Results Of Other Laboratory Tests Research Articles

Intensive Care Management of Eclampsia with HELLP Syndrome: A Case Report

Background: The incidence of HELLP syndrome is approximately 0.1-1% of all pregnant women and 5.5% of patients admitted to the ICU. Hemolysis, elevated liver enzymes, and thrombocytopenia are the characteristics of HELLP syndrome.
 Case Presentation: A 38-year-old patient with diagnosed G4P3A0L3 31-32 weeks of preterm pregnancy + eclampsia on MgSO4 regimen, HELLP syndrome + twice previous Sectio cesarean + breech presentation. On physical examination, the general condition was blood pressure 199/103 mmHg. The results of laboratory tests post-op were hemoglobin 7,1 g/dL, leukocytes 15.930, hematocrit 24%, and platelets 38,000. The results of other laboratory tests showed decreased albumin levels (Alb 2,4), increased levels of total bilirubin 14,7, direct bilirubin 10,8 and indirect bilirubin 3,9, increased liver enzyme SGOT 2001 SGPT 513.
 Conclusion: HELLP syndrome is a threatening clinical problem. Appropriate and adequate management, especially in the Intensive care unit, is needed to prevent severe complications to reduce morbidity and mortality rates in patients with HELLP syndrome.

Complete blood count in the elderly vs. selected biochemical parameters associated with inflammation. Results of PolSenior2 study

Introduction: Complete blood counts provide a lot of valuable information about the health condition. As the value of individual morphological parameters depends on many factors, the interpretation of the test result should be carried out taking into account clinical data and the results of other laboratory tests. Inflammation activates mechanisms that affect the amount of blood cells produced. Deviations in blood level of inflammatory markers (such as C-reactive protein (CRP), transferrin) and iron, may account hematological abnormalities. Aim: The assessment of the relationship between the examinated biochemical parameters and changes in selected hematological parameters. Material and methods: This analysis was based on laboratory data from 5623 participants of the nationwide PolSenior2 study, assessing the health of Poles over 60 years of age. Results: It was shown that in the study population with age, the concentrations of CRP, iron and transferrin change. Concentration of iron correlates positively with the concentration of transferrin, and negatively with CRP. It has been found that the incidence of anemia increases with age. Higher CRP levels and lower iron and transferrin levels were more frequently observed in the anemic group. Changes in the analyzed biochemical parameters correlated with a change (decrease or increase) in the red blood cell indices, the majority of leukocyte subpopulations and platelets. Conclusions: The analysis shows that inflammation, as expressed by changes in the concentrations of related biochemical parameters, can affect blood morphology. Therefore, when assessing abnormalities in blood morphology, the results of other laboratory assays, including biochemical markers associated with inflammation, should be taken into account.

Current possibilities for early diagnosis of systemic lupus erythematosus

The review presents the data available in the literature on the use of the lupus band test (LBT) for systemic lupus erythematosus (SLE). LBT is a direct immunofluorescence method used to detect immunoglobulins and complement factors in the dermoepidermal junction of skin biopsy specimens. LBT may be applied as one of the diagnostic tests for early diagnosis of SLE in patients without skin manifestations and in those of incomplete SLE. Like the results of other laboratory tests, those of LBT may be taken into account when establishing a final diagnosis only in conjunction with other clinical, immunological and instrumental data.

Analytical and Clinical Validation of Two Commercially Available Immunoassays Used in the Detection of TSHR Antibodies.

