Blood Count Results Research Articles

NUP98-HOXA9 Bearing Acute Myeloid Leukemia

Acute myeloid leukemia (AML) with NUP98-HOXA9 fusion gene is rare, which is caused by t(7;11)(p15;p15). Not only the prognosis is poor, the efficacy of conventional induction regimen is also barely satisfactory. Here we report two cases of NUP98-HOXA9 bearing AML. Patient 1 was a 54-year-old female. In September of 2019, she felt fatigue with complete blood count (CBC) result of leukocytes 246.78× 109/L, hemoglobin 81g/L, and platelet 119 × 109/L. Peripheral blood smear showed 5% blast cells, and bone marrow (BM) smear demonstrated AML-M5. Chromosome 46, XX, t (7; 11) (p15; p15) [20], NuP98/HOXA9 fusion gene, EVI1 expression, FLT3-ITD and KRAS mutation was also found in her BM. One course of standard induced chemotherapy regimen IA reached CR, with MRD＜10-4, low expression of EVI1, and FLT3-ITD(-)，normal chromosome, but NuP98/HOXA9（+）. After the second course of IA, relapse occurred partly due to delayed admission under the influence of COVID-19. Reinduction with IA, azacytidine +HE, FLAG regimen failed to reach remission, and the patient died of bone marrow suppression and gastrointestinal bleeding. Patient 2 was a 65-years-old male. In September of 2019, he suffered from fatigue and CBC showed leukocytes 2.52× 109/L, hemoglobin 36g/L and platelet 139 × 109/L. Peripheral blood smear showed immature cells of 7%, and his BM smear demonstrated AML-M4. Chromosome 46, XY, t (7; 11) (p15; p15) [18]/46, XY[1], NuP98/HOXA9 fusion gene and IDH2 R140Q mutation were found in the patient. He had a history of chemotherapy for small cell lung cancer. After induced by regimen of DIAG, DHEG and DCAG successively, he did not reach remission. Repeated fever and lung infection occurred during the course of the disease. He was discharged automatically due to the progression of lung cancer. NuP98/HOXA9 bearing AML is more common in young Asian women, and the majority is type M2. The two patients in this report were older with M4 or M5 type, which was rare in this kind of leukemia. NuP98/HOXA9 is a poor prognostic factor for AML. Patient 1 could reach cytogenetic CR after IA induction, relapsed before transplantation, and the effect of reinduction therapy was poor; Patient 2 did not achieve remission. It is suggested from the these patients that patients with NuP98/HOXA9 bearing AML should undergo hematopoietic stem cell transplantation as soon as possible after CR with intensive therapy if their physical conditions permit.

Blood Count Parameters As Early Predictors of Clonal Cytopenia of Undetermined Significance (CCUS) Using a Diverse Ethnoracial Data Set

Background: Hematologic malignancies are a spectrum of disease that frequently have an insidious onset and may be difficult to diagnose. Improved screening using basic complete blood count parameters are needed to enhance early detection of these processes. Aging results in an expansion of hematopoietic clones that may predispose individuals to subsequent development of a hematologic malignancy. Recent studies with next generation sequencing (NGS) and whole-exome sequencing have identified certain somatic mutations known as DTA mutations that are associated with aging (e.g., DNMT3A, TET2, and ASXL1). These mutations, although more commonly seen in myeloid malignancies, are initially benign but may develop into overt hematologic malignancy and are collectively termed clonal hematopoiesis of indeterminate potential (CHIP). Similarly, individuals with cytopenia and clonal mutations are designated as clonal cytopenia of undetermined significance (CCUS). However, these mutations carry a risk of progression to hematologic malignancy. Animal models have shown that clonal hematopoiesis can accelerate cardiovascular mortality due to increased atherogenesis by causing inflammation and endothelial injury via upregulation of inflammasome pathways. Also, it has already been shown that clonal hematopoiesis with increasing number of clonal mutations, higher variant allele frequency and mutations in known driver genes have a higher risk of progression to hematopoietic malignancy (acute myeloid leukemia, AML). Certain acute phase reactants, like C-reactive protein (CRP) or erythrocyte sedimentation rate (ESR) have been used in prior studies as markers of inflammation and are strongly associated with variations in red cell size as determined by the red cell distribution width (RDW), reflecting chimeric clonal origins. We therefore propose that RDW and mean corpuscular volume (MCV) with or without other blood count parameters (red cell count, white blood cell count and platelet count) might be used as important predictors of progression of myeloid neoplasms, especially myelodysplastic syndromes (MDS), clonal cytopenias (CCUS) and acute myeloid leukemias (AML). Methods: Utilizing Epic's self-service reporting tool SlicerDicer, cohort discovery was performed on the Caboodle Patients data model. Cohort criteria included individuals with the cytopenia diagnostic grouper that had undergone blood or bone marrow myeloid panel next generation sequencing, that also had concurrent or historic complete blood count (CBC) results. Patients with known acute leukemias were excluded. Once the cohort was identified, a data pull was performed that captured CBC values, age, gender, race, and ethnicity, in addition to the NGS results. The NGS results were ranked into 3 classes from 0 to 2. Class 0 included results with no apparent disease, while class 2 results included high grade myeloid mutations (i.e. mutations in NRAS, KRAS, TP53, RUNX1 or ASKL1). Class 1 mutations were considered low grade and featured mutations not seen in class 2. The collated data was analyzed using SAS software. Results: Overall 72 patients met inclusion criteria. Patients ranged in age from 23 to 92 years, 48% identified as female and 52% identified as male with a mixture of race and ethnicity (Table 1). Abnormalities in several CBC components including MCH, MCHC, RBC count, and hemoglobin concentration were associated with increased odds of identifying those with malignant myeloid processes (Figure 1). It is notable that no mutations in FLT3 or KIT were observed in this cohort. Discussion: Based on our preliminary data, these cost-effective parameters can be added to an algorithm for risk assessment of hematologic neoplasms and better predict which patients will further benefit from targeted gene testing. Also, additional data will be helpful and applying this data to modern machine learning techniques will further the clinical application of these findings. Figure 1View largeDownload PPTFigure 1View largeDownload PPT Close modal

