Complete Blood Count Results Research Articles

Hematologic and Biochemical Ranges and Health Assessments of Free-Ranging San Salvador Iguanas (Cyclura rileyi rileyi) in a Translocation Program

The San Salvador rock iguana (Cyclura rileyi rileyi) is a critically endangered lizard restricted to a single island and its islets in The Bahamas. As part of a translocation project, 21 San Salvador rock iguanas were captured for physical examinations, complete blood counts (CBC), plasma biochemical analyses, fecal and hematologic endoparasite analyses, and nutrition evaluations. All San Salvador rock iguanas appeared to be healthy based on weight, activity, and physical examination. Blood samples were collected in lithium heparin to determine CBC, hemoparasite, and biochemistry results, including vitamin and mineral analyses. The CBC results indicate that San Salvador rock iguanas have relatively higher levels of lymphocytes and monocytes and lower levels of heterophils and azurophils compared with other West Indies Cyclura species. Biochemistry values were similar to other Cyclura species, with wide ranges noted in cholesterol, triglycerides, and creatine phosphokinase. There were no hemoparasites seen. Fecal samples were collected and analyzed for parasites and bacteria (culture). Oxyurids were the only fecal parasite seen. Fecal bacterial culture was consistent with previously reported findings in other iguanid species. This information serves as baseline reference data for future health assessments of the San Salvador iguana and provides valuable information toward managing the translocation program for this endangered species.

Complete blood count test in the evaluation of anemia: More than a screening test?

Aim: Anemia is defined as a reduction in the red blood cell mass or blood hemoglobin concentration. Complete blood count (CBC) analyses provide comprehensive information with regard to the classification of anemia. We aimed to determine the prevalence and remind the possible etiologies of anemia in our province using CBC analyses.Material and Methods: This retrospective study was conducted in a secondary healthcare center in northern Turkey. A total of 2578 healthy children enrolled. Their sociodemographic features, clinical history, and CBC results were retrospectively reviewed from the hospital records. According to CBC analyses, hemoglobin (HGB), hematocrit (HCT), mean corpuscular volume (MCV), mean corpuscular hemoglobin concentration (MCHC), mean corpuscular hemoglobin (MCH) and red cell distribution width (RDW) levels were evaluated.Results: The prevalence of anemia in the whole study population was 27.6% (n=713). When stratified according to the age subgroups of the study, the prevalances varied between 21.3% and 41.2%. Among the anemic patients, 42.9% (n=306) had microcytic, 56.1% (n=400) had normocytic and 1% (n=7) had macrocytic anemia Conclusion: The prevalance of anemia was >20% in all the age groups, revealing that anemia is a significant public health problem in our province. Detailed analysis of the CBC provides comprehensive information regarding the classification of anemia. It saves time and money for well−child follow up by facilitating the direct application of etiologic tests.

Systemic Immune-Inflammation Index (SII) Predicts Increased Severity in Psoriasis and Psoriatic Arthritis.

Background: Psoriasis is a common chronic inflammatory dermatosis. Systemic immune inflammation index (SII) is an inflammation-based biomarker, which has been shown to be an effective prognostic factor in diseases with an inflammation-related etiology. Objectives: The aim of the present study was to investigate the potential efficacy of SII as a prognostic factor in patients with psoriasis and psoriatic arthritis. Materials and methods: This is a study developed based on the analysis of the medical records of patients with psoriasis. The study retrospectively evaluated the records of the participants for complete blood count results. The SII was calculated by the formula: neutrophil x platelet/lymphocyte. Neutrophil-lymphocyte ratio (NLR), monocyte-lymphocyte ratio (MLR) and platelet-lymphocyte ratio (PLR) were determined. Results: SII was significantly higher in patients with psoriasis than in controls (578.1 vs. 396, p<0.001). The differences between the median NLR (2.2 vs. 1.5, p<0.001), MLR (0.25 vs. 0.21, p<0.001) and the mean red cell distribution width coefficient of variation (13.8 vs. 12.8, p<0.001) values of patient and control group were significant. SII was higher in patients with moderate/severe psoriasis than patients with mild psoriasis (687.3 vs. 506.6, p=0.034). A positive correlation was observed between SII and PASI (p<0.001; r=0.37). SII was higher in patients with arthritis than patients without (672.1 vs. 548.2, p=0.018). Conclusion: This is the first study to prove that SII might serve as an independent prognostic indicator for patients with psoriasis and psoriatic arthritis.