Graves disease is caused by autoantibodies that target the thyroid-stimulating hormone receptor (TSHR). Anti-TSHR autoantibody measurement is routinely performed to differentiate between Graves disease and other causes of hyperthyroidism. We evaluated the clinical performance of a reference laboratory bioassay [the Thyretain thyroid-stimulating immunoglobulin (TSI) Bioassay by Diagnostic Hybrids] and 2 commercially available immunoassays: the TSI Bridge immunoassay by Siemens and the thyroid-stimulating hormone receptor antibody (TRAb) immunoassay by Roche. We further evaluated the analytical performance of the Siemens TSI and Roche TRAb assays. We performed method comparisons using 125 patient specimens submitted for TSI testing for clinical purposes. Concordance of patient results was assessed between the 3 methods, and chart review was performed to further evaluate samples that generated discordant results. All 3 methods were also evaluated for potential interference caused by human chorionic gonadotropin (hCG). The Roche and Siemens assays demonstrated acceptable day-to-day precision, within-run precision, and precision at the clinical decision cutoffs. Despite manufacturer-defined analytical measuring ranges up to 40 IU/L, the Roche and Siemens assays were linear to 20 IU/L and 15 IU/L, respectively. hCG concentrations up to 150000 IU/L did not interfere with any of the methods evaluated. Moderate agreement between methods was observed when testing patient specimens that generated negative (≤1.3) or weakly positive (1.4-3.8) results by the Thyretain assay. One hundred percent agreement was observed when the Thyretain assay was strongly positive (≥3.9). The 3 commercially available anti-TSHR autoantibody measurement methods demonstrated equivalent performance in patients with untreated Graves disease. Discordant results were observed when testing specimens collected from patients undergoing treatment for Graves disease. In these patients, the Siemens TSI assay more frequently generated results consistent with clinical history, results of other laboratory tests, and imaging studies than the Thyretain Bioassay and Roche TRAb assay.

Chronic Hepatitis B Reactivation Subsequent to Chronic Hepatitis C Treatment: A Case Report

Patients, who are coinfected with hepatitis B and C, are at high risk for a progression to severe liver disease (cirrhosis, decompensated liver disease), hepatocellular carcinoma, and unresponsiveness to treatment. In this article, a case who developed a reactivation of chronic hepatitis B subsequent to Chronic Hepatitis C (CHC) treatment is presented. A 42-year-old woman with HBV and HCV was admitted to infectious diseases clinic with a major complaint of fatigue for three months. Laboratory tests revealed an elevated alanine transaminase of 182 IU/L (Normal range: 0-55 IU/L), elevated aspartate transaminase of 150 IU/L, serum HCV-RNA levels of 2080195 IU/mL (genotype 1b), and HBV-DNA of 1184 IU/mL. The results of other laboratory tests were within the normal range and remained to be normal during the follow-up. Pegylated interferon alpha-2a (180 mcg/week) and ribavirin (1200 mg/day) were administered for the treatment of CHC for 48 weeks. After one year of CHC treatment, our case was admitted with the elevation in liver enzymes and HBV-DNA of 878215 IU/mL. The histopathological examination of liver tissue revealed a mildly active histologic activity (6/18) and a mildly active histological activity (1/6) according to ISHAK scoring. Tenofovir disoproxil tablet (245 mg/day) was initiated for the chronic hepatitis B treatment. The patient is followed up at the ambulatory clinic of infectious diseases. As a result, patients coinfected with HBV and HCV should be followed up for the reactivation of HBV after CHC treatment with either pegylated interferon-based therapy or oral direct-acting antiviral agents in the medium-term, and the cirrhosis and hepatocellular carcinoma in the long-term.

Thromboelastography as a novel viscoelastic method for hemostasis monitoring: Its methodology, applications, and constraints

Thromboelastography (TEG) is a novel viscoelastic method which provides a comprehensive assessment of hemostasis from clot initiation and development to fibrinolysis involving both cellular and plasmatic components of hemostatic system. Apart from surgery its role is expanding into medical specialties with increasing integration into laboratory settings. TEG complements the conventional coagulation tests in assessment of bleeding disorders. Further hemotherapy based on TEG results has been shown to reduce transfusion requirements in varied clinical settings besides helping in identifying coagulopathies in patients with major bleedings. This review article addresses briefly the methodology, clinical applications, interpretation of TEG results including authors' own experience of TEG in different clinical scenarios and limitations of TEG. Overall, this technique seems to be helpful for evaluation of hypercoagulable state and in detecting fibrinolysis which are difficult to be detected with conventional coagulation tests. Kaolin activated citrated blood samples analyzed within 30-60 min of sampling can provide reliable results in a laboratory setting. However, multiple assays using different activators or modifiers may be required for accurate results in selected cases. The operator should be aware about the various preanalytical and analytical variables which can affect the results including limitations of this technique. The tracing of the thromboelastography should be interpreted cautiously taking into consideration the clinical picture of the patient and results of other laboratory tests. With improved model and availability of more assays it is hoped that TEG and other such hemostasis analyzers would bring in the paradigm shift in the hemostasis monitoring and treatment of patients in future.

Using Machine Learning to Predict Laboratory Test Results.

