Hematological and coagulation parameters as predictors of death by Coronavirus disease in hospitalized patients: a Brazilian follow-up study

Abstract This study aimed to evaluate the hematological and coagulation parameters according to the clinical outcomes of coronavirus disease (COVID-19). We analyzed the hematological and coagulation parameters of hospitalized patients with COVID-19 at admission, and two and three weeks during hospitalization. To assess the performance of these parameters in predicting poor outcomes, receiver operating characteristic (ROC) curves were created. We studied 128 patients with COVID-19 (59.2±17.7 years, 56% male). Non-survivors (n=54, 42%) presented significant alterations in hematological and coagulation parameters at admission, such as increased in white blood cells (WBC), neutrophil, and band cell counts, as well as elevated prothrombin time (PT), activated partial thromboplastin time, and D-dimer levels. During follow-up, the same group presented a gradual increase in D-dimer and PT levels, accompanied by a reduction in PT activity, hemoglobin, and red blood cell count (RBC). ROC curves showed that WBC, neutrophil, and band cell counts presented the best area under the curve (AUC) values with sensitivity and specificity of >70%; however, a logistic regression model combining all the parameters, except for RBC, presented an AUC of 0.89, sensitivity of 84.84%, and specificity of 77.41%. Our study shows that significant alterations in hematological and coagulation tests at admission could be useful predictors of disease severity and mortality in COVID-19.

Validación concurrente para Chile de un cuestionario multidimensional de adaptación a la enfermedad para pacientes de una unidad de hematología intensiva / Concurrent validation a multidimensional adaptation questionnaire for Illness to patients in a intensive hematology unit in Chile

El objetivo de esta investigación fue adaptar y validar para Chile el Cuestionario Multidimensional de Adaptación a la Enfermedad para Pacientes Onco-hematológicos (CMAE-OH) en la Unidad de Hematología Intensiva de un hospital general de Santiago de Chile. Este instrumento diseñado en España, es semiestructurado, consta de ítems cualitativos y cuantitativos, que proporcionan información para intervención preventiva, evalúan bienestar psicológico y adaptación a la enfermedad en los pacientes hemato-oncológicos. La metodología de trabajo fue la validación de contenido realizada por un panel de expertos. La muestra total fue de 42 pacientes hospitalizados, con 62 por ciento de hombres y 38 por ciento de mujeres, entre 15 y 56 años de edad. Se comparan los índices de una muestra de Santiago de Chile con una muestra de Madrid a través de análisis factoriales e índice de confiabilidad. Tanto en Chile como en España la variable información sobre la enfermedad, que mide el nivel de conocimiento del diagnóstico, tratamiento y pronóstico, es la variable que presenta más alta correlación con la adaptación a la enfermedad...

The purpose of this research was to adapt and validate the “Cuestionario Multidimensional de Adaptación a la Enfermedad para Pacientes Onco hematológicos (CMAE-OH)” in the Intensive Hematology Unit of a general hospital in Santiago de Chile. This instrument was designed in Spain as a semi-structured format with qualitative and quantitative items. These give information for preventive interventions, evaluate subjective well-being, and measure adaptation to hemato-oncologic diseases. The methodology consisted in content validation using an expert panel. The total simple were 42 inpatients, 62 percent males and 38 percent females, with ages between 15 and 56 years. The Santiago de Chile results are compared with a Madrid sample through a factor analysis. In Chile and in Spain the variable information of the disease, which measures the level of knowledge of the diagnosis, treatment and prognosis, is the variable that has the highest correlation with adaptation to the disease...

Perfil hematológico de equinos submetidos à prova de Team Penning / Hematologic profile of horses subjected to Team Penning

As variações nos parâmetros hematológicos são utilizadas com intuito de avaliar o grau de treinamento ou estado clínico do animal. A avaliação hematológica de equinos em repouso tem sido objeto de estudo, a fim de estabelecer uma relação com treinamento ou capacidade atlética. Objetivou-se avaliar o perfil hematológico de equinos submetidos à prova de Team Penning, correlacionando o sexo e frequência da atividade física. Mediante punção da veia jugular externa coletaram-se dois mL de sangue de 29 equinos, 18 machos e 11 fêmeas, em repouso (Momento I) e após o exercício (Momento II). As amostras de sangue foram processadas em analisador hematológico automático veterinário (ABC VET - Horiba ABX Diagnostics). Os animais foram divididos em Grupos A, B, C e D, de acordo com o número de participações na prova. Observou-se que os valores de volume globular, hemoglobina, hemácias, leucócitos, neutrófilos em bastonetes e segmentados, e monócitos aumentaram após o exercício físico, ao contrário do número de linfócitos e eosinófilos, que reduziram. Não existiram diferenças significativas (p<0,05) entre machos e fêmeas ao confrontar as relações antes/depois. Além disso, evidenciou-se que o valor da relação MI/MII para volume globular, hemoglobina e número de hemácias variou de acordo com a frequência do exercício. Conclui-se que a prova de Team Peninng ocasiona alterações hematológicas em equinos, com interferência da frequência do exercício, independente do sexo.

