Routine Complete Blood Count Tests Research Articles

A rare case of ABO grouping discrepancy due to probable blood group switching which presented as lost antigens detectable only with indigenous reagents in less sensitive platforms compared to highly sensitive automated platforms using non indigenous reagents

Abstract: Blood group switching in the form of loss or diminished expression of RBC antigens has been reported in malignancies and infections. Blood group antigens are present on the red cell surface. ABO blood group system is the most clinically significant system. Some cases can present as grouping discrepancy. Here we present a rare case of ABO grouping discrepancy due to probable blood group switching which presented as lost antigens detectable only with indigenous reagents in less sensitive platforms compared to highly sensitive automated platforms using non indigenous reagents. 66 year old female whose historic blood group was A Rh D positive with history of uneventful transfusion of 2 units of A Rh D positive packed red cell one and half years back now presented with mycoplasma pneumonia and acute pulmonary edema. On routine complete blood count testing her hemoglobin was 3.6 gm%, request send to blood bank for pretransfusion testing. Testing performed via conventional tube technique and ABO blood group discrepancy was noted with forward grouping turned to be A Rh D positive (positive reaction with anti A1 lectin) and on reverse grouping 3+ reactions was observed in both A and B cell giving a picture of O blood group. Blood grouping was performed in different platforms including fully automated, semi automated and manual using commercially available antisera and human plasma as a source of anti A, anti B antibodies for forward grouping. The antisera used in automated platforms are non indigenous and that for manual are indigenous. Discrepancy was noted (Forward A and Reverse O) in CTT with commercially available antisera and human plasma as reagents for forward grouping .The same discrepancy was noted with CAT in neutral card with commercially available antisera for manual grouping. But when grouping performed with Column Agglutination Technology using matrix grouping gel card the discrepancy was resolved reporting the blood group as O. For further confirmation we repeated the blood grouping in another fully automated platform, SPRCA Technology (Immucore NEOIRIS) and in that also no discrepancy noted giving a picture of O group. This patient probably had undergone a blood group switching from A to O by losing some but not all A epitopes and started anti A antibody production. Some A epitopes which were not lost had been picked up by the commercially available antisera intended for manual grouping. These antisera are indigenous in origin. Also when human plasma was used as source of antibodies the A epitopes which were not lost were detected. But when grouping was done with non-indigenous antisera in both manual and automatic platform the A epitopes were not detected. This case points towards the relevance of incorporating indigenous antisera in automated platforms.

Pioneering predictions of AKI and AKIN severity in burn patients: a comprehensive CBC approach

This study aims to evaluate the utility of complete blood count (CBC) markers, in conjunction with the acute kidney injury network (AKIN) criteria, for the early detection, severity assessment, and prediction of mortality outcomes of acute kidney injury (AKI) in burn patients. The research seeks to fill existing gaps in knowledge and validate the cost-effectiveness of using CBC as a routine diagnostic tool for better management of AKI. The study was conducted at Hangang Sacred Heart Hospital. We performed a large-scale retrospective analysis of 2758 adult patients admitted to the burn intensive care unit over a 12-year period. Among these patients, AKI occurred in 1554 patients (56.3%). Based on the AKIN stage classification, 794 patients (28.8%) were categorized as AKIN 1, 494 patients (17.9%) as AKIN 2, and 266 patients (9.6%) as AKIN 3. We defined several ratio markers, including the Neutrophil-to-lymphocyte ratio (NLR), Platelet-to-lymphocyte ratio (PLR), Monocyte-to-lymphocyte ratio (MLR), systemic immune-inflammation index (SII), and various mean platelet volume (MPV) ratios. Our statistical analyses, conducted using the R programming language, revealed significant correlations between these markers and AKI severity. The AUC values for neutrophil count and WBC count were 0.790 and 0.793, respectively, followed by immature granulocyte count with an AUC of 0.727. For red blood cell (RBC)-related parameters, the AUC values for hematocrit (Hct), hemoglobin (Hb), and RBC count were 0.725, 0.713, and 0.713, respectively. Among the platelet-related parameters, only platelet distribution width (PDW) had an AUC of 0.677. Among the ratio markers, the NLR had the highest AUC at 0.772, followed by MPVNR and SII with AUC values of 0.700 and 0.680, respectively. The findings underscore the potential of CBC as an economical, routine test for AKI, thereby paving the way for enhanced patient outcomes. Our study suggests the utility of routine CBC tests, specifically WBC count and PLR, for predicting AKI and platelet, MPV, and NLR for mortality assessment in burn patients. These findings underscore the potential of easily accessible CBC tests in enhancing AKI management. However, further multicenter studies are needed for validation.

