kinase 2 ( JAK2) in virtually all patients. Patients with PV typically present with constitutional symptoms and thrombotic complications related to myeloproliferation but can present with only mild or no symptoms. In 2016, the World Health Organization (WHO) diagnostic criteria for PV were revised to use lower hemoglobin and hematocrit cut-off levels in order to avoid missing masked polycythemia. Accordingly, a hemoglobin concentration of more than 16 g/dL (HCT>48%) for females and 16.5 g/dL (HCT>49%) for males can be considered for PV evaluation (previously >18.5 g/dL for men and >16.5 g/dL for women). In conjunction, concerns arise about the unnecessary evaluation of individuals with otherwise high-normal hemoglobin levels, more so for those living at high altitude. Altitude exposure, amongst others, decreases plasma volume to increase [Hb] which may accordingly muddle the diagnosis of PV at altitude. Nonetheless, Red Cell Mass (RCM) is seldom assessed in clinical practice. In addition, red blood cell count, related indices, and serum erythropoietin may also be affected by high altitude, and their diagnostic performance in the evaluation of PV at altitude has not been prospectively assessed. Method: We collected lab records for all JAK2 requests over three years (2020-2022) in two referral hospitals serving a population residing at an altitude of 2,270-3,000 meters above sea level. Indications for requests, as well as laboratory data and imaging, were gathered. Complete blood count (CBC) and other laboratory values were collected when ordered within one week of JAK2 testing. For CBC, EDTA anticoagulated samples were processed using Sysmex XN-3100. For JAK2 testing, RNA isolated from peripheral blood samples (using the MagNA Pure System) was reverse-transcribed, amplified, and sequenced for any mutations involving exons 12, 13, 14, or 15 using an ABI 3730 XL genetic analyzer. For serum EPO, frozen serum samples were outsourced to Bio Scientia Labs, Germany. Reference values for serum erythropoietin were lab generated at 4.3-29 mIU/ml and were not validated for our altitude. . Results:Of the 208 JAK2 tests performed during the reviewed period, 132 (63.4%) were for polycythemia (Table 1). The JAK2 V617F mutation was found in 22 (16.7%) patients, with 10 (45.5%) of them being men. No JAK2 mutation other than the exon 14 V617F substitution was found. JAK2-positive patients had a median age of 61 years, while JAK2-unmutated patients had a median age of 47 years. Overt polycythemia, according to the WHO 2016 classification, was identified in 15 (68.2%) , while the remainder had masked PV ( defined as increased RBCs with normal hemoglobin/ HCT). Patients with PV had significantly higher RBCs and lower MCV/MCH/MCHC compared to those with JAK2-unmutated polycythemia. They also exhibited significant elevation of RDW-CW and significant neutrophilia, basophilia, thrombocytosis, and splenomegaly. All PV patients with available serum EPO tests had low values (median 2 mIU/ml). Conclusion: At altitude, patients with PV show the same age and sex characteristics as those living at low elevations. Patients with PV have higher RBCs and lower MCV/MCH/MCHC compared to those with JAK-unmutated (secondary) polycythemia. RDW is significantly increased in patients with PV, reflecting an associated iron deficiency. Serum EPO performed well at altitude to suggest the presence of PV. The low rate of positive JAK2 mutation in our high-altitude cohort may reflect poor selection of subjects and over-workup of otherwise altitude-associated erythrocytosis. Isolated mild polycythemia at altitude remains common. Using hemoglobin/hematocrit alone to select patients for PV evaluation has a low positive predictive value and may be associated with unnecessary workup. RBC indices and RDW, along with an evaluation for iron status, might help select those more likely to have PV and could decrease unnecessary workups.

