Red Cell Volume Research Articles

Abstract WP188: Relationships Of Hematocrit With Asymptomatic And Symptomatic Lacunar Ischemic Lesions

Introduction: Hematocrit at both low and high extremes can result in both hypoxia and thrombosis respectively. While both scenarios may predispose to ischemia, it is unclear whether hematocrit associates with small vessel cerebrovascular lacunar infarcts. Hypothesis: Hematocrit levels will associate with both asymptomatic and symptomatic cerebrovascular lacunar infarcts in stroke-free participants and ischemic stroke patients, respectively. Methods: A cross sectional observational analysis of a prospective, population-based cohort study of stroke-free, older adult (>50) participants from the Northern Manhattan study (NOMAS) receiving baseline hematocrit testing and MRI between 2003-2008 were analyzed. A second, single center prospective cohort of admitted adult ischemic stroke patients receiving baseline hematocrit testing and MRI between 2005-2018 was evaluated. Associations of hematocrit with covert, asymptomatic chronic lacunar infarcts from stroke-free participants in NOMAS were assessed using general additive models after adjusting for relevant covariates. Separate analyses were performed to assess associations of hematocrit with symptomatic acute lacunar infarct stroke etiology using similar adjusted models for patients admitted and enrolled into the ischemic stroke registry. Results: Of 1218 NOMAS participants analyzed, 6% had covert chronic lacunar infarcts. The association between hematocrit and covert chronic lacunar infarcts was U-shaped (X2: 9.21; p-value: 0.03). In the 1489 patients from the ischemic stroke registry, 23% were identified to have symptomatic acute lacunar infarcts. Linear relationships were identified with higher hematocrit and symptomatic acute lacunar infarct etiology (adjusted coefficient beta: 0.020; standard error: 0.009; p=0.03). Conclusions: We identified relationships of hematocrit with both asymptomatic and symptomatic lacunar infarcts in both stroke-free and ischemic stroke cohorts, respectively. There may be a relevant role of red blood cell volumes with ischemic cerebral small vessel disease pathophysiology. However, further studies are required to clarify the mechanisms behind these relationships.

Green Tea extrat Effect on number of blood Criteria of lab rabbits Afflicted whith Entamoeba histolytica parasite

The study includes the effect of alcoholic extract of green tea on the Newzealand white male rabbits putrefied by Entamoeba histolytica parasite which causes Amoebic dysentery disease. The study dependes on several criteria including the examination of variations in complete blood picture (C.B.P) presented by the whole and differential account of white and red blood cells, pressed red cells volume (P.C.V), hemoglobin (Hb) rate, and blood platelets number. The study concludes that variations in blood component occur when parasites enter and after the treatment with green tea alcoholic extract; where significant decrease result at level (P<0.01) in the total amount of white cells and granular cells and insignificant decrease in lymphatic cells, and single cells and red blood cells. hemoglobin rate also increased as well These results show the efficiency of green tea alcoholic extract in improving blood standards through variations occurring in blood proportion.

Frequency of Post-Transplant Erythrocytosis in Patients with Live Related Renal Transplant

Background: It is commonly observed in the patients undergoing kidney transplant. The red cell mass increased in this condition but the plasma volume remain normal. It is characterized by the hematocrit levels equal to 51% or greater than 51%. Study design: It was a cross-sectional and descriptive study conducted at the department of nephrology and transplantation, Pir Abdul Qadir Shah Jeelani Institute of Medical Sciences Gambat. This study was conducted for the duration of six months from January 2022 to June 2022. Material and Methods: There were total 90 patients selected for the study. There were 35 patients in the control group and 55 patients in the Post-transplant Erythrocytosis patients group. The 25 out of 35 were male and 7 were females. The 17 out of 55 were male and 38 were females. Haemoglobin and Hematocrit was assessed retrospectively. Those with Hct > 51 was labelled as PTE. The study comprised of control group and PTE group having post erythrocytosis patients. The duration of dialysis of the patients was 12 and 13 months for control and PTE group respectively. Results: The red cell and plasma volume of the control group and PTE was analyzed and it showed that most of the patients had their RCV and PV in the normal range. However, there were 5 patients in control group and 15 patients in PTE group that had reported low level of RCV. The percentage of alive patients with functional graft was more in case of control (97%) as compared to PTE group (83%). Conclusion: The study was done to find the frequency of post-transplant Erythrocytosis among patients and control group. It was found that there were several risk factors that could possibly play role in causing the disease. The 21% of the patients were diagnosed with PTE. Keywords: Erthrocytosis, haematocrit, and haemoglobin.