While clinical laboratories report most test results as individual numbers, findings, or observations, clinical diagnosis usually relies on the results of multiple tests. Clinical decision support that integrates multiple elements of laboratory data could be highly useful in enhancing laboratory diagnosis. Using the analyte ferritin in a proof of concept, we extracted clinical laboratory data from patient testing and applied a variety of machine-learning algorithms to predict ferritin test results using the results from other tests. We compared predicted with measured results and reviewed selected cases to assess the clinical value of predicted ferritin. We show that patient demographics and results of other laboratory tests can discriminate normal from abnormal ferritin results with a high degree of accuracy (area under the curve as high as 0.97, held-out test data). Case review indicated that predicted ferritin results may sometimes better reflect underlying iron status than measured ferritin. These findings highlight the substantial informational redundancy present in patient test results and offer a potential foundation for a novel type of clinical decision support aimed at integrating, interpreting, and enhancing the diagnostic value of multianalyte sets of clinical laboratory test results.

Resistance to acetylsalicylic acid in patients with type 2 diabetes mellitus is associated with lipid disorders and history of current smoking

BackgroundDiabetes mellitus (DM) is an important risk factor for stroke. Acetylsalicylic acid (ASA) is the most frequently used medication for prevention of cardio-cerebral vascular diseases. However, some patients experience ischaemic vascular events despite the use of ASA. This phenomenon is known as “aspirin resistance” (AR). The aim of this study was to assess the prevalence of AR in diabetic patients and search for factors associated with it.Materials and methodsThe examined group consisted of 96 subjects with diagnosed type 2 DM. Platelet function test was performed by the method of whole blood impedance aggregometry.ResultsAmong examined subjects, 51 patients (53.1 %) were sensitive to ASA action (ASA responders) and 45 patients (46.9 %) were resistant to ASA action (ASA non-responders). No association was found between platelet aggregation and gender, age, dose of ASA, known duration of diabetes, BMI, heart rate, mean systolic and diastolic blood pressure, and risk factors except for current smoking (p = 0.030). ASA non-responders were treated shorter with ASA than ASA responders (p = 0.010). The mean total cholesterol (p = 0.020), LDL concentration (p = 0.005), HCT (p = 0.010), WBC (p = 0.030), and PLT (p = 0.050) were significantly higher in ASA non-responders. No association was found between AR and results of other laboratory tests and medications. Multiple logistic regression analysis revealed factors associated with AR: current smoking and LDL concentration higher than 3.5 mmol/l.ConclusionsResults of our study did not confirm the association between poor glycaemic control in the diabetic patients and AR. Resistance to ASA in diabetic patients is associated with lipid disorders and history of current smoking.

Ureterosciatic hernia successfully treated by ureteral stent placement

A 76-year-old woman with history of cholecystectomy, hysterectomy, and vesicourethral suspension presented with acute lumbar backache and discomfort in the lower abdomen and severe nausea, with frequent vomiting, but without any associated fever. Physical examination revealed knocking tenderness at the left costal-vertebral angle. The patient's serum white blood cell count was 14,900/mm(3) and the results of other laboratory tests, including urinalysis, were normal. Non-enhanced computed tomography revealed left hydroureteronephrosis and obstruction of the distal left ureter with herniation into the sciatic foramen. A left ureteral stent was inserted with a double-J stent. The stent was removed after 2 months and thereafter the patient did not experience any recurrence.

Proximal Subungual Onychomycosis in a Patient with Classic Kaposi Sarcoma Caused byTrichophyton rubrum

A 58-year-old man presented with whitish patches on both great toenails for four weeks prior to visiting our hospital; the patches spread rapidly to other finger- and toe-nails. Prior to presentation, the patient had been diagnosed with idiopathic thrombocytopenic purpura two months ago and Kaposi's sarcoma three weeks ago. The patient was treated with human immunoglobulin for five days, and then received prednisolone 40 mg bid. Serology showed that the patient was negative for HIV and results of other laboratory tests were normal. The KOH slide preparation of the nail scraping showed long septated hyphae and numerous arthrospores. The fungus culture revealed whitish downy colonies on the front side and wine-red reverse pigmentation on Sabouraud's dextrose agar. Trichophyton rubrum was isolated on fungus culture and slide culture. The internal transcribed space (ITS) regions of ribosomal DNA of the cultured fungus were identical to Trichophyton rubrum. Proximal subungual onychomycosis (PSO) is the rarest form of onychomycosis. PSO initially presents as whitish patch(es) on the proximal side of the nail plate(s). Because PSO shows whitish to yellowish patches on the nail plate, the result of KOH examination of nail scrapings from the nail plate is almost always negative. Herein, we report on a case of multiple PSO in a patient with classic Kaposi sarcoma and suggest a method for easy KOH scraping on PSO.

