COMPARATIVE ANALYSIS OF HAEMATOLOGICAL PARAMETERS AMONG INFREQUENT AND REGULAR REPEAT WHOLE BLOOD DONORS IN A TERTIARY CARE CENTRE-A PILOT STUDY

Blood transfusion service is a vital part of our health care system. Stringent blood donor screening and medical examination plays a vital role in maintaining the quality and safety of blood components. Voluntary non-remunerated blood donors form the backbone of blood transfusion services. However, regular donation by such voluntary donors may cause significant depletion of iron stores in the body. This has the potential to adversely affect the donor's health, and also to lower the quality of blood being collected subsequently. Even though a pre-donation hemoglobin estimation is routinely done in blood centres, it may fail to recognize subclinical iron store depletion. Testing Ferritin level of all donors is not cost effective and practical in resource limited centres. This study was aimed to identify any significant changes in hematological parameters over repeated blood donations, that may point towards a potential Iron deficiency in an otherwise healthy donor. This was a cross sectional study involving 138 whole blood donors who had attended the blood centre, Department of Transfusion Medicine, Government Medical college, Thiruvananthapuram. The study subjects were categorized into 2 groups based on the number of donations and a Complete blood count (CBC) was done for each group. Data was analyzed using SPSS software, quantitative variables expressed as Mean and Standard Deviation, p value <0.05 was considered statistically significant. Results were analysed by Independent Samples T test. Statistically significant variables were further analysed using Kruskal-Wallis test. Second time blood donors constituted major part of sample size (20/138). Mean Hemoglobin value showed no significant change among the two donor categories. Mean corpuscular volume (MCV) of repeat whole blood donors is significantly lower than infrequent donors independent samples T test, tvalue=3.309. (p-value=0.001). Donors were further subdivided into 5 groups in the order of increasing number of donations and significant difference was observed in MCV and proved by Kruskal-Wallis test(H=19.1344) As per our study, a significant reduction in MCV among repeat donors with a normal hemoglobin value compared to infrequent donors. This might point towards an impending Iron deficiency anemia in near future. A prompt detection of subclinical iron deficiency in voluntary blood donors is the need of the hour since it can cause adverse consequences in donor health and can considerably lower the donor availability as well. Blood centres should take measures like routine Iron stores evaluation of regular repeat donors, educating donors regarding the importance of maintaing a healthy diet, Iron tablet supplementation to prevent donor Iron deficiency anemia (IDA) etc.

Evaluation and optimization of pre-pregnancy and pregnancy thalassaemia screening programmes in Hainan Province / 中国热带医学

@#Abstract: Objective　To evaluate the free thalassaemia screening programme for preconception and pregnancy in Hainan Province, and to provide a theoretical basis for optimizing the screening process for thalassaemia. Methods From November 2020 to July 2021, a survey was conducted on 10 396 adults with Hainan household registration who participated in the Epidemiological Survey of Thalassemia in Hainan Residents in 19 cities and counties of Hainan Province. All of them underwent routine blood tests, haemoglobin electrophoresis tests and genetic tests for thalassaemia. The optimal diagnostic cut-off values for mean corpuscular volume (MCV), mean corpuscular haemoglobin (MCH), and haemoglobin adult type 2 (HbA2) were determined using screening test indexes such as receiver operating characteristic curve and sensitivity. The diagnostic effectiveness of different primary screening programs for thalassemia gene carriers was evaluated. Results Using the existing MCV single-indicator thalassemia primary screening protocol in Hainan Province, where individuals with MCV<82 fL undergo thalassemia gene testing, resulted in a high missed diagnosis rate (34.06%) and low sensitivity (65.94%). The optimal cut-off values for MCV screening for alpha-and beta-thalassaemia were 84.45 fL and 79.05 fL, respectively; the optimal cut-off values for MCH screening for alpha-and beta-thalassaemia were 27.95 pg and 25.15 pg, respectively. The optimal cut-off value for HbA2 screening for alpha-thalassaemia was less than 2.55% and greater than 3.35% for beta-thalassaemia. The "combined HbA2 or MCH or MCV screening protocol" with the cut-off values recommended in this study had a better performance in primary screening for thalassemia, with the highest sensitivity (92.96%) and negative predictive value (92.67%) and the lowest underdiagnosis rate (7.04%), statistically significant differences compared with the existing protocol (P<0.05). Conclusions The current process of screening for thalassemia in Hainan Province may lead to missed diagnoses. The combined use of MCV, MCH and HbA2 for thalassemia screening, adopting locally suitable cutoff values for primary screening indicators, can improve the incidence of missed reporting of thalassemia and enhance diagnostic effectiveness.