A convolutional neural network-based, quantitative complete blood count scattergram-mapping framework promptly screens acute promyelocytic leukemia with high sensitivity.

Acute promyelocytic leukemia (APL) is a subtype of acute myeloid leukemia (AML) characterized by its rapidly progressive and fatal clinical course if untreated, although it is curable if treated in a timely manner. Promptly screening patients who have results that are suspicious for APL is vital to overcome early death. The authors developed an innovative framework consisting of ResNet-18, a convolutional neural network architecture, with the objective of quantitatively mapping a complete blood count (CBC) scattergram to quickly and robustly indicate a probable susceptibility to APL. Three hundred and twenty scattergrams of the white blood cell differential channel from 51 patients with APL, 510 scattergrams from 105 patients who had non-APL AML, and 320 scattergrams from 320 healthy controls were randomly stratified at a ratio of 4:1 and split into training and testing data sets to accomplish five-fold cross-validation. Both the area under the curve and the average precision of >0.99 were achieved in each fold. Three hundred four of the 320 APL scattergrams (95%) were correctly flagged by the model, which outcompeted the CBC review rules recommended by the International Society of Laboratory Hematology (all p<.001). External validation based on an independent testing data set that included 56 scattergrams from 31 patients with APL, 56 scattergrams from 55 patients with non-APL AML, and 64 scattergrams from 64 healthy controls also confirmed the sensitivity and specificity of the framework. To the authors' knowledge, their convolutional neural network-based framework is the first to use scattergram output from routine CBC analysis to map suspicious APL early with outstanding sensitivity, specificity, and precision. The authors also describe a new CBC workflow incorporating this framework upstream of the morphologic review, which would provide the earliest flag for APL. The authors propose an innovative way to visualize complete blood counts (CBCs) by mapping the difference in white blood cell counts using automated CBC analysis to identify potential acute promyelocytic leukemia (APL) using a convolutional neural network (CNN), which can eliminate the potential pitfalls of manual observation. Analyses of an unprecedented, realistic data set validated that the quantitative relationship between the CBC scattergram and an APL abnormality is highly consistent. This is the first study to date focusing on screening for APL using scattergrams of the difference in white blood cell counts from routine CBC tests and has significant clinical relevance. The authors recommend using this method even before analyzing cell images, which could provide the earliest way to screen for APL in a sensitive and accurateway.

Survival analysis and outcome prediction of COVID-19 patients: a retrospective observational study from tertiary referral hospital in Indonesia

Coronavirus Disease 2019 (COVID-19) pandemic has become a global concern. Recently, Indonesia contributed the third-highest number of new COVID-19 cases in the world. We provide supporting information for COVID-19 management. This retrospective cohort study was conducted at Dr. Soetomo General Hospital. Researchers collected demographics, comorbidity, initial laboratory tests, and complications data of patients. This study performed a comparative, survival, and Receiver Operating Characteristic (ROC) curve analysis. Survival analysis showed a decrease in the probability of survival associated with an increase in the variables of age, diabetes, white blood cell (WBC) count, and neutrophils percentage, and a decrease in lymphocytes percentage during hospitalization. Lymphocyte percentage, neutrophil-lymphocyte ratio (NLR), WBC count, neutrophil percentage, had an accuracy 0.727 (95%CI 0.642-0.812; p<0.001), 0.726 (95%CI 0.641-0.812; p<0.001), 0.706 (95%CI 0.615-0.796; p<0.001), and 0.700 (95%CI 0.612-0.788; p<0.001) respectively, in predicting worse outcome. Our study suggests routine complete blood count tests in the admission of a patient with COVID-19 infections, which can be used to determine the survival and prognosis of hospitalized patients.