The relationship between level of the red cell distribution width and the outcomes of patients who acquired pneumonia from community

BackgroundInflammatory and oxidative stress caused by infection has recently been proposed as a mechanism of association between the red cell distribution width (RDW) and infectious diseases, such as community-acquired pneumonia (CAP).ObjectiveThe present goal was to assess the prognostic importance of the RDW test in patients with CAP.Patients and methodsThe present research was a descriptive and prospective study of patients diagnosed with CAP. All were admitted to Chest Department of Assiut University Hospital between April 2017 and July 2018. Assessment of CAP severity at time of hospital admission using Pneumonia Severity Index was done for all enrolled patients. Complete blood count was measured by automated hematology analyzer, and RDW was reported as a part of the complete blood count result. Normal reference range of RDW was 11.5–14.5%. All of the patients were followed up until being discharged. The outcome variable was in-hospital mortality.ResultsThe current study involved 94 patients with CAP: 77 (82%) survived and 17 (18%) died. RDW level was significantly higher in nonsurvivors compared with survivors (18.52±3.07 vs. 12.76±2.08; P=0.022). A significant positive relationship was found between RDW level and Pneumonia Severity Index points (r=0.664; P=0.000). Regarding the diagnostic performance of the RDW test, it was observed that RDW level at cutoff point more than 16.1% had 94.12% sensitivity and 98.70% specificity for the prediction of inhospital mortality in patients with CAP.ConclusionThe present data indicated that the measurement of RDW on admission may provide the physician with a tool to predict the outcomes of patients with CAP and thus assist in decision making and management in such cases either alone or alongside the other well-established means, taking into account that RDW testing is simple, cheaper, and readily available.

Fibrinogen-Mediated Platelet Microaggregate Formation in Stored Whole Blood

Introduction: Whole blood is regaining popularity in resuscitation after hemorrhage. The platelet storage lesion that has been observed in apheresis platelets also exists in whole blood, where platelet count and aggregation response decline rapidly after collection and during storage in the blood bank. Platelet microaggregates form in unfiltered whole blood, resulting in relatively large but unstable thrombus formation in a flow model over collagen. We hypothesized that the presence of fibrinogen activates platelets within the whole blood unit and predisposes them toward premature aggregate formation. Methods: Fresh whole blood (WB) was collected in citrate tubes (4.3%, 10.9 mM) from healthy donors (n=4) according to an institutionally approved standard operating procedure. Blood was centrifuged at 200-g to collect the platelet-rich plasma (PRP). The remaining red blood cell (RBC) fraction was centrifuged at 2000-g to pellet RBCs which were washed with HEPES-buffered saline and repelleted; platelet-poor plasma (PPP) was saved. The PRP fraction was centrifuged with 1 µM prostacyclin at 700-g, and the platelet pellet was washed with Tyrode's buffer, repelleted, and resuspended in either fibrinogen-deficient plasma (Fg-DP) or PPP. Platelets were combined with washed RBCs to generate a reassembled whole blood sample containing 150,000 platelets/µl and a hematocrit of 40%. Samples were added to minibags and stored at 4 °C for 14 days. On days of testing (0, 3, 7, 14), 1 ml aliquots were stained with 1 µM calcein-AM for 30 min at 37 °C and run on the BioFlux 1000 microfluidics platform with arterial flow rates generating a shear rate of 980 s-1 over a collagen surface. Fluorescence microscopy images were captured and quantified over 10 min to observe platelet adhesion to the surface. Complete blood count (CBC) was measured on each aliquot. In a follow-up study, unmanipulated, stored whole blood was passed through a standard transfusion filter (200 µm pores) to determine the effects of removing microaggregates prior to microfluidics flow testing at each time point. Results: CBC results are in Figure 1, illustrating the decline of platelet count over storage as previously observed. Figure 2 shows representative images captured at the end of the 10 min flow period. In samples containing normal plasma, thrombus formation is impaired by day 3 of storage with aggregate structures appearing immediately in the microscopy images. These aggregates attach and release periodically over the course of flow, an effect that persisted through day 14. In samples reconstructed with Fg-DP, no microaggregates were observed during storage, although the density and size of thrombi diminished over time. In filtered whole blood samples, thrombus formation on days 3 and 7 more closely resembled the Day 0 fresh samples, but aggregates appeared on day 14 despite filtration. Discussion: WB contains all of the elements required for resuscitation after hemorrhage, however the platelet storage lesion may affect its function. The interaction of platelets and fibrinogen in a relatively static environment results in activation and aggregation of platelets. In apheresis units, studies have shown that using a platelet additive solution to dilute fibrinogen results in better platelet performance for longer periods of storage. Further study is required to determine the clinical significance of aggregate formation and whether mitigation strategies should be explored. Disclosures No relevant conflicts of interest to declare.

