Red Cell Parameters Research Articles

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

Some Haematological Parameters of Fuel Pump Attendants in Calabar Metropolis

Introduction: Occupational exposure to petroleum products and fumes has been reported to have toxic effects on various organs and body system including the circulatory system. This study examined some haematological parameters of the fuel pump attendants in Calabar Metropolis. Methods: One hundred (100) male and female participants (18-50 years) were recruited into this case control study. They consisted of 50 fuel pump attendants (28 males and 22 females) and 50 controls, all residing in Calabar metropolis. The haematological parameters were analyzed using the Sysmex XE- 2100 haematology autoanalyser. Data was analyzed using SPSS version 21.0 with Student’s t-test and Pearson’s correlation. P &lt;0.05 were used considered statistically significant. Results: Ninety percent of the fuel pump attendants were exposed for duration of 1-4 years. The packed cell volume (PCV), haemoglobin, mean cell volume (MCV) and neutrophil count of fuel pump attendants were significantly lower compared to the controls. Monocyte count was significantly higher in the fuel pump attendants than in the controls (p&lt;0.05). Platelet count correlated positively with TWBC (r=0.500, p=0.000) and neutrophil count (r=0.373, p=0.008) and negatively with lymphocyte count (r=-0.337, p=0.017). Conclusion: This finding implies that fuel has the potential to cause alterations in some haematological parameters, particularly in the red cell parameters and differential white cells, thus interfering with their normal function.

Have we ignored red cell parameters in Turner Syndrome? Results from a single specialist centre

Have we ignored red cell parameters in Turner Syndrome? Results from a single specialist centre

Hematological Profiles of Eligible Blood Donors at Kenyatta National Hospital, Kenya

Aim: To determine hematological profile of eligible blood donors at Kenyatta National Hospital (KNH), Kenya.&#x0D; Study Design: Adopted a cross-sectional study.&#x0D; Place and Duration of Study: Kenyatta National Hospital, between March 2021 and August 2021.&#x0D; Methodology: This study recruited 202 eligible blood donors comprising of 173 males and 29 females aged 18-57 years. Blood samples (4ml) were drawn from donated units into ethylene diamine tetraacetic acid (EDTA) tube. Hematological parameters were estimated using a complete blood count (CBC) analyzer (Humacount 5D®). A total of eighteen hematological parameters were analyzed. These parameters included; red blood cell (RBC) count, hemoglobin concentration, RBC indices, white blood cell (WBC) count, absolute and differential WBC and platelet (PLT) count. Results were presented in medians and 95% interquartile ranges and compared using Mann–Whitney U test.&#x0D; Results: The median counts for all hematological parameters were within the accepted reference ranges for the adult urban population in Kenya. The median and interquartile range for total red cell count was 4.9×106/µL [0.74], hemoglobin level was 14.3g/dL[1.8], hematocrit was 44.9% [5.1], white blood count was 4.9×103/µL [1.4] and platelet was 234×103/L [64]. Among the red cell parameters analyzed, male donors had a significantly higher RBC count (P&lt;0.001), hematocrit (P=0.001) and hemoglobin (P&lt;0.001) than female donors. Among white blood cell parameters analyzed, only lymphocytes (P=0.011) were significantly higher in female donors than male donors. Platelet count (P&lt;0.001) was also significantly higher in females than male donors. &#x0D; Conclusion: This study showed eligible donors at KNH had significant differences in red cell count, hematocrit, hemoglobin, lymphocytes and platelets between male and female donors. Additionally, it highlighted that some blood donors had hematological parameters below and above the recommended reference ranges. These findings support the need to review the current donor recruitment criteria recommending the inclusion of complete blood count in screening.

Peripheral Hematological Parameters in Sudanese Women with Polycystic Ovary Syndrome

The aim of this study is to assess the association between polycystic ovarian syndrome (PCOS) and hematological parameters [hemoglobin, red cell parameters, white blood cells (WBCs), platelets volume (MPV)]. This is a matched case-control study (60 women in each arm of the study) which was conducted in Saad Abualila infertility center Hospital in Khartoum, Sudan. Infertile women with PCOS were the cases and healthy non pregnant women were the controls. The gynecological characteristics were gathered through questionnaire and blood samples were analyzed for different blood parameters by automated hematology analyzer. While the two groups were matched in their age; body mass index was significantly higher in women with PCOs compared to the normal control. The investigated different hematological parameters (hemoglobin, RBCs, RDW, WBCs, platelets and MPV) showed no statistical difference between the women with PCOS and the controls.