Survival analysis and outcome prediction of COVID-19 patients: a retrospective observational study from tertiary referral hospital in Indonesia.

Coronavirus Disease 2019 (COVID-19) pandemic has become a global concern. Recently, Indonesia contributed the third-highest number of new COVID-19 cases in the world. We provide supporting information for COVID-19 management. This retrospective cohort study was conducted at Dr. Soetomo General Hospital. Researchers collected demographics, comorbidity, initial laboratory tests, and complications data of patients. This study performed a comparative, survival, and Receiver Operating Characteristic (ROC) curve analysis. Survival analysis showed a decrease in the probability of survival associated with an increase in the variables of age, diabetes, white blood cell (WBC) count, and neutrophils percentage, and a decrease in lymphocytes percentage during hospitalization. Lymphocyte percentage, neutrophil-lymphocyte ratio (NLR), WBC count, neutrophil percentage, had an accuracy 0.727 (95%CI 0.642-0.812; p<0.001), 0.726 (95%CI 0.641-0.812; p<0.001), 0.706 (95%CI 0.615-0.796; p<0.001), and 0.700 (95%CI 0.612-0.788; p<0.001) respectively, in predicting worse outcome. Our study suggests routine complete blood count tests in the admission of a patient with COVID-19 infections, which can be used to determine the survival and prognosis of hospitalized patients.

STUDY OF PROGNOSTIC VALUE OF RATIO OF NEUTROPHIL TO LYMPHOCYTE TO PREDICT PROGNOSTIC OUTCOMES IN PATIENTS WITH ACUTE ST ELEVATION MYOCARDIAL INFARCTION.

Introduction: Atherosclerosis is a inammatory disease of arterial wall which have multifactorial causes. So study was done to investigate the role of neutrophil lymphocyte ratio in prediction of in hospital adverse events in ST elevated myocardial infarction (STEMI) patients thrombolysed with streptokinase (SK). Material and methods: The study consisted observational retrospective longitudinal study. In this 70 patients [47 (67.1%) men, 23(32.8%) women, mean age 53.6 ± 11.16 years], diagnosed case of acute ST elevation MI. Patints were devided in two group according to NLR (High NLR and Low NLR) detected by CBC. Result: A Total of 42 cases developed complications; in high NLR groups had higher rate of complications like Arrhythmia 6(60%), cardiogenic shock 12(80%), heart failure 10(77%), Post MI Angina 2 (50%) in hospital than those in low NLR group. Conclusion: Our ndings reveal that N/L ratio, a simple marker which can be derived from a routine complete blood count test was signicantly and independently related to prognosis of Acute myocardial infarction.

Predictive accuracy of blood inflammatory markers on COVID-19 mortality

Background: The impact of COVID-19 may be more severe in developing countries. Our study aims to analyze the accuracy of several inflammatory biomarkers in predicting COVID-19 mortality, providing information about the most suitable markers for developing countries.&#x0D; Methods: A retrospective cohort study was conducted at Dr. Soetomo General Hospital, Indonesia, from March to June 2020. White Blood Cells (WBC) count, Neutrophil-Lymphocyte Ratio (NLR), Procalcitonin (PCT), D-Dimer, and C-Reactive Protein (CRP) have been collected from the electronic medical records. We performed survival analysis to provide the hazard ratio and Receiver Operating Characteristic (ROC) curve analysis to test for accuracy for each parameter.&#x0D; Results: A total of 423 patients who met the criteria for participating had a median age of 54 (IQR 45-61) years. Patients in the death group are characterized by older age and shorter length of hospitalization. The WBC, NLR, PCT, D-Dimer, and CRP are found significantly higher in the death group (P=0.000). The WBC, NLR, PCT, D-Dimer, and CRP have an Area Under the Curve (AUC) of 0.709, 0.773, 0.738, 0.721, and 0.769, respectively moderate accuracy in predicting COVID-19 patient mortality. We found that NLR is significantly more accurate than the age parameter (Z=3.527; P=0.000) but has equal accuracy with other laboratory parameters. &#x0D; Conclusions: Since NLR obtained the highest accuracy, we still recommend routine complete blood count tests as prognostic biomarkers with the highest feasibility to be performed in developing countries.

