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Introduction During pregnancy, women are at an increased risk of developing iron-deficiency anemia. Objective The objective of this study was to assess the diagnostic performance of the reticulocyte hemoglobin equivalent (RET-He) in the early detection of iron-deficiency anemia in a group of pregnant women and to establish a reference range for this parameter in a group of control individuals. Method: A total of 60 patients and 130 control subjects were included in the study. Blood samples collected from the subjects were submitted to a complete blood count and a serum ferritin test and the data were analyzed by comparing the groups and ROC curves. Results The reference range found for the RET-He was between 29.75pg and 38.24pg, with a median of 35pg. The receiver operating characteristic (ROC) curve analysis for the ferritin parameter showed an area under the curve of 0.732 for the RET-He, 0.586 for hemoglobin, 0.551 for the mean corpuscular hemoglobin concentration and 0.482 for the mean corpuscular volume. Conclusion Early diagnosis of iron deficiency anemia in pregnancy is essential to prevent damage to both maternal and fetal health. The RET-He presents an excellent potential as an auxiliary tool for the diagnosis of iron deficiency in pregnant women.

Introduction The demand for apheresis platelets has increased in the recent past and the shrinking donor pool has shifted the trend to collection of double-dose or higher yield of platelets. Objective The present study aimed to determine the effect of double-dose plateletpheresis on the target yield and donor platelet recovery. Methods The study was conducted on 100 healthy plateletpheresis donors, 50 of whom were in the study group, which underwent double-dose plateletpheresis (DDP), and 50 of whom were in the control group for single-donor plateletpheresis. Pre- and post-procedure samples of donors were subjected to a complete blood count. The DDP product was sampled for platelet yield and then split into two parts. Platelet yield, collection efficiency, collection rate, recruitment factor and donor platelet loss were calculated. Results The mean platelet yield in the SDP was 4.09 ± 1.15 × 1011 and in the DDP, 5.93 ± 1.04 × 1011. There was a significant correlation between the pre-donation platelet count and platelet yield. The total of platelets processed for the SDP were 5.42 ± 1.08 × 1011 and for the DDP, 7.94 ± 0.77 × 1011. The collection efficiency was 71.93 ± 25.14% in the SDP and 72.94 ± 16.28% in the DDP, while the collection rates were 0.78 × 1011 and 0.94 × 1011 per minute, respectively. The average recruitment factor observed was 0.98 in the SDP, while it was 0.99 in the DDP. The mean platelet loss observed in the SDP was 35.55 ± 8.53% and in the DDP, 37.76 ± 8.65%. Conclusion The double-dose plateletpheresis supplements the platelet inventory in developing countries where the apheresis donor pool is limited. It is prudent to ensure stringent donor selection criteria for donors donating high-yield platelet products, thus enhancing donor safety and retention.

Hematologic abnormalities are common in HIV and involve all blood cell lineages. A study on cytopenias, as correlated with disease progression, can be valuable in resource-limited settings. This study aimed to determine the hematologic profile of HIV patients and its association with CD4 count and antiretroviral (ARV) treatment.This is a retrospective cohort study involving adult Filipino HIV patients with complete blood count (CBC) and CD4 count determinations prior to the initiation of ARV treatment and after ≥6 months of ARV treatment. Logistic regression was performed to determine the association between cytopenias and a CD4 count200 cells/µL.The study included 302 patients. Anemia was the most common cytopenia. Anemia and leukopenia were associated with an increased likelihood of having a CD4 count200 cells/µL in ARV-naïve patients. In ARV-treated patients, leukopenia was associated with an increased probability of having a CD4 count200 cells/µL. An increase in hemoglobin, white blood cell (WBC) and platelet counts was observed after ≥6 months of ARV treatment.Anemia and leukopenia can be used as markers of immune status in HIV-infected individuals and improvement in the CBC parameters can be used to assess response to ARV treatment. Routine monitoring of hematologic parameters is recommended.

Background: Metabolic or non-metabolic many bone diseases can be distinguished in sickle cell anemia. Patients with sickle cell anemia have a high risk of osteopenia and osteoporosis. The aim of this study is to reveal bone mineral density abnormalities and related factors in patients with sickle cell anemia. Methods: A total of 70 patients with sickle cell anemia were retrospectively included in our study. Complete blood count (CBC) parameters, serum creatinine, lactate dehydrogenase (LDH), total bilirubin, direct bilirubin, uric acid, calcium, phosphorus, parathormone, alkaline phosphatase, 25 (OH) vitamin D, ferritin, C reactive protein (CRP) and calculated bone mineral densitometry measurements by Dual-Energy X-ray Absorptiometry (DEXA) were assessed and recorded to the statistics program. We diagnosed osteopenia and osteoporosis according to World Health Organization (WHO) criteria. To determine the status of avascular necrosis and bone fracture, we examined x-ray and magnetic resonance imaging reports and epicrisis reports of patients from the records. Results: The average age was 30.01 ± 8.64 years. Eighteen (26.5%) of the 68 patients whose Z-score was evaluated by DEXA had bone mass below the expected age-related range according to the Z score, while 50 (73.5%) had bone mass within the expected age-related range. Of the patients whose T score was evaluated by DEXA, 46.8% were normal (n=29), 45.1% were osteopenic (n=28) and 8.1% were osteoporotic (n=5). Conclusion: Patients with sickle cell anemia are at increased risk for osteoporosis, osteopenia, and osteomalacia. Bone health should be emphasized in these patients.

BACKGROUND Blood donors with high Hb are often deferred for the presumed risk of polycythemia vera (PV). However, adequate data to substantiate or refute this hypothesis is lacking. METHODOLOGY We conducted an observational study on blood donors found to have high hemoglobin (Hb ≥18 g/dl) during the pre-donation screening process using a portable hemoglobinometer at our blood center for four months. We adopted a cost effective methodology wherein a questionnaire was used to elicit the secondary causative factors of high hemoglobin and a complete blood count test to observe the blood cell parameters and JAK2V617F mutation test was performed in a subset of donors lacking secondary erythrocytosis (SE) history. RESULTS Of the total 7076 donors enrolled 112 male donors (1.58%) had high hemoglobin. The majority (70.4%) were repeat donors with mean age of 31.4 years. About 61% of the donors had attributable factors for SE like smoking, occupational exposure to carbon-monoxide. The mean hemoglobin value of capillary and venous hemoglobin demonstrated a statistically significant difference (p

The objective of this study was to quantify intraoperative bleeding in patients with cirrhosis and correlate it with clinical characteristics and laboratory coagulation tests.A case-control study was carried out with 74 patients with cirrhosis who were submitted to preoperative coagulation tests (complete blood count, platelet count, prothrombin time/international normalized ratio, thrombin time, activated partial thrombin time, platelet aggregation, fibrinogen, protein C, protein S, antithrombin, and von Willebrand factor level and activity). The levels of nitrogen compounds that can affect the platelet function were determined in saliva and blood by using automated enzymatic-colorimetric assays.Patients with cirrhosis had changes in almost all coagulation tests. The average volumes of intraoperative bleeding and blood lost per minute in the study group (5.36 mL/min and 0.19 mL/min, respectively) were greater than those in the control group (3.05 mL/min and 0.11 mL/min, respectively; P.05). In the control group, ascites (P = .012) and presence of periapical lesion (0.034) were positively correlated with bleeding (mL/min). With regard to coagulation tests and nitrogen compounds, only a positively moderate correlation with the platelet aggregation test was observed.No patients had hemorrhagic events and it was not possible to correlate a greater amount of bleeding with coagulation tests or nitrogen compounds in the study group.

Central vestibular disease is one of the most common problems in pet rabbits. Encephalitozoon cuniculi infection appears to be the most frequent etiology, but other causes have been described. It is known that infective endocarditis can cause thromboembolic disease affecting multiple organ systems in dogs. Secondary embolism from bacterial endocarditis commonly occurs, mainly in the spleen and kidneys; but cerebral thromboembolism disease secondary to infective endocarditis has rarely been reported in dogs. In this case, an 8-year-old, neutered male rabbit (Oryctolagus cuniculus) presented with mild hyperthermia, left head tilt and rolling. Radiographic examination, complete blood count, serum biochemistry and abdominal ultrasound were unremarkable. Magnetic resonance imaging did not show any abnormalities in the central nervous system. An Encephalitozoon cuniculi serology was performed with elevated IgM and IgG titers (1:320; 1:1280 respectively), the patient was hospitalized and treated for encephalitozoonis but the rabbit died 8 days after presentation and the body was submitted for necropsy. Histopathological examination revealed multifocal necrotizing and suppurative myocarditis, with multiple emboli in kidneys, lungs and central nervous system. Polymerase chain reaction, immunohistochemistry, and Ziehl-Neelsen staining of samples from the central nervous system and kidneys yielded negative results for Encephalitozoon cuniculi. Due to the positive predictive value of 92% of indirect fluorescent antibody technique Encephalitozoon cuniculi serology, in this case a false positive was suspected. Based on the results, final diagnosis of cerebral thromboembolism secondary to infective endocarditis was emitted. This is the first report of this process naturally occurring in rabbits, and it should be included in the differential diagnosis of central vestibular syndrome in this species.

