A novel prognostic biomarker for cutaneous malignant melanoma: red cell distribution width (RDW) to lymphocyte ratio.

It is well-known that inflammation plays a significant role in cancer formation and prognosis. Both lymphocyte count and red cell distribution width (RDW) has been used to predict prognosis in various cancers as an indicator of inflammation. Yet, the role of RDW-lymphocyte ratio (RLR) in determining prognosis is still unknown. We aimed to determine the prognostic role of RLR in cutaneous malignant melanoma (MM). One hundred fifteen patients with MM were included in the study retrospectively. The relationship of the clinical-pathological data with overall survival (OS) and progression-free survival (PFS) was analyzed using Kaplan-Meier curves. The cut-off values of neutrophil to lymphocyte ratio, systemic immune-inflammation index (SII), prognostic nutritional index (PNI) and RLR were determined as 2, 487, 51.5 and 6.52, respectively. OS was significantly longer in the low SII, high PNI, low RLR group, while PFS was longer in groups with high PNI and low RLR. In univariate analysis, it was determined that PFS was significantly correlated with Eastern Cooperative Oncology Group (ECOG) performance, TNM stage, PNI and RLR. Moreover, in univariate analysis, a significant correlation was determined between OS and age, ECOG performance, TNM stage, adjuvant interferon, SII, PNI and RLR. In multivariate analysis, ECOG performance, TNM stage and RLR were determined as independent prognostic factors for PFS, while TNM stage and RLR were found to be independent prognostic factors for OS. RLR could be a novel prognostic marker for both PFS and OS in patients with cutaneous MM.

Standardization and harmonization in hematology: Instrument alignment, quality control materials, and commutability issue.

INTRODUCTION: In the hub and spoke laboratory network, the number of hematology analyzers (HAs) within each core center has increased, and the control of HAs alignment is becoming necessary requirement to ensure analytical quality. In this scenario, HA alignment can be assessed by analyzing the same control material used for internal quality control on multiple HAs, assuming its commutability. The aim of the study was to verify the applicability of a protocol for the alignment of HAs based on control material rather than on fresh whole-blood samples. METHODS: The alignment of five HAs was evaluated for red (RBC, Hb, MCV, RET), white (WBC, NE, LY, MO, EO, BA, IG), and platelet (PLT) series parameters, following a protocol by SIBioC, using human sample (HS) and quality control material (QC), after the verification of commutability, according to the IFCC protocol. Maximum bias was derived from biological variation data. RESULTS: A complete alignment between instruments was confirmed for the majority of the parameters investigated both for HS and QC material. Partial misalignments or inconcludent results were instead evident for MCV, MO, EO, BA, and IG. Interestingly, QC material was found to be not commutable for LY, MO, and BA. CONCLUSION: The alignment of hematologic analyzers for main cell population parameters may be verified with both QC and HS, displaying consistent results and interpretation. The evaluation for some white series parameters (EO, BA, and IG) is critical, and particular attention must be paid to the values of the material used for the alignment.

COVID-19 disease-Temporal analyses of complete blood count parameters over course of illness, and relationship to patient demographics and management outcomes in survivors and non-survivors: A longitudinal descriptive cohort study.

BACKGROUND: Detailed temporal analyses of complete (full) blood count (CBC) parameters, their evolution and relationship to patient age, gender, co-morbidities and management outcomes in survivors and non-survivors with COVID-19 disease, could identify prognostic clinical biomarkers. METHODS: From 29 January 2020 until 28 March 2020, we performed a longitudinal cohort study of COVID-19 inpatients at the Italian National Institute for Infectious Diseases, Rome, Italy. 9 CBC parameters were studied as continuous variables [neutrophils, lymphocytes, monocytes, platelets, mean platelet volume, red blood cell count, haemoglobin concentration, mean red blood cell volume and red blood cell distribution width (RDW %)]. Model-based punctual estimates, as average of all patients' values, and differences between survivors and non-survivors, overall, and by co-morbidities, at specific times after symptoms, with relative 95% CI and P-values, were obtained by marginal prediction and ANOVA- style joint tests. All analyses were carried out by STATA 15 statistical package. MAIN FINDINGS: 379 COVID-19 patients [273 (72% were male; mean age was 61.67 (SD 15.60)] were enrolled and 1,805 measures per parameter were analysed. Neutrophils' counts were on average significantly higher in non-survivors than in survivors (P<0.001) and lymphocytes were on average higher in survivors (P<0.001). These differences were time dependent. Average platelets' counts (P<0.001) and median platelets' volume (P<0.001) were significantly different in survivors and non-survivors. The differences were time dependent and consistent with acute inflammation followed either by recovery or by death. Anaemia with anisocytosis was observed in the later phase of COVID-19 disease in non-survivors only. Mortality was significantly higher in patients with diabetes (OR = 3.28; 95%CI 1.51-7.13; p = 0.005), obesity (OR = 3.89; 95%CI 1.51-10.04; p = 0.010), chronic renal failure (OR = 9.23; 95%CI 3.49-24.36; p = 0.001), COPD (OR = 2.47; 95% IC 1.13-5.43; p = 0.033), cardiovascular diseases (OR = 4.46; 95%CI 2.25-8.86; p = 0.001), and those >60 years (OR = 4.21; 95%CI 1.82-9.77; p = 0.001). Age (OR = 2.59; 95%CI 1.04-6.45; p = 0.042), obesity (OR = 5.13; 95%CI 1.81-14.50; p = 0.002), renal chronic failure (OR = 5.20; 95%CI 1.80-14.97; p = 0.002) and cardiovascular diseases (OR 2.79; 95%CI 1.29-6.03; p = 0.009) were independently associated with poor clinical outcome at 30 days after symptoms' onset. INTERPRETATION: Increased neutrophil counts, reduced lymphocyte counts, increased median platelet volume and anaemia with anisocytosis, are poor prognostic indicators for COVID19, after adjusting for the confounding effect of obesity, chronic renal failure, COPD, cardiovascular diseases and age >60 years.