Annual audit of haematology tests performed at a laboratory of a tertiary teaching hospital in Dar es salaam Tanzania

Background Monitoring of laboratory performance is crucial as it plays a central role in diagnosis, management and clinical decision making. With commencement of haematology clinical and laboratory services at the MUHAS Academic Medical Centre (MAMC); smooth ordering, handling and transfer of specimen and timely return of results can be challenging. We aimed to assess the function and efficacy of haematology clinics and evaluate the capacity of MAMC laboratory in performing tests ordered from the haematology clinics, as established by hospital guidelines. Methodology This was a retrospective descriptive study conducted from 1st of January to 31st March, 2018 in MAMC in Dar es Salaam, Tanzania. The study involved the Haematology and Blood Transfusion outpatient clinic department and laboratory section. Analytical and post-analytical phases of laboratory functions were measured against established standards stipulated under MAMC specialized clinic and laboratory services guidelines. Results A total of 53 patients attended the weekly haematology clinics. None had Haemoglobin (Hb) or Complete Blood Count (CBC) results available before doctor’s consultation. 75 different haematological tests were ordered. 81.3% of orders were collected and only 21.3% of the collected have results available in the Hospital Information System (HIS). Sickle Cell Disease (SCD) tests are not performed at MAMC. Half of the hemoglobin results (Hb) and two-third of the complete blood count results (CBC) were under the Turnaround Time (TAT) from time of sample collection to results, respectively. The number is lower when taken from the time of test order. Conclusion The weekly haematology clinics at MAMC operate below the standards set by the hospital. This is significantly contributed by laboratory performance. The capacity and operation of the MAMC laboratory is still below set standards, both in terms of number of haematological tests it performs and attainment of set TAT. Reporting of results to the HIS is also not fully implemented. Keywords: Audit, Haematology, Sickle Cell Disease, Turnaround Time, Hospital Information System, Outpatient Department, Clinics, Haemoglobin, Complete Blood Count

The application of lymphocyte*platelet and mean platelet volume/platelet ratio in influenza A infection in children.

BackgroundTo explore the characteristics and regularity of complete blood count (CBC) changes among influenza A–positive child patients and to discover parameters that can help with the diagnosis and differential diagnosis.MethodsOne hundred and ninety‐one influenza A–positive children, two hundred and nineteen influenza A–negative children with influenza‐like symptoms, and two hundred and forty‐seven healthy children were included in this study. They were divided into three groups: influenza A–positive patient group, influenza A–negative patient group, and control group. Reverse transcriptase polymerase chain reaction testing and Sysmex XS‐800i hematology analyzer were used to obtain influenza A and CBC results, respectively. CBC along with parameters including lymphocyte‐to‐monocyte ratio (LMR), neutrophil‐to‐lymphocyte ratio (NLR), platelet‐to‐lymphocyte ratio (PLR), mean platelet volume/platelet ratio (MPV/PLT), and lymphocyte*platelet (LYM*PLT) was calculated and recorded for each child. The differences in these parameters among different groups were tested with SPSS 15.0. The diagnostic values were also evaluated.ResultsThe LYM and PLT of child patients with influenza A were significantly lower than those of both influenza A–negative patients with influenza‐like symptoms and healthy controls. Among all the parameters, LYM*PLT has the largest area under the curve and the highest diagnostic value, followed by MPV/PLT. Compared with using LMR or MPV/PLT, the diagnostic value of using LYM alone was, on the contrary, higher.ConclusionsLow LYM*PLT and high MPV/PLT may indicate influenza A infection in children with influenza‐like symptoms, which can be a useful indicator for diagnosis and differentiation of influenza A infection.

Are There Any Relationships Between Abnormal Seminal Parameters and Neutrophil-Lymphocyte Ratio, Platelet-Lymphocyte Ratio, and Red Blood Cell Distribution-Platelet Ratio?