Hydroxyurea Dosing in Very Young Children (HUGKISS): Challenges of Study Design

Introduction: The acute and chronic complications of sickle cell anemia (SCA) are well-known, with many of them arising in the first few years of life. The BABY HUG trial showed that 20 mg/kg/day of hydroxyurea therapy is safe, blunts the decline of fetal hemoglobin (HbF), and is clinically beneficial for very young infants and children with SCA. Nevertheless, children treated with hydroxyurea continued to develop acute complications and acquire end organ damage. Although the BABY HUG trial established the safety and efficacy of fixed dose hydroxyurea in very young children with SCA, further study was needed to define the optimal dosing regimen to maximize benefit in this group. We describe our approach to designing and implementing the Hydroxyurea Management in Kids: Intensive versus Stable Dosage Strategies (HUGKISS) study, which assessed the feasibility of enrolling and randomizing very young children with SCA to intensified versus fixed doses of hydroxyurea. The hematologic and clinical effects of both doses were also monitored. Methods: The HUGKISS trial was designed as a single-blind, multicenter, randomized controlled pilot study. It was felt that the objectives of HUGKISS could be safely and more efficiently obtained with a single-blind design (with investigators blinded), because a double-blind design would be logistically challenging and would place significant burden on families and pharmacies. For example, in one double-blind design, caregivers would have to administer two aliquots of study drug (hydroxyurea + hydroxyurea or hydroxyurea + placebo), thereby providing a potential source for medication error. However, because the HUGKISS study required dosage adjustment of hydroxyurea based on complete blood count results, a HUGKISS Enabled Local Provider for Evaluating Response (HELPER) was utilized. Each HELPER was an unblinded local medical provider, unaffiliated with the steering committee or data analysis, who was knowledgeable about SCA. This individual monitored hydroxyurea concordance and toxicities in real time. All patients received hydroxyurea at 20 mg/kg/day for 8 weeks. If they were stable and adherent, they were randomized to either continued fixed dosing or intensified dosing, which involved escalation of hydroxyurea dosing every 8 weeks to a maximum of 35 mg/kg/day. While the primary endpoint was assessing feasibility of enrollment and randomization, the main secondary endpoint assessed was changes in HbF levels. This choice reflected the age of the patient population, which would be undergoing a physiologic decline in HbF during the study period. We monitored adherence via the Medication Adherence Measure (MAM) and measurement of remaining hydroxyurea suspension in the prescribed bottle. Both were performed every four weeks. A medication possession ratio was calculated using the results from both methods, and used to quantitate adherence. Enrollment screening logs were also maintained at all sites. The most common reason for declining participation in HUGKISS was that families desired more time to "think about" hydroxyurea and participation in a trial, followed by disinterest in using hydroxyurea, and a fear of participating in clinical trials. Conclusion: Important considerations when designing trials involving young children with SCA include choice of endpoints, obtaining adequate enrollment, maintaining blinding of a liquid formulation with dose adjustments, and assessment of medication adherence. The HUGKISS study employed a novel single-blind design to facilitate safe and efficient administration of hydroxyurea for families, while also ensuring close monitoring of toxicities through a HELPER.

Can scoring systems be used for the triage of COVID-19 patients?

