Paradoxical effects of brain death and associated trauma on rat mesenteric microcirculation: an intravital microscopic study

OBJECTIVE: Experimental findings support clinical evidence that brain death impairs the viability of organs for transplantation, triggering hemodynamic, hormonal, and inflammatory responses. However, several of these events could be consequences of brain death-associated trauma. This study investigated microcirculatory alterations and systemic inflammatory markers in brain-dead rats and the influence of the associated trauma. METHOD: Brain death was induced using intracranial balloon inflation; sham-operated rats were trepanned only. After 30 or 180 min, the mesenteric microcirculation was observed using intravital microscopy. The expression of Pselectin and ICAM-1 on the endothelium was evaluated using immunohistochemistry. The serum cytokine, chemokine, and corticosterone levels were quantified using enzyme-linked immunosorbent assays. White blood cell counts were also determined. RESULTS: Brain death resulted in a decrease in the mesenteric perfusion to 30 percent, a 2.6-fold increase in the expression of ICAM-1 and leukocyte migration at the mesentery, a 70 percent reduction in the serum corticosterone level and pronounced leukopenia. Similar increases in the cytokine and chemokine levels were seen in the both the experimental and control animals. CONCLUSION: The data presented in this study suggest that brain death itself induces hypoperfusion in the mesenteric microcirculation that is associated with a pronounced reduction in the endogenous corticosterone level, thereby leading to increased local inflammation and organ dysfunction. These events are paradoxically associated with induced leukopenia after brain damage.

Discrimination of acute lymphoblastic leukemia from systemic-onset juvenile idiopathic arthritis at disease onset

OBJECTIVE: To assess clinical and laboratory features that differentiate acute lymphoblastic leukemia from systemic juvenile idiopathic arthritis at disease onset. METHODS: Fifty-seven leukemia patients with musculoskeletal involvement, without blasts on peripheral blood and without glucocorticoid therapy at disease onset and 102 systemic juvenile idiopathic arthritis patients (International League of Associations for Rheumatology criteria) were retrospectively evaluated. The following features were examined: fever, rheumatoid rash, arthritis, limb pain, hepatomegaly, splenomegaly, pericarditis, myocarditis, pleuritis, weight loss, bleeding, anemia, leukopenia, neutropenia, thrombocytopenia, erythrocyte sedimentation rate, and lactic dehydrogenase levels. RESULTS: The median age at disease onset was significantly higher in leukemia patients than in those with systemic-onset juvenile idiopathic arthritis (5.8 vs. 3.8 years). In addition, the frequencies of limb pain, hepatomegaly, weight loss and hemorrhagic manifestations were significantly higher in leukemia patients than in systemic-onset juvenile idiopathic arthritis patients (70 percent vs. 1 percent, 54 percent vs. 32 percent, 30 percent vs. 8 percent, and 9 percent vs. 0 percent, respectively). Likewise, the frequencies of anemia, leukopenia, neutropenia, thrombocytopenia and high lactic dehydrogenase levels were statistically higher in leukemia patients than in patients with systemic-onset juvenile idiopathic arthritis (88 percent vs. 57 percent, 39 percent vs. 1 percent, 60 percent vs. 1 percent, 77 percent vs. 1 percent, and 56 percent vs. 14 percent, respectively). Remarkably, multivariate analysis revealed that limb pain (OR = 553; 95 percent CI =46.48-6580.42) and thrombocytopenia (OR = 754.13; 95 percent CI =64.57-8806.72) were significant independent variables that differentiated leukemia from systemic-onset juvenile idiopathic arthritis. The R2 of the Nagelkerke test was 0.91, and the Kaplan-Meier survival curves were similar for acute lymphoblastic leukemia patients with and without limb pain. CONCLUSION: Our study emphasizes the importance of investigating leukemia in patients presenting with musculoskeletal manifestations and, in particular, limb pain associated with thrombocytopenia.

Reliable, Accurate Determination of the Leukocyte Differential of Leukopenic Samples by Using Hematoflow Method / 대한진단검사의학회지

