Routine Hematological Analysis Research Articles

Metabolic consequences on platelet parameters: Mean platelet volume and platelet distribution width in type 2 diabetes mellitus

Background: Diabetes mellitus encompasses metabolic disorders marked by chronic hyperglycemia, leading to various complications. It is considered a prothrombotic state associated with increased platelet reactivity. Parameters such as mean platelet volume (MPV) and platelet distribution width (PDW), which are indicative of platelet size, enzymatic activity, and prothrombotic risk, can be readily assessed during routine hematological analysis, facilitating early detection of this prothrombotic state. Aims and Objectives: The study aimed to investigate the varied alterations in platelet parameters in type 2 diabetes mellitus (T2DM) patients and tried to elucidate these parameters’ predictive role in diabetes complications. Materials and Methods: This prospective cross-sectional study was conducted between February 2022 and February 2024, involving 100 patients with T2DM and 100 healthy non-diabetic individuals. MPV, PDW, fasting blood glucose (FBS), and glycated hemoglobin (HbA1c) levels were measured and analyzed. Statistical analysis was carried out using the Student’s t-test, Mann–Whitney U-test, Chi-square test, and Spearman’s correlation tests in the Statistical Package for the Social Sciences software (version 21.0). Results: Most of the patients were in the age group of 40–70 years with male predominance. In comparing the 100 diabetics and 100 non-diabetics groups, MPV and PDW levels were notably higher in diabetics (11.46±1.75 vs. 9.40±1.02 fl, 21±2.57 vs. 16.72±1.48%) with statistical significance (P<0.01). Similarly, FBS and HbA1C levels were elevated among diabetics (179.38±70.25 vs. 90.64±5.93, 7.83±2.24 vs. 5.02±0.64) along with a positive correlation between platelet indices (MPV and PDW) and FBS, HbA1c levels in patients with T2DM. In addition, diabetic patients with complications exhibit significantly higher MPV, PDW, FBS, and HbA1c levels compared to those without complications. Conclusion: MPV and PDW levels show significant alterations in T2DM patients, with consistently elevated values, especially in those with complications. This underscores their potential importance as key indicators alongside glycemic indices such as FBS and HbA1c, in monitoring diabetes progression and anticipating associated complications.

Relationships of emerging biomarkers of cancer cachexia with quality of life, appetite, and cachexia

PurposeQuality of life (QoL), appetite, cachexia, and biomarkers [albumin, hemoglobin (Hb), neutrophils, lymphocytes, platelets, C-reactive protein (CRP), tumor necrosis factor alpha (TNFα), interleukin 6 (IL-6), interleukin 8 (IL-8), C-X-C motif chemokine ligand 5 (CXCL5) and citrullinated histoneH3 (H3Cit)] were compared for 40 cases with advanced cancer and 40 healthy controls. Baseline differences and significant relationships were explored for biomarkers with QoL, appetite, and cachexia.MethodsIn a prospective case–control, age and sex matched study, the European Organisation for the Research and Treatment of Cancer Quality of Life–C30 questionnaire (EORTC-QLQ-C30) for QoL, the Functional Assessment of Anorexia and Cachexia Therapy assessment (FAACT A/CS-12) for appetite, and a five-factor cachexia assessment tool for cachexia assessment were performed. Routine hematological measurements and blood chemistry analyses together with ELISA procedures and a Multiplex® bead array platform, were used for biomarker analysis. Descriptive statistics and regression analyses were undertaken. P < 0.05 defined statistical significance.ResultsGlobal health status (QL-G), functional scales (QL-FS), and symptom scales (QL-SS) differed for cases and controls (p < 0.01). In cases, differences were observed for QL-G (p < 0.01), QL-FS (p < 0.01), and QL-SS (p = 0.01) compared to standardized references values. FAACT A/CS-12 scores differed significantly between cases and controls (p < 0.01) and 30% of cases scored “poor” appetites. Cachexia was present in 60% of cases. Albumin, lymphocytes, platelets, Hb, platelet to lymphocyte ratio (PLR), systemic immune-inflammation index (SII), CRP, TNFα, all at p < 0.01, neutrophil to lymphocyte ratio (NLR) (p = 0.02), IL-6 (p < 0.04), and IL-8 (p = 0.02) differed significantly between cases and controls. No difference was found for CXCL5 or H3Cit. Albumin NLR, Hb, PLR, SII, TNFα, IL-8, and CRP showed significant relationships with all aspects of QoL. QL-FS was significantly related to CXCL5 (p = 0.04), significant relationships with FAACT A/CS-12 included: NLR (p = 0.002), Hb (p < 0.001), and PLR (p < 0.01). NLR, PLR, SII, TNFα, IL-6, IL-8, and CRP correlated positively to cachexia and albumin while Hb and lymphocyte count correlated negatively to cachexia.ConclusionCXCL5 and H3Cit were not reliable biomarkers for cancer cachexia, nor significantly related to QoL, appetite or cachexia. Albumin, NLR, Hb, PLR, SII, TNFα, IL-8, and CRP were reliable indicators of QoL, appetite, and cachexia. Future research should include other novel biomarkers namely growth differentiation factor-15 (GDF-15), fibroblast growth factor 21 (FGF-21), fractakline, interferon gamma (IFN-y), IL-16, macrophage colony stimulating factor (M-CSF), and macrophage procoagulant–inducing factor (MPIF).