Whether to send COVID-19 patients home with quarantine measures or to hospitalize and treat them on an inpatient basis is a very important decision in the treatment of COVID-19 patients. This study aimed to introduce a scoring system that will enable making decisions on inpatient or outpatient treatment of patients by scoring their symptoms, clinical, radiological, and laboratory results during the initial assessment. Data of patients over 18 years of age, examined for COVID-19 between March 11, 2020, and May 31, 2020, and who had a positive PCR result, and their radiological (computed tomography reports) and blood test (complete blood count, blood gas and laboratory results) results were recorded to develop our scoring system. A comparison of COVID-19 patients, who received outpatient and inpatient treatments by age variable, revealed a significant result (P < 0.001). The comparison of laboratory results showed a significant difference between both groups (P < 0.001). The comparison of the groups by the presence of comorbidity also revealed a significant result (P < 0.001). According to the scoring system that we developed (Cebeci score), a score of 5 points and above had a specificity of 81% and a sensitivity of 88% for indicating the probability of receiving inpatient treatment. We believe that the scoring system we developed will be a simple, practical, and leading guide for physicians to avoid dilemmas regarding the issue of whether to quarantine patients at home or to hospitalize them in order to use medical resources effectively.

Association of neutropenia at disease onset with severe surgical necrotizing enterocolitis and higher mortality: A retrospective study.

BackgroundNeutrophils are among the earliest immune cells recruited to the site of an intestinal injury, but their predictive role in the progression of necrotizing enterocolitis (NEC) has not been fully elucidated. This study aimed to evaluate if a reduction in neutrophils at the onset of NEC is associated with severe surgical NEC and/or NEC-associated deaths.MethodsThis is a retrospective cohort study in which neonates underwent surgery due to NEC during 2015–2020. The data on absolute neutrophil count (ANC), before and at the onset of NEC, were collected from the complete blood count results. The primary exposure was the difference in absolute neutrophil count (ΔANC) at NEC onset. The primary outcome was severe surgical NEC, defined as the residual small bowel length after intestinal resection of <30 cm.ResultsA total of 157 neonates were included in this study, of which 53 were diagnosed with severe surgical NEC. A decrease in ANC at the onset of NEC was associated with an increased probability of severe surgical NEC (crude odds ratio [OR] 1.248, 95% CI 1.107–1.407; P = 0.000). ΔANC (area under the curve [AUC] 0.729, 95% CI 0.653–0.797; P < 0.001] was a good predictor for severe surgical NEC. The addition of platelets to ΔANC at NEC onset (AUC 0.738, 95% CI 0.662–0.808; P < 0.001) resulted in a higher AUC and specificity for severe surgical NEC prediction than ΔANC alone. A reduction in the neutrophil count at NEC onset (ΔANC > 0) was associated with adverse outcomes (hazard ratio [HR] 3.48, 95% CI 1.64–7.36) and a lower survival probability (χ2 10.63; P < 0.001).ConclusionA reduction in the ANC at the onset of NEC was associated with severe surgical NEC and higher mortality. The addition of platelets to ΔANC at NEC onset resulted in a higher predictive value of severe surgical NEC. This study may provide a new insight into the bedside evaluation of NEC by analyzing data from the day of NEC onset.

Unreliable Automated Complete Blood Count Results: Causes, Recognition, and Resolution.

Automated hematology analyzers generate accurate complete blood counts (CBC) results on nearly all specimens. However, every laboratory encounters, at times, some specimens that yield no or inaccurate result(s) for one or more CBC parameters even when the analyzer is functioning properly and the manufacturer’s instructions are followed to the letter. Inaccurate results, which may adversely affect patient care, are clinically unreliable and require the attention of laboratory professionals. Laboratory professionals must recognize unreliable results, determine the possible cause(s), and be acquainted with the ways to obtain reliable results on such specimens. We present a concise overview of the known causes of unreliable automated CBC results, ways to recognize them, and means commonly utilized to obtain reliable results. Some examples of unreliable automated CBC results are also illustrated. Pertinent analyzer-specific information can be found in the manufacturers’ operating manuals.

Prediction of endometrial cancer recurrence by using a novel machine learning algorithm: An Israeli gynecologic oncology group study

ObjectivesEndometrial cancer is the most common gynecologic malignancy in developed countries. The overall risk of recurrence is associated with traditional risk factors. MethodsMachine learning was used to predict recurrence among women who were diagnosed and treated for endometrial cancer between 2002 and 2012 at elven university-affiliated centers. The median follow-up time was 5 years.The following data were retrieved from the medical records and fed into the algorithm: age, chronic metabolic diseases, family and personal cancer history, hormone replacement therapy use, endometrial thickness, uterine polyp presence, complete blood count results, albumin, Ca-125 level, surgical staging, histology, depth of myometrial invasion, LVSI, grade, pelvic washing cytology, and adjuvant treatment.We used XGBoost algorithm, which fits the training data using decision trees, and can also rate the factors according to their influence on the prediction. Results1935 women were identified of whom 325 had recurrent disease. On the randomly picked samples, the specificity was 55% and the sensitivity was 98%. Our model showed an operating characteristic curve with AUC of 0.84. ConclusionsA machine learning algorithm presented promising ability to predict recurrence of endometrial cancer. The algorithm provides an opportunity to identify at-risk patients who may benefit from adjuvant therapy, tighter surveillance, and early intervention.