The application value of mean red blood cell volume and red blood cell volume distribution width combined with total serum bilirubin in the early screening of neonatal hemolytic disease

BackgroundThe hemolytic nature of hemolytic disease of the newborn (HDN) is described as the abnormal destruction and decomposition of red blood cells, causing heterogeneous manifestations such as abnormal red blood cell volume and morphology. Mean corpuscular volume (MCV) and red blood cell volume distribution width (RDW) are commonly used parameters related to red blood cell volume. Total serum bilirubin (TSB) is routinely monitored among newborns. This study aims to explore the value of MCV and RDW, combined with TSB, to improve the efficiency of HDN diagnosis.MethodsThree hundred eighty-eight children with HDN and 371 children with non-HDN pathological jaundice who were diagnosed and treated in the neonatal department of our hospital from January 2019 to December 2020 were included in the study. Clinical data collected include examination results of laboratory indicators, such as MCV, coefficient of variation of red blood cell volume distribution width (RDW-CV), standard deviation of red blood cell volume distribution width (RDW-SD), and TSB. The differences in the indicators between the two groups of children were retrospectively analyzed.Results1) The detection rate of HDN in children in the early group was higher than that in the late group (P < 0.001). 2) The early-stage group had lower TSB levels and higher values of MCV, RDW-CV and RDW-SD (P < 0.001). Compared with the children in the non-HDN group, the indices in the HDN group were higher in the early stage (P < 0.001). 3) In the early stage, the TSB, MCV, RDW-CV, and RDW-SD were positively correlated with the diagnosis of HDN (P < 0.001). Early monitoring of TSB, MCV, RDW-CV and RDW-SD was valuable for HDN detection, the area under the curve (AUC) was 0.729, 0.637, 0.715, and 0.685, respectively (P < 0.001). 4) After a binary logistic analysis at TSB > 163.3 μmol/L, MCV > 96.35fL, and RDW-CV > 16.05%, the diagnosis rate of HDN increased (P < 0.001). The AUC of the HDN detected using the combined indicators was 0.841.ConclusionAt MCV > 96.35fL or RDW-CV > 16.05%, children with jaundice in three days of birth (especially children with TSB > 163.3 μmol/L) should be screened for HDN. A combination of TSB, MCV, and RDW-CV can improve the early detection rate of HDN, contribute to reduce the readmission rate and risk of hyperbilirubinemia.

Validation of a flow-cytometry-based red blood cell antigen phenotyping method.

Current manual and automated phenotyping methods are based on visual detection of the antigen-antibody interaction. This approach has several limitations including the use of large volumes of patient and reagent red blood cells (RBCs) and antisera to produce a visually detectable reaction. We sought to determine whether the flow cytometry could be developed and validated to perform RBC phenotyping to enable a high-throughput method of phenotyping using comparatively miniscule reagent volumes via fluorescence-based detection of antibody binding. RBC phenotyping by flow cytometry was performed using monoclonal direct typing antisera (human IgM): anti-C, -E, -c, -e, -K, -Jka , -Jkb and indirect typing antisera (human IgG): anti-k, -Fya , -Fyb , -S, -s that are commercially available and currently utilized in our blood transfusion services (BTS) for agglutination-based phenotyping assays. Seventy samples were tested using both flow-cytometry-based-phenotyping and a manual tube standard agglutination assay. For all the antigens tested, 100% concordance was achieved. The flow-cytometry-based method used minimal reagent volume (0.5-1μl per antigen) compared with the volumes required for manual tube standard agglutination (50μl per antigen) CONCLUSION: This study demonstrates the successful validation of flow-cytometry-based RBC phenotyping. Flow cytometry offers many benefits compared to common conventional RBC phenotyping methods including high degrees of automation, quantitative assessment with automated interpretation of results and extremely low volumes of reagents. This method could be used for high-throughput, low-cost phenotyping for both blood suppliers and hospital BTS.

Simultaneous observation of shape, volume, and hemoglobin content of a single red blood cell under the osmotic pressure difference

Simultaneous observation of shape, volume, and hemoglobin content of a single red blood cell under the osmotic pressure difference

Epidemio-Demographical Study of Anemia in School: Aged groups

it is defined as a reduction of the hemoglobin concentration or red blood cell (RBC) volume below the range ofvalues occurring in healthy persons.Material and method: The current study was cross-sectional study done in AL-Alam general hospital, we take 500children and adolescences and the age restricted from 6year to 18 year, the cases taken in the pediatric outpatientsdepartment regardless whether sick or healthy children or adolescences we take the history from the casesdepending on the signs and symptoms of anemia. Data were analyzed by using the Windows program The datawas summarized firstly in single master table manually . The Chi square test was used to determine whethersignificant differences occurred among the groups and where they occurred.Results: we find about 33.60% of cases were anemic including IDA ,and 25.96% was mild anemia this mean anemiahighly prevalent , and mainly at adolescents age group about(50%),also we find anemia more prevalent in ruralarea(42.5%) than urban area(32.2%) may be to low socioeconomic status in rural area, also the prevalence of anemiawas more in not student cases(40.47%) and high level of anemia in illiterate father and mother this indicate theeducational status important to parent and children to awareness about anemia and healthy food consumption.Conclusion: Anemia highly prevalent in our area and more in rural area than the urban area and more in adolescentage group.