Accurate and timely diagnosis of anemia in pregnancy is necessary for safe management of abortion care. Screening for anemia in abortion care is often accomplished using commercially-available point-of-care tests from capillary blood, but the validity of this test has not been investigated in the context of abortion care. We sought to determine the accuracy of a capillary hemoglobin (Hb) among pregnant patients seeking induced abortion.We conducted a retrospective study of patients seeking abortion care at the University of Illinois at Chicago. We identified 108 subjects with paired capillary Hb and venous complete blood count (CBC) hemoglobin measurements within 7 days of each other and within 14 days before abortion. Agreement analysis was performed using Passing-Bablok regression and Bland-Altman plots.More patients were deemed anemic by capillary than by venous Hb measurement (32% vs 19%, p = 0.030). Capillary Hb correlated with venous Hb (r = 0.85, p0.001). The average bias for capillary Hb was -1.1 ± 1.0 g/dL. Step-wise, multivariable linear regression identified venous Hb as the only determinant of capillary Hb, and failed to identify any other predictors of bias. The agreement analysis between capillary and venous Hb by Passing-Bablok regression demonstrated systematic and proportional differences.Results from capillary Hb may be biased toward diagnosing anemia and should be interpreted with caution.Misdiagnosing anemia in abortion care can have several consequences and may prevent timely medical abortion or cause delayed procedural abortion. Clinical correlation, and possibly confirmation by venous complete blood count measurement, should be considered before clinical decision-making based solely upon the capillary point-of-care assay.

OBJECTIVE To examine patient laboratory testing compliance by tracking time to submission of laboratory requisitions in Southern Alberta, Canada as part of a quality improvement initiative. METHODS Data was collected retrospectively from patients from the Chinook Primary Care Network in Alberta, Canada, who received a laboratory requisition consisting of a complete blood count (CBC) test order between September 1, 2016 and August 31, 2017. To allow for all laboratory requisitions created to be submitted within one year, the study collection period was from September 1, 2016 to August 31, 2018. Patient age, sex, and dates of laboratory requisition creation and submission were collected. The days-to-test-submission served as a marker of compliance. Association of age, sex, and clinic location with time to laboratory requisition completion was determined using Cox regression analysis. RESULTS During the study period, 70.4% (n = 1607) of laboratory requisitions created were completed within one year, and over half (50.5%) of the laboratory requisitions ordered were completed within two weeks. There were no significant associations between time to laboratory requisition submission and sex or clinic locations (P > 0.05), but there were significant associations between patients who were 20-49 or 70-79 and increased laboratory requisition compliance (P

Introduction The purposes of this study were (1) to compare the preoperative complete blood count (with differential), c-reactive protein (cRP), erythrocyte sedimentation rate (ESR), and intraoperative pathology (frozen section) results of patients undergoing surgical treatment for shoulder PJI by C. acnes vs. non-C. acnes bacteria, and (2) to estimate sensitivity, specificity, and positive and negative predictive values of these parameters. Methods Between 2004 and 2016, 167 consecutive shoulder PJIs were treated surgically. Infected implants included hemiarthroplasty in 39, anatomic TSA in 92, and reverse TSA in 36 shoulders. Shoulders were categorized in one of 4 groups: irrigation and debridement (21), one stage reimplantation (14), two-stage reimplantation (124), and permanent resection (8). Medical records were reviewed to record microorganisms isolated, intraoperative pathology, and preoperative cell count, ESR, and c-RP. Shoulders were further grouped into those that were positive only for C. acnes (37 shoulders) and those that were positive for any other microorganism (130 shoulders). In order to calculate sensitivity, specificity, and predictive values, the same data was collected for a separate group of 700 shoulder arthroplasties that underwent revision surgery for noninfectious reasons during the same time period. Results For the whole group of 167 infected shoulder arthroplasties, values were considered abnormal for leukocyte count in 15%, neutrophil count in 17%, ESR in 42%, cRP in 56% and pathology in 55%. Abnormal values were more common in the non-C. acnes group. The following positive predictive values were obtained: Leukocytes 47% (13% C. acnes, 43% other), ESR 65% (18% C. acnes, 62% other), cRP 70% (29% C. acnes, 66% other), and pathology 73% (30% C. acnes, 63% other). The following negative predictive values were obtained: Leukocytes 79% (94% C. acnes, 93% other), ESR 68% (86% C. acnes, 76% other), cRP 70% (88% C. acnes, 78% other), and pathology 87% (96% C. acnes, 91% other). Conclusion Bacteria other than C. acnes were responsible for 75% of the shoulder PJI treated consecutively with surgery at a single institution over a 12-year period. Negative predictive values for cell count, ESR, cRP, and pathology ranged between 70% and 81%, but there were much lower for C. acnes infection. Obtaining these tests in the evaluation of a painful shoulder arthroplasty should not be discontinued, since their positive predictive value for non-C. acnes infections seem reasonable and their negative predictive value is high. Level of evidence Level III; Retrospective Comparative Study

Rectal prolapse is rarely reported in rabbits and it has been historically described in association with infectious conditions of the gastrointestinal tract. Two adult pet rabbits (Oryctolagus cuniculus) were independently presented for rectal prolapse. The rabbits appeared healthy, with no medical history of consequence, and were still able to feed and defecate. Clinical examination revealed a firm and apparently non-painful rectal mass in both rabbits. Abdominal ultrasound and whole-body radiographs revealed no abnormality. Complete blood count and serum chemistry panels were within the normal range. Surgery was performed in both cases which involved resection of the mass for the first rabbit, and mass excision with partial rectal resection for the second. Postoperatively, the rabbits defecated normally and showed no complications. The histopathological conclusions were an inflammatory rectal polyp for the first rabbit and a rectal leiomyosarcoma for the second. Two and three years after initial presentation, both rabbits are alive, in good health with no signs of tumor recurrence. Neoplasia of the digestive tract should be considered as a differential for rabbits presenting with rectal prolapse.

Background Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a novel virus that belongs to the coronaviruses and causes coronavirus disease 2019 (COVID-19). In this study, we explored the demographic details, clinical features, and routinely conducted laboratory investigations of patients with COVID-19 during the second and third waves of the pandemic to understand their possible diagnostic and prognostic values in Egypt. Methods In this retrospective cohort study, the demographic characteristics, detailed medical history, laboratory findings, and symptoms of all enrolled patients with SARS-CoV-2 were collected from the medical records of Beni Suef University Hospitals between December 15, 2020, and April 15, 2021. Results This retrospective study included 473 patients, almost all of whom were elderly. The median age of the patients was 48 years, and those with moderate and severe disease were older than those with mild infections. The proportion of females was higher (63.4%) than males (36.6%). Diabetes mellitus (DM) was the most common comorbidity (17.3%), and fever was the most typical manifestation of COVID-19 (62.6%). Those with severe disease showed a higher C-reactive protein level (CRP) than those with moderate (p-value 0.009) or mild (p-value 0.01) diseases. Serum ferritin levels were significantly higher in patients with severe disease than in those with moderate disease (p-value 0.018). In contrast, d -dimer and serum creatinine were normal and showed no significant difference in all comparisons (p-value overall 0.21). Conclusion This study observed several variations in COVID-19 patients’ characteristics. The new manifestations included skin rash, bone and low back pains, and rigors. In contrast to females, most males had moderate-to-severe illness. Old age and higher body mass index was associated with increasing severity. d -dimer and complete blood count were normal and could not identify potential COVID‐19 patients. Patients who had mild illness were still at risk of developing post-COVID complications.