Dynamic Differences Of Red Cell Distribution Width Levels Contribute To The Differential Diagnosis Of Hepatitis B Virus-related Chronic Liver Diseases: A Case-control Study.

Objective: This study aims to clarify the changes and clinical significance of red cell distribution width (RDW) during HBV-related chronic diseases, including inactive hepatitis B virus (HBV) carriers, HBV immune tolerant individuals, chronic hepatitis B (CHB) patients and HBV-related hepatocirrhosis patients. Methods: RDW was measured 288 CHB patients, 100 patients with hepatitis B e antigen(HBeAg)-negative chronic HBV infection (inactive carriers), 92 patients with HBeAg-positive chronic HBV infection (immune tolerant), and 272 patients with HBV-related hepatocirrhosis. Their RDW changes were compared with 160 healthy controls. Correlations between RDW and clinical indicators were conducted. For HBeAg+ CHB patients, RDW was measured before and after antiviral therapy. The efficiency of RDW to distinguish hepatocirrhosis from CHB and/or inactive carriers was evaluated by receiver operating characteristic (ROC) curves. Results: RDW was higher in hepatocirrhosis patients than other groups of patients and healthy controls. Besides, HBeAg+ CHB patients possessed higher RDW than HBeAg- CHB patients. For HBeAg+ patients that underwent HBeAg seroconversion after antiviral therapy, RDW was decreased. RDW was positively correlated with total bilirubin and Child-Pugh scores and negatively correlated with albumin among hepatocirrhosis patients. The areas under the curve (AUC) of ROC curves to distinguish hepatocirrhosis from CHB patients was 0.7040 for RDW-standard deviation (RDW-SD) and 0.6650 for RDW-coefficient of variation (RDW-CV), and AUC to distinguish hepatocirrhosis from inactive carriers was 0.7805 for RDW-SD and 0.7991 for RDW-CV. Conclusions: RDW is significantly increased in HBeAg+ CHB patients and patients with HBV-related hepatocirrhosis and could reflect their severity. RDW could help to distinguish hepatocirrhosis from CHB patients and inactive HBV carriers.

Frequency of dog erythrocyte antigen 1 blood group and risk of incompatible transfusion in dogs of different breeds and mongrels from the city of Salvador - BA, Brazil / Frequência do antígeno eritrocitário canino 1 e risco de transfusão incompatível em cães de diferentes raças e mestiços da cidade de Salvador-BA, Brasil

The dog erythrocyte antigen 1 (DEA 1) is the most immunogenic blood group in dogs, and blood transfusions may trigger some undesirable effects in veterinary patients, which are directly associated with incompatible transfusions. The present study aimed to investigate the frequency of positive DEA 1 blood group in blood donor dogs from a blood bank in Salvador, Bahia, Brazil, and also to calculate the risk of managing incompatible blood in both first and second transfusion. A number of 203 dogs of different breeds, aged between 1 and 8 years, weighing 28 kg, with no degree of kinship and of both sexes in Salvador - BA, Brazil were evaluated to investigate the blood type DEA 1 frequency, by means of chromatography and flow cytometry tests for blood typing. The risk of incompatible blood transfusion in either a first or a second transfusion was also calculated. The frequency of the DEA 1 group ranged from 0% to 100% in various breeds, but with a mean positivity of 62.07% (126/203). And the lowest risk of an DEA 1 negative animal receiving DEA 1 positive blood within the group of animals evaluated was 0.92% at a first transfusion; and the risk of the same animal receiving incompatible blood for the DEA group 1 in the second transfusion was 0.008%. The highest risk of an DEA 1 negative animal receiving DEA 1 positive blood from these animals was 69.12%; and the risk of receiving incompatible blood for DEA 1 was 47.77%. In conclusion, the frequency of the DEA 1 group varied between the studied breeds and the risk of incompatible blood transfusions varies according to donor and recipiente breeds, but this can be overridden if blood typing tests are performed along with the cross-reaction test for compatibility.