Determination of Complete Blood Count Reference Intervals by an Indirect Method for Newborns, Adults, and Geriatric Ages.

The availability of a reliable reference interval is crucial for clinical decision-making. Correctly defined reference intervals for different age groups are currently unavailable for many parameters. Our study aimed to determine the complete blood count reference intervals in our region from newborn to geriatric ages with an indirect method. The study was carried out at Marmara University Pendik E&R Hospital Biochemistry Laboratory between January 2018 and May 2019 using the laboratory information system data. The complete blood count (CBC) measurements were performed by Unicel DxH 800 Coulter Cellular Analysis System (Beckman Coulter, FL, USA). A total of 14,014,912 test results belonging to infants, children, adolescents, adults, and geriatric ages were collected. We analyzed 22 CBC parameters, and an indirect method was used for reference interval determination. Data were analyzed according to the Clinical and Laboratory Standards Institute (CLSI) C28-A3 guideline for defining, establishing, and verifying reference intervals in the clinical laboratory. We have established reference intervals from newborn to geriatric ages for 22 hematology parameters [hemoglobin (Hb), hematocrit (Hct), red blood cell (RBC), mean red cell volume (MCV), mean red cell hemoglobin (MCH), mean red cell hemoglobin concentration (MCHC), red cell distribution width (RDW), white blood cell (WBC) count, WBC differentials, including percentages and absolute counts, platelet count, platelet distribution width (PDW), mean platelet volume (MPV) and plateletcrit (PCT)]. Our study showed that reference intervals established with data obtained from clinical laboratory databases are comparable to those created using direct methods.

Влияние засоления и повышенной температуры воды на характеристики крови рыб в условиях бореальных водоемов: результаты эксперимента с использованием молоди речного окуня Perca fluviatilis бассейна р. Камы (Пермский край, Россия)

As a result of secondary salinization of freshwater ecosystems the biota significantly changes, which results in declining the abundance and species diversity of aquatic organisms. This study aims experimental assessment of the hematological parameters of the juvenile perch Perca fluviatilis (Linnaeus, 1758), held at normal (background), as well as elevated mineralization and temperature. The experiment was carried out in August 2021 on perch YOY (young-of-the-year) collected by a fry seine in the lower reaches of the river Gaiva (Perm Kray). We presented the results of studying the peripheral blood of perch juveniles under natural temperature (8.7 ± 0.12 oC) and mineralization (0.26 ± 0.01 g/l) – a control group, as well as the species put into the aquariums 1) with natural temperature and high mineralization (5.3 ± 0.03 g/l), and 2) with higher temperature (19.7 ± 0.12 oC) and higher mineralization. At the end of the experiment (on 35th day) the peripheral blood samples (general analysis) were analyzed. The various destructive disorders of red blood cells were separately identified. The fish held in the highly mineralized water have lower hemoglobin levels, lower hematocrit and deformed blood elements, higher average volume of red blood cells, which indicates the suppression of hematopoiesis. The following disorders of erythrocytes were revealed in the studied fish: poikilocytosis, centric arrangement of the nucleus, scalloped contour, vacuolization of cytoplasm, agglutination, hypochromasia, chromatinolysis, anisocytosis (increase in size), hemolysis, nuclear shadows, formation of schistocytes. In fish contained in the aquariums with increased mineralization the number of aberrant erythrocytes was found higher than in fish from the control group. Combination of increased mineralization with increased temperature leads to the onset of the fourth stage of toxicosis resulting in a mass death of fish.

Decision support system for anemia diagnosis based on fuzzy model

Anemia is considered one of the most common diseases that affect the human body. In case of prolonged existence, it can lead to the development of chronic diseases due to excessive load on the vital organs. Effective treatments are available with early detection of the disease and largely depend on its underlying cause. In terms of severity, anemia can be divided into mild, moderate, and severe according to the level of hemoglobin. The morphological classification provides for the division of anemia into microcytic, normocytic, and macrocytic depending on the average volume of red blood cells. According to the hemoglobin, content anemia can be hypochromic, normochromic and hyperchromic. The article explores scientific and technical information on classification and fuzzy logic as well as describes the development of a decision support system for anemia diagnosis using a fuzzy logic inference model. During the analysis of existing literature, it was found that the use of naive Bayesian methods is optimal for solving the problem of determining anemia. But there is a possibility of minor errors in measuring features, so it is necessary to use the theory of fuzzy sets. Modulation of fuzzy logic inference was implemented using the Mamdani algorithm. The developed information system has two levels. The first level determines the severity of anemia. The second level is responsible for belonging to one of the classes: microcytic hypochromic, normocytic normochromic, and macrocytic. The software was written in Java on the basis of its own library to implement a computational algorithm for morphological classification of anemia and classification by severity according to the indicators of hematological laboratory tests. The application of the proposed architectural design of the system saves time for decision-making and eliminates the need for additional manpower to solve the problems of information and analytical support for management decision-making in support of business processes of anemia monitoring

Association Between the Ratios of Selenium to Several Elements and Mild Cognitive Impairment in the Elderly.