Neutrophil/lymphocyte and platelet/lymphocyte ratios as a biomarker in postoperative wound infections

Abstract Objectives We aimed to investigate retrospectively the association between the development of surgical wound infection after orthopedic surgery, and neutrophil/lymphocyte ratio (NLR) and platelet/lymphocyte ratio (PLR) obtained from complete blood count results. Methods A total of 120 patients who underwent orthopedic surgery between 2018 and 2020 were evaluated retrospectively in our study. Wound culture results, complete blood counts, C-reactive protein (CRP), erythrocyte sedimentation rate (ESR) values, orthopedic surgery, and wound types were obtained from the laboratory data administration system. The data were statistically analyzed using SPSS 22.0 software. Results A total of 70 patients who experienced surgical wound infection (66% males and 34% females) and 50 patients without wound infection (64% males and 36% females) were included in this study. The mean age was 46.8 ± 11.4 years for the patients with infection after surgery and 50.1 ± 11.7 years for the patients without infection. Preoperative CRP, NLR, and PLR, and post-operative white blood cell (WBC), neutrophils, ESR, CRP, NLR, and PLR values were significantly higher, and lymphocyte concentrations were significantly lower in the group with infection, in comparison with those without infection. In the postoperative period, CRP and ESR were high in patients with and without infection, while NLR was increased in only those with infection. A medium-level correlation was found between NLR and PLR, and CRP and ESR. Sensitivity was 66%, and specificity was 68% with a cut-off of &gt;3.5 for NLR, while sensitivity was 42% and specificity was 71% with a cut-off of &gt;135 for PLR. Conclusions We believe that the estimation of NLR and PLR values before the intervention in patients undergoing orthopedic surgery may be advantageous for identifying infection.

Haematological features in babies with perinatal asphyxia in Zimbabwe

Background: Perinatal asphyxia is failure to establish breathing at birth. It is a common cause of neonatal mortality in developing countries. Hypoxic Ischemic Encephalopathy (HIE) is the major complication of asphyxia, resulting in permanent neurological and other multi-organ damages. Some haematological changes have also been observed in patients with this disease.&#x0D; Objectives: The objective of this study was to investigate the haematological features in babies with perinatal asphyxia in Zimbabwe.&#x0D; Methodology: A prospective laboratory based cross sectional study was carried out at the Sally Mugabe Hospital Neonatal Unit from December 2018 to April 2019. Routine full blood counts on samples from babies with perinatal asphyxia on their first day of life. Peripheral blood smears were examined on all those with abnormal full blood count results.&#x0D; Results: Full blood counts were done on 180 babies with perinatal asphyxia of whom 103 (57%) and 77 (43%) were females and males respectively. The median white cell count and nucleated red cell count were elevated. The platelet and red cell count were decreased. Haemoglobin, haematocrit, and Mean Corpuscular Haemoglobin Concentration (MCHC) were within normal range. The Mean Corpuscular Volume (MCV) and Mean Corpuscular Haemoglobin (MCH) were increased. There was a correlation between increased nucleated red blood and white cell counts with the severity of perinatal asphyxia in the order of Asphyxia Without Hypoxic Ischemic Encephalopathy (AWHIE), Hypoxic Ischemic Encephalopathy (HIE I), HIE II, and HEI III. The most common haematological abnormalities were thrombocytopaenia 52(29%), anaemia 51(28%) and leukopaenia 28(16%). Twenty-four (47%) of anaemia patients had microcytic hypochromic anaemia. Thirty-one (47%) of 65 blood films examined exhibited immature granulocytes and 28(43%) had burr red blood cells.&#x0D; Conclusion: Babies with perinatal asphyxia may present with haematological abnormalities such as anaemia, thrombocytopaenia, leukocytosis and elevated nucleated red cell count as complications of sever hypoxia. Full blood count may be a useful in the effective management of perinatal asphyxia.

The Novel Use of Umbilical Cord Blood to Obtain Complete Blood Counts for Critical Neonatal Assessment.