O antígeno eritrocitário canino 1 (AEC 1) é o grupo sanguíneo mais imunogênico em cães, podendo as transfusões sanguíneas desencadearem alguns efeitos indesejáveis nos pacientes veterinários. Estes estão diretamente associados à transfusões incompatíveis. O presente trabalho teve como objetivo estudar a frequência do grupo sanguíneo AEC 1 em cães doadores de sangue de um banco de sangue de Salvador-BA, Brasil, e calcular o risco de administrar sangue incompatível tanto em uma primeira quanto em uma segunda transfusão. Foram avaliados 203 cães de diversas raças, de ambos os sexos, com idade entre 1 e 8 anos, peso a partir de 28 kg, sem nenhum grau de parentesco originários de Salvador ­ BA, Brasil, para pesquisa da frequência do tipo sanguíneo AEC 1, por meio de testes de imunocromatografia e citometria de fluxo para tipagem sanguínea. E calculado o risco de transfusão sanguínea incompatível tanto em uma primeira como em uma segunda transfusão. A frequência do grupo AEC 1 variou entre as raças estudadas de 0% a 100%, porém com uma positividade média de 62,07% (126/203). O menor risco de um animal AEC 1 negativo receber sangue AEC 1 positivo, dentro do grupo dos animais avaliados foi de 0,92% em uma primeira transfusão e o risco do mesmo animal receber sangue incompatível para o gruo AEC 1 na segunda transfusão foi de 0,008%. Quanto ao maior risco de um animal AEC 1 negativo receber sangue AEC 1 positivo destes animais foi de 69,12% e o risco do mesmo receber sangue incompatível para o AEC 1 foi de 47,77%. A frequência do grupo AEC 1 variou entre as raças estudadas e o risco de transfusões incompatíveis variou de acordo com as raças doadoras e receptoras, mas esse risco pode ser anulado se sempre forem realizados os testes para tipagem sanguínea junto com a prova de reação cruzada para compatibilidade.

Prognostic value of RDW in cancers: a systematic review and meta-analysis.

Red blood cell distribution width (RDW), a parameter that used to differentiate the type of anemia for several decades, recent studies suggest it was a prognostic factor in various types of cancer patients. However, the prognostic value of RDW in cancer patients remains controversial. Here, we performed a meta-analysis and systematic review to evaluate the prognostic value of RDW in cancer patients. Relevant studies were picked out from the databases of Web of Science, Embase, Pubmed and Cochrane Library. A total of 16 papers with 4267 patients were included in this meta-analysis, and the combined results indicated that elevated RDW was associated with poor over survival (OS) (HR = 1.47, 95%CI:1.29-1.66), poor cancer-specific survival (CSS) (HR = 1.46, 95%CI:1.08-1.85), poor disease-free survival (DFS) (HR = 1.91, 95%CI:1.27-2.56), poor event-free survival (EFS) (HR = 2.98, 95%CI:0.57-5.39) and poor progress-free survival (PFS) (HR = 3.21, 95%CI:0.33-6.75) after treatment. Furthermore, the similar results were observed in subgroup analysis stratified by cancer type, cutoff value of RDW, sample size and ethnicity. In conclusion, this meta-analysis demonstrated that RDW may be a potential prognostic marker in patients with cancer, and high RDW may also be associated with poor outcomes.

Elevated red blood cell distribution width is associated with liver function tests in patients with primary hepatocellular carcinoma.

BACKGROUND: Red blood cell distribution width (RDW), a routinely tested parameter of the complete blood count (CBC), has been reported to be increased in various cancers and correlated with the patients' clinical characteristics. However, the significance of RDW in primary hepatocellular carcinoma (pHCC) is largely unknown. The aim of this study was to evaluate the associations between RDW and the clinical characteristics of pHCC patients. METHODS: Medical records of 110 treatment-naive pHCC patients were retrospectively reviewed. Their clinical characteristics on admission, including RDW, liver function tests and tumor stage, were extracted, and their relationships were analyzed using Spearman correlation and Kruskal-Wallis test. Sixty-eight healthy individuals were set as controls. RESULTS: RDW was significantly increased in pHCC patients and correlated with the liver function tests. However, no correlation between RDW and tumor stage was found. CONCLUSION: RDW may be used to assess the liver function, but not the tumor stage in pHCC patients.

