Complete blood count as a biomarker for preeclampsia with severe features diagnosis: a machine learning approach.

OBJECTIVE: This study introduces the complete blood count (CBC), a standard prenatal screening test, as a biomarker for diagnosing preeclampsia with severe features (sPE), employing machine learning models. METHODS: We used a boosting machine learning model fed with synthetic data generated through a new methodology called DAS (Data Augmentation and Smoothing). Using data from a Brazilian study including 132 pregnant women, we generated 3,552 synthetic samples for model training. To improve interpretability, we also provided a ridge regression model. RESULTS: Our boosting model obtained an AUROC of 0.90±0.10, sensitivity of 0.95, and specificity of 0.79 to differentiate sPE and non-PE pregnant women, using CBC parameters of neutrophils count, mean corpuscular hemoglobin (MCH), and the aggregate index of systemic inflammation (AISI). In addition, we provided a ridge regression equation using the same three CBC parameters, which is fully interpretable and achieved an AUROC of 0.79±0.10 to differentiate the both groups. Moreover, we also showed that a monocyte count lower than 490 / m m 3 yielded a sensitivity of 0.71 and specificity of 0.72. CONCLUSION: Our study showed that ML-powered CBC could be used as a biomarker for sPE diagnosis support. In addition, we showed that a low monocyte count alone could be an indicator of sPE. SIGNIFICANCE: Although preeclampsia has been extensively studied, no laboratory biomarker with favorable cost-effectiveness has been proposed. Using artificial intelligence, we proposed to use the CBC, a low-cost, fast, and well-spread blood test, as a biomarker for sPE.

Inflammatory Hematological Indices, Cardiovascular Disease and Mortality: A Narrative Review. / Índices Hematológicos Inflamatórios, Doenças Cardiovasculares e Mortalidade: Uma Revisão Narrativa.

Cardiovascular diseases (CVDs) are the leading cause of death worldwide, which generates a significant economic burden of billions per year on the healthcare system. Chronic inflammation is known for its importance in the pathogenesis of atherosclerosis and CVDs. Currently, inflammatory hematologic indices, obtained through the results of the complete blood count (CBC), have been characterized as potential prognostic factors for mortality in CVD. These indexes are calculated from neutrophil, lymphocyte, platelet, and monocyte counts, are easily accessible, have simple calculations, and have low cost, which facilitates their application in practice. The aim of this paper was prepare a synthesis of studies that investigated the relationship of inflammatory hematologic indices with cardiovascular risk and mortality. The search was been conducted in PubMed, Scopus, Embase, Web of Science, and Virtual Health Library (VHL) databases. Studies that investigated the association between inflammatory hematologic indices with cardiovascular risk and mortality were been selected. 1,470 studies were obtained in the search, with only 23 being eligible. We found that the hematological index most associated with overall mortality, cardiovascular events, and cardiovascular mortality was the systemic immune-inflammation index (SII) followed by the systemic inflammatory response index (SIRI). The hematological inflammatory indices proved advantageous for screening and identifying patients who have high cardiovascular risk and mortality risk, and may be useful in directing the treatment of these patients, obtaining information about prognosis, and improving risk stratification.

As doenças cardiovasculares (DCV) são a principal causa de morte em todo o mundo, o que gera um fardo económico significativo de bilhões por ano no sistema de saúde. A inflamação crônica é conhecida por sua importância na patogênese da aterosclerose e das DCV. Atualmente, os índices hematológicos inflamatórios, obtidos através dos resultados do hemograma completo (HC), têm sido caracterizados como potenciais fatores prognósticos para mortalidade nas DCV. Esses índices são calculados a partir da contagem de neutrófilos, linfócitos, plaquetas e monócitos, são de fácil acesso, possuem cálculos simples e têm baixo custo, o que facilita sua aplicação na prática. O objetivo deste trabalho foi preparar uma síntese de estudos que investigaram a relação dos índices hematológicos com o risco cardiovascular e mortalidade. A busca foi realizada nas bases de dados PubMed, Scopus, Embase, Web of Science e Biblioteca Virtual em Saúde (BVS). Foram selecionados estudos que investigaram a associação entre índices hematológicos inflamatórios com risco cardiovascular e mortalidade. Foram obtidos 1.470 estudos na busca, sendo apenas 23 elegíveis. Descobrimos que o índice hematológico mais associado à mortalidade geral, eventos cardiovasculares e mortalidade cardiovascular foi o índice de inflamação imunológica sistêmica (SII), seguido pelo índice de resposta inflamatória sistêmica (SIRI). Os índices inflamatórios hematológicos mostraram-se vantajosos para triagem e identificação de pacientes com alto risco cardiovascular e risco de mortalidade, podendo ser úteis no direcionamento do tratamento desses pacientes, na obtenção de informações sobre prognóstico e na melhoria da estratificação de risco.

Complete Blood Count Values Over Time in Young Children During the Dengue Virus Epidemic in the Dominican Republic From 2018 to 2020.

Background: Dengue fever (DF) is a mosquito-borne illness with substantial economic and societal impact. Understanding laboratory trends of hospitalized Dominican Republic (DR) pediatric patients could help develop screening procedures in low-resourced settings. We sought to describe laboratory findings over time in DR children with DF and DF severity from 2018 to 2020. Methods: Clinical information was obtained prospectively from recruited children with DF. Complete blood count (CBC) laboratory measures were assessed across Days 1-10 of fever. Participants were classified as DF-negative and DF-positive and grouped by severity. We assessed associations of DF severity with demographics, clinical characteristics, and peripheral blood studies. Using linear mixed-models, we assessed if hematologic values/trajectories differed by DF status/severity. Results: A total of 597 of 1101 with a DF clinical diagnosis were serologically evaluated, and 574 (471 DF-positive) met inclusion criteria. In DF, platelet count and hemoglobin were higher on earlier days of fever (p < = 0.0017). Eighty had severe DF. Severe DF risk was associated with thrombocytopenia, intraillness anemia, and leukocytosis, differing by fever day (p < = 0.001). Conclusions: In a pediatric hospitalized DR cohort, we found marked anemia in late stages of severe DF, unlike the typically seen hemoconcentration. These findings, paired with clinical symptom changes over time, may help guide risk-stratified screenings for resource-limited settings.