To investigate the relationship between the correlation ratios of selenium (Se) and other elements and mild cognitive impairment (MCI) among older adults. A total of 1000 individuals participated in our research analysis. The concentrations of elements in whole blood were determined using inductively coupled plasma mass spectrometry to reflect their exposure levels. Participants' cognitive function was assessed using the Mini-Mental State Examination. Logistic regression analysis was used to evaluate the relationship between elemental ratios and MCI. Se concentration was positively correlated with red blood cell count (r = 0.219, p < 0.001), haemoglobin level (r = 0.355, p < 0.001), haematocrit (r = 0.215, p < 0.001), mean corpuscular haemoglobin (r = 0.294, p < 0.001) and mean corpuscular haemoglobin concentration (r = 0.428, p < 0.001) and negatively correlated with red cell volume distribution width-standard deviation (r = -0.232, p < 0.001) and platelet distribution width (r = -0.382, p < 0.001). Compared with the normal group, the ratios of Se/vanadium (V), Se/lead (Pb) and Se/cadmium (Cd) in the whole blood of the MCI group were significantly lower (all p < 0.001), while the ratios of manganese (Mn)/Se and iron (Fe)/Se were higher (all p < 0.001). The increase in the ratios of Se/V, Se/Pb and Se/Cd is related to a decreased risk of MCI among older adults; contrarily, an increase in the ratios of Mn/Se and Fe/Se may be a risk factor for MCI.

Balanced blood component resuscitation in trauma: Does it matter equally at different transfusion volumes?

BackgroundIt remains unclear whether the association between balanced blood component transfusion and lower mortality is generalizable to trauma patients receiving varying transfusion volumes. We sought to study the role red blood cell transfusion volume plays in the relationships between red blood cell:platelet and red blood cell:fresh frozen plasma ratios and 4-hour mortality. MethodsAdult patients in the 2013 to 2018 American College of Surgeons Trauma Quality Improvement Program database receiving ≥6 red blood cell, ≥1 platelet, and ≥1 fresh frozen plasma within 4 hours were included. The following 4 cohorts were defined based on 4-hour red blood cell transfusion volume: (1) 6 to 10 units, (2) 11 to 15 units, (3) 16 to 20 units, and (4) >20 units. The association between red blood cell:fresh frozen plasma, red blood cell:platelet, and 4-hour mortality was evaluated discretely for each red blood cell transfusion volume category, statistically adjusting for confounders. ResultsA total of 14,549 patients were included. In patients receiving 6 to 10 units of red blood cells, red blood cell:platelet ratios were not associated with 4-hour mortality, and only red blood cell:fresh frozen plasma ≥4:1 were associated with significantly higher odds of 4-hour mortality compared to 1:1. For patients receiving >10 red blood cell units, increasing red blood cell:platelet and red blood cell:fresh frozen plasma ratios were consistently associated with increased odds of 4-hour mortality. For example, in red blood cell volumes of 11 to 15, 16 to 20, and >20 units, risk-adjusted 4-hour mortality odds ratios for red blood cell:platelet ≥4:1 were 2.27 (1.47–3.51), 3.32 (2.26–4.90), and 3.01 (2.33–3.88), respectively. ConclusionThe association between balanced blood component transfusion and 4-hour mortality is not homogenous in trauma patients requiring different transfusion volumes and is specifically less evident in patients receiving lower volumes. Such findings should be considered in the current and future blood shortage crises across the nation.

Optimizing Use of Automated Isovolemic Hemodilution Red-Cell Exchange in a Patient Cohort with Sickle Cell Disease: A Quality Improvement Intervention