Comparative effect of ethanol extract of Moringa oleifera leaf and Boo-Sta Plus on the body weight and haematological indices of Wister albino rats

The comparative effects of ethanol extract of Moringa oleifera and Boo-Sta Plus on the red blood cell indices and body weight of Wistar albino rats were investigated. Fortification of food is not just trending in the human diet but also in the animal diet. Boo-Sta Plus have been employed in dietary fortification to achieve better results in meat quality, protein mass and weight gain, however, these artificial fortification causes antibiotic resistance and may have other negative health implications. Focus is now being directed on plant-based alternatives such as Moringa oliefera to curb these negative effects. Fresh leaves of Moringa oleifera were washed, oven dried and ground. Twenty (20) Wistar rats weighing (150-170 g) were divided into four groups containing five rats in each group (A, B, C and D). Rats in group A (control) received normal rat chow feed and water. Group B was fed 200 mg/kg body weight Moringa extract (low dose), Group C received 400 mg/kg body weight (high dose) and Group D received Boo Sta-Plus. All the experimental groups received their respective treatment in addition to feeding and water. Weekly body weight was recorded during the duration of 21 days of administration of leaf extract. At the end of 21 days of treatment, blood samples were obtained through cardiac puncture and analysed for haematological indices. The results show that Moringa oleifera leaf extract (low dose) and Boo-Sta Plus caused a significant increase (p < 0.05) in the RBC, Hb, PCV, whereas a high dose of the leaf extract caused a decrease in the red blood cell indices when compared with the control. The administration of extract caused weight increase at a high dose comparatively to the Boo-Sta Plus and control. It is therefore concluded that ethanol extract of Moringa oleifera has positive effects on blood parameters and body weight and could serve as a substitute for Boo-Sta Plus thereby curbing the adverse health implications of artificial boosters.

The Relationship between Complement Components C1R and C5 Gene Polymorphism and the Values of Blood Indices in Suckling Piglets.

The main mechanism of innate immunity is the complement system. Its components include the protein products of the C1R and C5 genes, which are involved in the classical activation pathway as well as the inflammatory and cytolytic immune responses, respectively. The aim of this study was to determine the relationship between PCR-restriction fragment length polymorphism in C1R (726T > C) and C5 (1044A > C) genes, and the values of hematological and biochemical blood indices in suckling crossbred (Polish Large White × Polish Landrace × Duroc × Pietrain) piglets (n = 473), considering their age (younger, 21 ± 3 days, n = 274; older, 35 ± 3 days, n = 199) and health status. The frequencies of the C5 genotypes deviated from the Hardy-Weinberg expectations. Younger piglets, healthy piglets, piglets that deviated from physiological norms and older piglets with the C1R TT genotype all had lower white and red blood cell indices. In piglets with the C5 CC genotype, younger piglets, piglets that deviated from physiological norms and older piglets, a greater number and/or percentage of monocytes were recorded in the blood. Older piglets also showed an increase in the number of leukocytes and granulocytes, along with a tendency for a decrease in the percentage of lymphocytes in their blood. We concluded that a polymorphism in the C1R gene may exhibit a functional association or genetic linkage with other genes involved in the process of erythropoiesis. Furthermore the relationship between the C5 gene polymorphism and the number and/or percentage of monocytes in the blood may modify the body's defense abilities. Piglets with the CC genotype, having an increased number/proportion of these cells in their blood, probably display a weakened immune response to pathogens or a chronic stimulation of the immune system.

Empagliflozin effects on iron metabolism as a possible mechanism for improved clinical outcomes in non-diabetic patients with systolic heart failure

Sodium-glucose co-transporter-2 (SGLT2) inhibitors improve clinical outcomes in patients with heart failure (HF), but mechanisms of action are incompletely understood. In the EMPA-TROPISM trial, empagliflozin reversed cardiac remodeling and increased physical capacity in stable non-diabetic patients with systolic HF. Here we explore, post hoc, whether treatment effects in this cohort, comprising patients who had a high prevalence of iron deficiency, were related to iron metabolism. Myocardial iron content estimated by cardiac magnetic resonance T2* quantification increased after initiation of empagliflozin but not placebo (treatment effect: P = 0.01). T2* changes significantly correlated with changes in left ventricular volumes, mass and ejection fraction, peak oxygen consumption and 6-minute walking distance; concomitant changes in red blood cell indices were consistent with augmented hematopoiesis. Exploratory causal mediation analysis findings indicated that changes in myocardial iron content after treatment with empagliflozin may be an important mechanism to explain its beneficial clinical effects in patients with HF.ClinicalTrials.gov: NCT03485222.