Unlocking the complete blood count as a risk stratification tool for breast cancer using machine learning: a large scale retrospective study.

Optimizing early breast cancer (BC) detection requires effective risk assessment tools. This retrospective study from Brazil showcases the efficacy of machine learning in discerning complex patterns within routine blood tests, presenting a globally accessible and cost-effective approach for risk evaluation. We analyzed complete blood count (CBC) tests from 396,848 women aged 40-70, who underwent breast imaging or biopsies within six months after their CBC test. Of these, 2861 (0.72%) were identified as cases: 1882 with BC confirmed by anatomopathological tests, and 979 with highly suspicious imaging (BI-RADS 5). The remaining 393,987 participants (99.28%), with BI-RADS 1 or 2 results, were classified as controls. The database was divided into modeling (including training and validation) and testing sets based on diagnostic certainty. The testing set comprised cases confirmed by anatomopathology and controls cancer-free for 4.5-6.5 years post-CBC. Our ridge regression model, incorporating neutrophil-lymphocyte ratio, red blood cells, and age, achieved an AUC of 0.64 (95% CI 0.64-0.65). We also demonstrate that these results are slightly better than those from a boosting machine learning model, LightGBM, plus having the benefit of being fully interpretable. Using the probabilistic output from this model, we divided the study population into four risk groups: high, moderate, average, and low risk, which obtained relative ratios of BC of 1.99, 1.32, 1.02, and 0.42, respectively. The aim of this stratification was to streamline prioritization, potentially improving the early detection of breast cancer, particularly in resource-limited environments. As a risk stratification tool, this model offers the potential for personalized breast cancer screening by prioritizing women based on their individual risk, thereby indicating a shift from a broad population strategy.

Umbilical Cord Blood as an Alternative to Neonatal Blood for Complete Blood Count: A Comparison Study.

OBJECTIVE: To assess concordance between umbilical cord blood (UCB) and neonatal blood (NB) laboratory test results at birth. STUDY DESIGN: This retrospective study considered very preterm neonates (<32 weeks' gestational age) admitted to a tertiary neonatal intensive care unit from 2012 to 2023. Inclusion criteria required neonates with a complete blood count measured in both UCB and NB drawn within 2 hours after birth. Median hemoglobin (Hb) and hematocrit (Hct) concentrations were compared between UCB (venous samples) and NB (venous, arterial, or capillary samples). RESULTS: A total of 432 neonates with paired UCB and NB values were included in the study. Hb concentration in UCB was 14.7 g/dL (IQR 13.5-16.1 g/dL) compared with 14.8 g/dL (IQR 12.6-19.3 g/dL) in venous NB samples, 13.9 g/dL (IQR 12.9-15.3 g/dL) in arterial NB and 18.7 g/dL (IQR 16.6-20.8 g/dL) in capillary NB. The regression equation showed a correction factor of 1.08 for converting Hb values from UCB to venous NB. Median Hct concentration in UCB was 0.45 L/L (IQR: 0.41-0.49 L/L) compared with 0.48 L/L (IQR 0.43-0.54 L/L) in venous NB, 0.42 L/L (IQR 0.38-0.45 L/L) in arterial NB and 0.57 L/L, (IQR 0.51-0.63 L/L) in capillary NB. CONCLUSIONS: Hb and Hct concentrations measured in UCB are similar to those measured in venous blood in very preterm infants and are valid alternatives for NB tests at birth. Hb and Hct concentrations in arterial and capillary NB are respectively lower and higher compared with UCB measurements.

Hemograms and serial hemogram-derived ratios in survivors and non-survivors of COVID-19 in Campinas, Brazil

Introduction The hemogram and hemogram-derivative ratios (HDRs) are becoming markers of the severity and mortality of COVID-19. We evaluated the hemograms and serial weekly HDRs [neutrophil-lymphocyte ratio (NLR), monocyte-lymphocyte ratio (MLR), platelet-lymphocyte ratio (PLR), neutrophil-platelet ratio (NPR) and systemic immune-inflammatory index (SII)] in the survivors and non-survivors of COVID-19. Methods We retrospectively reviewed the medical notes and serial hemograms of real-time reverse-transcription polymerase chain reaction (RT-PCR)-confirmed COVID-19 adults hospitalized from April 2020 to March 2021 from the time of diagnosis to the 3rd week of diagnosis. Results Of the 320 adults, 257 (80.3%) were survivors and had a lower mean age than the non-survivors (57.73 vs. 64.65 years, p < 0.001). At diagnosis, the non-survivors had lower hematocrit (p = 0.021), and lymphocyte (p = 0.002) and basophil (p = 0.049) counts and the hematocrit showed a p-value (Is this what you meant???) of 0.021); higher NLR (p < 0.001), PLR (p = 0.047), NPR (p = 0.022) and SII (p = 0.022). Using general linear models, the survivors and non-survivors showed significant variations with weekly lymphocyte count (p < 0.001), neutrophil count (p = 0.005), NLR (p = 0.009), MLR (p = 0.010) and PLR (p = 0.035). All HDRs remained higher in the non-survivors in the 2nd week and 3rd week of diagnosis and the HDRs were higher in the intubated patients than in the non-intubated patients. The NLR and SII were more efficient predictors of mortality in COVID-19 patients. Conclusions This study shows that serial lymphocyte and neutrophil counts, NLR, PLR, MLR, NPR and SII could serve as good and easily accessible markers of severity and predictors of outcomes in COVID-19 patients and should be used for the monitoring of treatment response.

Hematological profile of healthy Thoroughbred foals from birth to one month of age in Trinidad, West Indies.