P-145: The effect of a 6-week Nordic walking training cycle on myeloma-related blood parameters, vitamin 25(OH)D3 serum concentration and peripheral polyneuropathy symptoms in patients with multiple myeloma

<h3>Background</h3> Due to the use of new therapeutic strategies, patients with multiple myeloma (MM) live much longer, hence skeletal and neurological dysfunctions related to MM and advancing age are clinically significant. Properly selected training can bring bone health benefits, both in terms of fitness and blood parameters, as well as contribute to the improvement in the severity of peripheral polyneuropathy symptoms. <h3>Method</h3> The study involved 28 MM patients after therapy in remission were divided into 2 groups: participating in exercise training (NW, n=15) and control group (CG, n=13). Subjects from the NW group participated in moderate intensity Nordic walking training sessions (60-70% of estimated HRmax) for 1 hour, 3 times a week, for 6 weeks. The intensity of performed exercises was monitored in all subjects individually with the use of a heart rate monitor. Venous blood was collected twice in all participants: at baseline before the beginning of the training cycle and after 6 weeks (at the end of training cycle). Myeloma-related parameters and vitamin 25(OH)D3 concentration were analyzed. After completing the training cycle patients were also asked for determination of changes in the severity of symptoms of peripheral polyneuropathy. The research was approved by a local bioethics committee and all subjects voluntarily signed informed consent prior to participation. <h3>Results</h3> The applied training cycle (NW group) significantly increased the number of white blood cells (median by 0.56 103/µl, p=0.01), including neutrophils (by 0.62 103/µl, p=0.05). However, no significant impact of NW training on red cell and platelet parameters was observed. Participation in trainings was associated with a decrease in the serum levels of IgA, IgG and IgM, but only the changes in IgG concentration were statistically significant (by 1 g/l, p=0.017). The training contributed to the decrease in the concentrations of κ free light chains in the blood (by 2.2 mg/l, p=0.001) and the κ/λ ratio (by 0.7, p=0.005). However, no significant changes were observed for the concentrations of λ free light chains, beta-2-microglobulin, or monoclonal protein in serum. Serum 25(OH)D3 concentrations were significantly increased in all patients in the NW group (by 10.1 ng/ml, p<0.001). There were no significant changes in the control group. Additionally, patients with a higher initial 25(OH)D3 serum concentration resulted in an improvement in the peripheral polyneuropathy symptoms which was not observed in control group. <h3>Conclusions</h3> Nordic walking has proven to be a safe form of health training for patients with MM. NW has a positive effect on IgG levels, serum free kappa light chain concentration and κ/λ ratio and the concentration of 25(OH)D3. High initial vitamin 25(OH)D3 serum concentration leads to an improvement in symptoms of peripheral polyneuropathy as a result of participation in Nordic walking training.

Clinical utility of Abbott Alinity hq extended red blood cell parameters in differentiating β-thalassemia trait and iron deficiency anemia.

The objective of the study was to evaluate the performance of the Abbott Alinity hq advanced multi angle polarized scatter separation (MAPSSTM )-based optical RBC technology, for the differentiation between iron deficiency anemia (IDA) and β-thalassemia carrier status. Four hundred and sixty-four samples were analyzed. 228 were healthy controls, 30 were β-thalassemia carriers, and 40 were IDA. Receiver operating characteristics analysis evaluated the performance of red cell parameters and mathematical formulas. RBC concentration was the most efficient discriminant (area under the curve; AUC of 0.963, Youden Index of 0.88) followed by red blood cell distribution width in size distribution (AUC of 0.960 and YI of 0.86), and red blood cell distribution width coefficient of variation (AUC of 0.924, and YI of 0.74). The absolute reticulocyte concentration showed good diagnostic efficiency, with AUC of 0.808. Hemoglobin distribution width, the %CV of directly measured cellular hemoglobin concentration, and CHCr, the average hemoglobin concentration of reticulocytes have emerged as novel discriminating parameters, with AUC of 0.749 and 0.785, respectively. The England and Fraser index was the best discriminating mathematical formula based on Youden Index of 0.91. The Ricerca, red blood cell distribution width index, Green and King, and Mentzner Index formulas also showed strong discriminative power. The Shine and Lal index, together with the recent mathematical formula M/H, (ratio of percent microcytic and hypochromic red blood cells) demonstrated moderate performance with AUC of 0.796 and 0.740, respectively. Extended red cell analysis delivered by the advanced optical technology on the Alinity hq hematology analyzer has efficient diagnostic utility in the initial discrimination of the two most common microcytic anemias: IDA and β-thalassemia trait.