A Cross-sectional Study to Assess Pandu Vyadhi (Anemia) with Special Reference to RBC Indices and Morphology: A Study Protocol

Background: Ayurveda is a science of life & its holistic approach towards Dietary habits, seasonal regimes, daily regimes, lifestyle practices helps to maintain health of an individual. Inadequate dietary intake or lack of balanced diet leads to malnutrition & has major role in manifestation of various diseases Pandu vyadhi is one among them. Considering the sign & symptoms the disease is correlated with Anemia. It is a major global public health problem & most prevalent nutritional deficiency disorder affecting one third of the world’s population. The disease is more prevalent in low-income countries. It affects the patient both physically & mentally. Among the different form of therapies used for treatment of anemia in modern medicine shows adverse effects ranging from mild to severe. So there is need to seek out the safe & effective Ayurvedic treatment for anaemia. Clinical symptoms & laboratory investigations both are necessary for accurate diagnosis of disease. But due to lack of proper investigative methods a case of anemia becomes difficult to diagnose for its different types as per Ayurveda.
 Aim: To study & assess Pandu vyadhi with Special Reference to RBC indices and Morphology on peripheral smear.
 Methods: This is descriptive cross sectional study which focuses on assessing Pandu vyadhi with Special Reference to RBC indices and Morphology on peripheral smear.
 Conclusion: The present study generates reliable data of Pandu vyadhi in relation to various laboratory parameters which helps to plan specific treatment as mentioned in Ayurvedic classics for different types of Pandu vyadhi. The use of large sample size will also improve the precision of the study and increase the generalizability of the result.

Comparative Analysis of Red Blood Cells, White Blood Cells, Platelet Count, and Indices in Type 2 Diabetes Mellitus Patients and Normal Controls: Association and Clinical Implications.

Diabetes mellitus (DM) is a major health burden affecting 537 million adults worldwide, characterized by chronic metabolic disorder and various complications. This case control study aimed to assess the impact of type 2 diabetes mellitus (T2DM), including hyperglycemia levels, on hematological parameters and complete blood count (CBC) derived parameters. A total of 250 known diabetic patients from the Jazan Diabetic Center, Saudi Arabia, between January 2021 and December 2022, along with 175 healthy adult controls were recruited from Jazan Hospital's blood donation center. Demographic characteristics, medical histories, and relevant factors such as gender, age, BMI, treatment, disease duration, and comorbidities were collected with informed consent. The results of the red blood cell (RBC) count, RBC indices, and mean platelet volume showed significant differences between patients and controls, while the white cell (WBC) and platelet count were comparable between the two groups. CBC-derived parameters, especially neutrophil/lymphocyte ratio (NLR), and platelet/neutrophil ratio (PNR) exhibited significant differences. CBC and derived parameters serve as inexpensive tools for T2DM patients monitoring, indicating early blood cell alterations and potential development of anemia. Further studies are needed to explore their role in predicting T2DM pathogenesis and progression, aiming to reduce severe complications, mortality and morbidity.