OBJECTIVE: This study aimed to develop a sound database for the hematological reference intervals of thoroughbred foals in Trinidad, West Indies from birth to 1 month of age. ANIMALS: 89 foals. METHODS: Whole blood samples were taken from 89 foals throughout Trinidad at approximately 1 day, 1 week, and 1 month of age. These foals were examined to be classified as healthy or free from disease. Complete blood count (CBC), microscopic analysis of blood smears, and conventional PCR for Theileria equi and Babesia caballi were performed. RESULTS: Of the 89 foals, 67 were deemed healthy and suitable for establishing reference intervals. Foals in this study had lower mean hemoglobin and hematocrit values for all 3 times of sampling when compared to their North American counterparts. Age had a significant effect on hemoglobin, hematocrit, white blood cell (WBC), neutrophil, and platelet counts of the foals from birth to 1 month of age. CLINICAL RELEVANCE: Variations in reference intervals can occur due to differences in demographic, physiological, and environmental factors such as age, gender, breed, and geographical location. Given the changes in the hematological values over time, this study provides clinicians with valuable information that can be used to monitor the health status of newborn foals and detect disease conditions.

Razões derivadas do hemograma durante a pandemia da Sars-Cov-2: um estudo observacional retrospectivo em pacientes em hemodiálise / Complete blood count derived ratios during the Sars-Cov-2 pandemic: a retrospective observational study in hemodialysis patients / Ratios derivados del hemograma durante la pandemia de Sars-Cov-2: un estudio observacional retrospectivo en pacientes en hemodiálisis

Biomarcadores de inflamação derivados do hemograma como a razão neutrófilos/linfócitos (NLR), a razão plaquetas/linfócitos (PLR), a razão neutrófilos/plaquetas (NPR) e o índice de inflamação imune sistêmico (SII) já foram investigados como preditores de prognóstico de doenças inflamatórias sistêmicas, cardiovasculares, malignas, etc., e com a ocorrência da pandemia de SARS-CoV-2, também passaram a ser estudadas como biomarcadores de interesse nessa doença. Objetivo: Comparar retrospectivamente o valor dessas 4 razões hematimétricas durante os dois anos da pandemia (2020-2021), com o período anterior (os anos de 2018-2019), em uma população de pacientes doentes renais em hemodiálise. Métodos: Esta pesquisa foi submetida ao Comitê de Ética e Pesquisa da Universidade Estadual de Ponta Grossa (CEP-UEPG) e foi aprovada sob o número do parecer 5.024.864. Foram incluídos pacientes tratados no setor de Terapia Renal Substitutiva do Hospital Santa Casa de Ponta Grossa durante os anos 2018 ­ 2021, com n amostral de 155 pacientes. A coleta dos dados se baseou na consulta de prontuários eletrônicos. O valor das razões NLR, NPR, PLR e SII foram calculados a partir da contagem dos neutrófilos, linfócitos e plaquetas dos hemogramas, considerou-se um hemograma a cada trimestre nesse intervalo de 4 anos. Como a normalidade dos dados não foi atestada, seguiu-se a metodologia não-paramétrica, o valor de α foi fixado em 0,05. Resultados: O teste de Skillings-Mack apresentou um valor de p-simulado significativo (< 2.2e-16) na comparação de cada uma das quatro razões. Na análise post-hoc, as comparações trimestrais das medianas do SII, não apresentaram diferença significativa, as razões PLR, NPR e NLR apresentaram respectivamente, duas, três e seis, comparações com diferenças significativas. Conclusão: Houve comparações com diferenças significativas pontuais, não houve um aumento geral no valor das razões SII, PLR, NPR e NLR durante o período de pandemia (2020 - 2021) entre os pacientes em hemodiálise.

Complete blood count derived inflammation biomarkers such as neutrophil/lymphocyte ratio (NLR), platelet/lymphocyte ratio (PLR), neutrophil/platelet ratio (NPR) and systemic immune inflammation index (SII) have already been investigated as predictors of prognosis of systemic inflammatory, cardiovascular, malignant diseases, etc., and with the imminent SARS-CoV-2 pandemic, they also began to be studied as biomarkers of interest in this disease. Objective: To retrospectively compare the value of these 4 hematimetric ratios during the two years of the pandemic (2020-2021), with the previous period (2018-2019), in a population of kidney disease patients undergoing hemodialysis. Methods: This research was submitted to the Ethics and Research Committee of the State University of Ponta Grossa (CEP-UEPG) and was approved under protocol number 5.024.864. Patients treated in the Renal Replacement Therapy sector of Hospital Santa Casa de Ponta Grossa during the years 2018 ­ 2021 were included, with a sample size of 155 patients. Data collection was based on consultation of electronic medical records. The value of the NLR, NPR, PLR and SII ratios were calculated from the count of neutrophils, lymphocytes and platelets in the blood counts, considering one blood count every quarter in this 4-year interval. As the normality of the data was not attested, the non-parametric methodology was followed, the value of α was set at 0.05. Results: The Skillings-Mack test showed a significant simulated p-value (< 2.2e-16) when comparing each of the four ratios. In the post-hoc analysis, the quarterly comparisons of the SII medians did not show a significant difference, the PLR, NPR and NLR ratios showed two, three and six comparisons with significant differences, respectively. Conclusion: There were comparisons with significant specific differences, there was no general increase in the value of the SII, PLR, NPR and NLR ratios during the pandemic period (2020 - 2021) among hemodialysis patients.