Neutrophil to Lymphocyte Ratio and Clinical Outcomes in COPD

Chronic obstructive pulmonary disease (COPD) is a disabling condition that is characterised by poorly reversible airflow limitation and inflammation. Acute exacerbations of COPD are a common cause of hospitalisation and death among COPD patients. Several biochemical markers have been studied as outcome predictors in COPD; however, their measurement often requires significant time and resources. Relatively simple biomarkers of inflammation calculated from routine complete blood count tests, such as the neutrophil to lymphocyte ratio (NLR), might also predict COPD progression and outcomes. This review discusses the available evidence from studies investigating the associations between the NLR, COPD exacerbations and death in this patient group.

Incidence of Cancer Among Adults With Thrombocytosis in Ontario, Canada

Individuals with newly diagnosed cancer often have a high platelet count (thrombocytosis). Whether thrombocytosis is associated with the presence of an undiagnosed cancer remains unknown. To assess whether a new diagnosis of thrombocytosis is associated with a subsequent risk of cancer among adults. This population-based retrospective cohort study was conducted using linked laboratory data from Ontario, Canada, from January 1, 2007, to December 31, 2017, with follow-up until December 31, 2018. The study cohort included adults aged 40 to 75 years on the date of a routine complete blood count (CBC) test (index test) who had a normal platelet count in the 2 previous years and no history of cancer. Data analysis was performed in December 2020. Exposed individuals were those with a platelet count greater than 450 × 109/L. Matched unexposed control individuals had a platelet count within the reference range (150 × 109/L to 450 × 109/L) reported within 30 days of the exposure. Incident cancers within 5 years after diagnosis of thrombocytosis. Absolute and relative risks for cancer associated with thrombocytosis were estimated for all cancers and for cancers at specific sites. Of the 3 386 716 Ontario residents with a recorded routine CBC test result, 53 339 (1.6%) had thrombocytosis and a prior normal platelet count. Among individuals with thrombocytosis, the median age was 59.7 years (interquartile range, 50.2-67.4 years) and 37 349 (70.0%) were women. Among the 51 624 individuals with thrombocytosis included in the matched analysis, 2844 (5.5%) had received a diagnosis of a solid cancer in the 2-year follow-up period and 3869 (7.5%) had received a diagnosis within 5 years. The relative risk (RR) for developing any solid cancer within 2 years was 2.67 (95% CI, 2.56-2.79). Associations were found between thrombocytosis and cancers of the ovary (RR, 7.11; 95% CI, 5.59-9.03), stomach (RR, 5.53; 95% CI, 4.12-7.41), colon (RR, 5.41; 95% CI, 4.80-6.10), lung (RR, 4.41; 95% CI, 4.02-4.85), kidney (RR, 3.64; 95% CI, 2.94-4.51), and esophagus (RR, 3.64; 95% CI, 2.46-5.40). In this cohort study, an increased platelet count was associated with an increased risk of cancer for at least 2 years. The results suggest that individuals with unexplained thrombocytosis should be offered screening for several cancers.

Clinical Benefit of Routine Postoperative Hemoglobin Testing After Vaginal Hysterectomy and Reconstruction for Symptomatic Pelvic Organ Prolapse.