Effectiveness of Using Mean Corpuscular Volume and Mean Corpuscular Hemoglobin for Beta-thalassemia Carrier Screening in the Guangdong Population of China / 生物医学与环境科学（英文）

Beta (β)-thalassemia is one of the most common hemoglobinopathies worldwide, creating major public health problems and social burdens in many regions. Screening for β-thalassemia carriers is crucial for controlling this condition. To investigate the effectiveness of mean corpuscular volume (MCV) and mean corpuscular hemoglobin (MCH) for screening β-thalassemia, retrospective data were analyzed for 6,779 β-thalassemia carriers subjected to genetic testing following thalassemia screening in Guangdong province between January 2018 and December 2019. Prevalent mutations observed included CD41/42 (-TTCT) (38.43%), IVS-II-654 (C > T) (25.71%), -28 (A > G) (15.78%), CD17 (AAG > TAG) (10.03%), and β

Some Haematological Parameters among Urinary Schistosomiasis-Malaria Coinfected Children in Suburb of Malentouen Health District, West Region Cameroon

Background:Schistosomiasisand Malaria are among the most prevalent afflictions of humans who live in areas of poverty in the developing world. The present study was aimed at determining the socio demographic characteristics and prevalence of schistosomiasis and malaria in childrenliving in Suburb of Malentouen Health District and analyzing the effect of co-infection on haemoglobin level, mean corpuscular volume and platelet count. Methods:Questionnaires were distributed to parents or guardians of children attending public primaryschool in the area. A total of 429 pupils aged 6-15 years old were screened for urinary schistosomiasis and 228 out of the 429 were tested for. Prevalences of thetwo parasites were calculated; Haemoglobin level, Mean Corpuscular Volume and platelets count of the 228 participants were recorded.Results:The prevalence of malaria was 26.75%, where as that of schistosomiasis was 43.82%. 31(13.60%) of the participants were co-infected with the two parasites. Mean haemoglobin level obtained was 11.01± 1.19 G/dL, that of MCV was 84.50±5.31/fl and the mean platelet count was 255.13±96.99/μl. In malaria single infected and co-infected participants, low haemoglobin level (2= 50.315, p = .000), low MCV (2= 27.448, p = .000) and low platelets count (2= 37.253, p = .000)were observed with significant variations.Conclusions:The three haematological parameters analysed in this study (Hb, MCV, Platelets count), showed low level or amount in malaria and malaria-schistosomiasis infected participants. Moreover, thrombocytopenia in children in this endemic area may be useful as supportive diagnostic criteria for malaria in case with low level of parasite number

Macrocytosis is highly prevalent in Raebareli district, Uttar Pradesh, India

Background: Anemia is a most common health issue in Indian population mainly due to nutritional deficiencies. A number of factors contribute in anemia which is further categorized based on various parameters in hematological indices and microscopic examination.Methods: A retrospective study has been carried out on the patients (n = 1332) in a retrospective study on the patients (n = 1332) in Raebareli district to determine prevalence of anemia and subsequent categorization into normocytic, microcytic and macrocytic based on complete blood count (CBC) profile and blood smear.Results: This study demonstrates 15.54% patients were diagnosed for anemia and more than half of the total anemic patients (55.07%) were found to be suffered from macrocytosis which was found significantly more prevalent among male (65.17%) compare to female (38.38%) patients.Conclusions: Several factors may contribute to macrocytosis among male population including alcoholism in Raebareli region. However, female patients were found almost equally susceptible to all three forms of anemia: normocytic, microcytic and macrocytic. This study provides a key insight into prevalence and possible causes of different types of anemia in this region which may be useful for implementation of government health programs to counter this problem and provide better treatment plans.

Study of the prevalence of isolated vitamin B12 deficiency related dementia in patients presenting to a tertiary care hospital

Background: Objective of the study was to determine the prevalence of Isolated B12deficient dementia in patients presenting to a tertiary care hospital. The MMSE was much lower in B12 deficiency compared to irreversible causes Thus, shorter duration, severe dementia, focal neurological signs, and a vegetarian diet were significantly associated with the development of B12 deficiency.Methods: Based on exclusion and inclusion criteria 100 patients were included in this study, a detailed history of the patient were taken with respect to duration of dementia and its symptoms, type and treatment. Study in terms of the correlation of the clinical features with investigations and diet. Estimation of the prevalence of dementia with reference to B12 deficiency. Mean MMSE analysis, assessment of the improvement in MMSE after treatment with B12 injections after a6-8 wks period.Results: In this study most of our patients were in the 60-69 age groups across all causes of dementia, 22out of 26, B12 deficient patients were vegetarians. This value was in keeping with the known fact that a vegetarian diet predisposes a person to develop B12 deficiency. The association between B12 deficiency, high MCV and megaloblastic blood picture in peripheral blood smear was significant. The MMSE scores were significantly lower 13.42 in patients with B12 deficiency as compared to those with Alzheimer's 14.3 means and those with multi-infarct state 17.3 means.Conclusions: The duration of the presentation in B12 deficiency was10-12months averagely. There was a significant improvement in MMSE after treatment in pureB12 deficient patients (by 9 points) if they presented within one year of symptoms. Except for myelopathy, there was an improvement in other neurological symptoms and signs. Early diagnosis and proper treatment can make improvements in a patient's memory and quality of life.