Background/purpose: Our previous study found that 70 of 884 burning mouth syndrome (BMS) patients have serum gastric parietal cell antibody (GPCA) positivity but without thyroglobulin antibody (TGA) and thyroid microsomal antibody (TMA) (so-called GPCA+TGAˉTMAˉBMS patients). This study assessed whether these 70 GPCA+TGAˉTMAˉBMS patients had significantly higher frequencies of macrocytosis, anemia, hematinic deficiencies, and hyperhomocysteinemia than 553 GPCA-negative, TGA-negative, and TMA-negative BMS (GPCAˉTGAˉTMAˉBMS) patients or 442 healthy control subjects. Materials and methods: Complete blood count, serum iron, vitamin B12, folic acid, homocysteine, GPCA, TGA, and TMA levels in 70 GPCA+TGAˉTMAˉBMS patients, 553 GPCAˉTGAˉTMAˉBMS patients, and 442 healthy control subjects were measured and compared. Results: We found that 15.7%, 28.6%, 20.0%, 11.4%, 2.9%, and 25.7% of 70 GPCA+TGAˉTMAˉBMS patients and 3.8%, 17.7%, 15.9%, 3.8%, 2.7%, and 20.1% of 553 GPCAˉTGAˉTMAˉBMS patients had macrocytosis, blood hemoglobin, iron, vitamin B12, and folic acid deficiencies, and hyperhomocysteinemia, respectively. Moreover, both 70 GPCA+TGAˉTMAˉBMS patients and 553 GPCAˉTGAˉTMAˉBMS patients had significantly greater frequencies of macrocytosis, blood hemoglobin, serum iron, vitamin B12, and folic acid deficiencies, and hyperhomocysteinemia than 442 healthy control subjects (all P-values

Sanguinarine (SGN) is a benzophenathridine alkaloid extracted from Sanguinaria canadensis plant. SGN is incriminated in epidemic dropsy (ED) characterized by multiple-organ failure and anemia. Nevertheless, how SGN leads to anemia of ED remains poorly understood. This study was thus initiated to investigate the interaction of SGN with human red blood cells (RBCs) and to delineate associated molecular mechanisms. Heparin- and EDTA-anticoagulated blood was collected from healthy participants and whole blood was analyzed for a complete blood count, while isolated RBCs were examined for hemolytic and eryptotic markers following exposure to 1–100 μM SGN for 24 h at 37 °C. Calcium was measured by Fluo4/AM, hemolysis by hemoglobin leakage, membrane scrambling by Annexin V-FITC, cell size by forward scatter (FSC), cell granularity by side scatter (SSC), and oxidative stress by H2DCFDA. SGN led to increased Fluo4 fluorescence and dose-dependent hemolysis which was not ameliorated by exclusion of extracellular Ca2+ but was nevertheless sensitive to hyperosmotic conditions and to the presence of aspirin. SGN also caused significant increase in Annexin V-positive cells, decreased FSC and SSC values, and elevated DCF fluorescence. Moreover, significantly reduced lymphocyte and basophil percentages along with selective toxicity to platelets was noted. Collectively, SGN possesses sucrose- and cyclooxygenase-sensitive hemolytic potential and elicits eryptosis characterized by Ca2+ accumulation, phosphatidylserine externalization, morphological alterations including cell shrinkage and loss of granularity, and oxidative stress. In conclusion, this report reveals a novel activity of SGN against human RBCs and informs prospective policies in ED prevention and management.

To assess the accuracy of a simplified approach for the diagnosis of iron deficiency anemia (IDA) based on the complete blood cell count (CBC) and reticulocyte analysis.Five hundred fifty-six consecutive, nonselected patients referred for diagnosis and/or treatment of anemia were included in this diagnostic study to compare the performance of reticulocyte hemoglobin equivalent (RET-He) versus traditional biochemical markers for diagnosis and treatment of IDA. Complete blood count, serum ferritin, iron, and transferrin saturation were performed as clinically indicated. Reticulocyte hemoglobin equivalent was measured with a Sysmex XN-450 analyzer on the residual CBC sample. The study period was from September 20, 2017, through and including November 15, 2018.Patients (N=556) were studied at baseline, of whom 150 were subsequently treated with intravenous iron. Receiver operating characteristic analysis yielded an RET-He cut-off of 30.7 pg to identify IDA (area under curve, 0.733; 95% CI, 0.692 to 0.775), with 68.2% sensitivity and 69.7% specificity. Patients (n=240) were seen at follow-up, with 57 treated and 183 not treated with intravenous iron. Responsiveness was defined as a hemoglobin increase of ≥1.0 g: a combination of RET-He28.5 pg and hemoglobin value10.3 g/dL had 84% sensitivity and 78% specificity as response predictor (area under the curve, 0.749; 95% CI, 0.622 to 0.875).Data from CBC and RET-He can identify patients with IDA, determine need for and responsiveness to intravenous iron, and reduce time for therapeutic decisions. Limitations of this study are uncontrolled design, its single-site and retrospective nature, and that it requires prospective validation.

Case Presentation A 40-year-old woman presented with recurrent syncope. She reported multiple (>20) episodes of non-prodromal loss of consciousness, periodically provoked by physical exertion. One episode resulted in a nasal fracture due to the abrupt nature of her syncope. The characterization of each episode was inconsistent with a neurogenic seizure. Other causes of syncope (vasovagal, situational, carotid hypersensitivity, and orthostasis) were also deemed unlikely. On physical examination, a low-pitched, brief adventitious sound was appreciated after each S2 sound in the right lower sternal border. The remainder of the physical examination was unremarkable. Initial workup, including complete blood count, comprehensive metabolic panel, cardiac enzymes, and ECG yielded normal results. The chest radiograph did not show any gross cardiac or pulmonary parenchymal pathologic condition ( Fig 1 ). Telemetry did not demonstrate any malignant arrhythmias, and video-guided EEG did not document any seizure activity.

Background/purpose: Microcytosis is defined as having mean corpuscular volume

Background Laboratory studies are routinely obtained preoperatively and postoperatively for total hip arthroplasty (THA) and total knee arthroplasty (TKA). This study evaluates the necessity of routine, perioperative laboratory tests and identifies risk factors for laboratory-associated interventions. Methods This retrospective review evaluated 967 consecutive patients scheduled for primary, unilateral TKAs (n = 593) or THAs (n = 374) over an 18-month period at a single institution. Preoperative prothrombin time (PT) and International Normalized Ratio (INR), complete blood count (CBC), complete metabolic panel (CMP), and postoperative CBC and basic metabolic panel (BMP) were recorded along with any laboratory-associated intervention. Patient demographics and comorbidities identified risk factors for abnormal or actionable laboratory studies. Results Preoperatively, the actionable rates for PT/INR, CMP, and CBC were 0.3%, 1.4%, and 0.5%, respectively. Vascular, renal, and immunologic diseases were risk factors for an actionable CBC. Risk factors for an actionable CMP include cardiac arrhythmia and diabetes. There were no risk factors for an actionable PT/INR. Postoperatively, only 1.5% of BMPs and 1.5% of CBCs were actionable. Congestive heart failure, renal disease vascular disease, or history of cancer (P = .030) were risk factors for an actionable CBC. There were no risk factors for an actionable BMP. Patients with an abnormal preoperative lab were 2.4 times more likely to have an actionable postoperative lab. Patients with an actionable preoperative lab were 11.3 times more likely to have an actionable postoperative lab. Conclusion Routine preoperative and postoperative labs may not be necessary on all patients undergoing a TKA or THA. Comorbid risk factors and abnormal or actionable preoperative CMPs and CBCs can help determine the usefulness of postoperative laboratory assessments.

Introduction Knowing the epidemiology of acute meningitis may guide physicians to promptly administer appropriate empirical therapy, thereby minimizing morbidity and mortality. We aimed to determine the etiology, clinical manifestations, cerebrospinal fluid (CSF) findings, and outcomes of patients with acute meningitis. Methods We conducted a retrospective cohort study among a total 89 adult (age ≥15 years) patients with acute meningitis. Results Among them, 48 (53.9%) patients were men; the median age (interquartile range; IQR) was 49 (32.1–63.8) years. The most common coexisting conditions were HIV infection (30%), prednisolone therapy (16.9%), and diabetes mellitus (15.7%). Common clinical presentations were fever (74%), headache (70.8%), and confusion (31.5%). Causes of acute meningitis were Cryptococcus neoformans (37%), bacteria (31.5%), Mycobacterium tuberculosis (27%), and viruses (4.5%). In multivariate logistic regression, predicting factors of acute bacterial meningitis were higher white blood cells (WBCs) in a complete blood count [odds ratio (OR) 1.01 per increase of 100 cells/mm3; 95% confidence interval (CI) 1.00–1.02, p = 0.031], no HIV infection (OR 0.08; 95% CI 0.01–0.72, p = 0.023), and higher serum sodium (OR 1.13; 95% CI 1.01–0.23, p = 0.029). Overall, the median (IQR) duration of hospitalization was 23 (11–29) days. A total 26 (29%) patients had complications, such as septic shock, hydrocephalus, seizure, and brain edema. The in-hospital mortality rate was 7.9%. Conclusions In this setting, the most common cause of acute meningitis in adults was cryptococcosis followed by tuberculosis. Awareness of local epidemiology and patients’ risk factors are important to initiate appropriate antimicrobial therapy.