Correlation between change in platelet count and platelet indices in cases of acute ischemic stroke in tertiary care centre of northern India

Background: Platelet is the important factor in the pathogenesis of atherosclerotic complications, contributing to thrombus formation. As there is a significant correlation found between acute ischaemic stroke and platelet indices including platelet count with their prognostication, but no similar study has been documented from this area of the country, which has drawn attention to conducting this study. Methods: This is an observational, case-control study. Patients with acute ischaemic stroke and aged 18 years or above were included involving a total of 156 subjects (78 cases and 78 controls). They were examined clinically radio-logically and pathologically by platelet count and different indices like mean platelet volume (MPV), platelet distribution width (PDW), platelet to large cell ratio (P-LCR). Results: In the present study, mean PDW of cases is 17.69 fl with a SD of 3.22 fl and means PDW of the control group is 13.67 fl with a SD of 3.15 fl. There is statistically insignificant (p=0.26, CI-95%) changes in value of plateletcrit (PCT) among cases and control group (mean PCT of cases is 0.27% with a SD of 0.O7% and the mean PCT of control subjects is 0.29% with a SD of 0.07%). Conclusion: The observations here suggest a role for larger platelets in the genesis of cerebral thrombosis and are likely to represent changes occurring at the time of thrombopoiesis. Patients with larger platelets can easily be identified during routine haematological analysis. Hence, these indices serve as an important and cost-effective tool in predicting an impending ischemic event and can be used in the future, especially in resource poor countries like India. Keywords: mean platelet volume; platelet count; cerebrovascular accident; platelet distribution width; plateletcrit

Rapid Detection of Plasmodium vivax by the Hematology Analyzer for Population Screening.

In India, where malaria is endemic, the prompt and accurate detection of infections is crucial for disease management and vector control. Our study aimed to evaluate the "iRBC" flag, a novel parameter developed for routine hematology analyzers, for its sensitivity and specificity in detecting Plasmodium vivax (P. vivax) infections. We used residual blood samples from patients with suspected malaria and compared the iRBC flag results with microscopy, which serves as the gold standard. Additionally, we compared the results with rapid immuno-chromatographic tests (RDTs) commonly used in the field. Our study included 575 samples, of which 187 were positive for P. vivax. The iRBC flag demonstrated a high sensitivity of 88.7% and 86.1% on the XN and XN-L hematology analyzers, respectively, and a clinical specificity of 100% on both analyzers. Furthermore, the scattergram derived from each positive dataset exhibited distinct patterns, which facilitated rapid confirmation by laboratory specialists. Notably, the iRBC flag remained effective even in the presence of interfering conditions. Overall, our results indicate that the iRBC flag is a reliable and rapid screening tool for identifying P. vivax in routine blood testing. Our findings have significant implications for malaria detection and control in endemic regions like India.