A Longitudinal Study on Hematocrit Changes after Glifozins Exposure in Patients with Type 2 Diabetes

Background and Methods: Gliflozins are widely prescribed drugs in patients with type 2 diabetes. We pursue to explain abnormal increments in red cell parameters observed in this population, by means of a longitudinal study in 149 patients with a gliflozins exposure period of 12±6 months. Red cell parameters, HbA1c and other variables were recorded. Results: HbA1c fraction decreased (-0.5±1.3, 95% CI: -0.7 to -0.3, p&lt;0.001), while mean hemoglobin (0.5±0.9, 95% CI: 0.3 to 0.6, P&lt;0.001) and hematocrit (1.6±2.6, 95% CI: 1.2 to 2.0, P&lt;0.001) increased. Mean (SD) hematocrit increased 2.7±1.9 in 112 patients, and decreased -1.7±1.5 in 37 (p&lt;0.001 for subgroup differences). The larger increments in PCV were proportional to higher plasma fraction at baseline (p=0.009). Conclusion: Red cell parameters after gliflozins exposure tend to increase and may reach abnormally high thresholds in some patients with type 2 diabetes.

Importance of hematological parameters for micro- and macrovascular outcomes in patients with type 2 diabetes: the Rio de Janeiro type 2 diabetes cohort study

BackgroundThe prognostic importance of several hematological parameters has been scarcely investigated in type 2 diabetes. So, we aimed to evaluate their prognostic importance for development of complications in a cohort of type 2 diabetes.MethodsIn a prospective study, 689 individuals with type 2 diabetes had blood red cell, platelet and leukocyte parameters obtained at baseline. Multivariate Cox analyses examined the associations between several hematological parameters (including neutrophyl-to-lymphocyte, lymphocyte-to-monocyte, platelet-to-lymphocyte, and monocyte-to-HDL ratios) and the occurrence of microvascular (retina, renal and peripheral neuropathy) and cardiovascular complications (total cardiovascular events [CVEs], and major adverse CVEs [MACEs]), and all-cause and cardiovascular mortality. Improvements in risk discrimination were assessed by C-statistics and Integrated Discrimination Improvement (IDI) index.ResultsDuring a median follow-up of 10.5 years, 212 patients had a CVE (174 MACEs), 264 patients died (131 cardiovascular deaths); 206 had a renal, 161 a retinopathy and 179 patients had a neuropathy outcome. In multivariate-adjusted analyses, the lymphocytes count and lymphocyte-to-monocyte ratio were protective (hazard ratios [HRs]: 0.77 and 0.72, respectively), whereas the neutrophyl-to-lymphocyte and platelet-to-lymphocyte ratios were associated with increased risks (HRs: 1.19 and 1.17) for all-cause mortality. For cardiovascular mortality, the monocytes count, the neutrophyl-to-lymphocyte and monocyte-to-HDL ratios were associated with increased risks and the lymphocyte-to-monocyte ratio was protective. Higher lymphocyte-to-monocyte ratio was protective for renal failure outcome. However, none of them improved risk discrimination.ConclusionsLow lymphocytes count and leukocyte ratios that mainly included lymphocytes were predictors of macrovascular complications and mortality in individuals with type 2 diabetes. However, they did not improve risk prediction over traditional risk factors.

Changes in complete blood count parameters influenced by endocrine disorders.