Mean corpuscular volume ≤100 fl was an independent prognostic factor in patients with myelodysplastic syndrome and bone marrow blast<5 percent / 中华血液学杂志

Objective@#To explore the prognostic effects of mean corpuscular volume (MCV) in patients with myelodysplastic syndromes (MDS) .@*Methods@#321 newly diagnosed, untransfused primary MDS patients who administered from December 2009 to December 2017 were enrolled. The association of MCV with prognosis and several clinical features and genetic mutations were analyzed.@*Results@#Patients were divided into MCV≤100 fl (n=148) and MCV>100 fl (n=173) cohorts. Median overall survival of patients with MCV≤100 fl was shorter than their counterparts (27 months vs 72 months, P<0.001) . In subgroup analysis, MCV≤100 fl patients had worse survivals in bone marrow blast <5% cohort (34 months vs not reached, P=0.002) , but not so in ≥5 % cohort (17 months vs 20 months, P=0.078) . MCV≤100 fl was still an independent adverse variable (HR=1.890, 95%CI 1.007-3.548, P=0.048) after adjusting for clinical and laboratory variables and mutation topography in bone marrow blasts<5% cohort. In bone marrow blasts<5% cohort, patients with MCV≤100 fl had higher hemoglobin levels [90 (42-153) g/L vs 78.5 (28-146) g/L, P=0.015].The proportions of Revised International Prognostic Scoring System (IPSS-R) high/very high risks and poor/very poor IPSS-R karyotypes were higher in MCV≤100 fl cohort (28.8% vs 10.8%, P=0.003; 24.7% vs 12.9%, P=0.049) . MCV≤100 fl cohort had more genetic mutations than those with MCV>100 fl though without significance (0.988 vs 0.769, P=0.064) . Mutated SF3B1 was less frequently in MCV≤100 fl cohort (4.7% vs 15.4%, P=0.018) .@*Conclusion@#MCV≤100 fl was an independent adverse variable after adjusting for clinical and laboratory variables and mutation topography in MDS patients with bone marrow blasts<5%.

Mean corpuscular volume ≤100 fl was an independent prognostic factor in patients with myelodysplastic syndrome and bone marrow blast<5 percent / 中华血液学杂志

Objective: To explore the prognostic effects of mean corpuscular volume (MCV) in patients with myelodysplastic syndromes (MDS) . Methods: 321 newly diagnosed, untransfused primary MDS patients who administered from December 2009 to December 2017 were enrolled. The association of MCV with prognosis and several clinical features and genetic mutations were analyzed. Results: Patients were divided into MCV≤100 fl (n=148) and MCV>100 fl (n=173) cohorts. Median overall survival of patients with MCV≤100 fl was shorter than their counterparts (27 months vs 72 months, P<0.001) . In subgroup analysis, MCV≤100 fl patients had worse survivals in bone marrow blast <5% cohort (34 months vs not reached, P=0.002) , but not so in ≥5 % cohort (17 months vs 20 months, P=0.078) . MCV≤100 fl was still an independent adverse variable (HR=1.890, 95%CI 1.007-3.548, P=0.048) after adjusting for clinical and laboratory variables and mutation topography in bone marrow blasts<5% cohort. In bone marrow blasts<5% cohort, patients with MCV≤100 fl had higher hemoglobin levels [90 (42-153) g/L vs 78.5 (28-146) g/L, P=0.015].The proportions of Revised International Prognostic Scoring System (IPSS-R) high/very high risks and poor/very poor IPSS-R karyotypes were higher in MCV≤100 fl cohort (28.8% vs 10.8%, P=0.003; 24.7% vs 12.9%, P=0.049) . MCV≤100 fl cohort had more genetic mutations than those with MCV>100 fl though without significance (0.988 vs 0.769, P=0.064) . Mutated SF3B1 was less frequently in MCV≤100 fl cohort (4.7% vs 15.4%, P=0.018) . Conclusion: MCV≤100 fl was an independent adverse variable after adjusting for clinical and laboratory variables and mutation topography in MDS patients with bone marrow blasts<5%.