A-145 Development of a Novel Algorithm Using Red Blood Cell Indices for Screening of Alpha Globin Gene Deletions

Abstract Background Distinguishing between different causes of microcytic anemia is essential for management of anemic patients. More than 20 different RBC indices have been used to screen thalassemia trait with inconsistent results. Differentiation between iron deficiency anemia (IDA) and alpha-thalassemia is challenging based on RBC indices alone. Moreover, thalassemia and IDA may coexist. A highly sensitive screening algorithm is needed to select clinical cases for alpha globin gene analysis to reduce unnecessary testing and improve pre-test probabilities. Methods A retrospective study was performed to evaluate the reliability of 22 RBC indices (RBC, MCV, RDW, MCH, Mentzer Index, RDW Index, etc) and formulae in differentiating cases with 1–2 alpha globin gene deletions from negative cases, in a cohort of 90 individuals with confirmatory alpha globin gene analysis results. Results The number of patients with each alpha globin gene deletion pattern were: 37 patients with alpha-thalassemia trait, 21 silent carriers (one gene deletion), 31 patients with negative result and 1 patient with triplicated alpha globin gene. The mean RBC count in each group were 4.79 ± 0.65 (trait), 4.45 ± 0.73 (carrier), and 4.21 ± 0.84 (negative) (million/mm). The mean MCV in each group were 71.1 ± 4.8 (trait), 76.1 ± 5.9 (carrier), and 74.2 ± 9.3 (negative) (fL). The mean RDW in each group were 16.5 ± 3.0 (trait), 17.2 ± 3.4 (carrier), and 18.3 ± 4.9 (negative) (%). The mean MCH in each group were 22.0 ± 1.8 (trait), 23.8 ± 2.3 (carrier), and 23.5 ± 3.7 (negative) (pg). None of the RBC indices showed significant difference between carrier and negative groups, while 20 RBC indices showed significant difference (P < 0.05) between trait and negative groups. The sensitivities of the RBC indices in detecting 1–2 alpha globin gene deletions based on published cut-offs ranged between 3.4% and 81.0%, while the specificities ranged between 41.9% and 100%. A novel scoring algorithm was evaluated based on the combination of 12 selected RBC indices and formulae, with each index or formula contributing to a score of 0 or 1. The average value of the negative cases was used as the score cut-off value for each index or formula. The scoring algorithm gave a score distribution between 0 and 12, with lower scores indicating alpha globin gene deletions. It achieved a sensitivity of 96.6% in detecting 1–2 alpha globin gene deletions, with a negative likelihood ratio of 0.15. The negative likelihood ratio of the scoring algorithm outperformed each of the individual RBC indices at similar levels of sensitivities (>95%). Conclusion The novel algorithm is a highly sensitive tool for screening of alpha globin gene deletions, including one gene deletion. It is more effective at identifying negative cases compared to individual RBC indices. Implementation of the algorithm could efficiently reduce 10.0% (9/90) of the test volume of alpha globin gene analysis. A more stringent version of the algorithm that incorporates standard deviation in the cut-off values could potentially achieve nearly 100% sensitivity and reduce 5.6% (5/90) of the alpha globin gene analysis test volume.

A-146 A Review of RDW-CV and RDW-SD Measurements in Patients With Iron Deficiency Anemia in an Acute Care Hospital in Singapore