The objective of this study was to determine the clinical benefit of a routine complete blood count (CBC) on the first postoperative day after vaginal hysterectomy with reconstruction. This retrospective cohort study evaluated patients undergoing vaginal hysterectomy with native tissue prolapse repair between 2014 and 2019. Baseline and operative data, preoperative and postoperative blood counts, signs of anemia, and complications were recorded. Objective signs of anemia included tachycardia, hypotension, and low urine output. Subjective signs of anemia included dizziness, weakness, pallor, and diaphoresis. Complications, such as blood transfusions, additional testing, and readmission, were recorded. Five hundred and seventy patients had a postoperative CBC. The median preoperative hemoglobin level was 13.5 g/dL (min, 9.4; max, 16.9). Ninety-seven (17%) patients had a postoperative hemoglobin of 10 g/dL or less, with a median hemoglobin of 11.2 g/dL (min, 5.6; max, 14.9). Signs of anemia occurred in 72 (12.6%) patients: 64 (11.2%) showing objective signs, 13 (2.3%) reporting subjective symptoms, and 5 (0.8%) noting both. The most common objective sign was hypotension (n = 40; 63.5%). Five women received transfusions (0.9%). All patients receiving a blood transfusion showed objective signs of anemia; 3 (50%) patients had objective and subjective signs. Twenty-one (3.7%) patients had more than 1 CBC test during admission; 9 (42.9%) of these women were asymptomatic and had no further intervention. There were no readmissions related to postoperative anemia. Patients that require intervention for anemia after vaginal hysterectomy and reconstruction will manifest clinical signs or symptoms. Routine CBC testing in this cohort did not provide benefit and led to superfluous procedures in the vast majority of participants.

Relationship between patient ethnicity and prevalence of anemia during pregnancy and the puerperium period and compliance with healthcare recommendations - implications for targeted health policy

BackgroundAnemia is common during pregnancy and the puerperium. The association of ethnicity as well as other characteristics with anemia and compliance with healthcare recommendations has not been studied sufficiently and needs to be explored in order to implement a targeted health policy. We examined the association between ethnicity and the risk for prenatal and puerperium anemia and the compliance with healthcare recommendations. This effort aims to guide reforms in policies and practices that will assist in decreasing anemia prevalence in Israel.MethodsThis study was a secondary analysis of a prospective cohort study database including 1558 women who delivered vaginally at Emek Medical Center. Anemia was assessed before delivery by obtaining a complete blood count (CBC). After delivery, CBCs were taken in cases of postpartum hemorrhage, symptoms consistent with anemia, prenatal anemia or other clinical indications. The study population was divided according to their ethnicity (Jews and Arabs).The primary outcomes were anemia before delivery, anemia in the immediate postpartum and 6 weeks postpartum, and compliance with healthcare recommendations, which was defined as the rate of women who performed a routine CBC test 6-weeks-postpartum.ResultsThe rates of anemia before delivery and in the puerperium period were similar between Jews and Arabs (before delivery: 88 (11%) versus 98 (14%); 6 weeks postpartum: 55 (21%) vs 68 (28%), respectively;p > 0.05). Iron supplementation was high in both groups during pregnancy (~ 90%) and lower during the postpartum for Jews compared to Arabs (72% vs 83%,respectively; P < .0001). Only one third of the patients performed a CBC 6-weeks-postpartum regardless of ethnicity.ConclusionOverall compliance with health recommendation was high during pregnancy but low postpartum and was reflected in anemia persistence regardless of ethnicity.Because of the adverse long term impact of anemia on patient’s health, new policies need to be developed to improve patient’s compliance postpartum. A possible strategy is to combine the follow-up of the mother with the one of the newborn in the family health stations (Tipat Halav) and the community clinics similarly to the close follow-up during pregnancy. Additional methods may include active summoning for CBC test and assuring iron supplement consumption.