Complete blood count is one of the most common diagnostic methods used in everyday practice. Hormonal status is known to affect blood count parameters. The aim of this study is to summarize changes in blood count that may indicate endocrine disorders, based on a literature review. Red cell parameters deteriorate in thyroid disorders including autoimmune thyroiditis and tend to resolve with appropriate treatment implementation. The most frequent form of anaemia associated with thyroid dysfunction is normocytic anaemia. Macrocytic anaemia is more typical of autoimmune thyroiditis-induced hypothyroidism, while microcytic anaemia is more common in hyperthyroidism. Unexplained anaemia or an increase in red cell distribution width should prompt the investigation of thyroid disorders. Cushing's disease may manifest as an increase in white blood cells and platelets. In the blood smear, neutrophilia is often present, while lymphocytes and eosinophils may be within the lower normal range. Hypercortisolism may induce both hyperaemia and anaemia. In hypopituitarism, a decrease in red blood cell count, haemoglobin, haematocrit, and platelets is observed. Acromegaly may be accompanied by an increase in mean corpuscular volume of erythrocytes. Testosterone deficiency is manifested by a decrease in red cell parameters, whereas hyperandrogenism may lead to polycythaemia. In polycystic ovary syndrome an increase in white blood cell count reflects an underlying inflammatory state. Complete blood count analysis is an easily available and cost-effective additional tool in the diagnosis and treatment monitoring of endocrine disorders.

Red cell parameters, HbA2 levels, and the best discrimination index in beta thalassaemia trait in Sri Lanka

Introduction: Beta thalassaemia trait (BTT), also known as thalassaemia carrier state, leads to hypochromic microcytic indices. Identifying asymptomatic carriers on full blood count will help medical personnel to direct them for confirmatory tests such as High Performance Liquid Chromatography (HPLC) and prevent birth of babies with thalassaemia major by discouraging intermarriage between two individuals with BTT. Objectives: To describe red cell parameters and HbA2 levels of individuals with BTT in Sri Lanka and determine the best discrimination index for screening of BTT. Methods: BTT confirmed by HPLC (HbA2 ≥3.5%) during a two year period at the Medical Research Institute, Colombo, Sri Lanka were selected and full blood count (FBC) reports were analysed. Haemoglobin (Hb), RBC parameters; RBC count, MCV, MCH, MCHC, and RDW and HBA2 of the study population was analysed and the mean and the standard deviation (SD) was calculated for each parameter. These parameters were then analysed using Mentzer, Srivastava, England and Fraser, Shine and Lal, Green and King and Thal Index and sensitivity of each index for detecting BTT was calculated to ascertain which index identified BTT with maximum sensitivity. Results: 157 BTT cases without concurrent iron deficiency and 206 BTT without serum ferritin results were analysed. In the BTT group without iron deficiency, Hb was 8.3-11.1 g/dl; mean 9.7 g/dl, RBC count 4.1-5.7; mean 4.9. MCV 59.2-68.8 fl; mean 64 fl. MCH 18.1-21.9 pg; mean 20 pg. MCHC 29.4-32.6 g/dl; mean 31 g/dl. RDW 12.2-23% mean 17.6%. HBA2 level for BTT in Sri Lanka was 4.8% (SD 0.5). Sensitivity for each index was, Mentzer Index 57.1%; England and Fraser Index 25.3%; Srivastava Index 44.2%; Green and King Index 61.5% Thal Index 73.3%; Shine and Lal Index 98.7% and New index was 92.3%. Conclusions: All RBC parameters except MCHC were outside the normal ranges. A mean MCV of 64 fl (SD 4.8) and MCH of 20 (SD 1.9) best denoted BTT on FBC. The lower limit of HbA2 (4.3%) in BTT in Sri Lanka is slightly higher than the currently used diagnostic value of ≥ 3.5%. Shine and Lal Index with a sensitivity of 98.7% was the most reliable index to identify BTT in Sri Lanka. Vigilant application of above findings on FBC by first contact doctors will help to identify more thalassaemia carriers.