Abstract Background Red Cell Distribution Width (RDW) is a routinely available parameter on automated haematology analysers. This parameter is often used to help in the diagnosis of iron deficiency anaemia. RDW quantitatively measures the degree of anisocytosis of the red blood cells. The more common way of reporting RDW is RDW-CV, which is based on the coefficient of variation of the red blood cell distribution volume and is calculated using mean red cell volume. RDW can also be presented as RDW-SD, which is a direct measurement of the width of the red blood cell distribution curve and is not influenced by mean red cell volume. Conventionally, laboratories report RDW-CV as part of the red blood cell indices in full blood count (FBC) reports. However, it has been proposed that RDW-SD is a better indicator of iron deficiency anaemia compared to RDW-CV. The authors seek to review and assess the clinical utility of both RDW measurements in patients with iron deficiency anaemia in an acute care hospital in Singapore. Methods RDW data of samples from 271 unique individuals from Sysmex XN-9000 (Sysmex, Japan) automated haematology analysers over a period of two months were reviewed. These individuals were selected as they had plasma iron measured in the same blood collection. The individuals were sorted into two groups based on the plasma iron measurement: with iron deficiency (80%) and without iron deficiency (20%). The correlation of RDW-CV and RDW-SD with the plasma iron concentration of the individuals was studied. The RDW-CV reference range used were established for the local population by an in-house reference range validation study while that of the RDW-SD is from a recent Participant Summary Report for a College of American Pathologists (CAP) Hematology Automated Differential survey (FH9-B 2022). The sensitivity, specificity, predictive values, and overall efficiency of RDW-CV and RDW-SD were calculated and compared using the data collected. Results The sensitivity and specificity of RDW-CV in detecting iron deficiency anaemia are 45.2% and 68.5%. The positive and negative predictive values for RDW-CV are 85.2% and 23.7% respectively. The sensitivity and specificity of RDW-SD in detecting iron deficiency are 33.2% and 64.8%. The positive and negative predictive value of RDW-SD are 79.1% and 19.4% respectively. The overall efficiency of RDW-CV is 49.8%, significantly higher than 39.4% of RDW-SD. Conclusion This retrospective study suggested that RDW-CV is still a better blood cell index than RDW-SD in the differential diagnosis of iron deficiency anaemia in a predominantly Asian population. However, the use of RDW-SD reference range that is appropriate for the local population may improve the clinical utility of the RDW-SD.

When a synonymous mutation breaks the silence in a thalassaemia patient.

Synonymous mutations were considered to lack functional roles in human diseases; however, distinguishing deleterious synonymous mutations from benign ones is still a challenge. In this article, we identified a deleterious synonymous mutation β-codon 16 (C>T). HBB: c.51C>T, in compound heterozygous form with known β-thalassaemia mutation patients who clinically presented as non-transfusion-dependent thalassaemia (NTDT). A total of 9 families with 11 compound heterozygous index cases were reported. In the heterozygous state, codon 16 (C>T) mutation results in borderline HbA2 (3.18 ± 0.36%) and slightly reduced RBC indices (RBCs: 4.73 ± 0.75 × 106 /μL, Hb: 12.26 ± 2.60 g/dL, MCV: 79.48 ± 8.40 fL, MCH: 25.95 ± 4.15 pg). The compound heterozygous patients showed elevated HbA2 (5.98 ± 1.17%) and HbF (12.75 ± 7.51%) and presented clinically as NTDT with a mean Hb of 6.95 ± 1.29 g/dL. Many of them were dependent on few transfusions and had mild splenomegaly. Of the 11 patients, 5 (45.4%) were treated with hydroxyurea. This study highlights the clinical significance of synonymous mutation, when inherited with other β-thalassaemia mutations leading to the phenotype of NTDT. Thus, the study would help to improve screening protocols for β-thalassaemia carriers, which will ultimately improve the prevention programme.

Red blood cell - Platelet ratio (RPR) and Hemoglobin - Platelet ratio (HPR) in patients with rheumatoid arthritis: a study at Hue University of Medicine and Pharmacy Hospital

ABSTRACT Background: Rheumatoid arthritis (RA) is an autoimmune disease that causes chronic inflammation of the joints, resulting in destruction and deformation of bones and cartilage. In addition to causing joint damage, up to 30 - 70% of RA patients have chronic anemia that reduces quality of life. The inflammatory process affects some red blood cell and platelet indices such as increased platelet count, anemia and hypochromic microcytic cells. Red blood cell - platelet ratio (RPR) and hemoglobin - platelet ratio (HPR) are considered as indicators to help assess inflammation and activity level in patients with RA. This study describes hematological characteristics and the relationship of RPR and HPR indices with inflammation in patients with RA. Methods: The study was conducted on 30 patients with RA at the Department of General Internal Medicine - Endocrinology - Musculoskeletal and a control group of 30 healthy people who came to hospital of Hue University of Medicine and Pharmacy from April 2023 to August 2023. Results: Both RPR and HPR indices in the disease group were statistically significant lower than the control group (p < 0.001). The predictive value of rheumatoid arthritis of RPR and HPR with cutoff points of 0.016 and 0.455 respectively (p < 0.05). The RPR index was strongly positively correlated with HPR (p < 0.001). PLT was strongly negatively correlated with RPR (p < 0.001) and HPR (p < 0.001). Conclusion: The RPR and HPR indices in RA patients were lower than those in controls, and could be one of the indicators to help assess inflammation in patients.