Background Diagnosing a periprosthetic joint infection (PJI) can be challenging and often requires a combination of clinical and laboratory findings. Monocyte/lymphocyte ratio, neutrophil/lymphocyte ratio, platelet/lymphocyte ratio (PLR), and platelet/mean platelet volume ratio (PVR) are simple predictors for inflammation that can be readily obtained from complete blood count. The aim of this study is to evaluate the diagnostic utility of these markers in predicting PJI in total knee arthroplasty (TKA) patients. Methods A total of 538 patients who underwent revision TKA with calculable marker ratios prerevision in 2 groups were evaluated: (1) 206 patients with a preoperative diagnosis of PJI (group I) and (2) 332 patients treated for revision TKA for aseptic failures (group II). The diagnostic abilities of the markers were assessed via receiver operator characteristic curve analysis. Results The optimal threshold of PVR at 30.82 had the highest sensitivity of 87.7%, while the optimal threshold of PLR at 234.13 had the highest specificity of 82.5%. Both PLR and PVR, when combined with Musculoskeletal Infection Society thresholds for erythrocyte sedimentation rate, C-reactive protein, synovial WBC, and PMN%, achieve significantly higher sensitivity and specificity rates for PJI at or above 97% (PLR: 99.03%; 98.80%; PVR: 98.54%;97.89%). Conclusion Our study demonstrates that PVR and PLR, which are readily available and inexpensive to obtain from complete blood counts, when combined with serum and synovial fluid markers have increased sensitivity and specificity comparable to that of alpha defensin. This suggests that PVR and PLR can be used together with other hematologic and aspirate markers to increase the accuracy of PJI diagnosis in TKA patients.

The inflammatory factors of complete blood count (CBC) are associated with a decrease in the in vitro embryo production (IVP) outcome in women. The relation between the blood indices and in vitro fertilization (IVF) outcomes in bovines remains to be elucidated. Using ovum pick-up (OPU), oocytes were retrieved from heifers (n = 60) and inseminated separately with sperm. The blastocyst formation was recorded on day 7 after insemination for each animal and the blood indices were evaluated at the time of OPU. Then, heifers were classified on the basis of (1) blastocyst formation, cleaved vs. failed, or (2) inflammation, low-grade inflammation (lymphocyte counts > 5.6 × 109/L) vs. no inflammation (lymphocyte counts

Summary Plateletcrit, mean platelet volume (MPV) and platelet distribution width (PDW) are a group of derived platelet parameters obtained as a part of the automatic complete blood count. It has been shown in research studies that these platelet (PLT) indices may have diagnostic and prognostic value in certain diseases. This study aimed to understand the potential role of PLT indices as a diagnostic and prognostic marker in dogs and cats with pyometra. Fifty bitches and 34 female cats with pyometra, as well as 12 heathy bitches and 11 healthy female cats of different ages and breeds were included in the study. Although there were individual changes in PLT levels in our study, no statistically significant change was detected neither in cats nor dogs. Since the animals included in this study were brought to our clinics immediately after symptoms were seen, we think that is the reason why there was no change in PLT indices. We believe further research should be conducted for a better understanding on the subject in both humans and in animals.

espanolLa anemia se puede definir como una reduccion en uno o mas de los principales parametros de los globulos rojos (concentracion de hemoglobina, hematocrito o recuento de globulos rojos) por debajo de los valores minimos requeridos para una adecuada oxigenacion tisular. De hecho, se trata de una entidad muy frecuente en la poblacion general. La estrategia diagnostica para hacer distincion entre las multiples causas de anemia parte de una adecuada historia clinica y exploracion fisica completas. Los signos y sintomas asociados al sindrome anemico se complementaran con los datos analiticos de laboratorio: hemograma con los principales indices eritrocitarios, incorporando cifra de reticulocitos, y un estudio bioquimico amplio. Desde un punto de vista practico, es de utilidad clasificar las anemias basandose en las caracteristicas morfologicas de los eritrocitos, aportadas por los contadores automaticos y complementadas con el frotis de sangre periferica. EnglishAnemia can be defined as a reduction in one or more of the principal parameters of red blood cells (hemoglobin concentration, hematocrit, or red blood cell count) below the minimum values required for adequate tissue oxygenation. It is a very frequent entity in the general population. The diagnostic strategy to distinguish between the multiple causes of anemia starts with an adequate medical record and complete physical examination. A diagnosis is made based on the signs and symptoms associated with anemic syndrome in addition to laboratory test data: complete blood count with the main red blood cell indices, including the reticulocyte count, and a comprehensive biochemical study. From a practical point of view, it is useful to classify anemias based on the morphological characteristics of red blood cells, information provided by automated counts and supplemented with peripheral blood smears.

espanolLa anemia es la disminucion de la masa eritrocitaria normal de una persona, siendo insuficiente para un transporte optimo de oxigeno a los tejidos. El sindrome anemico es el conjunto de signos y sintomas derivados de este hecho y de los mecanismos compensadores segun la gravedad y duracion de la hipoxia. La poliglobulia se refiere a un aumento de la concentracion de hemoglobina y/o hematocrito en sangre periferica. El diagnostico de la causa especifica de poliglobulia es importante para el manejo adecuado del paciente. La anemia es el resultado de una o mas combinaciones de tres mecanismos basicos: perdida de sangre, disminucion de la produccion de hematies o aumento de la destruccion de hematies (hemolisis). Segun la clasificacion etiopatogenica, las anemias son regenerativas («perifericas») o arregenerativas («centrales»). El diagnostico de anemia en la practica clinica se realiza con la cifra de hemoglobina por debajo de los valores de referencia establecidos por la OMS y otros parametros eritrocitarios disponibles en un hemograma. Una historia clinica completa con anamnesis y exploracion fisica exhaustiva, junto con pruebas de laboratorio ademas del hemograma, como el frotis de sangre periferica, reticulocitos, prueba de Coombs y patron ferrico, entre otros, nos permitiran establecer el diagnostico diferencial inicial de la anemia basandonos en criterios morfologicos (microcitica, normocitica o macrocitica) y etiopatogenicos (regenerativas o arregenerativas). EnglishAnemia is a decrease in a person's normal red cell mass, making it insufficient for the optimal transportation of oxygen to tissues. Anemic syndrome is the set of signs and symptoms arising from this phenomenon and the compensatory mechanisms according to the severity and duration of the hypoxia. Polycythemia refers to an increase in the hemoglobin and/or hematocrit concentration in peripheral blood. The diagnosis of the specific cause of polycythemia is important for proper management of the patient. Anemia is the result of one or more combinations of three basic mechanisms: blood loss, a decrease in red blood cell production, or an increase in red blood cell destruction (hemolysis). According to the etiopathogenic classification, anemias are regenerative («peripheral») or non-regenerative («central»). A diagnosis of anemia is made in clinical practice with a hemoglobin figure below the reference values established by the WHO and other red blood cell parameters available on a complete blood count. A complete medical record with a comprehensive anamnesis and physical examination along with a complete blood count and laboratory tests, such as a peripheral blood and reticulocyte smear, Coombs test, and pattern of iron, among others, will allow us to establish an initial differential diagnosis of the anemia based on morphological (microcytic, normocytic, or macrocytic) and etiopathogenic (regenerative or non-regenerative) criteria.