Evaluation of Copper Status and Some Red Cell Parameters of Pregnant Women in Enugu State, South Eastern Nigeria

Copper is an essential trace mineral (micronutrient) that is naturally present in some foods and is available as a dietary supplement. Pregnancy, also known as gestation, is the time during which one or more offspring develops inside a woman.This study was desiged to assay the copper level of pregnant women in urban area and to evaluate the effect of the obtained valves on some blood parameters of the pregnant women. In this study, a total of 100 subjects and 50 controls was used. subjects were pregnant women while the controls were non-pregnant women. The copper level in subject was assayed with a serum copper test kit using automation with Bio E-lab fully automated chemistry analyzer and result of the complete blood count was gotten using Mindray Hematology analyzer. The mean for subjects (M=102.83±1.38) and control (M=102.68±0.94), p = 0.71. These results suggest that the difference between the copper level for subjects and controls is not really much.. The variables copper level and MCV were found to be slightly correlated, r(150) = ..018., p &gt; .005. Additionally, copper levels in the subjects was also found to negatively correlated with MCH, r(150) = .907, p &gt; .005. One-way analysis of variance showed that the correlation of copper levels was not significant on all of the red bloodcell parameters in the serum of the pregnant women.

English

BACKGROUND Microcytic hypochromic anaemia is commonly due to iron deficiency, anaemia of chronic disorder [ACD] and thalassaemic syndromes. Reticulocyte count reflects the erythropoietic activity of bone marrow and is thus useful in both diagnosing anaemias and monitoring bone marrow response to therapy METHODS All samples were selected from routine blood counts, and sent for investigation of anaemia, over a period of two years. These samples were run on the DxH800 (Beckman Coulter). 385 cases were selected for the study. Blood analysis for all these cases had been requested by general practitioners to investigate anaemia. These blood samples had been collected in ethylenediaminetetraacetic acid (EDTA) anticoagulant vacutainers and processed within 2 hours of collection. Determination of red cell and reticulocyte parameters in all blood samples, was performed using the Beckman Coulter 7-part analyser [Unicell DxH 800]. RESULTS Of the 156 cases of microcytic hypochromic anaemia studied, iron deficiency anaemia (IDA) was present in 91 cases, anaemia of chronic disorder (ACD) in 50 cases, beta thalassemia trait (BTT) in 15 cases. Of the 50 ACD cases, 37 were associated with IDA. The control group comprised of 229 adult medical students (143 women and 103 men) with a median age of 18.84 ± 0.98 years. We also had 4 cases of other haemoglobinopathies, which were microcytic hypochromic, but were not included in our study as the number of cases was too less to be analysed. CONCLUSIONS New reticulocyte parameters are useful for evaluation of iron status and diagnosing iron deficiency anaemias. They also are reliable parameters for recognising subsets of anaemic patients thereby improving the management of anaemia. KEYWORDS Reticulocyte, Microcytic, Hypochromic, Anaemia, Beckman Coulter

Hematological reference intervals for adult population of Dire Dawa town, East Ethiopia.

BackgroundReference interval (RI) for hematological parameters is used to interpret laboratory test results in the diagnosis, management and monitoring of hematologic disorders. Several factors including sex, age, dietary patterns, pregnancy status, ethnicity and geographic location affect hematological RIs. However, manufacturers derived reference value is currently in use in most developing countries including Ethiopia. This study aimed to establish hematological RIs for adult population living in Dire Dawa town, East Ethiopia.MethodsIn this cross-sectional study, 513 apparently healthy adults of Dire Dawa town were enrolled from January to March 2019. From these, 342 (171 males and 171 non-pregnant females) were aged 18–65 years while 171 were pregnant women aged 15–49 years. After obtaining written informed consent, 5ml fresh whole blood was collected of which 2ml was used for hematologic analysis using Mindray BC-3000plus hematology analyzer and 3ml for serological tests. The 2.5th and 97.5th RI was computed by non-parametric test employing SPSS version 24. P-value <0.05 was considered statistically significant.ResultMales had significantly higher reference value for most of red cell parameters (Hgb, RBC, HCT, MCH and MCHC) than females (p <0.05), while most of the WBC parameters were significantly higher in females than males. Moreover, non-pregnant women had higher values for most of red cell parameters than pregnant women. Pregnant women had higher WBC parameters than their non-pregnant counterparts.ConclusionThe hematologic RIs obtained in this study shows variation between genders, between pregnant and non-pregnant women, from the clinical practice currently utilised in Dire Dawa town and from studies conducted in Ethiopia, African countries as well as the Western population. It underscores the need for utilising gender and pregnancy specific, locally derived hematologic RI for better management, diagnosis and monitoring of hematologic disorders for adults of both genders and pregnant women.