Common reference intervals for aspartate aminotransferase (AST), alanine aminotransferase (ALT) and γ-glutamyl transferase (GGT) in serum: results from an IFCC multicenter study

Aspartate aminotransferase (AST), alanine aminotransferase (ALT) and γ-glutamyl transferase (GGT) measurements are important for the assessment of liver damage. The aim of this study was to define the reference intervals (RIs) for these enzymes in adults, paying attention to standardization of the methods used and careful selection of the reference population. AST, ALT and GGT were measured with commercial analytical systems standardized to the IFCC-recommended reference measurement systems. Three centers (two in Italy and one in China) measured their own freshly collected samples; one of these centers also measured frozen samples from the Nordic Countries RI Project and from a Turkish center. RIs were generated using non-parametric techniques from the results of 765 individuals (411 females and 354 males, 18-85 years old) selected on the basis of the results of other laboratory tests and a specific questionnaire. AST results from the four regions (Milan, Beijing, Bursa and Nordic Countries) were statistically different, but these differences were too small to be clinically relevant. Likewise, differences between the upper reference limits for genders was only 1.7 U/L (0.03 μkat/L), allowing a single RI of 11-34 U/L (0.18-0.57 μkat/L) to be defined. Interregional differences were not statistically significant for ALT, but partitioning was required due to significant gender differences. RIs for ALT were 8-41 U/L (0.13-0.68 μkat/L) for females and 9-59 U/L (0.15-0.99 μkat/L) for males, respectively. The upper reference limits for GGT from the Nordic Country population were higher than those from the other three regions and results from this group were excluded from final calculations. The GGT RIs were 6-40 U/L (0.11-0.66 μkat/L) for females and 12-68 U/L (0.20- 1.13 μkat/L) for males, respectively. For AST and ALT, the implementation of common RIs appears to be possible, because no differences between regions were observed. However, a common RI for GGT that is applicable worldwide appears unlikely due to differences among populations.

Mutational analysis for Wilson's disease

An asymptomatic 30-year-old man with chronic hepatitis B was referred to us by his primary care physician in March, 2005. He was HBeAg positive; his alanine aminotransferase (ALT) concentration was 182 U/L, and the hepatitis B virus (HBV) DNA concentration was 6·68×105 IU/mL. Clinical examination and results of other laboratory tests were unremarkable, so we started him on lamivudine 100 mg daily, which was the only available nucleoside analogue at that time. ALT and HBV DNA concentrations remained high after 18 months of lamivudine treatment; adefovir 10 mg daily was added. However, after 12 months of combination therapy, his ALT level remained high at 160 U/L, though the HBV DNA had dropped to 85·9 IU/mL.

Recurrent Intussusception and Gastrointestinal Bleeding Secondary to Gastric Heterotopia of the Small Intestine

Recurrent Intussusception and Gastrointestinal Bleeding Secondary to Gastric Heterotopia of the Small Intestine

Vitreous haemorrhage in elderly patients: management and prevention.

Vitreous haemorrhage can be caused by a disruption of normal retinal vessels, bleeding from diseased retinal vessels, bleeding from abnormal new vessels or extension of haemorrhage through the retina from other sources. In the elderly, vitreous haemorrhage usually occurs spontaneously and only occurs occasionally as a result of trauma. Appropriate management of vitreous haemorrhage is dependent on the most likely cause in a particular patient. As always, an accurate medical history with a careful clinical examination, static and dynamic ultrasonography performed by an experienced examiner, results of other laboratory tests and an understanding of the common causes of vitreous haemorrhage in each age group is essential to come to a 'best guess' diagnosis as to the cause of the vitreous haemorrhage and thus guide the physician toward the appropriate management. Immediate surgical removal of blood if indicated, as well as improving the vision gives the added benefit of allowing a full examination of the underlying retina. For those in whom surgical removal of blood is not recommended, a careful and frequent follow-up with serial B-scan ultrasound allows the 'best guess' diagnosis to be confirmed at each visit, until such time as the vitreous haemorrhage resolves sufficiently to allow a full and proper examination of the retina. Where there is a confirmed retinal tear, retinal detachment or other fundal pathology these are treated appropriately with laser or surgery (vitrectomy). Preventative measures are dependent on the underlying cause of vitreous haemorrhage. Some of the underlying causes such as posterior vitreous detachment cannot be prevented. In others, such as retinal vein occlusion, measures may need to be taken so as to reduce the risk of a similar event in the same or fellow eye and to reduce the risk of potentially life-threatening associated systemic conditions such as a stroke or myocardial infarction.