A comparative study on hematological parameters among the social and problem drinkers admitted in a tertiary care rehabilitation centre

Background: Alcoholism is a broad form for problems with alcohol and is generally used to mean compulsive and uncontrolled consumption of alcoholic beverages, usually to the determinant of drinker’s health, personal relationships and social standing. It is medically considered a disease, specifically an addictive illness. Alcohol has numerous adverse effects on the various types of blood cells and their functions. This study aimed to evaluate the hematological changes in alcoholic patients admitted in tertiary care hospital.Methods: The blood samples were collected from alcoholics admitted in a psychiatric and rehabilitation centre and the samples were processed in hematology laboratory in a tertiary care hospital. The hematological parameters (CBC) except ESR, were performed by using fully automated blood cell counters. The change in alcoholics was studied under two categories-social drinkers and problem drinkers. The results of these parameters were compared with age and sex matched normal population.Results: Total 200 cases included in which 110 were abstainers and 90 were alcoholics. Among alcoholics 67% were problem drinkers and 33% were social drinkers. The mean values of Hb, RBC and MCV in social drinkers were 11.1 g/dl, 3.1 million cells /μl and 100.5 fl, in problem drinkers were 9.8 g/dl, 2.89 million cells /μl and 105.5 fl, and in control population were 14.8 g/dl, 4.8 million cells / μl and 93 fl respectively.Conclusions: The study shown that parameters were changed in both social drinkers and problem drinkers. But predominant changes were observed in problem drinkers. The presence of elevated MCV and decreased RBC and Hb are suggestive of megaloblastic changes.

Evaluation of clinical, biochemical and hematological parameters in macrocytic anemia

Background: Macrocytosis can be seen in many hematological and non-hematological disorders and more than one cause may co-exist in an individual. Serum vitamin B12 and folic acid tests are routinely ordered but they are limited by their low sensitivity and specificity. This study is done to analyze the clinical, hematological and biochemical parameters in macrocytic anemia and to study the difference between megaloblastic and non-megaloblastic anemia in these parameters.Methods: There were 100 patients presenting with macrocytosis were taken in to study. A detailed clinical history and physical examination was done in all cases. CBC, biochemical investigations, peripheral blood examination, Vitamin B12, folate levels, bone marrow aspiration and reticulocyte count was done in all cases.Results: Primary bone marrow disorders were the most common cause of macrocytosis (45%). The other causes in decreasing order of frequency were megaloblastic anemia (36%), alcoholism and liver disease (15%), drug induced (2%) and idiopathic thrombocytopenic purpura (1%). There was a significant difference in the mean values of MCV and serum LDH between megaloblastic and non-megaloblastic macrocytosis. When serum LDH >1124.5IU/L or MCV>120.5fl (criterion values of ROC curve) with reticulocyte count <2% was taken as criteria, the sensitivity was 94.4% and specificity was 93% for diagnosing megaloblastic anemia.Conclusions: Systematic evaluation of macrocytosis will help us to distinguish megaloblastic and non-megaloblastic macrocytosis. The blood and biochemical parameters especially CBC, RC, and serum LDH along with supporting clinical features help us in diagnosing megaloblastic anemia in a setup where vitamin and metabolite levels are difficult to obtain.

Estimation of Hb, MCV, MCH variations in different types of febrile seizures

Introduction: Febrile seizures are seizures that occur between the age of 6 and 60 months with a temperature of 38°C (100.4°F) or higher, that are not the result of central nervous system infection or any metabolic imbalance, and that occur in the absence of a history of prior afebrile seizures. Aim of the study: To Estimate the HB, MCV, MCH variations in different types of Febrile Seizures. Materials and methods: This case-control study was conducted at the Department of Pediatrics, Tirunelveli Medical College Hospital, Tirunelveli, from 2017-2018.All cases of febrile seizures which include both simple febrile and complex febrile seizures between the age group of 6 and 60 months. The control group includes the children in the same age group with fever but without seizures Results: Among 75 children presenting with febrile seizures, 52 children were presenting with simple febrile seizures (69.3%) and 23 children were presenting with complex febrile seizures. Average mean Hb level in those children presenting with febrile seizures was 10.37 gm. Average mean Hb level in children those who do not have febrile seizures was 11.48 gm. The p-value between the mean Hb level of 2 groups was less than 0.001 which is statistically significant. In children with febrile seizures, the mean MCV was 70.83. In children, those who do not have febrile seizures the mean MCV was 77.89 which was higher than those of children having febrile seizures. The difference between the two groups was statically significant. Average mean of MCH in children with febrile seizures (23.69) was lower than the children those who are presenting without febrile seizures (27.58). Thus the p-value was less than 0.001 which was statistically significant. Conclusion: The hemoglobin levels were significantly lower in the case group compared to the control group. The present study concluded anemia as a risk factor for febrile seizures and emphasizes the importance of prevention and timely intervention and management of Iron deficiency anemia in children to decrease mortality and morbidity associated with febrile seizures.