Impact of serum C-reactive protein level as a biomarker of cancer dissemination in canine lymphoid neoplasia.

C-reactive protein (CRP) is a highly sensitive but non-specific acute phase protein that has been widely used to predict the biological behavior of patients with cancer. This study aimed to examine the significance of the serum CRP biomarker in predicting the prognosis of dogs with lymphoma. Blood samples (5 mL) were collected from 34 lymphoma dogs and control healthy dogs. Canine lymphoma clinical staging was classified using the World Health Organization (WHO) criteria. All lymphoma dogs were reclassified into two groups based on the disease stage. Stages IV and V were designated as advanced stages, and Stages I-III were designated as other stages. The serum CRP level was then determined using a commercial canine CRP fluorescent immunoassay kit and routine hematological and biochemical analyses. C-reactive protein levels, circulating inflammatory parameters, such as neutrophil-to-lymphocyte ratio, lymphocyte-to-monocyte ratio, and platelet-to-lymphocyte ratio, and albumin levels were compared between advanced stages (IV and V) and Stages I to III using Mann-Whitney U tests. Receiver operating characteristic (ROC) curves were also generated to determine the cutoff value, diagnostic sensitivity, and specificity of the CRP level. A prospective study identified 34 dogs recently diagnosed with canine lymphoma. C-reactive protein levels were significantly higher in lymphoma dogs in advanced stages (IV and V) than in lymphoma dogs in Stages I-III. According to the ROC curve analysis, a CRP cutoff level of 54.1 mg/L indicates advanced-stage canine lymphoma, which can be used as a biomarker to predict cancer dissemination. Serum CRP concentrations can assist clinical decision-making on the WHO stage in lymphoma dogs in clinical applications. The limitations of this study include a small number of lymphomas and no survival analysis.

Circulating histones contribute to monocyte and MDW alterations as common mediators in classical and COVID-19 sepsis

ObjectiveHistone proteins are physiologically involved in DNA packaging and gene regulation but are extracellularly released by neutrophil/monocyte extracellular traps and mediate thrombo-inflammatory pathways, associated to the severity of many human pathologies, including bacterial/fungal sepsis and COVID-19. Prominent and promising laboratory features in classic and viral sepsis emphasize monocyte distribution width (MDW), due to its ability to distinguish and stratify patients at higher risk of critical conditions or death. No data are available on the roles of histones as MDW modifiers.DesignComparison of MDW index was undertaken by routine hematology analyzer on whole blood samples from patients with COVID-19 and Sepsis. The impact of histones on the MDW characteristics was assessed by the in vitro time-dependent treatment of healthy control whole blood with histones and histones plus lipopolysaccharide to simulate viral and classical sepsis, respectively.Measurements and main resultsWe demonstrated the breadth of early, persistent, and significant increase of MDW index in whole blood from healthy subject treated in vitro with histones, highlighting changes similar to those found in vivo in classic and viral sepsis patients. These findings are mechanistically associated with the histone-induced modifications of cell volume, cytoplasmic granularity and vacuolization, and nuclear structure alterations of the circulating monocyte population.ConclusionsHistones may contribute to the pronounced and persistent monocyte alterations observed in both acute classical and viral sepsis. Assessment of the biological impact of circulating histone released during COVID-19 and sepsis on these blood cells should be considered as key factor modulating both thrombosis and inflammatory processes, as well as the importance of neutralization of their cytotoxic and procoagulant activities by several commercially available drugs (e.g., heparins and heparinoids).

Performance evaluation of a novel reticulocyte identification method that uses metachromatic nucleic acid staining based on a crossover analysis of emission DNA/RNA light (RNP Determination™) in hematology analyzer Celltac G.