Los biomarcadores de inflamación derivados del hemograma, como el índice de neutrófilos/linfocitos (NLR), el índice de plaquetas/linfocitos (PLR), el índice de neutrófilos/plaquetas (NPR) y el índice de inflamación inmune sistémica (SII), ya se han investigado como predictores del pronóstico de enfermedades sistémicas. enfermedades inflamatorias, cardiovasculares, malignas, etc., y con la inminente pandemia del SARS-CoV-2 también comenzaron a estudiarse como biomarcadores de interés en esta enfermedad. Objetivo: Comparar retrospectivamente el valor de estos 4 ratios hematimétricos durante los dos años de la pandemia (2020-2021), con el período anterior (2018-2019), en una población de pacientes con enfermedad renal en hemodiálisis. Métodos: Esta investigación fue presentada al Comité de Ética e Investigación de la Universidad Estadual de Ponta Grossa (CEP-UEPG) y fue aprobada con el dictamen número 5.024.864. Se incluyeron pacientes atendidos en el sector de Terapia de Reemplazo Renal del Hospital Santa Casa de Ponta Grossa durante los años 2018 ­ 2021, con un tamaño de muestra de 155 pacientes. La recolección de datos se basó en la consulta de historias clínicas electrónicas. El valor de los índices NLR, NPR, PLR y SII se calcularon a partir del recuento de neutrófilos, linfocitos y plaquetas en los hemogramas, considerando un hemograma cada trimestre en este intervalo de 4 años. Como no se comprobó la normalidad de los datos, se siguió la metodología no paramétrica, fijándose el valor de α en 0,05. Resultados: La prueba de Skillings-Mack mostró un valor p-simulado significativo (< 2,2e-16) al comparar cada una de las cuatro proporciones. En el análisis post-hoc, las comparaciones trimestrales de las medianas del SII no mostraron diferencia significativa, los ratios PLR, NPR y NLR presentaron, respectivamente, dos, tres y seis comparaciones con diferencias significativas. Conclusión: Hubo comparaciones con diferencias específicas significativas, no hubo un aumento general en el valor de los índices SII, PLR, NPR y NLR durante el período pandémico (2020 - 2021) entre los pacientes en hemodiálisis.

Hematological parameters: is there a difference between those released by the hematological analyzer and to the customer?

OBJECTIVE: This study aimed to compare the hematological parameters released by hematological analyzers with those released in customer reports. METHODS: We conducted a descriptive study in the laboratories of a medium-sized municipality in the state of Minas Gerais registered in the National Register of Health Establishments. Interviews were conducted using a questionnaire to obtain information regarding the parameters released by the analyzers and those available in the customer's report. RESULTS: Sixteen laboratories were evaluated, and none of them released all the parameters obtained from the hematological analyzers to customers. The red blood cell distribution width was released in 88% of the laboratories, atypical lymphocytes in 70%, mean platelet volume in 50%, platelet distribution width and platelet count in 20%. No laboratory released information on reticulocytes, fraction of immature reticulocytes and immature granulocytes, nucleated erythrocyte count, immature platelet fraction and reticulocyte hemoglobin, and large platelet rate. CONCLUSION: All evaluated clinical analysis laboratories had at least one parameter that was not released in the customer's report despite being released by the hematological analyzers. The lack of knowledge on the part of professionals about the clinical importance of each parameter of the complete blood count results in a loss in patient assessment, and it is important to include these parameters in the complete blood count report.

Pediatric chronic kidney disease: blood cell count indexes as inflammation markers.

INTRODUCTION: Chronic kidney disease (CKD) is defined as a progressive decline of kidney functions. In childhood, the main triggering factors are congenital anomalies of the kidneys and urinary tract (CAKUT) and glomerulopathies. Inflammatory responses present challenges for diagnosis and staging, which justifies studies on biomarkers/indexes. AIM: To define blood cell count indexes and verify their association with pediatric CKD etiology and staging. The included indexes were: Neutrophil-Lymphocyte Ratio (NLR), Derived Neutrophil-Lymphocyte Ratio (dNLR), Lymphocyte-Monocyte Ratio (LMR), Systemic Inflammation Response Index (SIRI), Aggregate Index of Systemic Inflammation (AISI), and Systemic Immune-Inflammation Index (SII). METHODS: We determined the indexes in 52 pediatric CKD patients and 33 healthy controls by mathematical calculation. CKD patients were separated in five groups based on the etiology and staging: Group IA: glomerulopathies at stage 1 or 2; IB: glomerulopathies at stage 3 or 4; IIA: CAKUT at stage 1 or 2; IIB: CAKUT at stage 3 or 4; and III: stages 3 or 4 of other etiologies. In addition, we combined all patients with CKD in one group (IV). Group V was a healthy control group. RESULTS: Lower values of LMR were observed for groups IB and IIB compared to group V (p = 0.047, p = 0.031, respectively). Increased values of SIRI were found for group III versus group V (p = 0.030). There was no difference for other indexes when the groups were compared two by two. CONCLUSION: The LMR and SIRI indexes showed promising results in the evaluation of inflammation, as they correlated with CKD etiologies and specially staging in these patients.

Prediction of Rupture by Complete Blood Count in Tubal Ectopic Pregnancies Treated with a Single-Dose Methotrexate Protocol.

OBJECTIVE: The availability of reliable and inexpensive markers that can be used to determine the risk of rupture during methotrexate (MTX) treatment in ectopic pregnancies (EPs) is considerable. The aim of the present study is to investigate the role of systemic inflammatory markers such as leukocytes (or white blood cells, WBCs), the neutrophil-to-lymphocyte ratio (NLR), and platelet distribution width (PDW), which are among the parameters of the complete blood count (CBC), in the prediction of rupture of EPs under MTX treatment. MATERIALS AND METHODS: A total of 161 patients with tubal EP who underwent a single-dose methotrexate (MTX) protocol were retrospectively analyzed, and the control group (n = 83) included patients cured by MTX, while the ruptured group (n = 78) included patients who were operated on for tubal rupture during the MTX treatment. The features of EP, beta-human chorionic gonadotropin (ß-hCG) levels, sonographic findings, and CBC-derived markers such as WBC, NLR, and PDW, were investigated by comparing both groups. RESULTS: The NLR was found to be higher in the ruptured group, of 2.92 ± 0.86%, and significantly lower in the control group, of 2.09 ± 0.6%. Similarly, the PDW was higher (51 ± 9%) in the ruptured group, and it was significantly lower a (47 ± 13%) in the control group (p < 0.05). Other CBC parameters were similar in both groups (p > 0.05). CONCLUSION: Systemic inflammation markers derived from CBC can be easily applied to predict the risk of tubal rupture in Eps, since the CBC is an inexpensive and easy-to-apply test, which is first requested from each patient during hospitalization.