Clinical analysis of vitamin B12 deficiency mainly manifested by recurrent aphthous ulcers / 口腔疾病防治

Objective@# To analyze the clinical characteristics and treatment experience of Vitamin B12 (VB12) deficient patients with recurrent aphthous ulcers (RAU) to improve the clinical efficacy. @*Methods@#A retrospective analysis was performed on 15 cases of recurrent oral ulcers from January 2016 to September 2018. The causes were analyzed according to the patients’ clinical characteristics. @*Results@# In total, 15 patients with RAU had no remission after routine immunotherapy. Further clinical examination suggested that vitamin B12 levels were reduced. The erythrocyte mean corpuscular volume (MCV) was significantly increased, and the average number of red blood cells (RBC) and hemoglobin (Hb) levels were decreased. RAU disappeared after vitamin B12 supplementation. Routine blood work showed that the MCV returned to the normal range, which was statistically significant compared with the pretreatment MCV (P < 0.001). Vitamin B12 serum levels were significantly higher (P < 0.001) than those before treatment.@*Conclusion @#When the main manifestation of vitamin B12 deficiency is recurrent oral ulcer symptoms, dentists should examine the lesions carefully, inquire about the medical history in detail, and perform further serological tests when necessary to avoid the overuse of immunosuppressive drugs for treatment.

Hematological parameters for male nile tilapia fed different oil sources / Parâmetros hematológicos de machos de tilápia do nilo alimentadas com diferentes fontes de óleo

Tilapia is one of the most bred species in Brazil because it is resistant to viral, bacterial and parasitic diseases when compared to other cultivated fish. Knowledge about the blood components and their function is important for normal and pathological balance. Different oil sources used to feed breeding males of Nile tilapia (Oreochromis niloticus) were evaluated on the hematological parameters. In the experiment, we used 80 male tilapias, 20 males for each treatment. The experiment was a completely randomized design with 4 treatments and four repetitions, which used a 32% CP diet and isoproteic isoenergetic 3,300 kcal DE kg-1 each implemented with a different oil source T1: linseed oil (OL), T2: soy oil (SO), T3: fish oil (OF) and T4: corn oil (CO).The feeding management consisted on two daily feeding at 8 am and 4 pm, in the amount of 3% body weight. The diet intake was 232.2 g/day. No significant difference was detected for the percentage of red cells, mean corpuscular volume, hematocrit, and mean leukocyte percentage. However, for the mean corpuscular hemoglobin concentration (CHCM) and hemoglobin, fish fed soybean oil presented significantly higher values than other treatments. The soybean oil, characterized by iron with a high bioavailability, led to higher levels of hemoglobin and CHCM in Nile tilapia, which possibly can reflect a greater oxygenation in fish. However, the fish oil originated greater values of both components of the blood (hematocrit, red cells) and immune (thrombocytes, monocytes, neutrophils and lymphocytes) system.

A tilápia é uma das espécies mais criadas no Brasil pois apresenta resistência a doenças virais, bacterianas e parasitárias, quando comparada a outros peixes cultivados. O conhecimento sobre os componentes do sangue e de suas funções é importante para o as condições de equilíbrio normais e patológicas. Foram avaliadas diferentes fontes de óleo na alimentação de machos reprodutoras de tilápia do Nilo (Oreochromis niloticus) sobre os parâmetros hematológicos. Para isso, foram utilizadas 80 machos reprodutores de tilápia do Nilo. Cada alimento foi suplementado com 6% de diferentes fontes lipídicas, sendo: óleo de soja; óleo de milho; óleo de linhaça; óleo de peixe. O manejo alimentar incluiu dois alimentação diária às 8 horas e 4 horas, no valor de 3% do peso corporal. A ingestão de dieta era 232,2 g / dia. Nenhuma diferença significativa foi detectada pela percentagem de glóbulos vermelhos, volume corpuscular médio, o hematócrito, eo percentual de leucócitos dizer. No entanto, para a concentração média corpuscular de hemoglobina (CHCM) e hemoglobina, peixes alimentados com óleo de soja apresentaram valores significativamente mais elevados do que outros tratamentos. O óleo de soja, caracterizada por ferro com uma elevada biodisponibilidade, levou a níveis mais elevados de hemoglobina e CHCM em tilápia do Nilo, que, possivelmente, podem refletir uma maior oxigenação nos peixes. No entanto, o óleo de peixe originado pelos maiores valores de ambos os componentes do sangue (o hematócrito, glóbulos vermelhos) e imunitários (trombócitos, monócitos, neutrófilos e linfócitos) do sistema.