Our experience on the management of acute mastoiditis in pediatric acute otitis media patients

ObjectiveThe incidence of complications due to acute otitis media (AOM) in childhood has decreased significantly with the use of new antibiotics in recent years. However, acute mastoiditis (AM) is still the most common complication that can lead to further intracranial conditions with high morbidity. Our study aimed to evaluate the clinical characteristics of children with AM and identify possible indicators for further intracranial complications associated with this condition. MethodsChildren hospitalized in our clinic with a diagnosis of AM were reviewed. Demographic data, disease-related symptoms, types of complications accompanied by AM, medical/surgical treatments modalities, and culture results were screened. The patients were divided into two groups as those with and without intracranial complications (ICCs). Routine complete blood count tests, biochemical analysis, and C-reactive protein (CRP) level measurement were evaluated and compared between the groups. ResultsOf the 28 AM patients, five (17.9%) had isolated AM. Complications associated with AM included sub-periosteal abscess (28.6%), facial paralysis (25%), meningitis (17.9%), meningitis with sigmoid sinus thrombosis (7.1%), and meningitis with cerebellar abscess (3.6%). Eight patients developed ICCs (28.6%), of whom three had more than one complication. Ceftriaxone was found to be the first-line medical treatment (57.1%). Streptococcus pneumoniae was the most common pathogen isolated from the cultures (42.9%). Three patients (10.7%) were treated non-surgically, eight (28.6%) with myringotomy and ventilation tube (VT) insertion, eight patients (28.6%) with abscess drainage and VT insertion, and nine (32.1%) with cortical mastoidectomy and VT insertion. There was no significant difference between the patients with and without ICCs in terms of complete blood count parameters. The CRP level and the CRP-albumin ratio were significantly higher in patients with ICCs than those without these complications (p < 0.001). ConclusionAM remains to be the most common complication of AOM in childhood and can lead to further life-threatening conditions. Additional interventions according to the type of the complication with VT insertion is safe and effective in the management of AM. In patients with AM, it is of great importance to determine whether there is an accompanying ICC. The CRP-albumin ratio is a simple and reliable calculation to detect ICCs in patients with AM.

Are Routine Laboratory Investigations Necessary Following Percutaneous Nephrolithotomy?

OBJECTIVETo determine how effective routine postoperative blood work is in identifying complications after percutaneous nephrolithotomy (PCNL), the gold standard treatment for large volume stone disease. Although major complication rates are low, hemorrhagic and sepsis-related complications are serious and can occur. Routine post-PCNL complete blood count is routinely performed by most endourologists but may be a low-value practice. METHODSA retrospective review was performed of all PCNL procedures at our center over a 3-year period. Patient demographic, stone characteristics and postoperative data were collected and analyzed. RESULTSThree hundred and eighty-five patients (196 female and 189 males) underwent PCNL for the treatment of urolithiasis. Mean age was 55.8 years and mean length of stay in hospital was 1.74 days. Most patients (82.9%) had neither ureteric stent nor percutaneous tube prior to PCNL. Postoperatively, 4 patients (1.0%) required a blood transfusion and 14 patients (3.6%) developed urosepsis. Patients who required either a transfusion or developed urosepsis demonstrated abnormal vital signs (tachycardia, hypotension, or fever) postoperatively. Sixteen patients (4.2%) had normal vital signs but had an extended hospital stay only to monitor abnormal blood work results. None these patients required a transfusion nor developed urosepsis but had a length of stay that was a mean of 1.5 days longer patients with normal postoperative vital signs and blood work. CONCLUSIONAbnormal vital signs alone identified all patients that required transfusion or treatment for urosepsis after PCNL. Routine complete blood count testing postoperatively may not improve detection of infectious or bleeding complications and may prolong hospital admission unnecessarily.

Combination value of biomarkers in discriminating adult onset Still's disease and sepsis.

Lymphocyte and plateletcrit (PCT) as proportions of routine complete blood count tests, have been studied as simple biomarkers for inflammatory diseases. The aim of our study was to investigate whether blood routine parameters, especially platelet parameters could be auseful tool to distinguish Adult onset Still's disease (AOSD) from sepsis. We retrospectively reviewed 58patients with AOSD and 55sepsis patients diagnosed at the First Affiliated Hospital of Nanjing Medical University between January, 2015 to December 2018. Laboratory data including ferritin, blood routine parameters and C‑reactive protein (CRP) level were collected, and the neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte (PLR) were calculated. The results showed that AOSD patients showed higher ferritin, lymphocyte and PCT (all P < 0.01) and these factors are independent risk factors for predicting AOSD. In receiver operating characteristic (ROC) curve analysis of LY, PCT and ferritin for distinguish of AOSD, the area under the curve (AUC) was 0.676 (0.576-0.777); 0.706 (95% CI = 0.596-0.816); 0.715 (0.617-0.814). Meanwhile, the AUC of the combination of lymphocyte, PCT and ferritin was 0.836 (0.737-0.909) with sensitivity 67.3, specificity 92.3, and the difference was significant. Thus we suggest that lymphocyte, PCT may be auseful tool to make adistinction between AOSD and sepsis, as supplementary biomarkers to ferritin.