Background: Red-cell exchange (RCE) is a mainstay of treatment for both acute and chronic complications of sickle cell disease (SCD). It is a resource-intensive intervention requiring transfusion of large volumes of antigen-matched red blood cells (RBC). Identifying suitable RBC units can be challenging due to variability in blood group phenotypes between patients with SCD and the donor population. This often results in use of O-negative units, which are a scarce resource. Efforts to reduce the volume of units transfused, while maintaining therapeutic efficacy is an important clinical need. Isovolemic hemodilution (IHD) prior to RCE reduces the required volume of RBCs. The aim of this project is to evaluate the effect of a change to IHD-RCE on RBC utilization in patients with SCD receiving standard RCE. Methods: All adult SCD patients receiving standard RCE at the Ottawa Hospital were identified. To safely attain a meaningful reduction in transfused RBCs, RCE treatment parameters were individualized for each patient (Table 1). Patient hematocrit was not allowed to decrease below 20% during the depletion phase, and IHD-RCE would be performed only if an estimated reduction in RBC volume of at least 200 mL was expected. Pregnant patients were excluded. Change in RCE protocol to IHD-RCE took place in January 2022. Transfusion and clinical data were obtained from databases at the Ottawa Hospital in the six months preceding and succeeding the change in RCE protocols to allow for a pre- and post-intervention comparison. Results: Thirty-four adults receiving regular RCE for SCD were identified. Twenty-two patients met criteria for a protocol change to IHD-RCE. The mean age of the IHD-RCE cohort was 31 years (SD 9.5). Males comprised 72.7% of this cohort, with the most frequent genotype of hemoglobin SS (68.2%). Over the one-year study period, 1963 RBC units were transfused: 1035 RBC units in the pre-intervention period, and 928 units in the post-intervention period, representing a reduction of 107 RBC units. 1958 (99.7%) of the RBC units transfused were transfused in the setting of RCE, with few (5 units; 0.03%) administered as simple RBC transfusions. Table 2 outlines patient outcomes during the study period. The mean number of RBC units transfused per patient in the pre- and post-intervention periods were 47 and 42.4 units, respectively. The mean number of RBC units per RCE session per patient was significantly reduced from 8.7 units in the pre-intervention period to 7.8 units in the IHD-RCE post-intervention period (mean difference: -0.9, 95% CI: -1.2 to -0.5). A total of 236 RCE sessions occurred during the study period. No difference in RCE session frequency was observed with a change to IHD-RCE during the six-month study period, nor time between RCE sessions. Therapeutic efficacy in attaining target hemoglobin S levels was not affected by the change to IHD-RCE. No adverse patient safety signals were observed during the IHD-RCE sessions to date. Conclusions: This study demonstrates that IHD-RCE, compared to standard RCE, substantially reduces RBC utilization. A total of 107 RBC units were conserved in our patient cohort of 22 chronic RCE patients directly from the transition to IHD-RCE from standard RCE. Based on local RBC per unit costs, this corresponds to an annualized saving of $95,444 CAD. With pressure on blood banks to provide appropriately matched units, and risks of alloimmunization and delayed hemolytic transfusion reactions amongst chronically transfused SCD patients, increased uptake of IHD-RCE should be considered for SCD patients on chronic RCE. Figure 1View largeDownload PPTFigure 1View largeDownload PPT Close modal

RDW Is an Independent Prognostic Biomarker in Patients with Chronic Graft-Versus-Host-Disease