Assessing the percentage of reticulocytes (%Retic) is useful for diagnosing and treating blood diseases that present with anaemia. The Celltac G+™ hematology analyzer (HA) uses a novel reticulocyte identification method that involves metachromatic nucleic acid staining with acridine orange and crossover analysis of emission light of DNA/RNA (determination of red cells, nucleic acid-containing cells, and platelets, RNP Determination™). The red and green fluorescence generated by stained single-stranded RNA and double-stranded DNA express immaturity and morphological abnormality of erythrocytes by detecting erythrocyte RNA and DNA content. The basic performance of the test automated analyzer (TAA) Celltac G+ was evaluated and compared with the flow cytometry reference method and the comparative automated analyzer (CAA) XN-1000/2000™. In addition, its precision, limit of quantity (LoQ), linearity, analytical measurement interval (AMI), accuracy, and comparability and the effects of interfering substances were evaluated. Evaluation of %Retic by the TAA demonstrated good precision and linearity. The AMI was confirmed from 0.02 to 8.23, and the LoQ in %Retic as the coefficient of variation within an 11% limit (SD, within a 0.01 limit) was 0.14. TAA correlated well with the reference method and routine HA (CAA). Some deviations were found between TAA and CAA in DNA measurements of erythrocytes from abnormal samples. Celltac G+ uses a novel measurement principle and can assess erythrocyte immaturity independent of DNA contents. It represents a new HA that provides novel, useful information on immaturity and morphological abnormality of erythrocytes.

Is Serum Uric Acid Level a Prognostic Value for Tinnitus Severity?

Objective: Tinnitus is a disease that concerns a large part of society and its pathophysiology and etiology have not been exactly clarified. This study will investigate the association between serum uric acid (SUA) levels and idiopathic subjective tinnitus. Material and Methods: Ninety-one tinnitus patients and 45 age- and sex-matched healthy volunteers were included in the study. Patients were divided into two groups as mild tinnitus and severe tinnitus according to the Tinnitus Handicap Inventory questionnaire. They underwent otolaryngologic examination, routine hematological and biochemical analyses, pure tone audiometry, doppler ultrasound, and magnetic resonance imaging to exclude possible causes of tinnitus. Patients with abnormalities in any test result were excluded from the study. The blood test results were statistically compared between the groups. Results: Except for SUA levels, no significant difference was found between groups in any blood test results (p&gt;0.05). Significant differences among the groups were determined in SUA levels (p=0.001). SUA levels were found to be significantly higher in the severe tinnitus group than in the mild tinnitus or control group (p=0.002, p=0.001). However, there is no statistically significant difference between the mild tinnitus group and the control group (p=0.617). Conclusion: In this study, it was observed that there was a clear correlation between higher SUA levels and severe tinnitus. But this association did not reveal SUA levels as an accurate biological marker for tinnitus. It could only be utilized as a marker of disease severity. Further studies will help to reveal the exact relation.

A Risk Score for Predicting Long-Term Mortality Following Off-Pump Coronary Artery Bypass Grafting.

Background: Off-pump coronary artery bypass grafting (OPCAB) comprises 15–30% of all bypass grafting surgeries. The currently available perioperative scores such as Euroscore and STS score do not specifically predict long-term mortality after off-pump procedures. The neutrophil-to-lymphocyte ratio (NLR) is one of the new, easily accessible markers of inflammation with proven predictive value in cardiovascular diseases. We aimed to develop the first risk score for long-term mortality after OPCAB and to determine if the perioperative value of NLR predicts long-term mortality in OPCAB patients. Methods: In total, 440 consecutive patients with multivessel stable coronary artery disease undergoing OPCAB were recruited. Differential leukocyte counts were obtained by a routine hematology analyzer. Data regarding mortality during a median follow-up time of 5.3 years were obtained from the Polish National Health Service database. An independent population of 242 patients served as a validation cohort. Results: All-cause mortality was influenced by different clinical risk factors. In multivariate regression analysis, chronic obstructive pulmonary disease, stroke history, post-operative NLR and LVEF were independent predictors of mortality. Combing all independent predictors predicted long-term all-cause mortality with 68.5% sensitivity and 71.5% specificity (AUC = 0.704, p < 0.001). After weighing these variables according to their estimates in a multivariate regression model, we developed a score to predict mortality in patients undergoing OPCAB (PREDICT-OPCAB Score, ranging from 0 to 10). Patients with a high score were at higher risk of mortality within the median 5.3 years of follow-up (score 0–3: 8.3%; 4–6: 27.0%; 7–10: 40.0%; p < 0.001 for score 0–3 vs. 4–6 and 7–10). This association was confirmed in the validation cohort. Conclusions: We developed and validated the first simplified risk score to predict mortality following OPCAB based on easily accessible clinical factors. This risk score can be used when obtaining a patient’s informed consent and as an aid in determining treatment.