ObjectiveThe aim of this study is to determine the relationship between neutrophil/lymphocyte ratio (NLR), platelet/lymphocyte ratio (PLR), and red blood cell distribution width (RDW)/platelet ratio (RPR) values, which are pro-inflammatory markers, with abnormal sperm parameters, and to evaluate their availability as predictive markers.Materials and methodsA total of 160 patients, 80 of whom were the control group, formed with match-pair analysis (Group 1), and 80 patients with abnormal sperm analysis, who met the study criteria (Group 2), were included in the study. Complete blood count results were recorded. NLR, PLR, and RPR values were calculated using hematological parameters, and a comparison was made between the two groups.ResultsThe mean age was 31.23 ± 5.1 years in Group 1 and 31.33 ± 6.4 years in Group 2. NLR values were 1.84 ± 0.57-1.87 ± 0.65 (P =0.77), PLR values were 105.42 ± 23.89-111.42 ± 34.54 (P = 0.62) and RPR values were 0.05 ± 0.009-0.05 ± 0.01 (P =0.45), respectively. There was no statistically significant difference between the groups.ConclusionsWe investigated whether NLR, PLR, and RPR results can be used as a predictive marker on abnormal sperm parameters. We do not recommend the use of these parameters as a predictive marker.

First trimester complete blood cell indices in early and late onset preeclampsia.

Objective:This study aimed to compare the first trimester complete blood count (CBC) indices of pregnancies complicated by early-onset preeclampsia (EOPE) or late-onset preeclampsia (LOPE).Material and Methods:A retrospective case-control study was conducted with 186 patients. Patients were classified into three subgroups: EOPE, LOPE, and control groups. First trimester CBC results were obtained for each patient. Hemoglobin, hematocrit, red blood cell distribution width, mean corpuscular volume, white blood cell (WBC) count, neutrophil, eosinophil, basophil, lymphocyte, monocyte, mean platelet volume, platelet distribution width, plateletcrit, and platelet count were compared. The neutrophil lymphocyte ratio was calculated by dividing the absolute lymphocyte count by the absolute neutrophil count. The platelet lymphocyte ratio was calculated by dividing the absolute lymphocyte count by the absolute platelet count.Results:The total number of cases was 21, 42, and 123, in the EOPE, LOPE, and control groups, respectively. There were statistically significant differences in the total WBC and neutrophil counts between the three groups (both p<0.05). WBC and neutrophil counts were found to be highest in the EOPE group, and the LOPE group had higher levels compared with controls. The optimal cut-off values to predict EOPE for WBC and neutrophil counts were 9.55×103/ μL (sensitivity 71.4% and specificity 70.7%) and 6.45×103/μL (sensitivity 66.7% and specificity 74.8%), respectively.Conclusion:Increased first trimester WBC and neutrophil counts may be predictive for EOPE.

Analytical comparison between two hematological analyzer systems: Mindray BC‐5180 vs Sysmex XN‐1000

BackgroundTo compare the Mindray BC‐5180 and Sysmex XN‐1000 instruments by analyzing the results of complete blood count in the external quality assessment in Shandong Province in 2018.MethodsIn the external quality assessment, 10 batches of quality control materials were issued throughout the year. The test items were WBC, RBC, Hb, PLT, and HCT. The laboratories using Mindray BC‐5180 and Sysmex XN‐1000 were screened, and the results were analyzed by t test, Passing‐Bablok regression analysis, and Bland‐Altman analysis.ResultsThirty‐six laboratories using Mindray BC‐5180 instruments and thirty‐six laboratories using Sysmex XN‐1000 instruments were screened, and the average difference between the two instruments results is not significant (P > 0.05, t test). Passing‐Bablok regression analysis showed that the 95% confidence interval of the regression equation interception of each test item included 0, and the 95% confidence interval of the slope contained 1, r > 0.98, which showed that the correlation is good. The Bland‐Altman analysis showed that both instruments had more than 95% of the points within the 95% consistency limit (WBC97.2%, RBC95.6%, PLT97.2%, Hb96.7%, HCT97.5%). Within the consistency limit, the absolute value of the difference between the Mindray BC‐5180 instrument and the Sysmex XN‐1000 instrument is WBC 0.14%, RBC 0.26%, PLT 2.7%, and Hb 1.9%. HCT is 0.69%, and the difference is clinically acceptable.ConclusionIt can be considered that the two instruments have good correlation and consistency, and the two instruments can replace each other.