BACKGROUND: Hematology analyzers may ineffectively recognize abnormal cells, and manual differential counts may be imprecise for leukopenic samples. We evaluated the efficacy of the Hematoflow method for determining the leukocyte differential in leukopenic samples and compared this method with the manual differential method. METHODS: We selected 249 blood samples from 167 patients with leukopenia (WBC counts, 500-2,000/microL) for analysis in this study. The EDTA-anticoagulated blood samples were analyzed using an automatic blood cell counter (DxH800; Beckman Coulter, USA) and flow cytometry (FC 500; Beckman Coulter) by using Cytodiff reagent and analysis software (Beckman Coulter). Hematoflow results were selected or calculated from DxH800 and Cytodiff results. Two trained pathologists performed a manual differential count by counting 50-100 cells. RESULTS: The precision of the Hematoflow method was superior to that of the manual method in counting 5 leukocyte subpopulations, immature granulocytes (IGs), and blasts. Blasts were detected in all 45 cases (100%) by Hematoflow. The correlation of the Cytodiff blast count to the reference count was high (r = 0.8325). For all other cell populations, the correlation of the Hematoflow results with the reference count was stronger than that of the other manual counts with the reference count. CONCLUSIONS: The Hematoflow differential counting method is more reproducible and sensitive than manual counting, and is relatively easy to perform. In particular, this method detected leukemic blasts more sensitively than manual differential counts. The Hematoflow method is a very useful supplement to automated cell counting.

Reliable, Accurate Determination of the Leukocyte Differential of Leukopenic Samples by Using Hematoflow Method / 대한진단검사의학회지

BACKGROUND: Hematology analyzers may ineffectively recognize abnormal cells, and manual differential counts may be imprecise for leukopenic samples. We evaluated the efficacy of the Hematoflow method for determining the leukocyte differential in leukopenic samples and compared this method with the manual differential method. METHODS: We selected 249 blood samples from 167 patients with leukopenia (WBC counts, 500-2,000/microL) for analysis in this study. The EDTA-anticoagulated blood samples were analyzed using an automatic blood cell counter (DxH800; Beckman Coulter, USA) and flow cytometry (FC 500; Beckman Coulter) by using Cytodiff reagent and analysis software (Beckman Coulter). Hematoflow results were selected or calculated from DxH800 and Cytodiff results. Two trained pathologists performed a manual differential count by counting 50-100 cells. RESULTS: The precision of the Hematoflow method was superior to that of the manual method in counting 5 leukocyte subpopulations, immature granulocytes (IGs), and blasts. Blasts were detected in all 45 cases (100%) by Hematoflow. The correlation of the Cytodiff blast count to the reference count was high (r = 0.8325). For all other cell populations, the correlation of the Hematoflow results with the reference count was stronger than that of the other manual counts with the reference count. CONCLUSIONS: The Hematoflow differential counting method is more reproducible and sensitive than manual counting, and is relatively easy to perform. In particular, this method detected leukemic blasts more sensitively than manual differential counts. The Hematoflow method is a very useful supplement to automated cell counting.

Effect of placental insufficiency on the hematological profile of neonates

Placental insufficiency is the major cause of intrauterine growth retardation. Umbilical artery [UA] Doppler allows the non-invasive assessment of the severity of impaired placental vascular abnormality. UA end diastolic velocities are positive [PEDV] in mild placental insufficiency but are absent or reversed [AEDV] in 60-70% of the tertiary villous vessels are damaged. The degree of placental dysfunction determines the severity of fetal disease. In addition to disturbances in placental respiratory function, hematologic abnormalities during fetal life and at birth can occur. To evaluate the relationship between umbilical artery end diastolic velocity in growth restricted fetuses and hematologic parameters in the neonate. All cases of suspected placental insufficiency born over one years period at Al-Galaa Teaching Maternity Hospital were included in the study. They were distributed among three groups: Group [I]: 56 cases both term and preterm with mild placental insufficiency and PEDV and Group [II]: 44 cases both term and preterm with severe placental vascular compromise and absent [AEDV] or reversed [REDV] Group [III]: 50 cases both term and preterm acting as controls. Placental insufficiency and growth restricted fetuses were studied with ultrasound and Doppler evaluations of end-diastolic velocity. A complete blood count to assess the hematological parameters was collected from venous cord blood from all neonates born to compromised mothers at birth and a second sample of peripheral venous blood was collected at 48 hrs of life. A total of 103 cases met the inclusion criteria of the study. Our results showed significant anemia, leucopenia, thrombocytopenia, with marked increase in nRBCs in group [II] cases with severe placental insufficiency and absent or reversed end-diastolic volume compared to cases in Group [I] with mild placental insufficiency and positive end-diastolic volume. Again all hematological indices were significantly lower, with a marked increase in the nRBCs in Groups [I] and [II] compared to the control group [III]. The severity of hematological alternations at birth and during the first 48 hours of life growth restricted neonates was proportionate to and predicted by the antenatal umbilical artery end diastolic velocity Doppler status

Evaluation of adaptogenic activity profile of herbal preparation.