Predictive and Diagnostic Biomarkers of Anastomotic Leakage: A Precision Medicine Approach for Colorectal Cancer Patients.

Development of an anastomotic leak (AL) following intestinal surgery for the treatment of colorectal cancers is a life-threatening complication. Failure of the anastomosis to heal correctly can lead to contamination of the abdomen with intestinal contents and the development of peritonitis. The additional care that these patients require is associated with longer hospitalisation stays and increased economic costs. Patients also have higher morbidity and mortality rates and poorer oncological prognosis. Unfortunately, current practices for AL diagnosis are non-specific, which may delay diagnosis and have a negative impact on patient outcome. To overcome these issues, research is continuing to identify AL diagnostic or predictive biomarkers. In this review, we highlight promising candidate biomarkers including ischaemic metabolites, inflammatory markers and bacteria. Although research has focused on the use of blood or peritoneal fluid samples, we describe the use of implantable medical devices that have been designed to measure biomarkers in peri-anastomotic tissue. Biomarkers that can be used in conjunction with clinical status, routine haematological and biochemical analysis and imaging have the potential to help to deliver a precision medicine package that could significantly enhance a patient’s post-operative care and improve outcomes. Although no AL biomarker has yet been validated in large-scale clinical trials, there is confidence that personalised medicine, through biomarker analysis, could be realised for colorectal cancer intestinal resection and anastomosis patients in the years to come.

The use of routine hematology analyzers for quality management of leukocyte depletion in blood transfusion products: a comment

The use of routine hematology analyzers for quality management of leukocyte depletion in blood transfusion products: a comment

Fragile neutrophils in surgical patients: A phenomenon associated with critical illness.

Leukocyte viability (determined by e.g. propidium iodide [PI] staining) is automatically measured by hematology analyzers to check for delayed bench time. Incidental findings in fresh blood samples revealed the existence of leukocytes with decreased viability in critically ill surgical patients. Not much is known about these cells and their functional and/or clinical implications. Therefore, we investigated the incidence of decreased leukocyte viability, the implications for leukocyte functioning and its relation with clinical outcomes. An automated alarm was set in a routine hematology analyzer (Cell-Dyn Sapphire) for the presence of non-viable leukocytes characterized by increased fluorescence in the PI-channel (FL3:630±30nm). Patients with non-viable leukocytes were prospectively included and blood samples were drawn to investigate leukocyte viability in detail and to investigate leukocyte functioning (phagocytosis and responsiveness to a bacterial stimulus). Then, a retrospective analysis was conducted to investigate the incidence of fragile neutrophils in the circulation and clinical outcomes of surgical patients with fragile neutrophils hospitalized between 2013-2017. A high FL3 signal was either caused by 1) neutrophil autofluorescence which was considered false positive, or by 2) actual non-viable PI-positive neutrophils in the blood sample. These two causes could be distinguished using automatically generated data from the hematology analyzer. The non-viable (PI-positive) neutrophils proved to be viable (PI-negative) in non-lysed blood samples, and were therefore referred to as 'fragile neutrophils'. Overall leukocyte functioning was not impaired in patients with fragile neutrophils. Of the 11 872 retrospectively included surgical patients, 75 (0.63%) were identified to have fragile neutrophils during hospitalization. Of all patients with fragile neutrophils, 75.7% developed an infection, 70.3% were admitted to the ICU and 31.3% died during hospitalization. In conclusion, fragile neutrophils occur in the circulation of critically ill surgical patients. These cells can be automatically detected during routine blood analyses and are an indicator of critical illness.

Identification of cardiovascular and molecular prognostic factors for the medium-term and long-term outcomes of sepsis (ICROS): protocol for a prospective monocentric cohort study.