Background The study assessed the effects of whole- or half-night shifts on leptin, melatonin, sex hormones, interleukin (IL)-1β, tumor necrosis factor-α (TNF-α), IL-6, hematological parameters, sleep quality and attentional performance in women working in the health sector. Materials and Methods Women working whole-night shifts (16:00-08:00 hours, n = 20), half-night shifts (16:00-24:00 hours, n = 20) or day shifts (08:00-16:00 hours, n = 20) participated in the study. Blood pressure, respiratory rate, proximal skin temperature (forehead), blood glucose, leptin, melatonin, estradiol, progesterone, IL-1β, TNF-α, and IL-6 concentrations, complete blood count and erythrocyte sedimentation rate (ESR) were measured in the beginning and at the end of the shifts. The participants filled in sleep quality questionnaires and performed visual attention tests. Results Half- and whole-night shifts caused problems in sleep duration and quality and disturbed the melatonin rhythm. Women working both half- and whole-night shifts had significantly higher nucleated erythrocytes (P = 0.006), eosinophils (P = 0.031), lymphocytes (P = 0.001) and leptin concentrations (P = 0.001) but had lower ESR (P = 0.046) and neutrophil percentage (P = 0.001) than that of day-time workers. Whole-night shifts caused additional changes including lower attentional performance (P = 0.035), lower platelet counts (P = 0.000) and lower estradiol levels (P = 0.029), but higher TNF-α levels (P = 0.000), than the control group. Moreover, whole-night shifts increased IL-1β levels before the shift (P Conclusions Half-night shifts disturbed sleep parameters and the melatonin rhythm, perturbed blood cell turnover and increased leptin levels. Whole-night shifts caused additional problems including suppressed estradiol, activated inflammatory responses and decreased visual attention. All together, the data suggest that night shifts, especially whole-night shifts, should be refrained from or countermeasures should be taken.

Aim of the work: To evaluate the red blood cell distribution width (RDW) values in psoriatic arthritis (PsA) patients and to study the relationship between these values and disease activation. Patients and methods: Forty seven patients with PsA and 56 age- and sex matched healthy controls were included in this study. Laboratory test results of both groups were retrospectively collected from medical records; these included levels for white blood cell count, hemoglobin, platelet, RDW, erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP). Disease activity score (DAS28) was used to evaluate disease activity. Results: The study comprised 47 PsA patients (32 females and 15 males) (F:M 2.1:1) with a mean age of 39.2 ± 9.9 (20–54) years and mean disease duration was 3.3 ± 1.94 (1–8) years. 39 (83%) patients were receiving monotherapy, 8 (17%) were receiving combined therapy. The RDW values were significantly higher when comparing active disease period (16 ± 3.9) of PsA patients versus inactive disease period (14.2 ± 1.04) and controls (14.03 ± 1.2) (p

Objective: Vitamin B12 deficiency among patients with heart failure (HF) may have been underestimated. High serum levels of methylmalonic acid (MMA) have been identified in several studies as an early indicator of vitamin B12 deficiency. Furthermore, MMA seems to constitute a biomarker of oxidative stress and mitochondrial dysfunction. There are scarce data regarding vitamin B12 and MMA in patients with HF. The aim of this study was to investigate vitamin B12 and MMA serum levels in patients with HF. Methods: One hundred five consecutive patients admitted to our hospital with symptoms and signs of acute decompensated HF were included in the study. Demographic and clinical characteristics as well as comorbidities and medical treatment before hospital admission were recorded. Transthoracic echocardiography was performed in all patients. Blood samples were collected during the first 24 hours of hospitalization and measured for complete blood count, biochemical profile, vitamin B12, N-terminal prohormone of brain natriuretic peptide, and MMA levels. Finally, 51 healthy individuals constituted the control group. Results: A total of 43.8% of patients with HF had elevated MMA levels, but only 10.5% had overt vitamin B12 deficiency, defined as serum cobalamin levels below 189 pg/ml. Mean MMA level was higher in patients with HF than in controls (33.0 ± 9.6 vs. 19.3 ± 6.3 ng/ml; p

Summary Objectives Reference values of hematologic parameters are imperative not only in clinical applications but also for monitoring of banned substances in sports. Since the values can be highly influenced by sexes, genetic origins and geographical factors, we assessed the haematological parameters of junior athletes from the Malaysian population. This study aimed to establish local haematological reference values of athletes and to compare the variation of these values between several sub-populations. Methods Complete blood count and erythropoietin level quantification were performed on a total of 126 subjects from 3 major ethnic groups to measure 11 haematology parameters. Independent Sample T-Test and Analysis of Variance were done in order to access the variation between several sub-populations. Results Results showed that 7 out of 11 haematology parameters were significantly different (P ≤ 0.05) among groups of gender and ethnicity. The variations between genders were seen in the red blood cell, haemoglobin, haematocrit, mean cell haemoglobin corpuscular, platelet and OFF-Score values. The values of mean corpuscular volume and mean cell haemoglobin corpuscular were found to be significantly different between ethnic groups. We also found that our haematological reference ranges for junior athletes fall within the previously established local population ranges. Conclusions The hematologic parameters have been proven to be highly influenced by sex and ethnicity of athletes. In this work, we managed to establish the reference ranges of hematologic parameters among Malaysian junior athletes. The data also included the values for reticulocytes, OFF-Score and serum erythropoietin that have never been reported before for the local population.

OBJECTIVE To 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. METHODS A 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. RESULTS Three 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. CONCLUSION Abnormal 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.

The neutrophil-lymphocyte ratio (NLR) is an inexpensive and useful inflammatory marker that incorporates the balance of the innate (neutrophil) and adaptive (lymphocyte) immune responses. Data exist on the association between NLR and mortality in various coronary diseases and in cancer surgery, but there is a paucity of data on the impact of preoperative NLR on vascular surgical outcomes. The aim of this study was to evaluate the relationship between preoperative NLR and elective endovascular aortic aneurysm repair (EVAR) outcome.A retrospective review of all patients who underwent elective EVAR at a single institution between 2010 and 2018 was conducted (n = 373). Only patients who had a preoperative complete blood count with differential within 30 days of their operation were included. The NLR was computed by dividing the absolute neutrophil count by the absolute lymphocyte count. A receiver operating characteristic curve was used to determine the optimal cutoff value of NLR with the strongest association with mortality. NLR was dichotomized so that patients with NLR above the threshold were at increased risk of mortality compared with those below it. Continuous variables were analyzed using Wilcoxon nonparametric signed-rank test and categorical variables with the Fisher exact test. A comparison of NLR and mortality was completed using Kaplan-Meier survival analysis. Cox regression analysis was used to evaluate factors associated with mortality through 5-year follow-up.Overall, 108 patients were included in this study. An NLR ≥ 4.0 was found to be associated with mortality (P .0001). Thirty-two patients composed the High-NLR (NLR ≥ 4.0) group and the remaining 76 patients formed the Low-NLR (NLR 4.0) group. Baseline characteristics were similar between groups, except that the High-NLR group was older (77.9 vs 74.4; P = .047). At a mean of 36.4 months follow-up, the overall mortality rate was 32.4%. Although there were no differences in the perioperative period, the Kaplan-Meier estimates of mortality were significantly greater in the High-NLR group at 1, 2, and 5 years postoperatively (P .0001). The mean preoperative NLR of the deceased was higher (5.94 ± 5.20; median, 4.75; interquartile range, 3.17-7.83) than those who survived (2.87 ± 1.61; median, 2.53; interquartile range, 1.97-3.49) (P .0001). Secondary interventions and sac enlargement rates were similar between groups. On univariable analysis, NLR (hazard ratio [HR], 1.17; 95% confidence interval [CI], 1.10-1.23; P .0001), age (HR, 1.06; 95% CI, 1.02-1.11; P = .004), and aneurysm diameter (HR, 1.04; 95% CI, 1.01-1.07; P = .003) were associated with mortality. On multivariable analysis, NLR (HR, 1.19; 95% CI, 1.12-1.27; P .0001), age (HR, 1.06; 95% CI, 1.01-1.11; P = .026), and aneurysm diameter (HR, 1.04; 95% CI, 1.02-1.07; P = .003) were associated with mortality.Patients with an elevated preoperative NLR, irrespective of other comorbidities, may represent a previously unrecognized subset of patients who are at heightened risk of mortality after elective EVAR. A complete blood count with differential is an inexpensive test that may be used as a prognostic indicator for outcome after EVAR. Further research is warranted to identify clinical, pathological, or anatomical factors associated with an elevated NLR and to determine modifiable factors, which may help improve long-term survival.