Metabolic signature associated with parameters of the complete blood count in apparently healthy individuals.

Metabolomics studies now approach large sample sizes and the health characterization of the study population often include complete blood count (CBC) results. Upon careful interpretation the CBC aids diagnosis and provides insight into the health status of the patient within a clinical setting. Uncovering metabolic signatures associated with parameters of the CBC in apparently healthy individuals may facilitate interpretation of metabolomics studies in general and related to diseases. For this purpose 879 subjects from the population‐based Study of Health in Pomerania (SHIP)‐TREND were included. Using metabolomics data resulting from mass‐spectrometry based measurements in plasma samples associations of specific CBC parameters with metabolites were determined by linear regression models. In total, 118 metabolites significantly associated with at least one of the CBC parameters. Strongest associations were observed with metabolites of heme degradation and energy production/consumption. Inverse association seen with mean corpuscular volume and mean corpuscular haemoglobin comprised metabolites potentially related to kidney function. The presently identified metabolic signatures are likely derived from the general function and formation/elimination of blood cells. The wealth of associated metabolites strongly argues to consider CBC in the interpretation of metabolomics studies, in particular if mutual effects on those parameters by the disease of interest are known.

The Predictive Value of Neutrophil-to-Lymphocyte Ratio for Hodgkin's Lymphoma Diagnosis in Patients with Asymptomatic Cervical Lymphadenopathy.

In patients with asymptomatic cervical lymphadenopathy, the physician often has to choose between evaluation via follow-up or open biopsy. Follow-up evaluation may lead to a delayed diagnosis of lymphoma, while an open biopsy is associated with surgical risks and costs. This dilemma can be avoided using predictive parameters. In the present study, we aimed to investigate whether neutrophil-to-lymphocyte ratio (NLR), a parameter which can be assessed quickly with ease and at low cost, has predictive value for Hodgkin's lymphoma diagnosis in patients with asymptomatic cervical lymphadenopathy. A total of 46 patients with asymptomatic cervical lymphadenopathy who underwent open biopsy were included in the study. Based on the biopsy results, the patients were divided into two groups, Hodgkin lymphoma (26 patients) and reactive lymphadenopathy (20 patients). The mean NLR in the groups was calculated and compared based on the results of complete blood count performed before biopsy. We found that mean NLR (P = 0.022) and mean neutrophil count (P = 0.046) were higher and mean lymphocyte count was lower (P = 0.054) in patients with Hodgkin's lymphoma compared to those in patients with reactive lymphadenopathy. Our results indicate that a high NLR may have predictive value for Hodgkin's lymphoma diagnosis in patients with asymptomatic cervical lymphadenopathy.

PB1744 THE ROLE OF FLT3 MUTATIONS IN ACUTE MYELOID LEUKEMIA: THE EFFECT ON THE COURSE OF THE DISEASE AND THE RESULTS OF THERAPY