IntroductionSepsis is one of the most prevalent life-threatening conditions in the intensive care unit. Patients suffer from impaired organ function, reduced physical functional capacity and decreased quality of life even after surviving sepsis. The identification of prognostic factors for the medium-term and long-term outcomes of this condition is necessary to develop personalised theragnostic approaches. Sepsis can cause cardiac impairment. The impact of this septic cardiomyopathy on patient’s long-term outcome remains unclear. This study aims to evaluate cardiovascular risk factors, particularly the occurrence of septic cardiomyopathy, regarding their suitability as prognostic factors for the short-term and long-term outcomes of septic patients. Additionally, the study seeks to validate preclinical pathophysiological findings of septic cardiomyopathy in the clinical setting.Methods and analysisIn this prospective monocentric cohort study, patients will be clinically assessed during the acute and postacute phase of sepsis and two follow-ups after 6 and 12 months. To determine the effect of septic cardiomyopathy and concomitant cellular and molecular changes on patient mortality and morbidity, a comprehensive cardiovascular and molecular deep phenotyping of patients will be performed. This includes an echocardiographic and electrocardiographic assessment, and the evaluation of heart rate variability, body composition, mitochondrial oxygen metabolism, macrocirculation and microcirculation, and endothelial barrier function. These analyses are complemented by routine immunological, haematological and biochemical laboratory tests and analyses of the serum metabolome and lipidome, microbiome and epigenetic modifications of immune cells. The reversibility of patients’ organ dysfunction, their quality of life and physical functional capacity will be investigated in the follow-ups. Patients with cardiomyopathy without infection and healthy subjects will serve as control groups.Ethics and disseminationApproval was obtained from the Ethics Committee of the Friedrich Schiller University Jena (5276-09/17). The results will be published in peer-reviewed journals and presented at appropriate conferences.Trial registration numbersDRKS00013347; NCT03620409.

Correlation of platelet count and platelet volume indices with coronary artery diseases

Introduction: Coronary artery disease is the most common non-communicable disease in the world. Platelet activation plays a central role in the transformation of atherosclerotic cardiovascular disease (CVD) into its potentially major adverse clinical events, such as ischemic stroke and myocardial infarction. Aim and objectives: The aim of this study was to study platelet parameters e.g. platelet count, mean platelet volume, platelet distribution width, and mean platelet concentrate in the spectrum of ischemic artery disease and to attempt a clinicopathological correlation. Materials and methods: This study was done in the hematological section of the pathology department at tertiary care hospital over a period from January 2016 to December 2018. The study population was divided into three groups healthy control, patients of myocardial infarction, and unstable angina. Results: The difference in mean platelet indices between the 3 study groups was significantly higher in MI and UA groups compared to healthy control. Mean platelet count in the control group was 2.60 Lac (± 0.92), cases of MI 2.34 Lac (±0.67), and in cases of unstable angina 2.56 Lac (±0.89). Mean platelet volume in the control group was 8.07 (±2.11), in cases of MI 12.3 (±1.98) and in cases of unstable angina 11.6 (±2.01). Conclusion: From the present study, it can be conclude that larger platelets can play a significant role in CAD. As platelet volume indices (PVI) can provide an alarming sign for the prethrombotic state in IHD. So in day to day routine hematological analysis of PVI and large platelets can help in the management of coronary artery disease.

Outcomes for dogs with functional thyroid tumors treated by surgical excision alone.

To describe clinical findings and survival times for dogs with functional thyroid tumors treated with surgery alone and investigate potential prognostic factors for outcome in these patients. 27 client-owned dogs. Medical records of 9 institutions were reviewed to identify dogs with hyperthyroidism secondary to thyroid neoplasia that were treated with surgery alone between 2005 and 2015. Data collected included signalment, hematologic and physical examination findings, tumor staging results, time from diagnosis to treatment, surgical procedure performed, histologic findings, evidence of recurrence or metastatic disease, and date of death or last follow-up. Median survival time and 1-, 2-, and 3-year survival rates were assessed by Kaplan-Meier analysis. Associations between variables of interest and the outcome of death were assessed with Cox proportional hazards models. Dogs from 8 institutions met inclusion criteria. Median age at diagnosis was 10 years (range, 8 to 13 years). Golden Retrievers and Labrador Retrievers were commonly represented (5 dogs each). Polyuria with polydipsia (15/27 [56%]) and weight loss (12 [44%]) were the most common clinical signs; 2 dogs without clinical signs had hyperthyroidism identified by routine hematologic analysis. One dog had metastatic disease at the time of diagnosis. Most tumors (23/27 [85%]) were malignant. Estimated median survival time was 1,072 days. No significant prognostic factors were identified. Dogs with resectable functional thyroid tumors had a good prognosis with surgical excision alone. Survival times for these dogs were similar to those in previous studies that included dogs with nonfunctional thyroid tumors.

