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Background Early diagnosis and prompt management are crucial for bacteremia and sepsis, as they have the potential to lead to septic shock and fatal outcomes. Bacteremia induces the recruitment of immature granulocytes (IGs) into the circulation, which indicates active bone marrow response. The goal of our present study is to determine the effectiveness of automated IG measurement as an alternate indicator for infection and also its clinical utility in predicting positive blood culture (BC) results. Methods We conducted a retrospective study including 100 BC-positive patients for whom complete blood count (CBC) and BC were done at the same time. Multiple hematological parameters including total white blood cell count (TWC), absolute neutrophil count (ANC), absolute lymphocyte count (ALC), IG count (IGC), and IG percentage (IG%) were obtained from the automated hematology analyzer, and IGC/TWC (IG ratio), IGC/ANC (immature-to-total neutrophil ratio), and ANC/ALC (neutrophil-to-lymphocyte ratio) were calculated using the primary data and compared with 100 uninfected normal individuals. Results The mean value of IG% and IGC between culture-positive and culture-negative groups were statistically significant (p-value < 0.05), suggesting that they are potential markers for bacteremia, and also the IG% was significantly higher in patients with positive BCs. Conclusion IG measurement is an easily accessible, cost-effective potential marker for screening bacteremia. Therefore, IGC and IG% could be incorporated as a part of the CBC report.
RESUMO
Beta-thalassemia is one of the most common inherited hematological diseases caused by more than 350 mutations in the ß-globin gene (HBB). Beta-thalassemia carrier or trait is associated with defects in one allele of the HBB gene. The majority of beta-thalassemia trait cases remain concealed in society and remain unnoticed as they are mostly asymptomatic or present with mild symptoms of anemia. There is a 25% chance of having children with beta-thalassemia major and a 50% chance of having carrier babies when two people with beta-thalassemia trait are married. Hence, it is important to identify the individuals with beta-thalassemia trait and provide counseling to understand the risks of pregnancy and its outcome. Aim To study the identification of beta-thalassemia trait cases along with their clinical findings and hematological correlation. Materials and methods Study Design This was a retrospective study conducted at Saveetha Medical College and Hospital for a period of four years from January 2020 to December 2023. Inclusion Criteria Age group more than 18 years, antenatal mother, cases of anemia who were refractory to iron treatment, and screening of family members in the positive cases of beta-thalassemia trait. Exclusion Criteria History of blood transfusion within three months was excluded. Data Collection A total number of 837 cases were screened to rule out the presence of beta-thalassemia trait/hemoglobin (Hb) variants. A 2 mL of intravenous blood samples were collected in an ethylene diamine tetraacetic acid (EDTA) vacutainer tube and processed in a Sysmex XN 1000 (Hyogo, Japan: Sysmex Corporation) automated hematology analyzer. The hematological parameters were analyzed. Statistical Analysis The study included both descriptive and analytical characteristics. Mean and standard deviation (SD) were calculated for all the hematological parameters. Beta-thalassemia trait was diagnosed with an HbA2 level of more than 4.0% through high-performance liquid chromatography (HPLC) analysis. Results Among the 837 samples studied for HPLC screening, 74 (8.8%) cases were found to have beta-thalassemia trait. The age group included was from 18 years to 56 years. Of 74 cases studied, 32(43%) were females and 42(57%) were males. Among the 74 cases studied, the Mentzer index <13 was seen in 58 (78%) cases and the Mentzer index >13 was seen in 16 cases (22%). Thirty-four cases (46%) of beta-thalassemia traits presented to the hospital with a history of fever for evaluation and antenatal screening accounted for 19 cases (26%). The mean red blood cell (RBC) count was 5.5 million/cu.mm; mean corpuscular volume (MCV) was 63.8 fL; mean corpuscular hemoglobin (MCH) was 19.6 pg; red cell distribution width coefficient of variation (RDW-CV) was 17.8%. Among the 74 cases studied, 37(46%) cases had an Hb of more than 11 g/dL, 22 cases had mild anemia, 12 cases had moderate anemia, and three cases had severe anemia. Conclusion This study concluded that regular monitoring of the Mentzer index along with HPLC analysis is an effective approach in identifying beta-thalassemia trait cases and further providing genetic counseling among the couples that will help in reducing high-risk pregnancy and the birth of a child with thalassemia major.