Background: Neonates undergoing clinical evaluations are often subjected to potentially painful phlebotomy for laboratory tests. The use of cord blood laboratory values for admission has been suggested as a means to decrease the risk of painful venipuncture and anemia.Methods: Peripheral and umbilical cord blood complete blood count (CBC) results were obtained from infants who required a CBC. Results were compared using the Sysmex XN heme analyzer (Sysmex, Kobe, Japan).Results: White blood cell (WBC) and hemoglobin (HgB) values were significantly higher in peripheral samples than in cord samples. The mean cord WBC count was 14.1 × 103/mm3 versus 15.6 × 103/mm3 peripherally (p < 0.001). The mean cord HgB was 15.8 g/dL versus 16.8 g/dL peripherally (p < 0.001). Cord platelet (Plt) counts were, conversely, lower in peripheral samples than in cord samples (264.8 × 103/mm3 versus 242.3 × 103/mm3, respectively; p < 0.001). Although statistically different, the mean CBC values from both samples were within the reference ranges. Delayed cord clamping (DCC) increased peripheral versus cord HgB difference nearly threefold (0.6-1.7 g/dL; p = 0.01).Conclusions: Cord blood is an acceptable source for CBC blood sampling in newborn infants and can be used for clinical decisions. CBC laboratory values for cord blood remained within the peripheral blood reference range, with slight variability between the two samples.

Case 304: Porphyria Cutanea Tarda

In 2017, a 72-year-old woman was seen in the gastroenterology department with a 2-month history of mild and intermittent abdominal pain without other accompanying symptoms. Her medical history was unremarkable, except for a previous visit due to facial photodermatitis 3 years earlier. Diazepam for a sleeping disorder was the only chronic medication recorded. Results of physical examination, blood count, and basic metabolic panels including assessment of renal and liver function were normal; only the ferritin level was slightly elevated (265 ng/mL [595 pmol/L]; normal range, 10-120 ng/mL [22-269 pmol/L]). Abdominal US was performed, followed by multiphasic contrast-enhanced CT and liver MRI due to the findings of the first study. A diagnosis was not established in that moment, and acetaminophen was prescribed for pain relief. As the symptoms continued, laboratory tests and imaging studies were repeated 2 years later, with similar findings and no notable changes.

Low red blood cell predicts high risk of temporary postoperative complications after carotid body tumor surgical resection.

BackgroundCarotid body tumor (CBT) is a rare paraganglioma located at the carotid bifurcation. The red blood cell count, hemoglobin, and hematocrit are indexes to be evaluated in blood routine tests. The purpose of this study was to clarify their predictive value for temporary postoperative complications in patients that had undergone CBT surgery.MethodsThis retrospective trial included data from 169 patients received surgical treatment for CBT from October 2008 to September 2018 in this retrospective study. Postoperative follow-up was conducted under the guidance of both vascular surgeon and neurologist. The symptoms existed less than 2 years postoperatively were regarded as temporary injuries. The red blood cell count, hemoglobin, and hematocrit were obtained from the complete blood count results of the participants. Analyses of multilevel multivariable regression and descriptive statistics were conducted.ResultsThe baseline data showed no significant difference. Patients were predominantly women (53.8%), with a mean age of 42.6 years. The total incidence of temporary postoperative complications was 22 (13.0%), including transient ischemic attack (8, 4.7%), tongue bias (7, 4.1%), dysphagia (2, 1.2%), hoarseness (4, 1.8%), and eyelid ptosis (1, 2.4%). The univariate and multivariate regression analysis results revealed that the occurrence of temporary postoperative complications was increased with age [odd ratio (OR, 0.09; 95% CI (CI), 0.9–1.0; P = 0.014], length of operation time (OR, 1.0; 95% CI, 1.0–1.0; P = 0.005), Shamblin type II vs. I (OR, 0.1; 95% CI, 0.0–0.5; P = 0.008), red blood cell count postoperative (OR, 0.2; 95% CI, 0.1–0.8; P = 0.026), hemoglobin (OR, 0.9; 95% CI, 0.9–1.0; P = 0.011), and hematocrit (OR, 0.8; 95% CI, 0.7–1.0; P = 0.025). The smooth curve fitting showed that the trend of complications occurrence rate was reduced with the increase of patients’ postoperative red blood cell count, hemoglobin, and hematocrit. Gender, weight, length of operation, Shamblin type, postoperative red blood cell count, hemoglobin, and hematocrit were included in the risk model with AUC = 0.86.ConclusionThese patients with CBT who received surgical resection with low postoperative red blood cell, hemoglobin, or hematocrit had a high risk of temporary postoperative complications. The risk prediction model established for predicting temporary postoperative complications showed satisfactory prediction effects.