Association of erythrocyte deformability with red blood cell distribution width in metabolic diseases and thalassemia trait.

Increased red blood distribution width (RDW) in anemia is related to disturbances in the cellular surface/volume ratio, usually accompanied by morphological alterations, while it has been shown in inflammatory diseases that the activity of pro-inflammatory cytokines disturbing erythropoiesis increases RDW. Recently it has been reported that higher RDW is related with decreased erythrocyte deformability, and that it could be related with the association of RDW and increased risk of cardiovascular diseases. In order to analyze the influence of morphological alterations and proinflammatory status on the relationship between RDW and erythrocyte deformability, we analyzed erythrocyte deformability along with RDW and other hematological and biochemical parameters in 36 α-thalassemia, 20 ß-thalassemia, 20 δß-thalassemia trait carriers, 61 metabolic syndrome patients and 76 morbidly obese patients. RDW correlated inversely with erythrocyte deformability in minor ß-thalassemia (r =-0.530, p <  0.05), and directly in both metabolic syndrome and morbidly obese patients (ρ= 0.270, p <  0.05 and ρ= 0.258, p <  0.05, respectively). Minor ß-thalassemia is often accompanied by more marked cell-shaped perturbations than other thalassemia traits. This could be the reason for this negative association only in this setting. Higher anisocytosis seems to be associated with greater morphologic alterations (shape/volume), which reduce erythrocyte deformability. The proinflammatory profile in metabolic patients can be related to the positive association of RDW with erythrocyte deformability found in these patients. However, further research is needed to explain the mechanisms underlying this association.

Influence of inflammatory and lipidic parameters on red blood cell distribution width in a healthy population.

Red blood cell distribution width (RDW) is a routine red blood cell count parameter which has been shown to be associated with inflammatory parameters. Recently, some authors proposed that RDW seems to be a marker of an adverse lipidic profile. In order to clarify whether RDW is related to inflammation, plasma lipids, or both, we determined anthropometric, hematimetric, inflammatory and lipidic parameters in 1111 healthy subjects. RDW correlated directly with age, body mass index (BMI), inflammatory parameters (plasma viscosity, erythrocyte sedimentation rate (ESR), fibrinogen, leukocyte and neutrophil count), and inversely with iron and hematimetric parameters (P <  0.05). When subjects were divided according to gender, RDW correlated inversely with triglycerides only in women (P <  0.05). When subjects were classified into RDW-quartiles, increased RDW values were accompanied by decreased serum iron levels and hematimetric indices (P <  0.01), whereas age and inflammatory markers increased according to RDW-quartiles (P <  0.001 and P <  0.05, respectively). However, plasma lipids did not change with increasing RDW-quartiles (P >  0.05). In the linear regression analysis, age, hemoglobin, MCV (beta coefficient: 0.202, -0.234, -0.316, P <  0.001) and fibrinogen (beta coefficient: 0.059, P = 0.048) were the only independent predictors of RDW. The present study indicates that RDW is associated with inflammatory markers and hematimetric indices, but not with plasma lipid levels in a healthy population.

Biochemical and hemato-immunological parameters in juvenile beluga (Huso huso) following the diet supplemented with nettle (Urtica dioica).

The present study investigated the effects of different dietary nettle (Urtica dioica) levels on biochemical, hematological and immunological parameters in beluga (Huso huso). Fish were divided into 4 groups before being fed for 8 weeks with 0%, 3%, 6% and 12% of nettle. The blood samples were collected on week 4 and 8. The use of nettle did not significantly change the mean cell volume, mean cell haemoglobin, lymphocytes, eosinophils, albumin, glucose, alanine aminotransferase, aspartate aminotransferase, alkaline phosphatase and lysozyme activity on week 4 and 8. After 4 weeks, the total red blood cell (RBC) and hematocrit (Ht) showed a significant increase in 12% nettle group compared to the 3% nettle and control groups but haemoglobin (Hb) had a significant change in 12% nettle compared to the control. At the same time was not found a significant change in the mean cell haemoglobin concentration (MCHC), total white blood cell (WBC), neutrophils, respiratory burst activity (RB), total immunoglobulin (Ig) and total protein (TP), triglyceride (Tri) and cholesterol (Chol). After 8 weeks, the fish treated with nettle exhibited significantly increase in neutrophil and Hb levels compared to the control and between treatment groups, 12% nettle group shown the highest Hb while RBC and Hct values significantly rose in fish fed by 12% compared to the control. Supplementing 6% and 12% nettle increased the WBC and MCHC compared to the other groups. The group fed 12% showed a highly significant difference in RB, TP and Ig after 8 weeks. However, Tri and Chol were significantly decreased in the juvenile beluga fed by the 6% and 12% nettle diet compared to the other groups. The results suggest that by using this herb there will be an improvement in hemato-biochemical parameters and immune function of juvenile beluga.