Extranodal NK/T‐cell lymphoma with extensive subcutaneous involvement, mimicking subcutaneous panniculitis‐like T cell lymphoma

A 22‐year‐old man had a subcutaneous nodule on the left thigh for 3 months. Physical examination showed an ulcerative nodule on the left thigh (Fig. 1). He suffered from a fever for 1 week. Laboratory tests revealed a white blood cell count of 7180/mm3, with 22.4% neutrophils, 68.5% lymphocytes, 8.4% monocytes, 0.3% eosinophils, and 0.4% basophils. Hemoglobin was 9.0 g/dL, hematocrit was 28.1%, and the platelet count was 202 × 109/L. Analysis of serum showed the following abnormal results: aspartate aminotransferase, 102 IU/L (normal, 13–37); alanine aminotransferase, 77 IU/L (normal, 7–43); alkaline phosphatase, 1296 (normal, 70–270); LDH, 1105 (normal, 120–520). Results of other laboratory tests including serum electrolytes, blood and tissue culture, and viral markers for hepatitis were negative or normal. Ultrasonography and computed tomography of abdomen and pelvis showed hepatosplenomegaly with ascites. Whole body bone scan showed an increased long bone activity of the left leg. Bone marrow aspiration was negative for neoplastic cells. Histologic examination from the thigh nodule revealed subcutaneous lymphoid infiltrates with involvement of the deep dermis. Examination at high power magnification showed small, medium, and large‐sized, pleomorphic lymphoid cells with hyperchromatic nuclei, nuclear debris, and phagocytic macrophages. Fat necrosis, partial rimming of fat spaces and clustering around blood vessels by pleomorphic lymphoid cells were also seen (Fig. 2). The immunohistochemical studies on paraffin sections revealed that most of the infiltrated lymphoid cells positively stained for CD56 (Fig. 3), granzyme B, TIA‐1, cytoplasmic CD3, and CD45RO, whereas CD4, CD8, CD20, and CD30 showed no immunoreactivity. Clonality of the infiltrate was analyzed by polymerase chain reaction (PCR). Nested PCR was performed using FR3A and VLJH as primers for IgH gene and Vγ – Jγ for T‐cell receptor γ chain gene. Polymerase chain reaction analysis showed a distinct band for TCR gene, confirming T‐cell monoclonality of infiltrating lymphocytes. EBV‐encoded small nuclear RNA was evident in lesional tissue by in situ hybridization. He was treated with two cycles of chemotherapy with CHOP‐BV (Cytoxan 735 mg, adriamycin 45 mg, vincristine 1.45 mg, prednisolone 75 mg, bleomycin 15 mg, VP‐16 150 mg). He died 5 days after chemotherapy.An ulcerative nodule on the left thighimage(a) Pleomorphic, small, medium and large‐sized lymphocytes with irregular hyperchromatic nuclei, nuclear debris, and phagocytic macrophages in the fat tissue. (b) A vascular involvement of pleomorphic lymphocytes and fat necrosis are seen (hematoxylin and eosin; original magnification × 100)imagePositive immunohistochemical staining for CD56 in atypical tumor cells (original magnification × 400)image

40-Year-Old Man With Anemia, Chronic Low Back Pain, and Hypoalbuminemia

40-Year-Old Man With Anemia, Chronic Low Back Pain, and Hypoalbuminemia

Right Atrial Membrane Interfering with Insertion of Pulmonary Artery Catheter

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Antibody to human endogenous retrovirus peptide in urine of human immunodeficiency virus type 1-positive patients.