Background Chronic graft-versus-host disease (cGVHD) is an important immunologic sequelae of allogeneic hematopoietic stem cell transplantation (HCT) that can lead to increased morbidity and mortality in long-term survivors. Red cell distribution width (RDW) is a measure of the variation of the mean corpuscular volume of red blood cells reflecting the degree of anisocytosis. Multiple epidemiological and longitudinal observational studies have shown that higher RDW values are associated with increased all-cause, cardiovascular and cancer-related mortality in different populations including patients as well as healthy participants but limited data exists in patients after HCT. Although RDW is affected to some degree by any type of anemia, the etiology of variation in RDW is considered to be multifactorial and overall incompletely understood. Whether RDW is affected by cGVHD activity or retains its prognostic significance for mortality is unknown. Patients and Methods The present study analyzed patients enrolled on the NIH cGVHD natural history study (NCT00092235) with existing measures of RDW (n=404). In addition to RDW, previously described laboratory markers of inflammation (Grkovic L. et al. Leukemia. 2012;26:633) significantly associated with cGVHD disease activity and other known prognostic factors associated with survival in cGVHD patients were considered. Results The median age of the cohort was 47.2 years (IQR 32-57) and male patients were slightly overrepresented (n=231, 57%). Information about the NIH global score was available in 98.5% of patients who had predominantly severe (72.4%) and moderate (25.6%) cGVHD (Table 1). The median potential follow-up of the total cohort was 11.9 years (IQR 8.4-14.5) and the 5-year overall survival (OS) 77.9% (95% CI, 68.3-77.0%), but the median OS was not reached. A clear split was identified between the first quartile and the remaining overlapping quartiles of RDW distinguishing two groups with statistically different OS: <13.4% vs ≥13.4% (p=0.0024, adjusted for 3 implicit cut-points). Five-year OS was 84.1% (95% CI, 75.3%-89.9%) and 69.1% (95% CI, 63.6%-74.0%) for patients with RDW <13.4% and ≥13.4%, respectively. In univariate analyses, RDW ≥13.4% was statistically associated with Karnofsky performance status (KPS) <80 (39% vs 19%; p=0.0003), cGVHD global score severe (77.6% vs 62%; p=0.0046), increasing involvement of skin (p=0.0023) and mouth (p=0.0043), steroid (70% vs 46%; p<0.0001) and mTOR inhibitor treatment (24% vs 7%; p=0.0002), extracorporeal photopheresis (22% vs 10%; p=0.0077), increased inflammatory markers CRP, C3 and C4 (all p≤0.0002, respectively) and lower IgG (p=0.0031) but not age, sex, kidney function (eGFR CKD-EPI 2021) or time from HCT to study consent. The multiple logistic model established oral cGVHD (OR 1.77; 95% CI, 1.2- 2.60), mTOR inhibitors (OR 3.49; 95% CI, 1.5- 8.30), LDH (OR 1.01; 95% CI, 1.01-1.02), Hb (OR 0.68; 95% CI, 0.57-0.80) and ANC (OR 1.21; 95% CI, 1.07-1.36) as independent factors associated with dichotomized RDW groups. The Cox proportional hazards model confirmed the independent association of RDW ≥13.4% with worse OS (HR 1.61; 95% CI, 1.05-2.47) and identified albumin <3.45 mg/dL (HR 1.78; 95% CI, 1.41-2.24) and IgG <6.3 g/L (HR 1.67; 95% CI, 1.20-2.31) as independent factors in addition to KPS <80 (HR 1.51; 95% CI, 1.06-2.14), eGFR <45 mL/min/1.73m2 (HR 2.27; 95% CI, 1.41-3.66) and lung cGVHD NIH grade 3 (HR 2.92; 95% CI, 1.86-4.57). Moreover, RDW ≥13.4% was associated with decreased relapse-free survival (5-year; 72.8% vs 87.8%; p=0.0062 for comparison of the full curves) and increased non-relapse mortality (5-year; 20.8% vs 7.6%; p=0.0082 for comparison of the full curves) but not with cumulative incidence of relapse (5-year; 6.5% vs 4.6%; p=0.45). Conclusion Patients with chronic GVHD and RDW ≥13.4% have a statistically worse overall survival due to higher risk of non-relapse mortality. Hypoalbuminemia and hypogammaglobulinemia — laboratory markers of increased inflammation and B-cell dysfunction — are additional independent poor prognostic factors identified by this study. It seems prudent that future therapeutic clinical trials should measure these laboratory markers to investigate whether they serve as surrogate biomarkers of chronic GVHD. Figure 1View largeDownload PPTFigure 1View largeDownload PPT Close modal

Predictive Ability of Coronary Artery Disease on Age Acceleration and Clinical Outcome in Adult Acute Myelogenous Leukemia

Background: Aging is strongly associated with hematologic malignancies. Chronological age (CA) fails to explain biological and clinical outcome differences among AML patients (pt) at same age. Phenotypic age (PA) has gained momentum to predict cause-specific mortality in individuals sharing similar CA. Age acceleration (AA), resulting from the difference between phenotypic or methylation age (MA) and CA correlates with all-cause mortality. Similarly, Clonal Hematopoiesis of indeterminate Prognosis (CHIP) is associated with AA [PMID: 34050697]. CHIP mutations (mut) may be inherited into AML from preexisting immortalized/transformed cells. Cells harboring CHIP induce inflammation and "accelerate" vascular complications [i.e coronary artery disease (CAD)]. In this study, we seek "proof of clinical concept" for an association between AA and AML outcome when accounting for the presence or not of CAD. Methods: After IRB approval, AML pt were selected to estimate PA based on "proposed score 9 clinical biomarker's score" [PMID: 29676998] including albumin, creatinine, glucose, c-reactive protein, lymphocyte percent, red cell mean cell volume, red distribution width, alkaline phosphatase, white blood count). PA was calculated at AML onset. Difference between PA and CA was recorded as Delta PA-CA. Positive and negative delta PA-CA were considered as AA vs rejuvenation. Given the association between inflammation, CAD and CHIP, we performed individual correlation survival analysis accounting for phenotypic age in AML pt with and without CAD. Descriptive statistics, univariate and multivariate analysis were performed using SAS software. Results: 81/253 (32%) AML pt were available. Pearson correlation revealed that in pt without CAD, PA negatively correlated with survival (R= -0.31, p= 0.04), an effect not observed among AML pt with established CAD (R= -0.10, p=0.52). With AML pt lacking CAD [42/81(51%)] representing our population of interest, median CA, PA and MA among pt with (N=31) or without (N=11) AA was 53 years (y) v 49, p=0.5, 84 v 44, p= 0.0001 and 79 v 44, p=0.0001. WBC was 27 K/uL v 32.4 K/uL, p=0.5, in pt with and without AA. Favorable (fav) ENL-2017 was 33% vs 18%, p=0.1, Int 11% vs 18%, p=NS and unfav 56% v 64%, p=NS in pt with and without AA. Overall survival (OS) was 439 d vs not reached (NR), in pt with and without AA, p=0.03, HR=6.5 CI 2.2-19.4. Multivariate cox regression considering ELN-2017 classification, age and PA revealed that only AA was independent predictor of outcome, p=0.03, HR-1.02, CI=1.002-1.03. Conclusions: AA is associated with inferior AML outcome without overt CAD. In our proof of concept cohort, and acknowledging small sample size, AA supersedes ENL-2017 classification and CA as predictors of inferior outcome in AML. Our study adds insight on how AA based on epigenetic clock estimation potentially influences not only leukemogesis, but also renders organ function inability to survive AML. Figure 1View largeDownload PPTFigure 1View largeDownload PPT Close modal