Objective Plateletcrit (PCT) reflects the total platelet mass in blood and can be calculated from a complete blood count. We examined the effect of PCT on outcomes of endovascular and open interventions for chronic limb ischemia. Methods Patients who underwent revascularization for chronic limb ischemia (Rutherford categories 3-6) between June 2001 and December 2014 were retrospectively identified. PCT on admission was recorded. Patients and limbs were divided into tertiles of low (0.046-0.211), medium (0.212-0.271), and high (0.272-0.842) PCT. Patency, limb salvage, major adverse limb events, major adverse cardiac events, and survival rates were calculated using Kaplan-Meier analysis and compared with log-rank test. Cox regression analysis was used for multivariate analysis. Results A total of 1431 limbs (1210 patients) were identified and divided into low PCT (477 limbs in 407 patients), medium PCT (477 limbs in 407 patients), and high PCT (477 limbs in 396 patients) groups. The patients in the high tertile were 2 years older that the patients in the other two tertiles (P = .009). Five-year primary patency was 65% ± 3% in the low-PCT group compared with 55% ± 3% and 51% ± 3% in the medium and high PCT groups, respectively (P = .004). Five-year secondary patency was 81% ± 2% in the low PCT group compared with 82% ± 2% and 72% ± 3% in the medium and high PCT groups, respectively (P = .02). Five-year limb salvage rate was 86% ± 2% in the low PCT group compared with 79% ± 3% and 74% ± 3% in the medium PCT and high PCT groups, respectively (P = .004). Multivariate regression analysis showed that low PCT was independently associated with primary patency after endovascular interventions (hazard ratio, 0.67 [0.47-0.95]; P = .02) but not after open interventions (hazard ratio, 0.72 [0.43-1.21]; P = .21). Conclusions High PCT is associated with poor patency and limb salvage rates after interventions for lower extremity chronic limb ischemia. Multivariate regression analysis confirmed association of low PCT with improved primary patency after endovascular interventions but not after open interventions. High PCT may be a marker of increased platelet reactivity and could be used to identify patients at high risk for early thrombosis and failure after interventions.

Background The utilization of reverse shoulder arthroplasty (RSA) has increased over time. Toxic increases of metal ion levels have been reported selectively after hip arthroplasty. However, studies evaluating the effect of RSA on in vivo metal ion levels have not been evaluated. Therefore, the purposes of this study were (1) to determine in vivo levels of cobalt, chromium, and nickel in a randomized controlled trial of patients undergoing reverse total shoulder arthroplasty (RSA) with one of four glenosphere sizes, and (2) to identify possible factors affecting changes in metal ion levels. Methods Between May 2016 and September 2018, 72 shoulders with cuff tear arthropathy, massive irreparable cuff tears, or glenohumeral osteoarthritis with posterior subluxation were randomized to undergo RSA using a single implant system and four possible glenosphere options based on size (36 or 40 mm) and offset (+2 mm, +6 mm). In vivo metal ion levels (cobalt, chromium, nickel) and complete blood count (CBC) were assessed preoperatively, 3-months, and 1-year after surgery. Clinical evaluation included pain, motion, Subjective Shoulder Value, ASES scores, and Oxford Shoulder Scores. Results Reverse shoulder arthroplasty led to statistically significant improvements in all outcome measures considered (p Conclusion In this randomized controlled trial of patients undergoing reverse total shoulder arthroplasty with a single design, in vivo levels of cobalt, chromium, and nickel remained reassuringly low. In addition, increase in glenosphere size, offset, or both, did not appear to affect in vivo metal ion levels over the short-term. Longer term studies are needed to further assess the effects of implant modularity on metal ion levels and their potential adverse effects in patients undergoing reverse shoulder arthroplasty. Level of evidence Level I; Randomized Controlled Trial

Aims The optimal antiplatelet therapy after atrial septal defect (ASD) or patent foramen ovale device closure (PFO) remain to be established. We evaluated the safety and effectiveness of 6-month 100 mg Aspirin (ASA) regimen in the very long-term follow up after intracardiac echocardiography (ICE) –aided interatrial shunt closure in a large retrospective cohort. Methods Single-center retrospective analysis which included medical and instrumental data of 789 consecutive patients referred to our institution over a 15 years period due interatrial shunt catheter-based closure. Results Finally, 734 patients were included in the analysis (mean age 46.1 ± 14.6 years, 398 females): ASD and PFO closure were successfully performed in 281 and 453 patients, respectively. Over the follow-up period, no major bleeding events were observed while the rate of minor bleeding events was 0.9%. Tolerance problems were detected in 3.4% of cases (n==28). In 11 patients (1.5%) an abnormal complete blood count was detected and monitored up to normalization. On a mean follow –up of 10.3 ± 3.0 years (range 1–15), 10 patients (1.36%) had a persistent moderate shunt 12 months after closure and maintained Aspirin 100 mg life-long, whereas the remaining 724 suspended the treatment after 6 months. Device thrombosis in ASD and PFO groups were 0% and 0.2%, respectively. A cerebral ischemic event occurred in 0.4% of the entire cohort. Conclusions A regimen of 100 mg of ASA for six months after ASD/PFO closure appeared to be both safe and effective in preventing device thrombosis and major bleedings.

To compare total serum bilirubin (TSB) levels, phototherapy usage, and hospital readmission for jaundice among neonates with Down syndrome vs controls.A retrospective cohort study using 15 years of multihospital data. We created control reference intervals (5th, median, and 95th percentiles) for initial TSB values hourly during the first days after birth, and determined the proportion of neonates with Down syndrome whose TSB exceeded the 95th percentile control interval. We determined the proportion with an initial TSB exceeding the upper control reference interval, the highest TSB recorded, the percentage of neonates receiving phototherapy, and the rate of hospital readmission for jaundice treatment.We compared 357 neonates with Down syndrome with 377 368 controls. Compared with controls, those with Down syndrome had 4.7 times the risk (95% CI, 3.9-5.7; P .0001) of an initial TSB exceeding the 95th percentile control interval (23.5% vs 5.0%), 8.9 times (95% CI, 8.1-9.8; P .0001) the phototherapy usage (62.2% vs 7.0%), and 3.6 times (95% CI, 1.6-8.2; P = .0075) the readmission rate for jaundice (17.4 vs 4.8 per 1000 live births).Neonates with Down syndrome have a substantial risk of early hyperbilirubinemia. The American Academy of Pediatrics currently advises obtaining an early screening complete blood count from neonates with Down syndrome. We submit that assessing their TSB is also advisable.

Neutrophil-lymphocyte ratio (NLR) and platelet-lymphocyte ratio (PLR) have become recently useful as predictive and prognostic tools in patients with various medical conditions. Aim of the work: To evaluate NLR and PLR in systemic lupus erythematosus (SLE) and their relation to disease clinical characteristics, nephritis, disease activity and damage. Patients and method: The study involved 110 Egyptian SLE patients; 80 with lupus nephritis (naive and relapsing) and 30 without as well as 50 matched control. Patients were subjected to full clinical examination, SLE disease activity index (SLEDAI) scoring, and damage using Systemic Lupus International Collaborating Clinics Damage Index (SLICC-DI). Laboratory and immunology profiles included the complete blood count (CBC) with differential white blood cell counts and estimation of both NLR and PLR, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), protein/creatinine ratio, anti-nuclear antibody (ANA), anti-double stranded deoxyribonucleic acid (anti-dsDNA), serum complements and interleukin-6 (IL-6) levels. Result: Both NLR and PLR were significantly higher in SLE patients (4.8 ± 1.4 and 281.7 ± 66.7 respectively) compared to controls (3.8 ± 2 and 138.2 ± 50.4). Both ratios were significantly elevated in patients with active lupus nephritis (at presentation or as a flare) and were comparable between naive and relapsing lupus nephritis patients. In lupus nephritis patients, NLR and PLR significantly correlated with proteinuria, ESR, hypocomplementemia, IL6, SLEDAI and SLICC-DI. The best NLR cut-off value to predict nephritis activity was 5.65, whereas the best PLR cut-off value was 316.5. Conclusion: NLR and PLR appear to be potentially useful cheap parameters of activity, relapse and severity in SLE patients with nephritis. Keywords: Neutrophil, platelet, Lymphocyte, Systemic lupus erythematosus, Lupus nephritis

Introduction The avoidance of repeat chemistry testing such as Complete Blood Count (CBC) and Electrolyte Panel (EP) on clinically stable patients was identified as important utilization goals by Choosing Wisely Canada. The purpose of this study was to assess the volume of overutilization of CBC and EP in an inpatient setting in Alberta, Canada, and provide an estimated cost assessment of unnecessary testing. Methods The total laboratory testing volumes of two common test panels were collected retrospectively for one-year from January to December 2018. Data was collected on test panels performed in an emergency room (ER) and inpatient setting from three separate Laboratory Information Systems covering the provincial population in Alberta, Canada. Total initial test panel instances, total repeated panels, repeated panels that were previously normal or abnormal, and estimated costs were examined. Cost assessment was completed based on Reference Median Cost (RMC) analysis for each of these two common test panels. Results During the study period, 2,020,467 (CBC) and 1,455,983 (EP) initial test panel instances were recorded, of which 67.7% and 73.5% were repeated for the CBC and EP, respectively. There was a higher proportion of EP repeated inappropriately (previously normal; 35.6%) compared to CBCs (5.4%). The cost to the province for inappropriately repeating CBC and EP were estimated to be RMC $0.52 million and RMC $1.90 million CAD, respectively. Conclusion Results from this study can assist policy makers in implementing utilization management initiatives and update clinical practice guidelines to reduce costs to healthcare without compromising patient care.