Haemotropic Mycoplasma sp. in a sow from Assam, India

Haemotropic Mycoplasma are specialized bacteria affecting red blood cells. They are associated with weakness, anaemia, stunted growth and mortality in piglets and reproductive failure in the adults. The present communication reports the detection of this organism (tentatively diagnosed as M. suis) in Assam in the blood of a pyrexic and recumbent sow brought for treatment at the Veterinary Clinical Complex of Lakhimpur College of Veterinary Science, Assam Agricultural University. Giemsa-stained blood smear revealed about 1% erythrocytes were infected with coccoid and ring forms of the organism. Estimation of red cell parameters in the blood sample revealed that haemoglobin (Hb), packed cell volume (PCV), total erythrocytes count (TEC) values were within the normal range. This is the first report of the organism from the state of Assam and further investigation on the extent of prevalence is warranted.

Discrimination of Iron Deficiency, Alpha and Beta Thalassemia on the Basis of Red Cell Distribution Width and Reticulocyte Indices.

The two major causes of microcytic anemia are iron deficiency and thalassemia. In clinical practice, in some cases, differentiation of microcytic and hypochromic anemia become difficult on the basis of traditional red cell parameters. This study primarily aimed to evaluate the usefulness of red cell distribution width (RDW), immature reticulocyte fraction (IRF), and reticulocyte hemoglobin equivalent (Ret-He) in the discrimination of alpha thalassemia, beta thalassemia, and latent iron deficiency. In this retrospective study laboratory data including complete blood counts of females diagnosed with alpha thalassemia, beta thalassemia, and latent iron deficiency were retrospectively reviewed. Receiver operating characteristic (ROC) curve was constructed to evaluate the applicability and discriminatory efficiency of RDW, IRF, and Ret-He. Sensitivity and specificity of RDW-CV and RDW-SD was lower in the alpha thalassemia and beta thalassemia groups. Immature reticulocyte fraction (IRF) and reticulocyte hemoglobin equivalent (Ret-He) were significantly higher in the iron deficient group as compared to alpha and beta thalassemia. In alpha and beta thalassemia, RDW-SD and RDW-CV were found to be poor discriminators. Sig-nificantly reduced levels of Ret-He were observed in alpha thalassemia and beta thalassemia in comparison to iron deficient group. While iron deficient group was characterized by increased values of RDW-SD, RDW-CV, IRF, and Ret-He.

Study of peripheral blood smear findings in patients of anemia and to compare it with automated hematology analyzer generated red cell parameters

Introduction: Anemia is one of the common medical conditions prevalent in our society. The correct categorization of varying types of anemia is essential for therapeutic purposes. Various laboratory tests are done to find out its underlying cause, but peripheral smear (PS) study of red blood cells (RBCs) morphology is important along with study of red blood cell indices in the classification of anemia.&#x0D; Objectives: This study was done to evaluate RBC morphology on peripheral smear examination in patients of anemia and to compare these findings with cell counter generated red blood cells indices comprising of Mean corpuscular volume (MCV), Mean corpuscular hemoglobin concentration (MCHC) and Mean corpuscular hemoglobin (MCH)&#x0D; Methodology: Red blood cell morphology on peripheral blood smear was studied in 350 patients of anemia irrespective of age and gender received under six months duration from 1st January 2019 to 30 th June 2019 and findings were compared with cell counter generated red cell parameters generated by automated hematology analyzer.&#x0D; Results: Most common anemia seen on smear examination was microcytic hypochromic anemia which accounted for 210 (60%) cases followed by dimorphic anemia in 73 (20.86%) cases. Most of the patients were female, comprising of 227 (64.85%) cases. Highest numbers of patient were in the age group of 21-30 years (20.30%). Sensitivity of MCV was 78%, MCHC was 14% and MCH was 80% in detection of microcytic hypochromic anemia. The sensitivity of MCV and MCH was found to be 100 % in detection of macrocytic anemia. Sensitivity of MCHC was only 10% for detection of macrocytic anemia. The sensitivity of MCV, MCHC and MCH was 78%, 100% and 67 % respectively in detection of normocytic normochromic anemia. &#x0D; Conclusion: The peripheral smear examination should always be interpreted along with the red blood cell indices generated by an automated analyzer in order to classify various types of anemia.

Dynamic changes in murine erythropoiesis from birth to adulthood: implications for the study of murine models of anemia.