Peritoneal Fluid Analysis of the Newborn Calves with Intestinal Atresia - a Clinical Approach

Background: Anomalies and fetal problems are encountered in all animals. Intestinal atresia is a congenital anomaly of both humans and animals. Intestinal atresia has four morphological types, and they can be observed in jejunum, ileum, cecum, colon, rectum and anus (type I: mucosal atresia, type II: atretic ends separated by fibrous cord, type III: atretic ends separated by a “V” shaped mesenteric gap or atretic end coil like an “apple peel”, type IV: multiple atresia). In calves, it is also commonly encountered; it is still a question to be replied about the exact prognosis of the patients with intestinal atresia. Thus, the main objective of the present study was to evaluate peritoneal fluid analysis results of calves with intestinal atresia.Materials, Methods &amp; Results: Twenty-two calves were presented with abdominal distension and lack of defecation. Clinical and radiological findings pointed out the intestinal atresia. Blood samples were collected for routine hematological and serum total protein (TP) analysis. Peritoneal fluids were aspirated with sterile technique from the caudal abdomen, and biochemical features, cell contents and microbiological cultures of the peritoneal fluids were analyzed. Following to preoperative, surgical and necropsy findings, intestinal atresia were diagnosed as type II, III and IV in calves. Neutrophilic leukocytosis was observed in calves with type IV intestinal atresia. Red blood cells and platelet counts were determined in the peritoneal fluids. TP and density values of the peritoneal fluid were high in all cases. These results pointed the presence of the acute infection and peritonitis. Statistical comparison of each parameter showed that there was no significant difference between the types of intestinal atresia. Microbiologically, fecal origin bacteria were cultured in 12 calves.Discussion: In general, four types of intestinal atresia are encountered in calves, and all types are fatal pathologies; thus, surgery should urgently be planned as soon as diagnostic work-ups are completed after birth. Peritoneal fluid analysis is a useful diagnostic choice because changes in the peritoneal fluid parameters help to diagnosis of the intra-abdominal pathology. Intestinal atresia as more common anomaly in Holstein, Jersey and Montafon breed calves. In animals with intestinal atresia, surgical treatment is not usually recommended due to economic reasons and small chance of postoperative success. Long-term survival rate of surgically treated animals depends on the type of intestinal atresia and applied surgical technique. Atresia recti and ani may occur simultaneously with atresia coli, and all atresias (atresia coli, ani, recti or ani et recti) can be successfully treated by surgery. Continuous distention of the large intestinal segments leads to ischemia, necrosis, peritonitis and bowel perforation. Peritoneal fluid analysis should include the classic parameters for diagnosis, but these analyses are often insufficient to identify the etiology or pathogenesis of the disease. An increase in total WBC count and percentage of the neutrophil cells in the peritoneal fluid indicate the acute infectious origin inflammation. Additional parameters in the peritoneal fluid analysis have been established to improve diagnostic precision and specific information. Presence or absence of the bacteria in the peritoneal fluid samples is important to characterize the transudate and exudate. Changings in the peritoneal fluid values does not related to type of the intestinal atresia in calves.

A Novel Preoperative Nomogram for Predicting Lymph Node Invasion in Renal Cell Carcinoma Patients Without Metastasis.