Investigation of red blood cell and platelet indices in adult dogs suffered from myxomatous mitral valve disease with and without pulmonary hypertension.

Pulmonary hypertension (PH) is a common complication of cardiopulmonary disease. In dogs, PH commonly occurs secondary to myxomatous mitral valve disease (MMVD). Red blood cell and platelet indices including mean corpuscular volume (MCV), mean corpuscular hemoglobin (MCH), mean corpuscular hemoglobin concentration (MCHC), red cell distribution width (RDW), mean platelet volume (MPV) and platelet distribution width (PDW), have previously been found to be indicators for predicting and prognosing PH in humans. Therefore, this study aimed to investigate whether these indices are associated with MMVD and/or PH in dogs. Two hundred and forty-six dogs were retrospectively recruited for the study and classified into 4 groups: normal (n = 49), MMVD (n =102), PH (n =17), MMVD+PH (n =78). A sub-analysis was performed in dogs with MMVD without evidence of PH according to stage B1 (n =20), stage B2 (n =15), stage C (n =67). The data are expressed as median (interquartile range). No significant differences (p < 0.05) were found in MCV, RDW and MPV among all groups (normal, MMVD, PH and MMVD+PH). However, decreases in MCH and MCHC were found in MMVD [22.40 (20.90-23.50) pg and 35.25 (33.08-36.90) g/dL], MMVD+PH [22.25 (20.85-23.98) pg and 35.65 (33.30-37.33) g/dL] and PH groups [21.20 (20.60-22.20) pg and 33.80 (32.75-35.70) g/dL] compared to the normal dogs [24.29 (23.55-24.90) pg and 38.20 (37.50-39.05) g/dL] (p < 0.001). Decreases in PDW were found in dogs in the MMVD+PH [15.10 (14.98-15.30) %] groups compared to dogs in the normal group [15.30 (15.10-15.50) %] (p = 0.004). Sub-analysis of MMVD dogs without PH showed a decrease in MCH in dogs with stage B2 MMVD [21.00 (20.50-22.90) pg] and stage C MMVD [22.40 (20.90-23.20) pg] compared to normal dogs [24.29 (23.55-24.90) pg] (p < 0.001). MCHC of dogs with stage B1 [36.55 (33.53-37.78) g/dL] (p = 0.004), B2 [32.90 (32.00-35.00) g/dL] (p < 0.001) and C MMVD [35.30 (33.30-36.80) g/dL] (p < 0.001) were lower than those of normal dogs [38.20 (37.50-39.05) g/dL]. PDW in the stage C MMVD group [15.10 (15.00-15.30) %] was reduced compared to the normal group [15.30 (15.10-15.50) %] (p = 0.042) and the stage B1 MMVD group [15.35 (15.23-15.68) %] (p = 0.002). MCH, MCHC and PDW were negatively correlated with the left atrial and left ventricular size. Decreases in MCH and MCHC are related to MMVD, precapillary PH and postcapillary PH while PDW are associated with MMVD severity but not with the presence of PH.

Haematological and Innate Immunological Reference Intervals for Farmed Yellow Catfish &lt;i&gt;Horabagrus brachysoma&lt;/i&gt; and Their Seasonal Variations

The reference intervals for haematological and innate immune response variables of healthy adult yellow catfish Horabagrus brachysoma raised in captivity were determined. Reference ranges were established for all parameters and significant (P &lt; 0.05) seasonal variations in most of the haematological and innate immune parameters were observed. Total erythrocyte count, packed cell volume, serum lysozyme and myeloperoxidase activities were found to be higher during winter season whereas most of the red blood cell indices, superoxide production by phagocytes, serum ceruloplasmin and anti-protease activities were marked to be significantly higher during rainy season of the year. Except high total leucocyte count and mean corpuscular haemoglobin, other parameters were found to be significantly lower during summer, possibly indicating a higher disease risk in summer months for this species. However, no significant variations in these variables were obtained between male and female catfish during breeding season. The information generated would be indirectly helpful for determining health status of this endangered species.