Background:Acute myeloid leukemia (AML) is a group of diseases with various chromosomal aberrations (CA) and genetic abnormalities that have different prognostic significance. Approximately 45% of patients are not diagnosed with CA, which have intermediate risk. The prognosis of patients with normal karyotype (NK) is heterogeneous and requires stratifications with use polymerase chain reaction (PCR). The most mutations among AML patients are FLT3 gene mutations. This mutations are potential predictors of adverse prognosis, affecting the overall survival (OS) and disease‐free survival (DFS). The individualize approach to therapy and use target drugs can lead to improve the treatment efficiency.Aims:To determine impact of FLT3 gene mutations on survival in patients with AML.Methods:A retrospective study of the frequency of occurrence of FLT3 gene mutations and the assessment of their influence on the indicators of complete blood count (CBC) parameters, bone marrow, as well as disease outcomes in 199 patients with AML were conducted. To evaluate the status of FLT3, the polymerase chain reaction (PCR) method was used with further restriction and determination of 2 main types of mutations: FLT3‐ITD and FLT3‐TKD. The effect of the presence and type of FLT3 gene mutation on OS and DFS was analyzed. The statistical analysis included the Kruskall‐Wallis ANOVA tests and the analysis of OS and DFS using the Kaplan‐Meier estimator. Descriptive statistics technique included the arithmetic mean, median, 95% confidence interval, using Mann‐Whitney test.Results:In the studied group of patients with AML the frequency of occurrence of FLT3 gene mutations is 28.1% (FLT3‐ITD ‐ 22.6% (45/199), FLT3‐TKD ‐ 5.5% (11/199), the combination of FLT3‐ITD and FLT3‐TKD ‐ 1.0% (2/199)), the rest ‐ 70.9% (141/199) of patients without FLT3 gene mutations. Comparing CBC results, higher levels of leukocytosis (p = 0.0009) and blastosis of bone marrow (p = 0.01) were observed in group with FLT3+ mutation than without FLT3–. DFS results were significantly lower in FLT3+ group than in FLT3–group. The duration median of DFS in FLT3+ group was 8 months, in FLT3– group ‐ 20 months (p &lt; 0.00001). Significant differences were obtained (p = 0.0002) in the duration of OS between the FLT3‐ITD+, FLT3‐TKD+ and FLT3– groups. The median OS was 16 months for the group with FLT3‐ITD+ mutation, 17 months for FLT3‐TKD+ and was not achieved for FLT3–group. Statistically significant differences in the duration of OS between groups with NK were obtained: the median of OS among FLT3+ patients was significantly less comparing with the FLT3– group: 13 months and not reached, respectively (p = 0.00015).Summary/Conclusion:AML is a heterogeneous group regarding prognosis and response to therapy in which the molecular genetic status is the decisive factor in the prognosis and the course of the disease. The introduction in clinical practice of kinase inhibitors in patients with AML FLT3+ would improve survival rates and quality of life of patients.

Useful Platelet Indices for the Diagnosis and Follow-Up of Patent Ductus Arteriosus.

The aim of this study was to assess the utility of early postnatal platelet indices in the prediction of hemodynamically significant patent ductus arteriosus (hsPDA) and its response to pharmacological treatment in preterm infants. The medical records of 971 infants with gestational age < 30 weeks and birth weight < 1,500 g were analyzed retrospectively. Infants with hsPDA comprised the study group and those without hsPDA comprised the control group. Complete blood count results were recorded, and red cell distribution width-to-platelet ratio (RPR) and platelet mass were calculated. A total of 481 infants, 169 in the hsPDA group and 312 in the control group, were included. In terms of platelet indices, the hsPDA group showed significantly lower mean platelet volume (MPV) and platelet mass, whereas RPR was significantly higher (p < 0.05, respectively). Multiple logistic regression analysis showed that RDS (relative ratio [RR]: 2.39; 95% confidence interval [CI]: 1.45-3.93; p < 0.001), MPV < 7.85 (RR: 3.71; 95% CI: 2.29-6.01; p < 0.001), and RPR > 0.070 (RR: 5.33; 95% CI: 3.28-8.65; p < 0.001) were independent risk factors for hsPDA. Low MPV and platelet mass and high RPR in the first hours of life are risk factors for hsPDA and hsPDA refractive to pharmacological treatment with ibuprofen in preterm infants.

Use of Routine Complete Blood Count Results to Rule Out Anaplasmosis Without the Need for Specific Diagnostic Testing.

Anaplasmosis presents with fever, headache, and laboratory abnormalities including leukopenia and thrombocytopenia. Polymerase chain reaction (PCR) is the preferred diagnostic but is overutilized. We determined if routine laboratory tests could exclude anaplasmosis, improving PCR utilization. Anaplasma PCR results from a 3-year period, with associated complete blood count (CBC) and liver function test results, were retrospectively reviewed. PCR rejection criteria, based on white blood cell (WBC) and platelet (PLT) counts, were developed and prospectively applied in a mock stewardship program. If rejection criteria were met, a committee mock-refused PCR unless the patient was clinically unstable or immunocompromised. WBC and PLT counts were the most actionable routine tests for excluding anaplasmosis. Retrospective review demonstrated that rejection criteria of WBC ≥11 000 cells/µL or PLT ≥300 000 cells/µL would have led to PCR refusal in 428 of 1685 true-negative cases (25%) and 3 of 66 true-positive cases (5%) involving clinically unstable or immunocompromised patients. In the prospective phase, 155 of 663 PCR requests (23%) met rejection criteria and were reviewed by committee, which endorsed refusal in 110 of 155 cases (71%) and approval in 45 (29%), based on clinical criteria. PCR was negative in all 45 committee-approved cases. Only 1 of 110 mock-refused requests yielded a positive PCR result; this patient was already receiving doxycycline at the time of testing. A CBC-based stewardship algorithm would reduce unnecessary Anaplasma PCR testing, without missing active cases. Although the prospectively evaluated screening approach involved medical record review, this was unnecessary to prevent errors and could be replaced by a rejection comment specifying clinical situations that might warrant overriding the algorithm.