ObjectiveTo provide a preoperative predictive model to support clinical decision-making regarding the selection of in renal cell carcinoma (RCC) patients who will benefit the most from lymph node dissection.MethodsThis retrospective analysis enrolled 374 RCC patients without distant metastasis who underwent surgical treatment from January 2006 to December 2017. The relationships between lymph node invasion (LNI) and age at surgery; gender; body mass index(BMI); the presence of clinical symptoms such as flank pain, hematuria or a palpable mass; clinical T stage (cT stage); clinical N stage (cN stage); and the results of routine hematological and serum biochemical analyses were investigated. All the variables were included in univariate and multivariate logistic regression analyses, and the significant variables were then included in a novel nomogram to predict the probability of LNI. Then, we calibrated the nomogram with an internal validation set.ResultsSix of eighteen variables were significant in the univariate logistic regression analysis. After multivariate logistic regression analysis, age at surgery (OR=0.643, 95% CI: 0.421–0.975), cT stage (OR=3.034, 95% CI: 1.541–5.926), cN stage (OR=6.353, 95% CI: 3.273–12.456), lymphocyte percentage (OR=0.481, 95% CI: 0.256–0.894), and the presence of clinical symptoms (OR=2.045, 95% CI: 1.065–3.924) were independent predictors of LNI and were included in the nomogram. The C-index of this nomogram was 0.824.ConclusionPreoperative basic laboratory findings combined with the results of a physical examination and radiological examination can indicate the probability of LNI in RCC patients.

PB1705 CBC PARAMETERS BASED DERIVED PREDICTIVE FACTOR FOR ACUTE PROMYELOCYTE LEUKEMIA

Background:Acute promyelocytic leukemia (APML) due to coagulopathies drives hematological distress in clinical practices. A targeted and timely offered treatment can be a benefitting tool for patients.Aims:Present study was conducted to introduce pre‐microscopic screening of patients with acute promyelocytic leukemia (APML) through research potential parameters generated by routine hematology analyzers during CBC analysis.Methods:Blood samples of controls and patients (APML and other hematological neoplasms) were analyzed on Sysmex XN‐1000. Peripheral blood film was examined for morphological diagnosis. CBC parameters and values for intensities of white blood cell's side, forward, and side florescence light scatter were recorded from analyzer software. Statistical and machine learning (unsupervised) tools were used to evaluate the predictive power of routine and research CBC parameters. Novel APML factor was derived from white blood cell and platelet count along mean value of neutrophil side fluorescence light (NE‐SFL) through logistic regression. At proposed cutoff value (‐2.011), APML factor was challenged for prediction of APML among present study cases.Results:Values for white blood cell (WBC), platelet, and NE‐SFL were exceptionally discriminative for APML 5.65, 29.5, and 54.4 respectively in comparison to non‐APML 7.96, 219, and 47.00 respectively cases. In combination, WBC and platelet count increased the predictive power of NE‐SFL when utilized in derivation of our proposed “APML factor”: ‐4.5070 + (0.049213 x NE‐SFL) + (‐0.017431 x PLT) + (‐0.0058366 x WBC). This factor gave robust impact in differentiation of APML with high values 0.935 and 0.985 for sensitivity and negative predictive power (NPP) respectively at cutoff of ‐2.011.Summary/Conclusion:Our proposed APML factor has strong potential to be incorporate/calculate and examine as part of CBC report for early prediction of APML.

Comparative study of hematological and blood chemistry of Persian sturgeon (Asipencer persicus) exposed to two common anticoagulants

The effects of heparin and ethylenediaminetetraacetic acid (EDTA) on plasma biochemistry and hematological parameters in Asipencer persicus were studied. Differences in ALT and ALP activity were found between serum and heparinized plasma (P&lt;0.05). AST activity in EDTA treated samples increased (P&lt;0.05) compared to its values in serum. On the contrary, ALP activity showed a significant decrease compared to its serum level (P&lt;0.05). Samples collected with EDTA showed an increase in haematocrit, mean corpuscular volume (MCV) and white blood cells (WBC) values (P&lt;0.05) when compared to those collected in heparin. The other measured biochemical parameters did not show any variation. The present study suggests the use of heparin as a preferred anticoagulant for routine haematological analyses in the Persian sturgeon. However, both of these anticoagulants inflicted changes in selected biochemical parameters.

Verification and quality control of routine hematology analyzers

Verification and quality control of routine hematology analyzers