RBC Indices in Rural Pregnant Women in Faridabad Belt

RBC Indices in Rural Pregnant Women in Faridabad Belt

Oxidative-Stress-Related Alterations in Metabolic Panel, Red Blood Cell Indices, and Erythrocyte Morphology in a Type 1 Diabetic Rat Model

Diabetes mellitus is often associated with vascular complications in which hyperglycemia-induced oxidative stress may be the cause of the impaired vessels and circulating blood cells. The aim of this study was to follow the hyperglycemia-related metabolic and morphological changes in blood and urine samples of Wistar rats. Animals were divided into streptozotocin-induced diabetic (acute and chronic), insulin-treated diabetic, reversed diabetic, and control groups. In chronic diabetic rats, decreases in albumin, total protein, and antioxidant glutation concentration were measured, while glutamic-pyruvic transaminase, alkaline phosphatase, red blood cell (RBC) count, hematocrit, and hemoglobin levels were increased. Moreover, an increased level of the phenotypic variants was detected in the RBC population of the diabetic animals. In conclusion, we verified the sensitivity of RBCs to long-lasting hyperglycemia, and to insulin deficiency, which were both accompanied with an increased level of RBC-derived parameters and the presence of eccentrocytes, hemolyzed RBCs, and codocytes. Moreover, our results show that the response of the RBC glutation system to oxidative stress depends on the duration of hyperglycemia, and that the short-term activation of this defense system is exhausted in a long-lasting oxidative environment. Insulin therapy was effective in the case of most parameters, which clearly emphasizes the importance of maintaining blood glucose at physiological level.

Utility of red blood cell parameters and indices of iron homeostasis in evaluation of microcytosis without anemia or with mild anemia: a diagnostic accuracy study

Introduction: Asymptomatic microcytosis may be a prelude to microcytic hypochromic anemia of varied causes. Evaluation of red cell indices may help delineate cases needing further investigation like hemoglobin high-performance liquid chromatography (Hb-HPLC). In addition, markers of iron homeostasis will help confirm iron-deficient erythropoiesis (IDE)/iron deficiency anemia (IDA). Materials and Methods: This was a single institutional hospital-based study over a period of 18 months. The sample size was 60, which include all age groups, males and females, and values of mean corpuscular volume (MCV) &lt; 80 fL, Hb ≥ 10g/dL were taken as the inclusion criteria. Various derived red cell indices, Hb-HPLC, and iron parameters were assessed. HbHPLC and serum ferritin with transferrin saturation (TSAT) values were taken as the gold standard for diagnosis of hemoglobinopathies/thalassemia trait and IDA/IDE, respectively. Statistical Analysis: Mean with standard deviation was calculated for normally distributed data such as Hb, RBC count, RDW, MCV, MCH, MCHC, and hematocrit. Median with range was calculated for non-normally distributed data. Results: Out of 60 samples, 24 (40%) and 36 (60%) had abnormal and normal proportion of Hb variants, respectively. In total, seven indices were evaluated, which included Mentzer’s index, red cell distribution width index, Ehsani’s index, Sirdah’s formula, Matos–Carvalho index, Shine and Lal index, and Sehgal’s index. The Shine and Lal index showed better sensitivity (89%) and specificity (73%) for diagnosing pure thalassemia trait. The Sirdah index showed better sensitivity (78%) and specificity (42%) in diagnosing IDE/IDA. Ferritin showed better sensitivity (74%) and specificity (84%) in diagnosing pure IDA and TSAT showed better results in diagnosing IDA/IDE. Conclusion: The Shine and Lal index and Mentzer index can be used as screening tools and help detect subjects who require appropriate follow-up with confirmation by HbHPLC. Serum ferritin remains the gold standard for diagnosis of IDA.