Effects of Molybdenosis on Antioxidant Capacity in Endangered Przewalski's Gazelles in the Qinghai Lake National Nature Reserve in the Northwestern China.

The purpose of this study is to investigate the effects of molybdenosis on antioxidant capacity in endangered Przewalski's gazelles (Procapra przewalskii) in the animal rescue center in the Qinghai Lake National Nature Reserve in Northwestern China. Ten P. przewalskii in molybdenosis were selected and treated orally with copper sulfate (CuSO4) at a dose of 20g/animal/5days for 20days. Ten healthy P. przewalskii were also selected and allocated to healthy pastures for 20days. Samples of soil, forage, and animal tissue were collected. The values of mineral and hematological parameters were measured. Results showed levels of molybdenum (Mo) in soil and forage were significantly higher than those in healthy ranches (P < 0.01). The Mo content of blood and hair in gazelles from the rescue center was also significantly higher than those in the healthy ranches animals (P < 0.01). The copper (Cu) contents in blood and hair from the rescue center were significantly lower than those from the healthy pasture (P < 0.01). Hemoglobin (Hb) and red cell volume (PCV) in the gazelles from the animal rescue center were significantly lower than those from animals in healthy ranches (P < 0.01). Aspartate aminotransferase (AST), lactate dehydrogenase (LDH), phosphocreatine kinase (CPK), and alkaline phosphatase (ALP) were significantly higher than those from gazelles in healthy ranches (P < 0.01). The antioxidant capacity in gazelles from the animal rescue center was significantly lower than that of gazelles in healthy ranches. Supplementing CuSO4 significantly decreased the Mo content of blood and cured molybdenosis in gazelles. In summary, the Mo content of soil and forage was very excessive for gazelles in the animal rescue center. The antioxidant capacity of P. przewalskii has been seriously affected by molybdenosis.

Sputnik V vaccine-related complications and its impression on inflammatory biomarkers in healthcare providers

PurposeThe current pandemic made scientists create new platforms of vaccines to fight against SARS-CoV-2. Without a doubt, the new forms of present vaccines could develop a diversity of unknown complications. Sputnik V vaccine with two different adenovirus vectors (Ad26 priming and Ad5 boost) was first announced safe and effective by Russia. However, there are controversies surrounding this vaccine such as the possible decline of its immunogenicity and diminished neutralizing capacity against some Covid-19 variants. In addition, its impression on serum biomarkers is not clearly surveyed. The present study aimed to evaluate the frequency of Sputnik V vaccine-related complications and its impression on inflammatory and hematologic biomarkers. Materials &methodsAn observational cohort study was performed to evaluate the side effects and serum biomarkers changes in healthcare workers receiving Sputnik V vaccine. The vaccine adverse events were recorded daily within 60 days. The blood samples were obtained before vaccination, and on the10th day after each dose of vaccination. The prevalence of all complications and inflammatory biomarkers levels were compared between two doses. All analyses were performed using SPSS software version 22.0. ResultsTotally, 126 participants completed the study. The mean age was 37.19 ​± ​7.73 years. The prevalence of all complications was higher following the first dose than the second dose. The most common side effects were pain at the injection site, body pain, fever, headache, weakness, vertigo, sore throat and sleep disorder. The hematocrit, mean corpuscular volume of red blood cells and neutrophils count declined following vaccination significantly (P-value; 0.04, 0.039, 0.000 respectively). ConclusionIt seems the side effects of Sputnik-V vaccine are mild and decrease significantly after the second dose. The decreasing level of hematocrit, MCV and neutrophil count was found significant following vaccination.