Aim Asthma is a chronic disease of the airways characterized by inflammation. Neutrophils and platelets play a role in the inflammatory process. Neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) have recently been evaluated in various chronic diseases. However, there are only limited data on the association between NLR, PLR and asthma in adult patients. Our aim was to investigate the role of blood NLR and PLR in asthma control. Materials and methods Eighty patients with asthma and 23 healthy controls were included in the study. Complete blood count (CBC), neutrophil count, lymphocyte count, platelet count, C-reactive protein (CRP), and NLR and PLR values were recorded for the study group and controls. An asthma control test (ACT) was performed by a pulmonologist. Patients with asthma were divided into two groups: those with and without controlled asthma. Results The mean age in the patient and control groups was 41.5 ± 11.6 years and 42.0 ± 10.5 years, respectively. Median PLR was significantly higher in the asthma group at 111.9 (range: 82.6–154.9) compared with the control group at 95.9 (range: 89.3–109.0) (P = 0.048). Median platelet count was higher in the asthma group than in the control group (P = 0.009). Median platelet count and PLR in the uncontrolled group were significantly higher than those in the controlled group (P = 0.039; P Conclusion According to our data, PLR may be of value in prediction of asthma control in asthma patients. PLR can be assessed quickly and easily to evaluate asthma control.

Summary Background Cystic fibrosis (CF) is an inherited disorder that causes severe damage to multiple organs in the body. Nutritional management has a dramatic effect on growth and survival in CF patients. This study aimed to assess the nutritional status of Egyptian pediatric patients with CF before and after proper nutritional counseling and supplementation. Methods This is an interventional observational study conducted on fifty children with CF recruited from CF clinic, Children's Hospital, Cairo University. The patients were subjected to history taking, clinical examination, full nutritional assessment, including signs of vitamins deficiencies, Subjective global assessment (SGA), anthropometric measurements, laboratory assessment (complete blood count, kidney, liver function tests and Prealbumin as a nutritional marker). After the initial assessment all the patients were subjected to a proper nutritional plan plus vitamin and mineral supplementations then reassessed them after 3 months. Results SGA showed that 60% of the patients had severe malnutrition, 62%, 78%, and 48% of the patients were below −2 Z score for height, weight, and BMI respectively which decreased to 45%, 40%, and 32% after nutritional supplementation. 43% of the patients were anemic, 29% were hypoalbuminemic, and 80% had low serum Prealbumin levels. After 3 months of follow up, only 17% had anemia, 11% had hypoalbuminemia, and 41% had low serum Prealbumin. Compliance was detected in 76% of caregivers during the follow up. Conclusion CF patients had considerable impairment in their nutritional status. Proper caloric intake and vitamin supplementation had a valuable impact on their growth and prognosis.

Purpose Current American Academy of Pediatrics guidelines for children with Down syndrome (DS) recommend a complete blood count (CBC) at birth and hemoglobin annually to screen for iron deficiency (ID) and ID anemia (IDA) in low-risk children. We aimed to determine if macrocytosis masks the diagnosis of ID/IDA and to evaluate the utility of biochemical and red blood cell indices for detecting ID/IDA in DS. Methods We reviewed data from 856 individuals from five DS specialty clinics. Data included hemoglobin, mean corpuscular volume, red cell distribution width (RDW), percent transferrin saturation (TS), ferritin, and c-reactive protein. Receiver operating characteristic curves were calculated. Results Macrocytosis was found in 32% of the sample. If hemoglobin alone was used for screening, all individuals with IDA would have been identified, but ID would have been missed in all subjects. RDW had the highest discriminability of any single test for ID/IDA. The combination of RDW with ferritin or TS led to 100% sensitivity, and RDW combined with ferritin showed the highest discriminability for ID/IDA. Conclusion We provide evidence to support that a CBC and ferritin be obtained routinely for children over 1 year old with DS rather than hemoglobin alone for detection of ID.

Background C-reactive protein (CRP) is considered a marker of inflammation. We sought to evaluate the association between CRP level and commonly use blood tests in apparently healthy population. Methods A cross-sectional study of all visits in a routine health examination center between 1/2002 and 7/2018. CRP, complete blood count and chemistry blood panel were evaluated in each visit. Visits of individuals who had CRP above the 99th percentile or use statins were excluded. Correlation between CRP and blood tests was evaluated in the whole cohort as well as in sub-populations. Results Blood parameters of 33,261 visits were included. Moderate positive correlation between CRP and white blood cells count (r = 0.269), neutrophils count (r = 0.275), triglycerides (r = 0.275), alkaline phosphatase (r = 0.221) and gamma glutamyl transpeptidase (r = 0.220) was evaluated. Correlation with triglycerides was stronger in female then in males (r = 0.38 vs. 0.25). Uric acid was positively correlated in females and males. In participants under 30 years, inverse correlation with hemoglobin, creatinine and albumin levels and positive correlation with cholesterol were documented. Conclusion Significant moderate association between CRP and several blood tests was evaluated in apparently healthy population. This information should be used for further studies of the relationship between inflammation and biological processes.

Background There is a paucity of prognostic factors for patients with stage I non-small cell lung cancer (NSCLC) undergoing operations. We investigated the prognostic role of preoperative complete blood count values in patients with stage I NSCLC patients undergoing operations. Methods A retrospective medical record review was performed of patients who underwent operations for stage I NSCLC between 2000 and 2015. Patients who died within 30 days of the operations were excluded. The primary end point was recurrence. Preoperative complete blood count values were analyzed, and a median value was used as the cutoff. Statistical analysis used χ2 and t tests along with univariate and multivariate analyses by Cox regression modeling. Results The study included 103 patients. A high lymphocyte count was significantly associated with recurrence (5-year recurrence-free survival [RFS] of 69.8% for high vs 95.7% for low, P = .003), as well as high platelet (5-year RFS of 72.0% for high vs 91.8% for low, P = .02). Independent prognostic factors on multivariate analysis were high lymphocyte (hazard ratio [HR], 7.27; P = .005) and platelet counts (HR, 7.49; P = .003) as well as tumor (HR, 5.40; P = .008) and treatment characteristics (HR, 4.59; P = .01). Among patients with pT1 lesions, high lymphocyte (HR, 8.41; P = .03) and high platelet counts (HR, 19.78; P = .004) remained independent prognostic factors. Neither NLR nor PLR were significantly associated with recurrence. Conclusions In patients with pathologic stage I NSCLC undergoing surgical resection, the preoperative blood count from peripheral blood may provide prognostic value. Of significance, in patients with pT1 N0 NSCLC, high lymphocyte count and high platelet count were associated with higher recurrence.

Physicians may encounter blood or tissue eosinophilia through a routine complete blood count with differential or a tissue pathology report. In this article, the basic biology of eosinophils is reviewed and definitions of blood eosinophilia, as well as the challenges of defining tissue eosinophilia, are discussed. Conditions associated with eosinophilia are briefly discussed as well as a general approach to evaluating eosinophilia. Future challenges include determining which eosinophil-associated diseases benefit from eosinophil-targeted therapy and identifying biomarkers for disease activity and diagnosis.