Early Blood Biomarkers to Improve Sepsis/Bacteremia Diagnostics in Pediatric Emergency Settings.

Background: Sepsis is the leading cause of death in children worldwide. Early recognition and treatment are essential for preventing progression to lethal outcomes. CRP and Complete Blood Count (CBC) are the initial preferred tests to distinguish between bacterial and viral infections. Specific early diagnostic markers are still missing. Aim: To investigate diagnostic value of Neutrophil–Lymphocyte Ratio (NLR), Mean Platelet Volume (MPV) and Platelet–MPV ratio (PLT/MPV) to distinguish sepsis/bacteremia and viral infection. Methods: We conducted a retrospective data analysis of case records of 115 children from 1 month to 5 years of age. All cases were divided into two groups—sepsis/bacteremia (n = 68) and viral (n = 47) patients, and further subdivided according to the time of arrival into early or late (≤12 or 12–48 h post the onset of fever, respectively). Analysis of CBC and CRP results was performed. NLR and PLT/MPV were calculated. Results: Sepsis/bacteremia group demonstrated higher absolute platelets count (370.15 ± 134.65 × 109/L versus 288.91 ± 107.14 × 109/L; p = 0.001), NLR (2.69 ± 2.03 versus 1.83 ± 1.70; p = 0.006), and PLT/MPV (41.42 ± 15.86 versus 33.45 ± 17.97; p = 0.001). PLT/MPV was increased in early arrival sepsis/bacteremia infants (42.70 ± 8.57 versus 31.01 ± 8.21; p = 0.008). NLR and MPV were significantly lower in infants (≤12 months) with viral infection on late arrival (1.16 ± 1.06 versus 1.90 ± 1.25, p = 0.025 for NLR and 8.94 ± 0.95fl versus 9.44 ± 0.85fl, p = 0.046 for MPV). Conclusion: Together with standard blood biomarkers, such as CRP, neutrophils, or platelets count, PLT/MPV is a promising biomarker for clinical practice to help discriminate between viral disease or sepsis/bacteremia in all children, especially in early onset of symptoms. NLR and MPV could support exclusion of sepsis/bacteremia in late arrival cases.

Perioperative change in neutrophil-to-lymphocyte ratio (NLR) is a prognostic factor in patients with completely resected primary pulmonary sarcomatoid carcinoma.

There has been controversy regarding prognostic factors for surgically resected primary pulmonary sarcomatoid carcinoma (PSC). Recently, several studies have shown that neutrophil-to-lymphocyte ratio (NLR) was a prognostic factor for various types of cancers from multiple organs. Therefore, we performed this study to evaluate whether NLR is related to prognosis after complete surgical resection of primary PSC. From Oct. 2003 to Sep. 2015, a total of 50 patients underwent surgical resection for primary PSC. After excluding patients with any history of other malignancy and incompletely resected cases, a total of 37 patients were included, and data were retrospectively collected and analyzed. Change in postoperative NLR and the initial NLR (ΔNLR) was calculated from the perioperative complete blood count (CBC) results. Mean age of the cohort was 62.2±1.9 years, and 31 patients (83.8%) were male. Twenty patients (54.1%) were revealed as pN0. Overall 5-year survival rate was 50.3%. Seventeen patients (45.9%) had locoregional or distant metastases. Univariate survival analysis revealed age >70, ΔNLR >17 as risk factors for overall survival (P=0.009, 0.005) and disease-free survival (P=0.036, 0.018). Multivariate Cox-regression analysis revealed age >70 and ΔNLR >17 as independent risk factors for overall survival and ΔNLR >17 as the only independent risk factor for the disease-free survival. In patients with completely resected primary PSC, perioperative ΔNLR had a significant effect on the overall survival and disease-free survival. Older age was also an independent risk factor for overall survival.