Egg white protein hydrolysate ameliorated sepsis-induced inflammatory injuries in kidney and liver based on metabolomics analysis

Sepsis caused by infection could induce systemic inflammation and various organ damages. Bioactivities of peptides derived from eggs were proved by lots of researchers; hence they might be further developed for therapeutic use. In this study, the hydrolysate named “PEP” was obtained by enzymatic hydrolysis and purification. Rats were divided into control, LPS, PEP1 and PEP2 groups. The rat model was established using lipopolysaccharide (LPS) at 10 mg/kg by intraperitoneal injection. The results of blood counts, pro-inflammatory cytokines (TNF-α and IL-6), BUN and Cr levels and pathological damage in tissue or serum suggested that PEP alleviated LPS-induced injuries. Plasma metabolites of PEP were analyzed and identified using UPLC-MS/MS, which revealed that seven pathways might play critical roles in the protection process, involved in oxidative stress, energy and amino acid metabolism. Our data suggest that PEP ameliorated LPS-induced acute liver and kidney injuries, which is helpful for further development and research.

Neutrophil-Lymphocyte Ratios in Dry Age-Related Macular Degeneration

ABSTRACT Inflammation plays a role in the etiopathogenesis of age-related macular degeneration (AMD). A retrospective case-control study was conducted to assess the significance of the neutrophil-lymphocyte ratio (NLR) as a systemic inflammatory indicator in dry AMD. Clinical diagnosis and complete blood count (CBC) results were extracted from medical records for patients with dry AMD and age/sex-matched controls. This study included 90 patients diagnosed with dry AMD and 270 controls without AMD. There were no significant differences in the CBC results between the cases and controls. Patients with dry AMD had a slightly higher mean NLR than controls; however, this increase was not significant (P = .13). In the NLR model, age and sex were significant factors affecting the NLR values in the dry AMD group (P = .03 and 0.01, respectively). The NLR alone cannot predict dry AMD. Therefore, exploring other routine laboratory measurements may shed light on early disease prediction and prevention.

Analysis of Single Blood Entities Using an Ultramicroelectrode through Single-Entity Electrochemistry

The research was conducted with the aim of analyzing individual human blood cells in the presence of redox species based on single-entity electrochemistry. Various blood cells (e.g., red blood cell, white blood cell, and platelets) perform a role directly related to survival, such as oxygen transport, hemostasis, and immune response, as they move through the whole body’s blood vessels. However, with the current lab-on-a-chip typed biosensor technology, the factors that can be measured using a small amount of blood are limited to uric acid, cholesterol, glucose, or hemoglobin in the blood. In clinical laboratories, common methods for measuring individual blood counts are automated hematology analyzers based on the automated Coulter cell counting method or flow cytometry, which produce a huge amount of blood count results, but are limited. For this reason, it is proposed a method for detecting individual blood cells that can be applied to a biosensor simply and quickly.References Ran, An. et al. (2021) ‘Emerging point-of-care technologies for anemia detection’, Lab on a Chip, 21(10), pp. 1843-1865.J-H, Lin. et al. (2020) ‘A Multifunctional Microfluidic Device for Blood Typing and Primary Screening of Blood Diseases’ ACS Sensors, 5(10), pp. 3082-3090.J, Lee. et al. (2020) ‘Determination of Serotonin Concentration in Single Human Platelets through Single-Entity Electrochemistry’, ACS Sensors, 5(7), pp. 1943-1948.T.L.T, Ho. et al. (2018) ‘Determining mean corpuscular volume and red blood cell count using electrochemical collision events’, Biosensors and Bioelectronics. 110, pp. 155-159.A-C, Villani. et al. (2017) ‘Single-cell RNA-seq reveals new types of human blood dendritic cells, monocytes, and progenitors’, Science. 356, No.6335.

Length of hospital stay and risk factors associated with prognosis in COVID-19 patients: surprising results.

In this study, we aimed to investigate the risk factors that may affect the prognosis and length of hospital stay of COVID-19 patients, particularly immunoglobulin A. Patients admitted to the relevant department or intensive care unit with a diagnosis of COVID-19 between April 2020 and January 2021 were included in the study. Demographic characteristics of the patients and blood type, immunoglobulin A (IgA), C-reactive protein, D-dimer, procalcitonin, ferritin, troponin I, complete blood count, biochemical, and COVID-19 (SARS-CoV-2) reverse transcription polymerase chain reaction test results were evaluated retrospectively from the hospital files and data system. A total of 164 COVID-19 patients were included in this study. The median age was 72 (range: 30-95) years and the gender distribution of women and men was 66/98 (40.2% vs. 59.8%, respectively). There was no statistically significant relationship between blood type and hospitalization time or mortality (p=0.497 and p=0.923, respectively). There was furthermore no statistically significant relationship between Rh group and the duration of hospitalization or prognosis (p=0.198 and p=0.827, respectively). There was no statistically significant correlation between IgA level and hospitalization time or prognosis (p=0.066, r=0.144). In the analysis of defined risk factors independently associated with death, the following were found to be significant indicators of mortality: leukopenia [beta: -2.973, OR (95% CI): 0.051 (0.003-0.891), p=0.041], glucose [beta: 0.014, OR (95% CI): 1.014 (1.001-1.028), p=0.037], D-dimer [beta: 0.001, OR (95% CI): 1.001 (1.000-1.001), p=0.023], duration of hospitalization [beta: -0.218, OR (95% CI): 0.804 (0.708-0.913), p=0.001], and duration of stay in the intensive care unit [beta: 0.348, OR (95% CI): 1.416 (1.186-1.690), p<0.001]. In our study, no relationship was found between IgA level and hospitalization time or mortality among COVID-19 patients. However, leukopenia and increased glucose, D-dimer, neutrophil count, urea, and durations of hospital and intensive care stays were found to be important predictors of mortality.