Anemia microcítica-hipocrómica: anemia ferropénica versus b talasemia menor / Microcytic and hypochromic anemia: iron deficiency anemia versus b thalassemia trait / Anemia microcitica-hipocrômica: anemia ferropênica versus b talassemia menor

Las anemias microcíticas hipocrómicas (m-H) presentan VCM<80 fL y HCM<27 pg. Son producto de la baja biodisponibilidad del hierro (Fe), o del defecto de la síntesis de globinas o del HEMO. La más frecuente es la anemia por deficiencia de hierro (ADH), seguida por las talasemias y las anemias de procesos crónicos. Menos frecuentes son aquellas por defectos en el HEMO o por causas genéticas del metabolismo del Fe. El objetivo del trabajo es revisar, por medio de parámetros de distinta complejidad, diferencias entre ADH y b talasemia heterocigota (b-Tal-het), las m-H de mayor prevalencia en nuestro medio. Los recuentos de eritrocitos y reticulocitos, hemoglobina, ferremia, ferritina, saturación de la transferrina, HbA2, porcentaje de alteraciones morfológicas son menores en la ADH. El VCM, el HCM, la ADE, los índices de microcitosis, transferrina, y los receptores solubles de transferrina son menores en b-Tal-het. El estrés oxidativo está aumentado en ambas patologías. En el análisis de estos parámetros se discute el grado de deficiencia de Fe y/o la mutación de b-Tal-het. Se aplica un algoritmo para m-H a partir del Fe sérico. Una vez descartadas las m-H más comunes, se debe investigar a-Tal-het, la cual se considera la causa de la mayoría de m-H inexplicadas.

Microcytic hypochromic anemia (m-H) presents MCV<80 fL and MCH<27 pg. m-H can result from iron availability, defects in globin or HEMO synthesis. The most frequent m-H is iron deficiency anemia (IDA), followed by thalassemias and anemia chronic disease. Rare m-H are a consequence of HEME defects or iron metabolism genetic defects. The aim of this study is to review the differential diagnosis between IDA and b thalassemia trait (b thal trait), the most frequent in our environment. Results of laboratory tests are analysed. Erythrocytes, hemoglobin, reticulocytes, iron, ferritin, transferrin saturation, HbA2 and percentage of morphologic changes are lower in IDA compared with b Thal trait. MCV, MCH, RDW, microcytic index, transferrin and soluble transferrin receptor are higher in IDA compared with b Thal trait. Oxidative stress is increased in the two forms of microcytoses. Degree iron deficiency in IDA and b Thal trait mutation must be considered in the analysis of the parameters. A flowchart is proposed to evaluate m-H stemming from serum iron value. After excluding the most frequent causes of microcytic anemia, a thalassemia trait must be considered.

As anemias microcíticas hipocrômicas (m-H) apresentam VCM<80 fL e HCM<27 pg. São produto da baixa biodisponibilidade do ferro (Fe), ou do defeito da síntese de globinas ou do HEMO. A mais frequente é a anemia por deficiência de ferro (ADH), seguida pelas talassemias e as anemias de processos crônicos. Menos frequentes são aquelas por defeitos no HEMO ou por causas genéticas do metabolismo do Fe. O objetivo do trabalho é revisar, através de parâmetros de diversa complexidade, diferenças entre ADH e b talassemia heterocigota (b-Tal-het), as m-H de maior prevalência no nosso meio. As contagens de eritrócitos e reticulócitos, hemoglobina, ferremia, ferritina, saturação da transferrina, HbA2, percentagem de alterações morfológicas são menores em ADH. O VCM, o HCM, a ADE, os índices de microcitose, transferrina, receptores solúveis de transferrina são menores em b-Tal-het. O estresse oxidativo está aumentado em ambas as patologias. Na análise destes parâmetros é discutido o grau de deficiência de Fe e/ou a mutação de b-Tal-het. Aplica-se um algoritmo para m-H a partir do Fe sérico. Depois de serem descartadas as m-H mais comuns, deve investigar-se a-Tal-het, a qual é considerada a causa da maior parte de m-H inexplicadas.