Valores da Amplitude de Distribuição do Tamanho dos Eritrócitos (RDW) em eqüinos Puro Sangue Inglês (PSI) submetidos a exercícios de diferentes intensidades / Values of Red Blood Cell Distribution Width (RDW) in thoroughbred horse submitted to exercise of different intensity

O presente estudo foi delineado para avaliar as alterações nos valores da amplitude de distribuição do tamanho dos eritrócitos (RDW) e do volume globular médio (VGM) em eqüinos PSI submetidos a exercícios de diferentes intensidades. Foram colhidas amostras de sangue de 60 eqüinos, PSI, sendo 30 machos e 30 fêmeas, distribuídos nos seguintes grupos: eqüinos de 24 a 36 meses de idade não submetidos a treinamento e após um período de 12 meses de treinamento; eqüinos de 36 a 48 meses de idade em fase de treinamento, antes e após o trote e antes e após o galope. As amostras foram processadas no contador automático de células Cell-Dyn 3500R (Abbott Diagnostic). Os valores médios obtidos para o RDW aumentaram significativamente após o trote e galope, demonstrando ocorrer alteração no grau de anisocitose porém os valores do VGM não apresentaram alterações nesses mesmos momentos.

In order to evaluate the influence of exercise of different intensities on Red Blood Cell Distribution width (RDW) and Packed Cell Volume (VG) in Thoroughbred horses, blood was collected from 60 animals, 30 males and 30 females, subdivided in groups of horses with 24 to 36 months of age and not in training, and after 12 months of training, and horses with 36 to 48 months of age in training. Blood samples where collected before and after trot and gallop. Samples where analyzed with a automatic cell counter (Cell-Dyn 3500R, Abbott Diagnostic). Red Blood Cell Distribution width (RDW) values increased significantly after trot and gallop demonstrating a variation in the size of red blood cells, while Packed Medium Cell Volume (VGM) values did not show variations before or after exercise.

Proposta de um método alternativo para a determinação da concentração de hemoglobina / Proposed an alternative method to determinate the hemoglobin concentration

A hemoglobina (Hb), principal componente das células vermelhas sanguíneas, é um conjugado de proteínas que serve como transporte de O2 e CO2, sendo assim, indispensável à manutenção da vida dos mamíferos. A quantidade de hemoglobina por 100 mL de sangue pode ser utilizada como índice da capacidade de transporte de oxigênio. O teor total de hemoglobina no sangue depende principalmente do número de eritrócitos e, em menor grau, da quantidade de hemoglobina existente em cada eritrócito. Dependendo do método utilizado e dos cuidados com os quais o laboratório afere seus instrumentos, os métodos para a determinação da hemoglobina que utilizam o espectrofotômetro e contadores automáticos, apresentam uma precisão de 4 a 5% e 2 a 3% respectivamente. Como alguns métodos para dosagem da hemoglobina baseiam-se na medida do índice de hemólise, introduzimos no presente trabalho uma técnica na qual foi utilizada apenas água deionizada como diluente, que, seguramente também provoca tal fenômeno. O método proposto tem como objetivo investigar a compatibilidade entre os resultados obtidos com os que fazem uso do ferricianeto de potássio e hidróxido de amônia. A concentração de hemoglobina foi determinada em 30 amostras de sangue recentemente colhidas com EDTA em tubo a vácuo. Para efeito comparativo, foram utilizados dois tipos de padrão: o que acompanha o kit e uma amostra de sangue devidamente padronizada pelo laboratório (LACT). Os resultados obtidos demonstram diferenças significativas entre os métodos realizados com o padrão do fabricante, enquanto que, com o padrão de referência do laboratório, foi verificada uma significativa compatibilidade. Portanto, os dados indicam que o método proposto poderá ser útil na determinação da concentração de hemoglobina no laboratório clínico, não esquecendo o fato de que, além de outras vantagens, a toxicidade causada pelo ferricianeto é totalmente eliminada.