OBJETIVO: A disponibilidade de marcadores confiáveis e baratos que podem ser usados para determinar o risco de ruptura durante o tratamento com metotrexato (MTX) em gestações ectópicas (GEs) é considerável. O objetivo do presente estudo é investigar o papel de marcadores inflamatórios sistêmicos, como leucócitos (ou glóbulos brancos, glóbulos brancos), a relação neutrófilo-linfócito (NLR) e largura de distribuição de plaquetas (PDW), que estão entre os parâmetros do hemograma completo (hemograma), na predição de ruptura de PEs sob tratamento com MTX. MATERIAIS E MéTODOS: Foram analisados retrospectivamente 161 pacientes com EP tubária submetidas a protocolo de dose única de metotrexato (MTX), sendo que o grupo controle (n = 83) incluiu pacientes curadas com MTX, enquanto o grupo roto (n = 78) incluíram pacientes operadas por ruptura tubária durante o tratamento com MTX. As características de EP, beta-gonadotrofina coriônica humana (ß-hCG), achados ultrassonográficos e marcadores derivados de CBC, como WBC, NLR e PDW, foram investigados comparando os dois grupos. RESULTADOS: A RNL foi maior no grupo roto, de 2,92 ± 0,86%, e significativamente menor no grupo controle, de 2,09 ± 0,6%. Da mesma forma, o PDW foi maior (51 ± 9%) no grupo roto, e foi significativamente menor a (47 ± 13%) no grupo controle (p < 0,05). Outros parâmetros do hemograma foram semelhantes em ambos os grupos (p > 0,05). CONCLUSãO: Marcadores inflamatórios sistêmicos derivados do hemograma podem ser facilmente aplicados para predizer o risco de ruptura tubária na Eps, uma vez que o hemograma é um exame de baixo custo e fácil aplicação, solicitado primeiramente a cada paciente durante a internação.

Hematologic parameters and the effect of hemoparasites of wild anurans in Northern Sinaloa, Mexico.

BACKGROUND: Few hematologic profiles for free-ranging amphibians are available. Hematologic evaluation is a useful tool for determining the health of amphibian populations and providing further knowledge for conservation actions. OBJECTIVES: Hematologic variables and the presence and effect of hemoparasites in anuran species were evaluated in Northern Sinaloa, Mexico. METHODS: Blood samples were collected from wild anurans of eight species to perform blood cell counts, leukocyte differential counts, and serum protein concentrations using manual methods and refractometry. In addition, morphologic identification and quantification of the hemoparasites were performed on blood smears. RESULTS: Differences were observed by sex, age, and season for the hematologic values of Incilius alvarius (n = 23), Incilius mazatlanensis (n = 46), Rhinella horribilis (n = 64), Leptodactylus melanonotus (n = 46), Lithobates forreri (n = 135), Lithobates catesbeianus (n = 20), Smilisca fodiens (n = 42), and Scaphiopus couchii (n = 7). Intra- and extra-erythrocytic hemoparasites were found in 56.2% of amphibian hosts; the hemoparasite infection of R. horribilis and L. melanonotus was higher in the dry season, showing increases in erythroplastids and monocytes. For L. forreri, males were more infected than females, and increases in leukocytes were associated with infections of different types of hemoparasites species. CONCLUSIONS: Hematologic values, hemoparasite prevalence, and the response to hemoparasite infection vary among amphibian species, sex, and age, as well as on season and hemoparasite type. This highlights the importance of hematologic evaluations in wild amphibian populations to determine the subclinical effects of hemoparasite infections.

Complete blood count and C-reactive protein to predict positive blood culture among neonates using machine learning algorithms.

PURPOSE: The authors aimed to develop a Machine-Learning (ML) algorithm that can predict positive blood culture in the neonatal intensive care unit, using complete blood count and C-reactive protein values. METHODS: The study was based on patients' electronic health records at a tertiary neonatal intensive care unit in São Paulo, Brazil. All blood cultures that had paired complete blood count and C-reactive protein measurements taken at the same time were included. To evaluate the machine learning model's performance, the authors used accuracy, Area Under the Receiver Operating Characteristics (AUROC), recall, precision, and F1-score. RESULTS: The dataset included 1181 blood cultures with paired complete blood count plus c-reactive protein and 1911 blood cultures with paired complete blood count only. The f1-score ranged from 0.14 to 0.43, recall ranged from 0.08 to 0.59, precision ranged from 0.29 to 1.00, and accuracy ranged from 0.688 to 0.864. CONCLUSION: Complete blood count parameters and C-reactive protein levels cannot be used in ML models to predict bacteremia in newborns.

