Misleading HbA1c Measurement in Diabetic Patients with Hemoglobin Variants.

BACKGROUND AND OBJECTIVES: Hemoglobin A1c (HbA1c) is widely used for the monitoring and management of diabetes mellitus. The aim of this study is to investigate the influence of hemoglobin (Hb) variants on the measurement of HbA1c. MATERIALS AND METHODS: HbA1c levels of 845 blood samples obtained from diabetic patients with various hemoglobin types were measured using a turbidimetric inhibition immunoassay and capillary electrophoresis. RESULTS: Of 845 patients with diabetes, 65.7% (555/845) have the normal hemoglobin type (A2A) and 34.3% (290/845) have various abnormal hemoglobin types, including heterozygous HbE 30.2% (255/845), homozygous HbE 1.9 % (16/845), Hb Constant Spring (CS) trait 1.4% (12/845), CSEA Bart's 0.2% (2/845), and beta-thalassemia trait 0.6% (5/845). In most of the patients with diabetes, HbA1c levels determined by two different methods, inhibition immunoassay and capillary electrophoresis, gave strong positive correlation (R = 0.901, P < 0.001), except for those with homozygous HbE (N = 16) and CSEA Bart's (N = 2). In all 18 patients with homozygous HbE and CSEA Bart's, the HbA1c was undetectable by capillary electrophoresis, meaning that their estimated average glucose was undeterminable, although their HbA1c levels could be measured using an inhibition immunoassay. The discrepancy of HbA1c results obtained from two different methods is noted in patients without HbA. CONCLUSIONS: We have demonstrated the erroneous nature of HbA1c measurement in patients with hemoglobin variants, especially in those without HbA expression. Therefore, in the population with a high prevalence of hemoglobinopathies, hemoglobin typing should be considered as basic information prior to HbA1c measurement.

Total lymphocyte count: a surrogate marker for predicting CD4+ count in enrolled process for antiretroviral therapy in resource-limited settings.

OBJECTIVE: The purpose of the present study was to evaluate the correlation between total lymphocyte count (TLC) and CD4+ count and TLC cut-off for predicting CD4+ count < 200 cells/mm3. MATERIAL AND METHOD: The 176-naïve HIV-infected patients from the OPD Khon Kaen Hospital, were recruited for CD4+ count by flow cytometer and TLC by automated cell counter. All results were analyzed by STATA statistical software for sensitivity, specificity, PPV and NPV. RESULTS: From 176 patients, 61 (34.7%) had CD4+ > 200 cells/mm3 and 115 (65.3%) had CD4+ < 200 cells/mm3. The ROC curve between CD4+ count and TLC showed TLC < 1,800 cells/mm3 could predict CD4+ count < 200 cells/mm3 with 78.26% sensitivity, 73.77% specificity, 84.91% PPV, and 64.29% NPV. The sensitivity was further decreased and specificity was increased when TLC was lower than cut-off. CONCLUSION: The presented finding indicates that the appropriated TLC for predicting CD4+ count. < 200 cells/mm3 was TLC < 1,800 cells/mm3. TLC can also be used as a surrogate marker for starting ARV therapy in resource limited setting.

Evaluation of a manual CD4+ count kit for determination of absolute CD4+ T-lymphocyte counts.

OBJECTIVE: The aim of the present study was to evaluate a manual CD4+ count kit assay (CD4+: cytospheres) for CD4+ T-lymphocyte count compared with flow cytometric method in HIV infected patients. MATERIAL AND METHOD: One hundred thirty three HIV infected patients were recruited from the out patient department of Khon Kaen Hospital. Blood samples were done by a manual CD4+ count kit assay (CD4+: cytospheres) and flow cytometry for CD4+ T-lymphocyte count. The data were analyzed for diagnostic test and correlation coefficient. RESULTS: The data of cytospheres assay and flow cytomeric method showed good correlation (r = 0.88) for the total group. At the absolute CD4+ T-lymphocyte 200 cells/cu.mm, the cytospheres assay demonstrated sensitivity 83.10% (76.73-89.47%), specificity 93.55% (89.37-97.72%), PPV 93.65% (89.51-97.79%), NPV 82.86% (76.45-89.26%). In the case of CD4+ T-lymphocyte count were lower than 200 cells/cu.mm, the cytospheres assay displayed progressive decrease in sensitivity successive increase in specificity. CONCLUSION: The cytospheres technique is an alternative noncytofluorometric assay for CD4+ T-lymphocyte count. This test may be useful for screening in HIV infected adult patients in community hospitals where flow cytometry technique is not available. But the assay is limited in determination only absolute CD4+ T-lymphocyte count with higher than 30 cells/cu.mm. This technique is not benefit in pediatric HIV/AIDS patient due to percentage CD4+ value did not obtained. The quality control should be concern technical skill and proficiency testing for laboratory setting.

Potent reactive oxygen species-JNK-p38 activation by sodium salicylate potentiates death of primary effusion lymphoma cells.

BACKGROUND: Primary effusion lymphoma (PEL) is a rare but aggressive form of non-Hodgkin's B-cell lymphoma in immunodeficient patients. Resistance to conventional chemotherapeutic regimens is common in PEL and contributes to a very poor prognosis; hence, novel potent anti-PEL agents are required. Anticancer effects of non-steroidal anti-inflammatory drugs (NSAIDs) are well-established in epithelial cancer but are unclear in hematological malignancies. Therefore, the anticancer activities of selected NSAIDs, sodium salicylate (NaS), on PEL cell lines are of interest. MATERIALS AND METHODS: Anti-proliferation of NaS on PEL cell lines was shown by MTT. Apoptosis induction and caspase activations were determined by flow cytometry analysis. ROS production was accessed by DCFH-DA. Western blot was performed to determine molecular mechanisms. RESULTS: NaS effectively inhibited cell proliferation of all PEL cell lines. Caspase-dependent apoptosis was demonstrated and simultaneous induction of reactive oxygen species production and c-Jun N-terminal kinases (JNK)-p38 activation was observed prior to apoptosis induction, and these might be responsible for NaS-induced apoptosis. CONCLUSION: Significant anticancer effects of NaS on PEL cell lines were found. A novel role of NaS for PEL treatment is suggested.