Effect of vaginal fold prolapse occurrence in a pregnant bitch on parturition process

Vaginal prolapse is defined as a protrusion of edematous vaginal tissue into the vaginal lumen and often through the vulvar lips of the bitches. Vaginal prolapse is frequently related to the increase in plasma estrogen level during the proestrus, estrus period and at the end of the pregnancy. In the pregnant bitches, however, vaginal prolapse is a rare condition. The objective of this case was to determine the effect vaginal fold prolapse events occurred during the last period of pregnancy on parturition. This article describes a 1-year-old Dogo Argentino bitch, weighing 29kg, presented due to vaginal prolapse which occurred during the last trimester of pregnancy. On clinical examination, the case was diagnosed as vaginal fold prolapse with about diameter of 50mm. Transabdominal ultrasonography was performed to evaluate the bitch's pregnancy status and revealed live fetuses in the uterus. The bitch and fetuses were healthy in performed examinations. And then the vaginal mass was cleaned and placed into normal position. Blood samples were taken for hematological tests. The results of complete blood count were within normal range. Serum estradiol and progesterone levels were 6.93 pg/ml and 23.27 ng/ml, respectively. Parturition was started spontaneously 58 days after mating and a healthy puppy was born. Unborn puppies were detected and C-section was performed. Seven live puppies were removed from the uterus. In conclusion; it was determined that the vaginal fold prolapse event that occurred during the last period of pregnancy was no effect to start of parturition. And also, it was concluded that monitoring of the parturition process would be beneficial for the health of the mother and the puppies.

The Use of HPLC as a Tool for Neonatal Cord Blood Screening of haemoglobinopathy: A Validation Study.

BackgroundNewborn cord blood screening identifies infants with underlying haemoglobinopathies before they develop the characteristic symptoms or sequelae.AimsThis study was performed to validate the interpretation high-performance chromatography (HPLC) along with complete blood count (CBC) results as a tool for universal neonatal screening of hemoglobin disorders in Oman.MethodsHPLC and CBC data on subjects who participated in the National Neonatal screening program at birth were obtained from archival records. The results recorded at birth were compared with a second study performed on the same subjects, after approval from the local medical research and ethics committee.ResultsOnly 290 subjects from amongst the original cohort of 3740 newborns could be recalled between April 2010 to March 2011, to repeat HPLC and CBC, as well as perform confirmatory DNA studies, wherever necessary. All these subjects had been documented to show an initial abnormal result. 31 cases who had no HbA at birth on HPLC were confirmed as either homozygous β-thalassaemia major (n=5 subjects) or homozygous sickle cell anemia (n=26 subjects) by appropriate DNA analysis. Additionally, amongst 151 subjects, 72 subjects were studied in the initial study by Hb Bart’s quantitation using the alpha thalassaemia short program at birth. In this cohort, 42 subjects with Hb Bart’s >1% at birth could be confirmed as having either deletional or non-deletional thalassaemia by GAP PCR studies. No case of HbH was detected in this cohort. Further, carrier status for structural hemoglobin variants (HbS, HbC, HbD, HbE) (n=67) and beta thalassaemia allele with low HbA at birth (n=29 out of 41) were confirmed by relevant molecular studies.ConclusionsThe study validated the earlier observation by 100% concordance with the results of CBC and HPLC. Presence of Hb Bart’s at birth does not always mean the presence of alpha thalassemia, as subjects with Hb Bart’s below 1% by quantitation, were shown to be normal by molecular studies.

Metastatic Transmissible Venereal Tumor in A Twelve Year Old Castrated Local Dog

A twelve year old local castrated male dog presented with complaint of difficult urination and bloody urine was diagnosed as having metastatic transmissible venereal tumour based on the results of cytology and per-cutaneous abdominal ultrasound. Physical examination revealed enlarged inguinal lymph nodes and distended but firm prepuce. In addition, the preputial orifice had a friable cauliflower growth. Results of complete blood count revealed normal packed cell volume and severe neutrophilic leukocytosis. Cytology of impression smear from the preputial mass and fine needle aspirates of inguinal lymph nodes revealed round cells with large nucleus/cytoplasmic ratio, prominent chromatin clumping and numerous cytoplasmic vacuolation. Treatment involved weekly intravenous injection of vincristine sulphate (0.5mg/m2) for six weeks, resulting in progressive reduction in prepuce and inguinal lymph nodes and complete resolution of the preputial mass by week three. In conclusion, diagnosis of transmissible venereal tumor with metastasis to inguinal lymph node in a dog twelve years after castration suggests that surgical castration is not sufficient to protect dogs from coitally transmitted infection.