Pyometra in queens - changes in haemato-biochemical parameters

Background: Pyometra is a bacterial and hormone-induced reproductive disease that occurs in the post-estrus luteal phase in intact queens. Pyometra is more common in the diestrus period due to the high progesterone concentration (in queens that mated, spontaneously ovulated, or were induced to ovulate). However, it can also be seen due to the use of exogenous hormones such as progesterone for the suppression of estrus. More research is needed in cases of pyometra in queens, as well as in bitches. Because, considering that the pathogenesis and characteristics of feline pyometra is similar to bitches, studies on pyometra-affected bitches are taken as reference in studies and applications on queens. From this point of view, the aims of this study were to reveal the changes in complete blood count, blood gas, and serum biochemistry parameters in feline pyometra cases and to determine the correlation between the mentioned parameters. Materials, Methods & Results: In the study, a total of 25 female cats of different breeds were used, between the ages of 6 months and 7 years, 15 were diagnosed with pyometra, and 10 healthy. Anamnesis, clinical findings, and ultrasonographic examinations were used in the diagnosis of pyometra. Abdominal ultrasonography was performed on queens brought to the clinic with complaints such as anorexia, polydipsia, polyuria, abdominal tension, and fever. The control group (n =10) consisted of queens that were introduced to the clinic and were reproductively healthy. Before any treatment in queens with pyometra and the control group, 1 mL blood samples were taken from v. cephalica to evaluate complete blood count, blood gases and serum biochemistry parameters. In complete WBC, Lym, Mon, Gra, RBC, Hb, HCT, MCV, MCH and PLT parameters and, blood gas parameters such as pH, pCO2 , pO2 , sO2 , Na, K, Cl, lactate, glucose, HCO3 , and BE were also evaluated in taken blood samples. Biochemical parameters BUN, creatinine, ALT, AST, ALP, amylase, T.BIL, D.BIL, P, CHOL, TG, LDH, TP, CPK, ALP, Ca, GGT were measured in serum samples. After examination and laboratory analysis, ovariohysterectomy was performed on queens as a treatment. Granulocyte, WBC, HCT and MCH levels of the pyometra group were higher (P < 0.05) and Lym levels were lower (P < 0.05) compared to the control group. According to these results, pH, HCO3 , and BE were lower (P < 0.05) in queens with pyometra than those in the control group, while Na and lactate parameters were higher (P < 0.05). According to the results of biochemical analysis, it was determined that BUN, creatinine levels, GGT, and LDH enzyme activities were found to be higher in the pyometra group compared to the control group, while the Ca level was found to be low (P < 0.05). A positive correlation was observed between BUN and creatinine and LDH, WBC, granulocyte, HCT, and lactate, and a negative correlation between lymphocytes, pH, and BE in the correlation analysis performed on queens with pyometra and control group. However, a positive correlation was observed between creatinine and LDH and HCT, and a negative correlation between lymphocyte, pH and BE. Discussion: There is not enough information about pyometra in queens. As a result, it was determined that there were significant changes in complete blood count, blood gases and serum biochemical parameters in queens with pyometra in this study. These changes were generally thought to be related to dehydration and sepsis or endotoxemia. In addition, it was evaluated that prerenal azotemia occurring in pyometra affected queens may cause renal dysfunction. For this reason, it is thought that the results obtained in the presented study may contribute to the diagnosis, treatment, and prognosis of pyometra cases in queens.

Diagnosis of transmissible venereal tumors in bitches - platelet indices are a remarkable marker?

Background: Hematological analyses are seen as more preferred laboratory analyses in canine transmissible venereal tumor studies. There is no information about the availability of platelets and their indices in routine practice in canine transmissible venereal tumor cases. Taking this as a starting point, this study analyzed the usefulness of platelet indices in dogs with transmissible venereal tumor in clinical laboratory diagnosis as well as examined the relationship between white blood cells, red blood cells, platelets (PLT), main platelet volume (MPV), platelet distribution width (PDW), plateletcrit (PCT), and the ratio of main platelet volume to platelets (MPV/PLT). Materials, Methods & Results: In the study, a total of 42 bitches of various breeds were used. Nineteen healthy bitches were used as a control group, and the others 23 with cTVT as a study group. Metastasis was not observed in any of the bitches involved in the study. History, clinical findings, and cytological examinations were evaluated for the diagnosis of cTVT. In animals with hemorrhagic discharge and neoplastic lesions, a vaginal cytological examination was performed. Typical TVT cells with large nuclei and intracytoplasmic vacuoles were observed in the vaginal cytological examinations, and the diagnosis of TVT was made. Healthy bitches (19) and those with TVT (23) were 39.16 5.37 months and 47.61 5.14 months old, respectively. From all animals, 2 mL blood samples were collected from V. cephalica to evaluate PIs in the complete blood count (CBC). Collected blood samples were analyzed using an automated hematology analyzer. As a result of the analysis, WBC, RBC, HGB, HCT, MCV, MCHC, RDW, PLT, MPV, PDW, PCT, and MPV/PLT data were obtained. Mild leukocytosis, an increase in PLT, and a decrease in MCV and MPV/PLT were determined in the study group compared to the control group. Cut-off values in CBC of bitches with TVT were determined as WBC: 13.35 (sensitivity: 78%; specificity: 90%); MCV: 67 (sensitivity: 57%; specificity: 95%); PLT: 315.50 (sensitivity: 65%; specificity: 74%); and MPV/PLT: 0.028 (sensitivity: 78%; specificity: 58%). In CBC analyses, a strong negative correlation between PLT and MPV/PLT was detected in both groups. Discussion: Canine transmissible venereal tumors are common in both stray and pet dogs. It is naturally transferred from animal to animal during mating by live tumor cells. This tumor can commonly affect the external genitalia and internal organs in some cases. It generally has the look of cauliflower, and its surface is ulcerated, inflammatory, hemorrhagic, and infectious. More preferred laboratory analyses are complete blood count and blood chemistry analysis in cTVT for to evaluate the success of treatments. Platelet indices have been investigated in many diseases such as endotoxemia, chronic enteropathy, mammary tumor, parvoviral enteritis, septic peritonitis, lymphoma, pyometra, visceral leishmaniasis, and babesiosis in dogs. There is no information available for either diagnostic or prognostic use of the PIs in canine TVT cases. Ultimately, in light of the presented study's results, platelet indices, especially PLT and the MPV/PLT ratio, seem to be notable laboratory markers in terms of easy accessibility and low-cost assessment techniques in canine transmissible venereal tumor cases. New data, however, should be established by a thorough follow-up study using a larger sample size and addressing its usefulness as a diagnostic or prognostic marker in canine transmissible venereal tumors.

Neutrophil/lymphocyte ratio and other blood cell component counts are not associated with the development of postmolar gestational trophoblastic neoplasia.