Клінічна та лабораторно-інструментальна характеристика мультисистемного запального синдрому в дітей

Purpose - to improve diagnostics and making multisystem inflammatory syndrome diagnosis in children based on the study of the clinical course and determination of laboratory and instrumental features. Materials and methods. 15 cases of multisystem inflammatory syndrome in children who were hospitalized in the Infectious Diseases Boxed Department No.1 of the Vinnytsya Regional Children’s Clinical Hospital in 2021 were analyzed. Results. The most common symptom was fever. Gastrointestinal disorders (53.33%), neurocognitive and vegetative symptoms (86.67%) were also found in children. Arthralgias, myalgias and pains in the lower extremities were in 33.33% of children, respiratory symptoms - in 20.00% of ones. Almost half of the children had skin rashes at physical examination. Scleritis and conjunctivitis was also noted in the quarter children. Leukocytosis was detected in 8 children (53.33%) in the results of blood count. Majority of children had elevated erythrocyte sedimentation rate, C-reactive protein and fibrinogen. D-dimer was increased in all children. 46.67% of children, according to chest ultrasound had fluid in the pleural cavity up to 7-10 mm, signs of interstitial pulmonary edema, increased echo-signals along the axillary line and the consolidation zone in the middle right lung from 3 mm to 6 mm. 60.0% of children had enlarged liver, spleen, fluid in the abdomen and enlarged multiple mesenteric lymph nodes according abdominal ultrasound. Conclusions. The diagnosis of multisystem inflammatory syndrome should be made according to the main criteria. It requires differential diagnosis with a number of infectious and systemic diseases. Prolonged fever and neurocognitive symptoms were the most common symptoms in hospitalized patients. Gastrointestinal and cardiovascular disorders, skin rashes prevailed. Typical laboratory changes were elevated markers of inflammation, evidence of coagulopathy and markers of previous coronavirus infection. Significant features among echosonographic changes were enlargement of parenchymal organs and signs of effusion in the cavities. Child protection from the impact of coronavirus infection should be improved. The research was carried out in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee of the participating institution. The informed consent of the patient was obtained for conducting the studies. No conflict of interests was declared by the authors. Keywords: multisystem inflammatory syndrome, MIS-C, SARS-CoV-2, children.

Evaluation of the relationship between the level of addiction and exhaled carbon monoxide levels with neutrophil-to-lymphocyte and platelet-to-lymphocyte ratios in smokers

INTRODUCTIONSmoking has been reported to increase systemic inflammation. The neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) are used as markers for systemic inflammation. In this study, the primary aim was to determine the NLR and PLR ratios in smokers. Secondly, we aimed to evaluate the relationship between the level of addiction and carbon monoxide (CO) level in the expiratory air, with these ratios.METHODSThis study was designed as a single-center, cross-sectional study. It was conducted with chronic smokers aged 18–40 years, without known health problems, visiting the smoking cessation outpatient clinic of a tertiary hospital. Sociodemographic data and smoking characteristics were collected, and exhaled CO levels were measured. Complete blood count (CBC) results were recorded, including NLR and PLR.RESULTSThe mean age of 247 patients was 31.2±6.1 years, with the majority of patients (68.4%) being male. While the mean value of CO was 11.6±5.6 ppm, 42.1% of cases had a high level of addiction. A statistically significant relationship was found between NLR and addiction levels, the CO level, and the amount of smoking in cigarettes/day and packs/year (all p=0.000). A statistically significant relationship was also found between PLR and addiction levels, CO level, cigarettes/day and packs/year (p=0.000, p=0.03, p=0.000, p=0.003, respectively).CONCLUSIONSWe found that as the level of addiction, cigarette use, and exhaled CO levels increased in smokers, NLR and PLR increased. Our data revealed that NLR and PLR may be a simple and easily assessable proxy of systemic inflammation in smokers.