Neutrophil to lymphocyte ratio and clinical outcomes in COPD: recent evidence and future perspectives

Chronic obstructive pulmonary disease (COPD) is a disabling condition that is characterised by poorly reversible airflow limitation and inflammation. Acute exacerbations of COPD are a common cause of hospitalisation and death among COPD patients. Several biochemical markers have been studied as outcome predictors in COPD; however, their measurement often requires significant time and resources. Relatively simple biomarkers of inflammation calculated from routine complete blood count tests, such as the neutrophil to lymphocyte ratio (NLR), might also predict COPD progression and outcomes. This review discusses the available evidence from studies investigating the associations between the NLR, COPD exacerbations and death in this patient group.

Discriminating myelodysplastic syndrome and other myeloid malignancies from non-clonal disorders by multiparametric analysis of automated cell data

BackgroundWe investigated the usefulness of novel complete blood count (CBC) data for discriminating myeloid malignancies from non-clonal CBC abnormalities. MethodsData were obtained during routine CBC tests of 119 samples from 37 myelodysplastic syndrome (MDS) patients, 92 samples from 45 myeloproliferative neoplasm (MPN) patients, and 15 samples from 11 chronic myelogenous leukemia (CML) patients using a DxH800 (Beckman Coulter). Data obtained from patients with hypocellular bone marrow and from those with other non-clonal diseases with CBC abnormalities were included in the comparisons. ResultsFor cell population data of neutrophils, the means of median, upper median, lower median, and low angle light scatters were significantly lower in MDS patients than in patients without hematological malignancies. Low hemoglobin density (LHD) did not significantly differ between the MDS and non-clonal cytopenia patients, but it was significantly higher in the MPN and CML patients. We selected 13 parameters and scored the MDS diagnosis using cut-off values obtained from receiver operating characteristic (ROC) curve analysis. Using a score > 9, MDS was distinguished from non-clonal cytopenia with a sensitivity of 92.4% and a specificity of 85.4%. ConclusionsMultiparametric analyses of new automated parameters are useful for discriminating MDS from non-clonal cytopenia.

Clinical Utility of Routine CBC Testing in Patients with Community-Acquired Pneumonia.

The goal of this study was to identify situations in which routine complete blood count (CBC) testing could be avoided in patients with community-acquired pneumonia (CAP). This was a retrospective study of 50 patients with CAP. Vital signs, lab results, assessment and plan data, and computerized provider order entry logs were collected to determine if a lab result or clinical finding changed clinical management. Clinical stability was defined based on Patient Outcomes Research Team study criteria. There were 94 CBCs obtained after admission, of which only 6 were associated with management changes. Only two of these instances involved management changes related to patients' pneumonia, while the other cases represented chronic illnesses. Among all patients, the positive likelihood ratio of a post-admission CBC predicting a change in clinical management was low (1.12 [95% confidence interval, 0.86-1.44]). Low utility of CBC testing after admission may represent an opportunity to improvethe value of care in CAP patients. Journal of Hospital Medicine 2017;12:336-338.

Red Blood Cell Distribution Width Is Associated with Severity of Leukoaraiosis.