Liver, spleen, and bone marrow are 3 key erythropoietic tissues in mammals. In the mouse, the liver is the predominant site of erythropoiesis during fetal development, the spleen responds to stress erythropoiesis, and the bone marrow is involved in maintaining homeostatic erythropoiesis in adults. However, the dynamic changes and respective contributions of the erythropoietic activity of these tissues from birth to adulthood are incompletely defined. Using C57BL/6 mice, we systematically examined the age-dependent changes in liver, spleen, and bone marrow erythropoiesis following birth. In addition to bone marrow, the liver and spleen of newborn mice sustain an active erythropoietic activity that is gradually lost during first few weeks of life. While the erythropoietic activity of the liver is lost 1 week after birth, that of the spleen is maintained for 7 weeks until the erythropoietic activity of the bone marrow is sufficient to sustain steady-state adult erythropoiesis. Measurement of the red cell parameters demonstrates that these postnatal dynamic changes are reflected by varying indices of circulating red cells. While the red cell numbers, hemoglobin concentration, and hematocrit progressively increase after birth and reach steady-state levels by week 7, reticulocyte counts decrease during this time period. Mean cell volume and mean cell hemoglobin progressively decrease and reach steady state by week 3. Our findings provide comprehensive insights into developmental changes of murine erythropoiesis postnatally and have significant implications for the appropriate interpretation of findings from the variety of murine models used in the study of normal and disordered erythropoiesis.

Cold antibodies association with cellulitis, deep vein thrombosis and abnormal red cells indices: A Case Report.

Objectives: To provide awareness to the pathologists and technologists all about the red cells parameters in cold antibodies concerned cases. Case Report Findings: A sixty seven-years-old male admitted in emergency department of our hospital, having clinical history of swelling and pain in both the lower limb and feet, on physical examination, provisionally diagnosed as a case of Cellulitis and deep vein thrombosis(DVT). Blood specimen was obtained for general hematological investigations. Full blood count (FBC) was performed on sysmex XP-100 hematological analyzer which showed invalid findings especially red cells indices which were not corresponding to the hemoglobin (Hb) concentration of the patient. Blood sample was repeated, to confirm invalid red cells indices which showed values as in the 1st blood specimen. Blood smears revealed aggregation of red cells. By warming the ethylenediamine tetra-acetic acid (EDTA) tube containing the blood specimen, in water bath at 37⁰C for one hour and repeated the FBC on hematological analyzer and found the corrected red cells indices. Conclusion: Basic knowledge of cold antibodies and warming the blood sample at 37⁰c for one hour helps the correct diagnosis.

Role of Red Cell Indices in Screening for Beta Thalassemia Trait: an Assessment of the Individual Indices and Application of Machine Learning Algorithm.

Antenatal screening for beta thalassemia trait (BTT) followed by counseling of couples is an efficient way of thalassemia control. Since high performance liquid chromatography (HPLC) is costly, other cost-effective screening methods need to be devised for this purpose. The present study was aimed at evaluating the utility of red cell indices and machine learning algorithms including an artificial neural network (ANN) in detection of BTT among antenatal women. This cross-sectional study included all antenatal women undergoing thalassemia screening at a tertiary care hospital. Complete blood count followed by HPLC was performed. Receiver operating characteristic(ROC)curve analysis was performed for obtaining optimal cutoff for each of the indices with determination of test characteristics for detection of BTT. Machine learning algorithms including C4.5 and Naïve Bayes (NB) classifier and a back-propagation type ANN including the red cell indices was designed and tested. Over a period of 15months, 3947 patients underwent thalassemia screening. BTT was diagnosed in 5.98% of women on the basis of HPLC. ROC analysis yielded the maximum accuracy of 63.8%, sensitivity and specificity of 66.2% and 63.7%, respectively for Mean corpuscular hemoglobin concentration (MCHC). The C4.5 and NB classifier had accuracy of 88.56%-82.49% respectively while ANN had an overall accuracy of 85.95%, sensitivity of 83.81%, and specificity of 88.10% in detection of BTT. The present study highlights that none of the red cell parameters standalone is useful for screening for BTT. However, ANN with combination of all the red cell indices had an appreciable sensitivity and specificity for this purpose. Further refinements of the neural network can provide an appropriate tool for use in peripheral settings for thalassemia screening.