Safety and immunogenicity of live intranasal pertussis vaccine GamLVP in the experimental infant hamadryas baboon model

Introduction. The Gamaleya National Center of Epidemiology and Microbiology has developed a live intranasal pertussis vaccine, GamLVP, for protection against whooping cough. It is indicated for vaccination of infants and revaccination of adults of all age groups. Preclinical studies on suckling mice or rats and adult monkeys as well as clinical trials involving adult volunteers demonstrated safety and efficacy of the GamLVP vaccine. The expansion of the GamLVP vaccine to be used for vaccination of infants requires additional preclinical studies to assess its safety and immunogenicity in the most suitable experimental model of infant hamadryas baboons (Papio hamadryas).The aim of the study was to assess safety and immunogenicity of the GamLVP vaccine administered intranasally for a single dose, two-dose, and three-dose immunization of P. hamadryas infants.Materials and methods. The study was performed in three 1–2-month-old P. hamadryas infants kept, together with their mothers, in a separate cage. The results of the complete blood count and biochemical profile tests were measured before and after the immunization and experimental infection. The enzyme immunoassay (EIA) was used to detect any changes in the levels of specific IgG antibodies in sera from the mothers and infants; the agglutination test (AT) was used to measure titers of total anti-pertussis antibodies.Results. The intranasal immunization of P. hamadryas infants with the GamLVP vaccine triggered development of a specific humoral immune response mediated by IgG antibodies (pertussis toxin + filamentous hemagglutinin), increased titers of total agglutinating anti-pertussis antibodies, caused no local and systemic reactions, caused no changes in the complete blood count and biochemical profile. The experimental infection of the GamLVPimmunized P. hamadryas infants did not cause any changes in the laboratory blood test values and any clinical manifestations typical of the pertussis infection.

Anemia Burden among Hospital Attendees in Makkah, Saudi Arabia

Background Anemia is a major health problem in Saudi Arabia and has multiple etiologies. Many studies have been conducted in Saudi Arabia in specific population groups like school children, adolescents, university students, and females in the reproductive age group, and most have reported high prevalence of anemia. This study was conducted in a specialist hospital in Makkah city and includes all outpatients aged 15 years and above. Objective To study the burden of anemia among hospital attendees, its stratification based on gender and age, and its severity along with the morphological types of anemia. Methods This is a study conducted at a specialist hospital in Makkah city and one-month data were collected retrospectively from the laboratory database and include demographic and routine hematological results of complete blood count (CBC). Results A total of 21,524 patients were included, out of which 9444 (43.9%) were males and 12020 (56.1%) were females. The overall prevalence of anemia was 38.7% (8339). Prevalence was very high in females, accounting for 68.2% (5689), whereas it was 31.8% (2650) in males. There were 39.6% (3301), 43.9% (3657), and 16.6% (1381) cases of mild, moderate, and severe anemia, respectively. In females, anemia was more prevalent in the age group of 15 to 49, which is considered as the reproductive age group. Microcytic anemia was the most prevalent type observed in this age group, accounting for 40.7% of all anemia cases. Normocytic anemia was more prevalent in the males, accounting for 52%. Conclusion Our study showed high prevalence of anemia among the patients attending outpatient departments in a specialist hospital. Females have high prevalence of anemia when compared to male population. Microcytic anemia was the most common anemia type among females and was seen in the 15–49 age group. There is an increase in prevalence of anemia with age for males, whereas, in females, increased prevalence is observed in the reproductive age groups and the anemia prevalence maintained a steady decrease towards the 5th to the 9th decades. Normocytic anemia was more prevalent in the 5th to the 9th decades, indicating that there are more etiologies other than iron deficiency in the causation of anemia. Macrocytic anemia was the least reported anemia type. Anemia of mild and moderate severity was predominant in both genders, although severe anemia showed higher prevalence in females as compared to males. Conclusion Our study showed high prevalence of anemia among the patients attending outpatient departments in a specialist hospital. Females have high prevalence of anemia when compared to male population. Microcytic anemia was the most common anemia type among females and was seen in the 15–49 age group. There is an increase in prevalence of anemia with age for males, whereas, in females, increased prevalence is observed in the reproductive age groups and the anemia prevalence maintained a steady decrease towards the 5th to the 9th decades. Normocytic anemia was more prevalent in the 5th to the 9th decades, indicating that there are more etiologies other than iron deficiency in the causation of anemia. Macrocytic anemia was the least reported anemia type. Anemia of mild and moderate severity was predominant in both genders, although severe anemia showed higher prevalence in females as compared to males. Conclusion. Anemia is highly prevalent in adolescents, adults, and the elderly in Makkah region. The most common cause is thought to be iron deficiency, although other causes are not uncommon. The authorities need to address the problem of prevention and reduction in anemia prevalence by taking effective measures and interventions.