The Effect of Drowning in a Bathtub on Erythrocytes in Victims / 日本温泉気候物理医学会雑誌

<p>  <b>Objective</b>: The aim of the present study was to investigate the effect of bathtub drowning on erythrocytes in victims. </p><p>  <b>Methods</b>: Thirty-nine consecutive victims with CPA were included in the present study and consisted of 16 males and 23 females, 8-95 years of age, median 78 years old. Data on the arrival examination were analyzed, which consisted of serum sodium (Na) and chloride (Cl), hematocrit (Ht)/hemoglobin (Hb) ratio, mean corpuscular volume (MCV) and mean corpuscular hemoglobin (MCH). In addition, the changes of MCV level in accordance with treatment in two bathtub drowning victims, one who was resuscitated and the other who had been under treatment in our hospital, were compared with those in two water intoxication patients.</p><p>  <b>Results</b>: Of the 39 victims, 18 showed serum Na levels to be lower than normal range (NR) but no victim showed one higher than NR. In serum Cl level, 22 victims showed levels below NR but no one showed a level above NR. As to the value for the Ht/Hb ratio, the ratios were within NR in only three victims and were above NR in the rest. In MCH, three victims showed levels below NR and one victim showed a level above NR. In MCV, 16 victims showed levels above NR but no one showed a level below NR. The comparison of MCV between drowning victims and water intoxication patients pointed out a difference in the effect on treatment: in cases of drowning, MCV increased only on the day of the event and returned to baseline the next day, whereas in cases of water intoxication, MCV remained unchanged for a few days after treatment and then increased. </p><p>  <b>Conclusion</b>: It is well known that freshwater drowning induces both hyponatremia and hypochloremia, which are caused by water transferred from alveoli to blood vessels. The increased MCV in bathtub drowning victims is induced by the expansion of erythrocytes through lower osmotic pressure, which exceeds the decreased change in hematocrit due to hemodilution, although the mechanism of the change in MCV in water intoxication cases is not identified.</p>

The Effect of Drowning in a Bathtub on Erythrocytes in Victims / 日本温泉気候物理医学会雑誌

  Objective: The aim of the present study was to investigate the effect of bathtub drowning on erythrocytes in victims.   Methods: Thirty-nine consecutive victims with CPA were included in the present study and consisted of 16 males and 23 females, 8-95 years of age, median 78 years old. Data on the arrival examination were analyzed, which consisted of serum sodium (Na) and chloride (Cl), hematocrit (Ht)/hemoglobin (Hb) ratio, mean corpuscular volume (MCV) and mean corpuscular hemoglobin (MCH). In addition, the changes of MCV level in accordance with treatment in two bathtub drowning victims, one who was resuscitated and the other who had been under treatment in our hospital, were compared with those in two water intoxication patients.  Results: Of the 39 victims, 18 showed serum Na levels to be lower than normal range (NR) but no victim showed one higher than NR. In serum Cl level, 22 victims showed levels below NR but no one showed a level above NR. As to the value for the Ht/Hb ratio, the ratios were within NR in only three victims and were above NR in the rest. In MCH, three victims showed levels below NR and one victim showed a level above NR. In MCV, 16 victims showed levels above NR but no one showed a level below NR. The comparison of MCV between drowning victims and water intoxication patients pointed out a difference in the effect on treatment: in cases of drowning, MCV increased only on the day of the event and returned to baseline the next day, whereas in cases of water intoxication, MCV remained unchanged for a few days after treatment and then increased.   Conclusion: It is well known that freshwater drowning induces both hyponatremia and hypochloremia, which are caused by water transferred from alveoli to blood vessels. The increased MCV in bathtub drowning victims is induced by the expansion of erythrocytes through lower osmotic pressure, which exceeds the decreased change in hematocrit due to hemodilution, although the mechanism of the change in MCV in water intoxication cases is not identified.

Differences of erythrocyte distribution width and prothrombin time in patients with different degrees of liver injury / 重庆医学

Objective To investigate the change trend of erythrocyte distribution width (RDW) and prothrombin time (PT) in patients with different degrees of hepatic injury and its clinical significance .Methods A total of 100 inpatients with hepatitis B (HB group) ,100 patients with liver cirrhosis (cirrhosis group) and 50 patients with primary hepatocellular carcinoma (HCC) asso-ciated with HBV (liver cancer group) in the Second Affiliated Hospital of Chongqing Medical University from January 2014 to June 2015 were selected .The peripheral blood RDW and the average volume of erythrocytes (MCV) of all the subjects were detected by Sysmex XE-2100 automatic hematology analyzer .The PT was measured by Stago Rack Evolutio automatic coagulation analyzer and compared .Results There was no significant difference in RDW between the cirrhosis group and the HCC group (P=0 .099) ,and the difference between the other groups was statistically significant (P<0 .01) .As the disease progressed ,the RDW gradually in-creased .There was no significant difference in MCV comparison among all groups (P>0 .05) .There was no significant difference in PT between the HB group and the cirrhosis group (P=0 .234) ,and the difference between the other groups was statistically signif-icant (P<0 .01) .As the disease progressed ,PT gradually increased .Conclusion The increase of RDW and PT are related to the severity of liver injury .RDW may be an index to predict the degree of liver injury in patients .