OBJECTIVE: To relate preevacuation platelet count and leukogram findings, especially neutrophil/lymphocyte ratios (NLR) and platelet/lymphocyte ratios with the occurrence of gestational trophoblastic neoplasia (GTN) after complete hydatidiform mole (CHM) among Brazilian women. METHODS: Retrospective cohort study of patients with CHM followed at Rio de Janeiro Federal University, from January/2015-December/2020. Before molar evacuation, all patients underwent a medical evaluation, complete blood count and hCG measurement, in addition to other routine preoperative tests. The primary outcome was the occurrence of postmolar GTN. RESULTS: From 827 cases of CHM treated initially at the Reference Center, 696 (84.15%) had spontaneous remission and 131 (15.85%) developed postmolar GTN. Using optimal cut-offs from receiver operating characteristic curves and multivariable logistic regression adjusted for the possible confounding variables of age and preevacuation hCG level (already known to be associated with the development of GTN) we found that ≥2 medical complications at presentation (aOR: 1.96, CI 95%: 1.29-2.98, p<0.001) and preevacuation hCG ≥100,000 IU/L (aOR: 2.16, CI 95%: 1.32-3.52, p<0.001) were significantly associated with postmolar GTN after CHM. However, no blood count profile findings were able to predict progression from CHM to GTN. CONCLUSION: Although blood count is a widely available test, being a low-cost test and mandatory before molar evacuation, and prognostic for outcome in other neoplasms, its findings were not able to predict the occurrence of GTN after CHM. In contrast, the occurrence of medical complications at presentation and higher preevacuation hCG levels were significantly associated with postmolar GTN and may be useful to guide individualized clinical decisions in post-molar follow-up and treatment of these patients.

Advanced clinical parameters: A complementary hydroxyurea adherence evaluation in sickle cell anemia treatment.

OBJECTIVES: Given the complex pathology of sickle cell anemia (SCA) and low adherence to hydroxyurea (HU) treatment, there is a need to seek parameters that identify recent changes in patient status. The advanced clinical parameters (ACPs) allow an early analysis of hematopoiesis. We aimed to draw the demographic profile of non-adherent SCA patients and to verify the use of ACPs as a measure of HU treatment adherence. METHOD: In a cross-sectional study, we divided 83 SCA subjects treated with HU into Children (<12 years old) and adolescents/adults (≥12 years old). Their hemogram with the ACPs, electronic medical charts and pharmacy claim data were analyzed. RESULTS: Non-adherent ≥12 years old patients had significantly increased WBC, absolute neutrophil, lymphocyte, monocyte, and basophil counts, RBC, RET, RDW, and PLT, and significantly decreased MCV and MCH. Subjects in the adolescent/adult group with IG† ≥0.035 cells/mm3 had the RR for non-adherence increased by 4.6 times (p = .014), and the systemic immune inflammation index (SII) of non-adherent patients was also significantly higher (p = .042). CONCLUSION: IG† presents clinical utility in early identification of non-adherence to HU, especially when combined with other parameters, suggesting the evaluation of ACPs in laboratory routine, as they can be easily implemented.

Leishmaniose visceral canina: avaliação de hemograma e mielograma / Canine Visceral Leishmaniasis: Evaluation of the complete blood count and myelogram

A leishmaniose visceral (LV) é uma enfermidade crônica, multissistêmica e comum, que afeta os cães e pode apresentar alterações em diversos exames laboratoriais, inclusive no hemograma e mielograma. Desse modo, o objetivo deste trabalho foi descrever e avaliar as alterações no hemograma e mielograma de seis cães positivos para leishmaniose atendidos no Hospital Universitário Ivan Macedo Tabosa da Universidade Federal de Campina Grande. Os diagnósticos foram confirmados através da observação das formas amastigotas de Leishmania sp em aspirados de medula óssea. No hemograma, a maior parte dos animais apresentou anemia, trombocitopenia e leucocitose com neutrofilia. Além disso, dois animais apresentaram leucopenia. No mielograma, a maioria dos animais apresentou hiperplasia granulocítica e megacariocítica, além de hipoplasia eritroide. Conclui-se que a realização de exames laboratoriais, como hemograma e mielograma, em animais suspeitos de LV é importante para o acompanhamento do quadro clínico do paciente e para a seleção de medidas terapêuticas a serem adotadas, o que pode refletir positivamente no prognóstico.

Visceral leishmaniasis (VL) is a chronic, multisystemic, and common disease that affects dogs and that can present changes in several laboratory tests, including blood count and myelogram. Thus, this work aimed to describe and evaluate changes in the blood count and myelogram of six dogs positive for leishmaniasis treated at the Veterinary Hospital Ivan Macedo Tabosa of the Federal University of Campina Grande. The diagnoses were confirmed by observing the amastigote forms of Leishmania sp in bone marrow aspirates. In the blood count, most animals presented anemia, thrombocytopenia, and leukocytosis with neutrophilia. Besides, two animals had leukopenia. In the myelogram, most animals presented granulocytic and megakaryocytic hyperplasia, in addition to erythroid hypoplasia. It is concluded that the performance of laboratory tests, such as blood count and myelogram, in animals suspected of VL is important for monitoring the patient's clinical condition and for selecting the therapeutic measures to be used, which can reflect positively on the prognosis.