Background As a result of concerns about hypertriglyceridemia, liver enzyme abnormalities, and leukopenia during isotretinoin therapy for acne, patients are often monitored closely with routine laboratory assessments, although the value of this practice has been questioned. Methods We conducted a cohort study of patients receiving isotretinoin for acne between January 1, 2008, and June 30, 2017, using the OptumInsights Electronic Health Record Database (Optum, Eden Prairie, MN) to evaluate the frequency of laboratory abnormalities. Poisson regression was used to evaluate for changes to the frequency of routine laboratory monitoring over time. Results Among 1863 patients treated with isotretinoin, grade 3 or greater triglyceride and liver function testing abnormalities were noted in fewer than 1% and 0.5% of patients screened, respectively. No grade 3 or greater cholesterol or complete blood count abnormalities were observed. There were no meaningful changes in the frequency of laboratory monitoring over time. Limitations Limitations include that we are unable to evaluate the clinical notes to understand the exact clinical decision making when clinicians encountered abnormal laboratory values. Conclusion Although laboratory abnormalities are rare and often do not influence management, frequent laboratory monitoring remains a common practice. There are opportunities to improve the quality of care among patients being treated with isotretinoin for acne by reducing the frequency of lipid and liver function monitoring and by eliminating complete blood count monitoring.

OBJECTIVE: Preoperative inflammatory parameters are associated with outcome in renal cell carcinoma; however, their predictive value in tumors with sarcomatoid dedifferentiation (sRCC) is uncertain. We aimed to evaluate the association between preoperative and postoperative inflammatory parameters and the outcome of patients with locoregional and metastatic sRCC who underwent nephrectomy. METHODS AND MATERIALS: After obtaining IRB approval, we identified 230 patients with sRCC treated between 1994 – 2018 with a complete blood count drawn ≤1 month before nephrectomy. Preoperative neutrophil-lymphocyte ratio (NLR), lymphocyte-monocyte ratio and platelet-lymphocyte ratio were evaluated as continuous variables. Postoperative NLR, 1–8 weeks after surgery, and % change in NLR were calculated. Cox regression models were used to identify predictors of outcome. RESULTS: The study cohort included 105 metastatic patients and 112 patients with locoregional disease. Patients with metastatic disease had significantly higher preoperative NLR (4.31 vs. 3.29) and PLR (248 vs. 194), and lower preoperative LMR (2.6 vs. 3.23). Median follow-up for patients with locoregional and metastatic disease was 36 months and 20 months, respectively, and estimated 5-year cancer specific survival (CSS) rates were 56% and 15%, respectively. Preoperative NLR was a significant predictor of CSS for both metastatic (HR=1.23, 95% CI 1.1–1.37, p

A 70-year-old man who tested positive for SARS-CoV-2 presented to the hospital with confusion and a seizure. A computed tomography of the head was normal. The initial complete blood count showed severe thrombopenia and microangiopathic hemolytic anemia. Low ADAMTS13 activity confirmed the diagnosis of thrombotic thrombocytopenic purpura (TTP). Treatment with corticosteroids and plasma exchange was successful and the patient recovered completely. As no other causes were found, COVID-induced TTP was diagnosed. A combination of inflammation and immune dysregulation could explain this presentation.

Objective In the present study, we sought to better characterize the patients with coronavirus disease 2019 (COVID-19) most at risk of severe, outpatient thrombosis by defining the patients hospitalized with COVID-19 with arterial or venous thrombosis diagnosed at admission. Methods We conducted a single-center, retrospective analysis of COVID-19 patients. We found a shift in the proportions of thrombosis subtypes from 2019 to 2020, with declines in ST-segment myocardial infarction (from 22.0% to 10.1% of thrombotic events) and stroke (from 48.6% to 37.2%) and an increase in venous thromboembolism (from 29.4% to 52.7%). The patients with COVID-19–associated thrombosis were younger (age, 58 years vs 64 years; P = .043) and were less frequently women (31.3% vs 43.9%; P = .16). However, no differences were found in the body mass index or major comorbidities between those with and without COVID-19. COVID-19–associated thrombosis correlated with greater mortality (15.2% vs 4.3%; P = .016). The biometric profile of patients admitted with COVID-19–associated thrombosis compared with regular thrombosis showed significant changes in the complete blood count, liver function test results, D-dimer levels, C-reactive protein, ferritin, and coagulation panels. Conclusions Outpatients with COVID-19 who developed thrombosis requiring hospitalization had increased mortality compared with outpatients without COVID-19 who developed thrombosis requiring hospitalization. Given the significantly higher inflammatory marker levels, it is possible this is related to different mechanisms of thrombotic disease in these patients. The inflammation could be a therapeutic target to reduce the risk, or aid in the treatment, of thrombosis. We call for more studies elucidating the role that immunothrombosis might be playing in patients with COVID-19.

The effect of the synthetic diazo dye L1, that titled 4,6-bis((E)-(2-nitrophenyl) diazenyl) benzene-1,3-diol in the Mus musculus L. from Balb/ C was deliberated. This diazo dye was revealed fine ability to destroy the cancer living cells and reduce the growth of human breast MDA-MB231 cancer cells. Injecting the L1 to the mice can affect the complete blood count (CBC) test in contrast with the control (C). The results were indicated that the variations) and the white blood cell count (WBC), were very slightly effected by L1 in contrast with C. Statistical analysis was carried on these results using SPSS version 20. The results were giving P

Background: Sodium chloride intoxication is commonly described in mammals, but there are no clinical reports of sodium chloride intoxication in a pet domestic rabbit. Case description: A pet domestic rabbit was presented for an acute onset of seizure-like activity, ataxia, vestibular-associated rolling, and obtunded mentation. The result of a computed tomography scan of the head was within normal limits and complete blood count revealed neutrophilia. Results of a serum biochemical profile included marked hypernatremia and elevated alanine aminotransferase. Subcutaneous fluids, oral fenbendazole, anti-inflammatory therapy, and assisted feedings were started while the cause of hypernatremia was investigated. Further discussion with owners revealed that the patient was provided a Himalayan salt rock, which was purchased from a pet store and promoted for improving the mood of a pet rabbit. This helped to confirm the cause of hypernatremia and a diagnosis of salt toxicity. The rabbit's clinical signs and serum sodium level resolved after 48 hours of supportive care. Conclusions and case relevance: This is the first report of sodium chloride toxicosis in a pet rabbit and should be considered as a differential diagnosis for acute onset of neurologic signs in rabbits. Clinicians should be aware of commercial salt products being marketed for rabbits.

Introduction The present study evaluates the predictive value of such markers as ischemia-modified albumin (IMA), malondialdehyde (MDA) and glutathione peroxide (GSH-Px), in addition to parameters associated with inflammation, oxidative stress and ischemia, playing roles in the pathology of acute appendicitis (AA), including c-reactive protein (CRP), procalcitonin (PCT) and complete blood count (CBC) parameters and their ratios, for the diagnosis of AA in adults. Material and methods The study included 51 patients with histologically confirmed appendicitis and 45 healthy controls who referred to the emergency care unit between January and June 2018. The appendicitis cases were classified into two groups, as complicated and non-complicated, based on postoperative pathological investigations. Results Of all the appendicitis cases, 68.5% (n = 35) were non-complicated and 31.4% (n = 16) were complicated. IMA (positive LR = 3.0, negative LR = 0.1), GSH-Px (positive LR = 0.5, negative LR = 1.8), MDA (positive LR = 1.8, negative LR = 0.6), CRP (positive LR = 7.2, negative LR = 0.2), PCT (positive LR = 0.7, negative LR = 1.3), WBC (positive LR = 2.9, negative LR = 0.3), neutrophil-lymphocyte ratio (positive LR = 3.2, negative LR = 0.1) thrombocyte lymphocyte ratio (positive LR = 1.6, negative LR = 0.5) and IMA/albumin ratio (positive LR = 3.3, negative LR = 0.1) levels in the appendicitis cases were evaluated by a characteristic receiver operating characteristic (ROC) curve. In addition, IMA levels were significantly higher in the complicated cases (0.40 ± 0.05 AbsU) than in the non-complicated cases (0.29 ± 0.04 AbsU) (p Conclusion Our results showed that IMA (negative LR = 0.1), CRP (positive LR = 7.2, negative LR = 0.2), NLR (negative LR = 0.1) and IMA/albumin ratio (negative LR = 0.1) can serve as important diagnostic biomarkers for AA patients. We therefore believe that before clinically confirming an AA diagnosis, these parameters may be used as diagnostic tools in addition to CBC parameters, CRP levels and radiological imaging studies.