The herbal formulation, AVM is a proprietary formula that consists of extracts of herbs that have been used in Indian traditional medicine to promote physical and mental health, improve defense mechanisms of the body and enhance longevity. AVM (500 and 1000 mg/kg) was tested for its adaptogenic activity by determining antistress, anabolic and immunomodulatory effects. In antistress activity, pretreatment with AVM significantly attenuated the changes in ascorbic acid (from blood and adrenal), cortisol (from plasma and adrenal) and adrenal gland weights induced due to restrain stress (physical immobilization). Its antistress effect at 1000 mg/kg was comparable to that of diazepam (5 mg/kg) treated group. Leucopenia, and anemia induced by cyclophosphamide (CYP) was shown to reduce significantly by AVM. Treatment of AVM + CYP had increased spleen and thymus weights significantly as compared to CYP alone treated group. The anabolic activity was evaluated by weight gain of the levator ani muscle, ventral prostrate gland and seminal vesicles in rats as compared to untreated control.

Encefalitis equina venezolana: estudio clínico y de laboratorio en pacientes pediátricos / Venezuelan equine encephalitis: clinical and laboratory study in pediatric patients

Se hizo el estudio clínico y de laboratorio de nueve niños con encefalitis producida por el virus de la encefalitis equina Venezolana, demostrado por aislamiento del virus y por la prueba de inhibición de la hemaglutinación. Casi todos los pacientes tenían anticuerpos demostrables en el séptimo día de evolución de la enfermedad. El examen clínico indica que los síntomas y signos más frecuentes fueron: fiebre, convulsiones y otras manifestaciones de excitación cortical. Los exámenes hemáticos revelaron leucocitosis inicial con ulterior tendencia hacia leucopenia. Con fórmula leucocitaria normal al comienzo seguida de neutropenia en la mayoría de los casos. El líquido cefalorraquídeo presentó pleocitosis con linfocitos en dos casos y neutrófilos en otro. Hubo hiperglucorraquia en el 50 por ciento de los niños y aumento de la albúmina raquídea. Las pruebas cualitativas para globulinas fueron positivas en tres oportunidades

A clinico-haematologic profile of paroxysmal nocturnal haemoglobinuria.

Clinico-haematological parameters in sixteen patients of paroxysmal nocturnal haemoglobinuria (PNH) are presented. Their modes of presentation included recurrent episodes of cola-coloured urine (6/16), refractory anaemia (9/16) and predominant thrombotic manifestations (1/16). Laboratory investigations revealed the presence of anaemia (16/16), reticulocytosis (14/16), thrombocytopenia (11/16), leucopenia (5/16) and cellular bone marrow (14/16). Two patients had hypoplastic bone marrow initially but subsequently developed PNH. The patients were treated with haematinics, prednisolone (16/16) and oxymethalone (2). Prednisone was effective in suppressing haemolytic episodes. Oxymethalone given to the 2 patients with hypoplastic bone marrow resulted in amelioration of anaemia in one but no effect in the other patient.

O leucograma: interpretaçäo na prática médica / The leukogram: interpretation on medical practice

O autor discorre sobre as principais funçöes dos elementos celulares sangüíneos da série branca, procurando descrever seu aumento e diminuiçäo em número nas várias moléstias, assim como o mecanismo interpretativo dessas variaçöes

Metodologia laboratorial e controle de qualidade em hematimetria / Laboratorial methods and control of the quality in hematimetry

Com a finalidade de introduzir no debate sobre leucopenia as variaçöes metodológicas, o autor faz uma breve análise crítica dos métodos laboratoriais de hematimetria e do Controle de Qualidade. Descreve um sistema de Controle de Qualidade em uso há 10 anos, com coeficientes de variaçöes reais em torno de 2% para eritrócitos e 6% para leucócitos, a adoçäo no Brasil do sistema de comparaçäo e calibraçäo interlaboratórios baseados nas médias de VCM e CHCM. Säo apresentadas também, resumidamente, as técnicas de avaliaçäo da celularidade da medula óssea com a variaçäo de resultados obtidos na leitura para os diversos métodos e tipo de material analisados

Valores de leucócitos em um grupo de trabalhadores rurais / Leukocytes value in a rural workers group

Os autores estudam a prevalência da reduçäo de leucócitos, menos de 5.000/mm3, em uma populaçäo rural constituída por 803 cortadores de cana na regiäo de Piracicaba. Encontraram 44 casos (5,5%) de reduçäo de leucócitos, no primeiro exame; em duas determinaçöes de sangue com intervalos de 3 meses, obteve-se 66 casos (8,34%). Mostram que leucopenia com menos de 4.000/mm3 só foi encontrada em 0,75% dos casos. Além disso, em 9 casos foi possível repetir o hematológico completo em abril de 1987, reforçando a idéia de que em 2/3 dos casos a leucopenia é transitória. Constataram que na quase totalidade, os casos eram de raça negra