Reticulocyte parameters of normal human and its relationship with mature erythrocyte parameters / 国际检验医学杂志

Objective To investigate the relationship between the parameters of the red blood cells and the corresponding param‐eters of mature red blood cells .Methods Blood samples of 112 healthy males and 110 healthy females were tested for these reticu‐locyte parameters by using Siemens Advia2120 hematology analyzer .Reference intervals were established .Comparisons between these reticulocyte parameters and the corresponding parameters of mature erythrocytes were drawn .Results Reference intervals for the healthy group recruited in this study were determined as follows .Females ,percentage of reticulocyte (Retic% ):0 .45% ~1 .76% ,absolute reticulocyte number(Retic#):(22~86)× 109/L ,mean corpuscular hemoglobin content of reticulocyte(CHr):30 . 1~36 .4 pg ,mean corpuscular volume of reticulocyte(MCVr):99 .5~113 .7 fL .Male ,Retic% :0 .54% ~1 .93% ,Retic# :(29~104)× 109/L ,CHr :32 .6~36 .6 pg ,MCVr :97 .6~112 .7 fL .The absolute reticulocyte of male is significantly higher than that of female;MCVr was significantly larger than mean corpuscular volume of mature erythrocytes ,which was also slightly larger in male than that in female;CHr was significantly higher than mean corpuscular hemoglobin of mature erythrocytes while mean corpuscular hemoglobin concentration of large reticulocytes was lower than that of mature erythrocytes;red blood cell volume distribution width of reticulocytes was lower than that of mature erythrocytes;the hemoglobin content distribution width of mature erythrocytes has a higher uniformity compared with reticulocytes .Conclusion The reference ranges of not commonly used parameters of reticulocytes were established ,and were compared with the corresponding parameters of red blood cells .

Investigation on reference intervals of MCV,MCH and MCHC levels determined by Mindray BC-6800 hematology analyzer / 重庆医学

Objective To investigate the reference intervals of mean corpuscular volume (MCV) ,mean corpuscular hemoglo‐bin(MCH) and mean corpuscular hemoglobin concentration (MCHC) examined by the MindrayBC‐6800 hematological analyzer to establish the reference intervals suitable for our laboratory .Methods According to the method recommended by the NCCLS C28‐A3 ,600 healthy adult individuals were selected as the reference individuals .MCV ,MCH and MCHC levels were determined by the MindrayBC‐6800 hematological analyzer for constructing the reference intervals ;other 150 healthy persons undergoing the physical examination were selected and their MCH ,MCV and MCHC detection results were collected for verifying the established reference intervals .Results The detection results of MCV ,MCH and MCHC in healthy adults showed a normal distribution ,MCV had sta‐tistical difference among different age periods (P<0 .05);the reference intervals :82 .278 -94 .242 fL for young adults ,83 .032-94 .608 fL for the middle‐aged persons and 83 .137-96 .343 fL for the elderly .MCH had statistical differences between different se‐xes and among different age periods ;the reference intervals :27 .785-32 .415 pg for male young adults ,28 .324-32 .456 pg for male middle‐aged persons and 28 .274-32 .966 pg for male elderly ;27 .367-31 .973 pg for female young adults ,27 .445-32 .215 pg for female middle‐aged persons and 27 .532 -32 .468 pg for female elderly .MCHC had statistical difference between different sexes (P<0 .05) ;the reference intervals :328 .611-352 .810 g/L for male and 323 .771-348 .750 g/L for female .In 150 individuals un‐dergoing the physical examination ,the proportion of individuals locating at the outside of reference interval was less than 10 .0% , therefore the newly established intervals were suitable for this laboratory .Conclusion The sex difference or/and age differences of MCV ,MCH and MCHC exist among adult populations .So the reference intervals are respectively established according to the prac‐tical situation ,which are suitable for this laboratory by verification .

Mean reticulocyte volume enhances the utility of red cell mean sphered cell volume in differentiating peripheral blood spherocytes of hereditary spherocytosis from other causes.

Context: Mean sphered cell volume (MSCV) and mean reticulocyte volume (MRV) are additional reticulocyte parameters generated while processing the blood samples on Beckman coulter LH 755 in the reticulocyte mode using the volume, conductivity and scatter technology. It has been observed that the difference between mean corpuscular volume (MCV) and MSCV is higher in the cases of hereditary spherocytosis (HS) and this difference is increasingly being utilized as a screening tool for spherocytes. In addition now there have been new observations that reticulocyte volume in cases of HS is less as compared to normal reticulocyte. Aims: Our aim was to test the usefulness of reticulocyte parameters like MSCV and MRV in distinguishing cases of HS and autoimmune hemolytic anemia (AIHA). Materials and Methods: This is a retrospective and partly prospective study where peripheral blood ethylenediaminetetraacetic acid samples from cases of HS (n = 57) and AIHA (n = 29) were processed on LH 755 in both the differential and the reticulocyte mode. The data generated were analyzed and compared with data from normal healthy donors (n = 46). Results: Using an algorithm of MCV — MSCV >10 and MRV — MSCV <25, a sensitivity of 84.2% and specifi city of 94.7% was observed in cases of HS. Conclusions: With the reticulocyte analysis, we may now have a simple and cheap additional tool for screening of HS.