Variations in hematologic parameters are used to assess the degree of training or clinical state of the animal. The hematologic evaluation of horses at rest has been an object of study in order to establish a correlation with training or athletic capacity. The purpose of this study was to evaluate the hematologic profile of horses subjected to Team Penning competitions, correlating sex and frequency of physical activity. Two milliliters of blood were drawn through a puncture made in the external jugular vein from 29 horses, 18 males and 11 females, at rest (Moment I) and after exercising (Moment II). The blood samples were processed in an ABC VET automated veterinary hematology analyzer (Horiba ABX Diagnostics). The animals were divided into Group A, B, C and D according to the number of times they participated in the competition. The values of globular volume, hemoglobin, erythrocytes, rod-shaped segmented neutrophils and monocytes increased after the physical exercise, unlike the number of lymphocytes and eosinophils, which decreased. A comparison of the before/after exercise correlations showed no significant differences (p<0.05) between males and females. In addition, it was found that the value of the MI/MII ratio for the globular volume, hemoglobin and number of erythrocytes varied according to the frequency of the exercise. It was concluded that the Team Penning competition produces hematologic alterations in horses, which are affected by the frequency of exercising, regardless of sex.

Validation of ESR analyzer using Westergren ESR method.

Erythrocyte sedimentation rate (ESR) is one of the most frequently ordered laboratory test. ESR analyzers were developed to provide a quick and efficient measure of ESR. We compared the results of ESR obtained by an ESR analyzer with those by the Westergren method in a group of 75 patients Linear regression analysis showed a good correlation between the two results (r = 0.818, p < 0.01). The intra class correlation was 0.82. The analyzer method had the advantages of safety, decreased technician time and improved patient care by providing quick results.

Malaria: the value of the automated depolarization analysis.

This retrospective and descriptive study was carried out in the University of Malaya Medical Center (UMMC) from January to September, 2004. This study aimed to evaluate the diagnostic utility of the Cell-Dyn 4000 hematology analyzer's depolarization analysis and to determine the sensitivity and specificity of this technique in the context of malaria diagnosis. A total of 889 cases presenting with pyrexia of unknown origin or clinically suspected of malaria were examined. Sixteen of these blood samples were found to be positive; 12 for P. vivax, 3 for P. malariae, and 1 for P. falciparum by peripheral blood smear as the standard technique for parasite detection and species identification. Demographic characteristics showed that the majority of patients were in the age range of 20-57 with a mean of 35.9 (+/- SD) 11.4 years, and male foreign workers. Of these, 16 positive blood samples were also processed by Cell-Dyne 4000 analyzer in the normal complete blood count (CBC) operational mode. Malaria parasites produce hemozoin, which depolarizes light and this allows the automated detection of malaria during routine complete blood count analysis with the Abbot Cell-Dyn CD4000 instrument. The white blood cell (WBC) differential plots of all malaria positive samples showed abnormal depolarization events in the NEU-EOS and EOS I plots. This was not seen in the negative samples. In 12 patients with P. vivax infection, a cluster pattern in the Neu-EOS and EOS I plots was observed, and appeared color-coded green or black. In 3 patients with P. malariae infection, few random depolarization events in the NEU-EOS and EOS I plots were seen, and appeared color-coded green, black or blue. While in the patient with P. falciparum infection, the sample was color-coded green with a few random purple depolarizing events in the NEU-EOS and EOS I plots. This study confirms that automated depolarization analysis is a highly sensitive and specific method to diagnose whether or not a patient has malaria. This automated approach may prove to be particularly useful in situations where there is little or no clinical suspicion of malaria.

Comparison of erythrocyte sedimentation rate measurement by the automated SEDIsystem[TM] and conventional westergren method using the Bl and and Altman statistical method

To compare the performance of SEDIsystem[TM], a fully automated analyzer for the measurement of the erythrocyte sedimentation rate [ESR], with the manual Westergren method. Materials and Both methods were applied to 150 randomly selected subjects. The linear regression and Bl and and Altman data analysis methods were used to measure the agreement between the automated and manual methods. The regression analysis showed a good correlation between the two methods [r = 0.91]. The Bl and and Altman data analysis showed no systematic bias [95% confidence interval for mean difference]; however, limits of agreement were between 11.52 and -37.88. This indicates that ESR values measured by the SEDIsystem may be 11.52 mm/h above or 37.88 mm/h below the reference method. A greater scatter of data was also observed with abnormally high [>25mm/h] ESR results [mean of difference = -21.4 and limits of agreement = -45.2 and 2.26] compared with normal [<25 mm/h] readings [mean of difference =-3.9 and limits of agreement =-13.5 and 5.7]. The Bl and and Altman statistical analysis showed a wide degree of scatter between results obtained by the two ESR techniques that was not clearly demonstrated using the linear regression analysis. The automated system was found to underestimate ESR with the Bl and and Altman statistical analysis, and therefore a correction factor is recommended

Hematology tests of blood anticoagulated with magnesium sulphate.