Valores hematológicos em trabalhadores em exposiçäo ao benzeno / Hematological values in workers in exposition to benzene

Alguns parâmetros eritro-leucocitários foram investigados em trabalhadores dos setores secundários e terciários da economia, e em desempregados, aposentados, residentes em quatro dos principais bairros de Cubatäo: Cubatäo Sede (CS), Vila Nova Cubatäo (VNC), Jardim Casqueiro (JC) e Vila Parisi (VP). Além dos valores médios de leucócitos totais (VMLT) dos vários elementos da contagem diferencial e de hemoglobina elaboramos Classificaçäo indicadora de alteraçöes leucocitárias (CIGAL) baseada em dados da literatura e no critério usado pelos órgäos oficiais (INAMPS e INPS) para caracterizar os indivíduos como "leucopênicos". Observou-se associaçäo entre CIGAL e ocupaçäo dos trabalhadores: a percentagem de "leucopênicos" foi menor entre os supervisores, 10%, e maior entre técnicos, 28,3%. Embora näo se note associaçäo, a frequência de leucopênicos é maior entre aposentados e desempregados (32,3 e 36,9%) menor entre os funcionários públicos (20,0%) e intermediária entre trabalhadores de diversos ramos industriais. Os operários da indústria sidero-petroquímica (indústria e empreiteiras) foram os únicos trabalhadores a apresentar diferenças significativas em relaçäo a VMLT e VMN, segundo bairro: isto porque os residentes na VNC e JC têm maior estabilidade no emprego e maiores chances de apresentar leuco-neutropenia de origem benzênica, do que os residentes na VP. As diferenças de VMEo e VMHb entre as populaçöes dos quatro bairros säo explicadas pelo fato da VMEo mais alta e VMHb mais baixos observados na VP estarem relacionados com precárias condiçöes de vida deste bairro. A elevada frequência de leuco-neutropenia e alta exposiçäo ao benzeno coloca sérios problemas sociais que devem ser equacionados através de rigoroso controle dos ambientes de trabalho e a realizaçöes de estudos epidemiológicos

Benzenismo: alteraçöes näo hematológicas / Benzenism: changes no hematological

Säo feitas consideraçöes sobre a toxicidade do benzeno, sendo enfocados alguns aspectos de sua disposiçäo no organismo e da natureza de sua açäo tóxica. Um esquema da biotransformaçäo do xenobiótico é apresentado e referências säo feitas às teorias que pöem em evidência a formaçäo de produtos intermediários, que seriam os responsáveis pelos seus efeitos nocivos. Entre estes, é dado um destaque aos näo hematológicos, isto é, à açäo leucemogênica, mutagênica e imunogênica do benzeno

Hemograma en las infecciones: segunda parte / Hemogram in infections (2d part)

En esta segunda parte del análisis del hemograma de las infecciones se revisan cuatro formas típicas de la serie blanca y su contribución en el diagnóstico de las enfermedades. La revisión incluye leucocitosis con neutrofilia y desviación hacia la izquierda; leucopenia con desviación hacia la izquierda; leucocitosis con linfocitosis absoluta y leucocitos normales con linfocitosis relativa. Además se analizan las alteraciones hematológicas especiales que ocurren en los recién nacidos infectados y las eosinofilias causadas por infecciones parasitarias

Medical check-up on polyvinyl chloride tubes manufacture workers

Forty-three workers and 20 individuals as control group in the polyvinyl chloride tubes manufacture unit in the United Arab Emirates were investigated to scope their : respiratory, kidney, blood count, and liver function screening tests. Moderate C.O.P.D. was reported in 11.6% of workers. Abnormality in urine analysis was reported in 13.9% of workers which needs further investigation. Leucopenia and border line platlets count was reported in 4.6% of workers. Regarding liver function screening tests, a significant difference in the trans-aminase enzymes values was reported and that indicates strict control and clarifies the importance of transaminase values in screening the liver function in these conditions

Possible mechanism of hydrocortisone induced eosinopoenia.

Hydrocortisone (HC) injection in rabbits induced eosinopoenia (reduction in absolute eosinophil count) which could be successfully abolished by beta--adrenoceptor antagonists, a propranolol, sotalol, practolol and H 35/25 but not by alpha--adrenoceptor antagonist, phenoxybenzamine. Reserpine per se produced eosinopoenia followed by eosinophilia. However, reserpine pretreatment failed to abolish HC-induced eosinopoenia. It is suggested that the eosinopoenia is mediated through beta--adrenoceptors, which could not be differentiated into beta 1/beta 2--adrenoceptor subtypes as has been possible for other beta-adrenoceptor mediated responses.