Red blood cell distribution width (RDW) is one of the routine hematologic parameters reported in the complete blood count test, which has been recognized as strong prognostic marker for various medical conditions, especially cardiovascular disease. We evaluated that RDW was also associated with the leukoaraiosis; common radiological finding of brain and that has been strongly associated with risk of stroke and dementia. In the present study, we included 1006 non-stroke individuals who underwent brain MRI and routine complete blood count test including RDW. Fazekas scale was used to measure the severity of leukoaraiosis based on fluid-attenuated inversion recovery image, and the severity was dichotomized to mild-degree (Fazekas scale: 0–1) and severe-degree leukoaraiosis (Fazekas scale: 2–3). Univariate and multivariate logistic regression models were constructed to evaluate independent risk factor for severe-degree of leukoaraiosis. Mean age of 1006 subjects was 64.34 ± 9.11 year, and mean of RDW was 12.97 ± 0.86%. The severe-degree of leukoaraiosis (Fazekas scale ≥ 2) was found in 28.83%. In the multivariate logistic regression, 4th quartile of RDW (> 13.3%) were significantly associated with the presence of severe-degree of leukoaraiosis (adjusted odds ratio, 1.87; 95% confidence interval, 1.20–2.92) compared to the 1st quartile of RDW (< 12.5%). The significance was not changed after adjustments for hemoglobin and other hematologic indices. These findings suggest that RDW is independently associated with severity of leukoaraiosis.

Reducing Unnecessary Postoperative Complete Blood Count Testing in the Pediatric Intensive Care Unit.

Complete blood count (CBC) testing commonly occurs to determine the need for blood transfusions after surgical procedures. Many clinicians believe postoperative CBCs are "routine." To decrease unnecessary routine CBC testing in a low-risk cohort of postoperative patients in the pediatric intensive care unit (PICU) at The Children's Hospital of Philadelphia by 50% in 6 months. Quality-improvement study. Data from our institution regarding frequency of ordering laboratory studies and transfusion requirements were collected for prior quality-improvement work demonstrating the safety and feasibility of avoiding routine postoperative CBCs in this cohort. Baseline survey data were gathered from key stakeholders on attitudes about and utilization of routine postoperative laboratory testing. Patient and clinician data were shared with all PICU clinicians. Simple Plan-Do-Study-Act cycles involving education, audit, and feedback were put into place. Percentage of postoperative patients receiving CBCs within 48 hours of PICU admission. Balancing measures were hemoglobin level below 8 g/dL in patients for whom CBCs were sent and blood transfusions up to 7 days postoperatively for any patients in this cohort. Sustained decreases below our 50% goal were seen after our interventions. There were no hemoglobin results below 8 g/dL or surgery-related blood transfusions in this cohort within 7 days of surgery. Estimated hospital charges related to routine postoperative CBCs decreased by 87% during 6 postintervention months. A simple approach to a systemic problem in the PICU of unnecessary laboratory testing is feasible and effective. By using local historical data, we were able to identify a cohort of patients for whom routine postoperative CBC testing is unnecessary.

Is Mean Platelet Volume a Possible Marker in Acute Peritonitis?

MPV (mean platelet volume) is one of the determinants of the platelet function which is situated in the routine complete blood count tests and was shown to be inversely correlated with inflammation. We aimed to evaluate MPV values in patients with peritoneal dialysis and in acute peritonitis attacks. 37 patients with PD and 42 healthy subjects were included in the study. 42 peritonitis attacks of the patients were recorded. C reactive protein (CRP) levels and complete blood count tests were analyzed. Mean MPV values were significantly higher in patients with PD in the stable period compared with the control group (p <0.001). Mean MPV values were significantly lower and CRP values were significantly higher in peritonitis attack periods, compared with the stable period of the same PD patients, both (p <0.001). In the correlation analysis, MPV levels in the peritonitis attack were negatively correlated with CRP levels, hospitalization day, peritoneal fluid and plasma leukocyte count (r= -0.751, p<0.001); (r= -0.355, p=0.002, ; ( r= -0.851, p<0.001) ; (r= - 0.579, p<0.001) respectively. In conclusion, our results suggest that assessment of MPV in acute peritonitis in PD patients may indicate systemic inflammation. MPV may be used as an hepler marker to predict the severity of acute peritonitis.