Human endogenous retrovirus (HERV)-like sequences are normal inherited elements that constitute several hundredths of the human genome. The expression of genes located within these elements can occur as a consequence of several different events, including persistent inflammation or genotoxic events. Antibodies to endogenous retroviral gene products have been found in a number of infectious, chronic, and malignant diseases, suggesting a role in disease initiation and progression. We studied human immunodeficiency virus type 1 (HIV-1)-infected patients for evidence of urine antibody to a HERV peptide and investigated correlates with clinical and laboratory parameters. Forty-three HIV-1-infected patients in documented asymptomatic, symptomatic, or AIDS stages of disease and 21 age- and gender-matched, uninfected controls were tested for antibody to HERV-related peptide 4.1. Urine specimens were examined in a blinded fashion with the Calypte Biomedical Corp. experimental enzyme immunoassay for antibody to peptide 4.1. Results were compared with demographic data, medical history, clinical state of disease, and results of other laboratory tests. Thirty-six percent of the asymptomatic (Centers for Disease Control and Prevention [CDC] category A) and 81.3% of both the symptomatic (CDC category B) and AIDS (CDC category C) patients were positive for antibody to HERV-related peptide 4.1. None of the controls were positive. In this study, antibodies to HERV-related peptide 4.1 were found more frequently in patients with advanced stages (categories B and C) of HIV-1 disease than in those patients with an earlier stage (category A) of HIV disease. In HIV patients, severe immunosuppression, defined as having had at least one opportunistic infection, correlated with the expression of antibody to a HERV-related peptide.

Urine leukocyte esterase as a screening tool for sexually transmissible diseases and vulvovaginitis in adolescent females

Study Objective: To determine the predictive value of leukocyte esterase as a means of screening for sexually transmissible disease or vulvovaginitis in adolescent females.Design: A prospective study was performed comparing the results of urine leukocyte esterase and the finding of sexually transmissible diseases or vulvovaginitis.Participants: Seventy-four females (mean age = 17.4 years) from a Chicago suburban adolescent family planning clinic who were requesting birth control services were enrolled in the study.Interventions: Patients submitted an initial 10–20 cc of a voided urine specimen for leukocyte esterase testing prior to undergoing a pelvic examination for Neisseria gonorrhoeae culture, Chlamydia trachomatis microtrak, vaginal wet mount preparation, and a Pap smear. Urine leukocyte esterase was recorded as positive (trace, +1, + 2) or negative and compared with the results of other laboratory tests for sexually transmissible diseases or vulvovaginitis.Results: Thirty-eight leukocyte esterase-negative subjects had no detectable infections. Thirty-six subjects were leukocyte-esterase positive: 2 had urinary tract infection, 9 had a sexually transmissible disease or vulvovaginitis, and 25 had no detectable infections.Conclusion: Urine leukocyte esterase was found to have a statistically significant predictive value for sexually transmissible disease and vulvovaginitis (p = 0.003).

Serum total bile acid levels in canine dirofilariasis.

The concentrations of serum total bile acids (SBA) were measured by the enzyme-fluorimetric method in 60 dogs with dirofilariasis classified into 4 groups based on the severity of the disease. The results obtained were as follows: the SBA levels in the serious (38.0nM±40.8 (S.D.), n=14) and hemoglobinuria (24.4nM±18.3, n=26) groups were significantly higher than in the normal (5.3nM±3.9, n=94), subclinical (9.0nM±9.3, n=9) and mild (7.3nM±6.8, n=11) groups. There were significant correlations between the SBA concentration and the results of several laboratory tests in all the 4 filariasis groups and 3 filariasis groups without hemoglobinuria. Moreover, a significant correlation was found between the SBA concentration and the lecithin cholesterol acyltransferase (LCAT) activity, and this seemed to be ascribable to the decreased LCAT production caused by liver injury rather than to the direct inhibition with bile acids. Despite the severe liver cell damage, the SBA level of the hemoglobinuria group was not as high as that of the serious group, and no significant correlation was found between the SBA concentration and the cholesterol concentration or the results of other laboratory tests. These findings suggest that the bile acid metabolism in this group was slightly different from that in the other filariasis groups. The SBA concentration was not uniform after removal of the heartworm. The levels of SBA were 29.4nM±23.4 and 32.5nM±29.3 before and after removal of the heartworm, respectively. Besides, there was no significant correlation between the SBA and plasma hemoglobin concentrations. The latter strikingly decreased after removal of the heartworm. SBA did not seem to directly correlate with intravascular hemolysis in the hemoglobinuria group.