Related factors of urinary tract infections in inpatients based on real world data

To analyze the risk factors for urinary tract infection (UTI) among inpatients. The case data of 1 875 inpatients receiving urinary bacterial culture in Beijing Haidian Hospital from October 2019 to May 2021 were analyzed retrospectively. According to the etiological diagnostic criteria of UTI, they were divided into infection group and non-infection group. The species and distribution of pathogens in the infection group were analyzed, and the case data and laboratory indexes were subjected to univariate analysis. The variables with statistical significance were selected for binary logistic regression to analyze the risk factors of urinary tract infection and establish a prediction model. The receiver operating characteristic (ROC) curve was drawn for each parameter included in the model, and the area under the curve (AUC) was calculated. The diagnostic and predictive efficacy of each parameter alone and their combination for UTI were evaluated. So, a total of 1 162 patients with non-infection group and 713 patients with UTI were detected. Among the cultured pathogens, the constituent ratio of Gram-negative bacteria, Gram-positive bacteria and fungi was 57.2%(408/713), 35.9%(256/713) and 6.9%(49/713) respectively. Multivariate analysis showed that, Age, duration of urinary catheterization>7 d, stroke and orthopedic surgery were the risk factors of UTI among inpatients. The use of antibiotics is a protective factor for urinary tract infections. The prediction model of UTI was established by the risk factors, age, duration of urinary catheterization>7 d, stroke, orthopedic surgery, urinary leukocyte esterase, urinary nitrite and Coefficient of variability of red blood cell volume distribution width (RDW-CV). The AUC of the combination of the eight parameters in diagnosing and predicting UTI was 0.835 (95%CI: 0.816-0.855), with the sensitivity of 70.7% and the specificity of 82.8%. In conclusion,the combination of the eight parameters can better assist in the diagnosis and prediction of UTI, and provide an experimental basis for clinicians to judge UTI.

Nomogram for Predicting Postoperative Portal Venous Systemic Thrombosis in Patients with Cirrhosis Undergoing Splenectomy and Esophagogastric Devascularization.

The aim of the study is to develop a nomogram for predicting postoperative portal venous systemic thrombosis (PVST) in patients with cirrhosis undergoing splenectomy and esophagogastric devascularization. In total, 195 eligible patients were included. Demographic characteristics were collected, and the results of perioperative routine laboratory investigations and ultrasound examinations were also recorded. Blood cell morphological traits, including the red cell volume distribution width (RDW), mean platelet volume, and platelet distribution width, were identified. Univariate and multivariate logistic regressions were implemented for risk factor filtration, and an integrated nomogram was generated and then validated using the bootstrap method. A color Doppler abdominal ultrasound examination on a postoperative day (POD) 7 (38.97%) revealed that 76 patients had PVST. The results of the multivariate logistic regression suggested that a higher RDW on POD3 (RDW3) (odds ratio (OR): 1.188, 95% confidence interval (CI): 1.073-1.326), wider portal vein diameter (OR: 1.387, 95% CI: 1.203-1.642), history of variceal hemorrhage (OR: 3.407, 95% CI: 1.670-7.220), and longer spleen length (OR: 1.015, 95% CI: 1.001-1.029) were independent risk parameters for postoperative PVST. Moreover, the nomogram integrating these four parameters exhibited considerable capability in PVST forecasting. The nomogram's receiver operating characteristic curve reached 0.83 and achieved a sensitivity and specificity of 0.711 and 0.848, respectively, at its cutoff. The nomogram's calibration curve demonstrated that it was well calibrated. The nomogram exhibited excellent performance in PVST prediction and might assist surgeons in identifying vulnerable patients and administering timely prophylaxis.

National analysis of whole blood and component versus component transfusions in civilian trauma patients who underwent a thoracotomy or laparotomy: Toward improving patient outcomes and quality of care

BackgroundThis study aimed to investigate the associations of whole blood and component versus component transfusions with in-hospital mortality, complication rates, intensive care unit length of stay, and packed red blood cells transfusion volumes in adult civilian trauma patients. MethodsWe performed a retrospective cohort study of the American College of Surgeons Trauma Quality Program Participant Use File 2016 to 2019 dataset. Adult civilian trauma patients (aged >18 years) sustaining injuries of at least moderate severity who received whole blood and component or component within 4 hours of arrival and underwent thoracotomy or laparotomy were included. Multivariable regression analysis was used to compare outcomes between whole blood and component and component groups. ResultsA total of 37,384 patients met eligibility criteria, of which 218 received whole blood and component and 37,166 received component. There was no significant difference in in-hospital mortality between whole blood and component and component groups for those who underwent thoracotomy (adjusted odds ratio = 0.408, P = .413) or laparotomy (adjusted odds ratio = 1.046, P = .857). Thoracotomy patients who received whole blood and component had no difference in 4-hour or 24-hour pack red blood cell volumes (3336 mL vs 3106 mL, P = .754; 3 658mL vs 3,636mL, P = .982), intensive care unit length of stay (10.68 days vs 8.63 days, P = .542), or complications rates compared to those who received component. Laparotomy patients who received whole blood and component had no difference in 4 hour or 24-hour packed red blood cell volumes (2,758 mL vs 2,721mL, P = .927; 3,538 mL vs 3,385 mL, P = .754), intensive care unit length of stay (11.78 days vs 9.90 days, P = .177), or complications rates compared to those who received component. ConclusionStudy findings have indicated that a combined resuscitation with whole blood and component transfusion in adult civilian trauma patients is a viable alternative to component transfusion alone.