Long-term clinical efficacy and safety of thalidomide in patients with transfusion-dependent β-thalassemia: results from Thal-Thalido study

Regular blood transfusion is the mainstay of treatment in transfusion-dependent β-thalassemia (TDT); however, transfusions culminate in an array of serious complications. Therefore, a single-arm, non-randomized clinical trial was conducted in hydroxyurea refractory TDT patients to explore the long-term safety and efficacy of thalidomide. The primary outcomes for efficacy were rise in hemoglobin (Hb) level and changes in transfusion frequency. Whereas, several clinical and laboratory parameters were assessed for safety of thalidomide. Secondary outcomes included changes in serum ferritin, serum lactate dehydrogenase (LDH), serum uric acid, red blood cell indices, and size of liver and spleen. A total of 532 patients were followed for a period of 30 months. Significant increase in mean Hb level was identified at 6 months (1.4 g/dL, p ≤ 0.001) and 30 months (2 g/dL, p ≤ 0.001) in comparison with baseline. A total of 408 (76.7%) patients responded to thalidomide therapy (excellent responders 25.8%, good responders 31%, and partial responders 19.9%) and attained transfusion independence within 6 months of therapy. A significant decline in mean ferritin, LDH level, liver size, and spleen size was observed. No unfavorable effects were observed on kidney and liver functions. Mild adverse events were reported in 48 (9%) patients and serious adverse events, including cerebral vascular accident and portal vein thrombosis were reported in two patients each. This study concludes that thalidomide is an effective and well-tolerated drug that can improve Hb levels and reduce transfusion burden in hydroxyurea refractory TDT patients.Trial registration: This trial is registered at http://www.clinicaltrial.gov as # NCT03651102.

Differences in selected blood parameters between brachycephalic and non-brachycephalic dogs.

Cranial and upper-airway anatomy of short-nosed, flat-faced brachycephalic dogs predisposes them to brachycephalic obstructive airway syndrome (BOAS). Periodic apnoea increased inspiratory resistance, and an inability to thermoregulate effectively are characteristic of BOAS, but internationally accepted objective markers of BOAS severity are missing. The objective of this study was to compare the selected blood parameters between non-brachycephalic (NC) and brachycephalic (BC) dogs, exploring the possibility of developing a blood test for BOAS severity grading in the future. We evaluated blood biochemistry, complete blood cell counts, red blood cell (RBC) indices, reticulocyte counts, a blood-born marker of intermittent hypoxia (glutathione, NO production), RBC hydration, deformability, and blood markers of metabolic changes and stress between BC (n = 18) and NC (meso- and dolichocephalic, n = 22) dogs. Reticulocyte counts and the abundance of middle-fluorescence immature reticulocytes were significantly (p < 0.05) higher in BC dogs compared to NC dogs. BC dogs had significantly more NO-derived NO/NO in plasma than NC dogs. RBCs of BC dogs were shedding significantly more membrane, as follows from the intensity of eosin maleimide staining, and had a significantly higher mean corpuscular hemoglobin concentration than NC dogs. Intracellular reduced glutathione content in RBCs of BC dogs was significantly lower, while plasma lactate was significantly higher in BC dogs compared to NC dogs. Plasma cholesterol and triglycerides were significantly lower, and cortisol was significantly higher in BC dogs compared to NC dogs. Eosinophil counts were significantly lower and the neutrophil-to-lymphocyte ratio was higher in BC dogs compared to NC dogs. Taken together, our findings suggest that the brachycephalic phenotype in dogs is associated with alterations at the level of blood cells and, systemically, with oxidation and metabolic changes. The parameters identified within this study should be further investigated for their potential as objective indicators for BOAS.