Aspectos hematológicos e sazonais da infecção natural por Hepatozoon ssp. em cães no sertão da Paraíba / Hematological and seasonal aspects of natural infection by Hepatozoon spp. in dogs in the Sertão of Paraíba

O objetivo deste trabalho foi realizar um levantamento casuístico de diagnósticos de Hepatozoon durante 2018 e 2019, enfatizando os aspectos hematológicos de maior incidência relacionados aos animais e a sazonalidade. A pesquisa foi realizada no Laboratório de Patologia Clínica do Hospital Veterinário do Instituto Federal da Paraíba e em um laboratório veterinário particular, localizado no município de Sousa/PB. Os dados foram obtidos através de uma avaliação retrospectiva de hemogramas realizados em 718 amostras de cães, provenientes da zona urbana e diagnosticados para Hepatozoon spp. Verificou-se que 35 (4,8%) cães foram positivos, a partir da visualização de gamontes parasitando neutrófilos. Dentre esses animais infectados, 16 (45%) eram fêmeas e 19 (55%) eram machos. Em relação à idade, houve predominância em animais jovens com até três anos, totalizando 25 (72%) animais. A infecção natural por Hepatozoon spp. foi superior na estação mais seca, entre os meses de janeiro e maio. Os aspectos hematológicos foram variáveis nos animais infectados, onde os mais observados foram: anemia em 23 (65%); trombocitopenia em 14 (40%); leucocitose por neutrofilia em 11 (31%) e hiperproteinemia em 11 (31%) dos animais. Conclui-se que a prevalência da infecção por Hepatozoon spp. foi de 4,8% em cães na região urbana do Sertão Paraíbano, destacando-se o período dos meses mais quentes, com ocorrência maior em cães sem raça definida (SRD), sem predileção por sexo e idade. Os achados hematológicos entre os animais infectados foram variáveis, com maior frequência de anemia, trombocitopenia, leucocitose e hiperproteinemia.

This study aimed to conduct a case-by-case survey of diagnosed cases of Hepatozoon during in the period from 2018 - 2019, emphasizing the hematological aspects of higher incidence related to the animals and the seasonality. The research was carried out at the Clinical Pathology Laboratory of the Veterinary Hospital of the Federal Institute of Paraíba, and at a private Veterinary Laboratory located in the city of Sousa/PB. Data were obtained through a retrospective evaluation of blood counts performed in 718 samples of dogs from urban areas and diagnosed for Hepatozoon spp. It was found that 35 (4.8%) dogs were positive, from the visualization of gamontes parasitizing neutrophils. Among these infected animals, 16 (45%) were female and 19 (55%) were males. Regarding the age, there was a predominance in young animals up to 3 years old, totalizing 25 (72%) animals. The natural infection by Hepatozoon spp. was higher in the driest season, from January to May. The hematological aspects were variable in the infected animals, where the most observed were: anemia 23 (65%), thrombocytopenia 14 (40%), leukocytosis by neutrophilia 11 (31%), and hyperproteinemia 11 (31%). It is concluded that the prevalence of infection by Hepatozoon spp. was 4.8% in dogs in the urban region of Sertão Paraíbano, highlighting the period of warmer months, with a greater occurrence in mixed breed dogs (SRD), with no predilection for sex and age. The hematological findings among the infected animals were variable, with a higher frequency of anemia, thrombocytopenia, leukocytosis, and hyperproteinemia.

Perfiles hematológicos en pacientes infectados con malaria en un área endémica del Perú / Hematological profiles of malaria-infected patients in an endemic area of Peru

RESUMEN Objetivos. Evaluar la variación de los perfiles hematológicos antes, durante y después del tratamiento de pacientes infectados con malaria no complicada por Plasmodium vivax (Pv) y P. falciparum (Pf) en una población de la región Loreto. Materiales y métodos. El estudio se realizó entre 2010 y 2012, en Zungarococha (Iquitos). Los 425 participantes tuvieron tres visitas (visita 1-día 0-antes del tratamiento, visita 2-día 7-durante tratamiento, visita 3-día 28-después del tratamiento), hemograma completo, diagnóstico microscópico y molecular (PCR). Resultados. En la primera visita, se encontraron 93 (21,9%) positivos a Pv y 34 (8,0%) a Pf. Todos los positivos mostraron una reducción en los indicadores hematológicos de hematocrito, recuento de glóbulos blancos (RGB), neutrófilos abastonados y segmentados, eosinófilos y plaquetas (p<0.001) en comparación con el grupo negativo. Se encontró un porcentaje mayor de neutrófilos abastonados en Pf y de neutrófilos segmentados en Pv comparado al grupo negativo. Se observó variaciones en los perfiles hematológicos después del tratamiento para ambas especies, los neutrófilos abastonados disminuyeron, las plaquetas aumentaron, los eosinófilos se incrementaron al día 7 y decaen el día 28, el hematocrito y los neutrófilos segmentados disminuyeron al día 7 y se normalizaron el día 28. Las diferencias entre especies en el tiempo mostraron una disminución diaria de neutrófilos abastonados en infectados con Pv que en Pf. Conclusiones. El perfil hematológico en pacientes positivos a malaria no complicada varía en el tiempo durante y después del tratamiento. Estos son indicadores de la progresión de la enfermedad y ayudan en la vigilancia terapéutica de pacientes infectados con Plasmodium.

ABSTRACT Objectives. To evaluate the variation of hematological profiles of patients infected with uncomplicated Plasmodium vivax (Pv) and P. falciparum (Pf) malaria before, during and after treatment in a population of the Loreto region. Materials and methods. This study was conducted between 2010 and 2012, in Zungarococha (Iquitos). The 425 participants had three visits (visit 1-day 0-before treatment, visit 2-day 7-during treatment, visit 3-day 28-after treatment), complete blood count, microscopic and molecular diagnosis (PCR). Results. At the first visit, 93 (21.9%) participants were found positive for Pv and 34 (8.0%) for Pf. All positives showed a reduction in hematocrit, white blood cell count (WBC), ablated and segmented neutrophils, eosinophils and platelets (p<0.001) compared to the negative group. A higher percentage of ablated neutrophils was found in Pf and segmented neutrophils in Pv compared to the negative group. Variations in hematological profiles were observed after treatment for both species; ablated neutrophils decreased, platelets increased, eosinophils increased at day 7 and declined at day 28, hematocrit and segmented neutrophils decreased at day 7 and normalized at day 28. Interspecies differences over time showed a bigger daily decrease in ablated neutrophils in Pv-infected when compared to Pf. Conclusions. The hematological profile in uncomplicated malaria-positive patients varies over time during and after treatment. These are indicators of disease progression and help in the therapeutic surveillance of Plasmodium-infected patients.