Venous blood treated with magnesium sulphate (MgSO4) at blood collection was used for hematology tests. Complete blood counts and automated leukocyte differentials were obtained using a hematology analyzer, and the results obtained for blood treated with MgSO4 were similar to those for blood treated with dipotassium ethylenediaminetetraacetic acid (EDTA K2). Coagulation tests such as activated partial thromboplastin time, platelet factor 3 availability and prothrombin time were dose-dependently affected by the use of MgSO4. Thrombin time was prolonged by addition of MgSO4, and fibrin concentrations determined by coagulometry tended to decrease with addition of MgSO4, although fibrin concentrations determined by the weighing method were unaffected by MgSO4. MgSO, was thus found to potently inhibit blood coagulation and can be used as an anticoagulant for hematology tests.

Study on the accuracy of automated hematology analyzers in Shanghai.

The objectives of this study were to research on the accuracy of automated hematology analyzers of various types from different manufacturers and to observe the deviation among these instruments. Fresh anticoagulated blood from healthy donors on 115 hematology analyzers in 114 different hospitals were determined. RESULTS: The maximum coefficients of variation (CVs. %) among instruments of three main manufacturers (Sysmex, Beckman Coulter and Abbott) of red blood cell count (RBC), hemoglobin (Hgb), hematocrit (Hct), white blood cell count (WBC) and platelet count (Plt) were 3.2%, 3.8%, 3.6%, 9.3% and 10.8%, respectively. The maximum deviations among these parameters of different instruments were 0.74%, 1.65%, 5.45%, 7.06% and 18.55%, respectively. By improving laboratory quality management, the results of hematology analyzer determination may be more reliable than manual methods. The difference among various manufacturers was very small about RBC, Hgb, Hct, WBC and Plt the results from all kinds of instruments will tend to be comparable.

Problems related to rapid methods for erythrocyte sedimentation rate test and their solution.

The erythrocyte sedimentation rate (ESR) test is one of the most common and traditional laboratory tests in the world. It reflects both plasma concentration of acute-phase proteins of large molecular size and anemia (International Council for Standardization in Hematology, 1993). The ESR test method is easy to perform and inexpensive. Therefore, it is used today as a routine test worldwide. However, the ESR has some demerits, in requiring a large volume of sodium citrate or ethylenediamine tetraacetic acid (EDTA) blood and at least 2-hour testing time. When ESR is tested manually, incorrect results are obtained if the ESR test tube is not stood strait-up and vertically (Dobashi et al, 1994). Reading error for the meniscus line and surrounding temperature at the testing site cause inaccuracy (Manley, 1957). The 2-hour testing time is not practical for modernized automated laboratories. Its test procedures present the risk of infection from contact with pathogen-bearing blood (Imafuku and Yoshida, 2001). In this context, several kinds of simple, rapid and safe methods have been developed. Of these new systems, we selected 4 and evaluated their performance. This paper reports critical reviews of such devices.

Valores de referencia en la citometría hemática del personal que acude a consulta al Hospital Central Militar / Out-patient average values of blood cell counts in the Military Central Hospital of Mexico. A reference pattern

Con el objeto de comprobar si los valores de referencia en la citometría hemática que utiliza el Hospital Central Militar, eran aplicables a la población, se realizó un estudio transversal, observacional y analítico. El estudio abarcó población militar, derechohabiente y civil (pediátricos y adultos) a los cuales se les determinó hemoglobina, hematócrito, número de eritrocitos, índices eritrocitarios, número de leucosito, plaquetas y volumen plaquetario; el aparato que se utilizó para realizar estas determinaciones fue el analizador de hamatología Coulter Mod. STKS. Mediante el análisis estadístico se llegó a la conclusión de que sí existía diferencia estadísticamente significativa de los parámetros estudiados con los reportados en las referencias nacionales e internacionales encontradas. Estas diferencias muy probablemente se hayan debido a la diferencia de altitudes y metodologías utilizadas para cada uno de los estudios en cuestión

El plan internacional de la OMS de evaluación externa de la calidad en hematologia / The WHO international quality assessment scheme for haematology

Es esencial asegurar la calidad en el laboratorio medico. Un componente importante de este proceso es la evaluación externa de la calidad para confirmar un desempeno confiable en todos los laboratorios y garantizar que se mantiene la comparabilidad entre ellos. En varios países existen planes nacionales de evaluación externa de la calidad. La Organización Mundial de la Salud (OMS) ha establecido un programa con el proposito de fomentar la organización de planes similares en todos los países. Con este fin se elaboro un plan internacional de evaluación externa de calidad para cada una de las especialidades de hematologia, quimica clinica, microbiologia y parasitologia. En este articulo se describe la organización del plan internacional en hematologia. En la actualidad participan en el 62 laboratorios pertenecientes a 49 países. Se detallan el funcionamiento del plan, la respuesta de los participantes y la medida en que este ha contribuido a mejorar las normas de la practica en sus laboratorios