Rheological determinants in patients with Gaucher disease and internal inflammation.

The purpose of this study was to determine whether the inflammatory response in patients with Gaucher disease (GD) is accompanied by enhanced adhesiveness/aggregation of both red and white blood cells. Sixty patients with GD and matched controls were included. The degree of erythrocyte and leukocyte adhesiveness/aggregation was determined by using a simple slide test and image analysis. Patients with GD had significantly elevated concentrations of fibrinogen (328 vs. 262 mg/dl, P < 0.0001) and accelerated erythrocyte sedimentation rates (27 vs. 13 mm/H, P < 0.005). This was accompanied by a significantly enhanced degree of erythrocyte (75 vs. 85, P < 0.0001) and leukocyte (3.5 vs. 1.3, P < 0.002) adhesiveness/aggregation. The low-grade, smoldering, and subclinical internal inflammation in individuals with GD is accompanied by an increased degree of erythrocyte and leukocyte adhesiveness/aggregation. These findings might have rheological consequences in terms of microcirculatory slow flow and tissue hypoxemia.

Telemedicine-based application for the detection of inflammation in pediatrics.

To assess the feasibility of using telemedicine for the diagnosis of inflammation in a pediatric population. The degree of erythrocyte adhesiveness/aggregation and the number of white blood cells on peripheral blood slides were evaluated using an image analysis system and transferred to an operator in a remote location. A highly significant correlation was found between the degrees of erythrocyte adhesiveness/aggregation as well as estimated white blood cell count determined by a remote operator and the objective measurements of both erythrocyte sedimentation rate and white blood cell count. A reasonable estimate of both erythrocyte sedimentation rate and white blood cell count can be obtained by using telemedicine in a group of children with acute infection/inflammation.

The erythrocyte adhesiveness/aggregation test (EAAT). A new biomarker to reveal the presence of low grade subclinical smoldering inflammation in individuals with atherosclerotic risk factors.

BACKGROUND: Multiple acute phase proteins and atherosclerotic risk factors increase the aggregability of erythrocytes. METHODS AND RESULTS: We used a simple slide test and image analysis to determine the degree of erythrocyte adhesiveness/aggregation in the peripheral blood of 222 women and 221 men with no, one, two or more atherosclerotic risk factors. The degree of erythrocyte adhesiveness/aggregation correlated significantly with the concentration of commonly used variables of the acute phase response. We also showed that individuals with low erythrocyte adhesiveness/aggregation tend to be younger and to have fewer risk factors for atherosclerosis, including diabetes mellitus, hypertension, hyperlipidemia and smoking. CONCLUSIONS: The association between increased erythrocyte adhesiveness/aggregation, higher concentrations of acute phase proteins, and increased atherosclerotic risk factors points to a possible clinical applicability of the erythrocyte adhesiveness/aggregation test (EAAT) to reveal the presence of both low-grade subclinical smoldering inflammation and morbid biology in individuals with risk factors for atherosclerosis.

A simple biomarker to exclude the presence of low grade inflammation in apparently healthy individuals.

BACKGROUND: Atherosclerosis is accompanied by a low grade inflammatory response. HYPOTHESIS: To use erythrocyte aggregability as a biomarker to exclude the presence of low grade inflammatory response in apparently healthy individuals. METHODS: The adhesiveness/aggregation of red blood cells was quantitated by using a simple slide test and image analysis. RESULTS: We included 121 apparently healthy individuals and found a significant correlation between the degree of erythrocyte adhesiveness/aggregation and either the concentration of high sensitive CRP (r = 0.6, P < 0.001), erythrocyte sedimentation rate (r = 0.5, P < 0.0001) or fibrinogen (r = 0.5, P < 0.0001). By using certain cutoff points for the erythrocyte adhesiveness/aggregation test we could define individuals with a very low grade inflammatory response. CONCLUSIONS: By using this inexpensive and rapid assessment, we could clearly discriminate between individuals with a very low inflammatory response and those with a more intense one. This biomarker should be further evaluated as a possible screening test for use in large populations of apparently healthy individuals in whom the detection of low grade inflammation might contribute to guiding appropriate lifestyle modifications and therapeutic interventions.

Detection of a thrombolysis-related reduction in red blood cell adhesiveness/aggregation using a simple slide test.

Increased red cell aggregability might have unfavorable rheological effects in the microcirculation. It has been suggested that thrombolysis-related hypofibrinogenemia might be associated with a reduced erythrocyte adhesiveness/aggregation. We followed the reduction in erythrocyte adhesiveness/aggregation using a simple slide test and image analysis that measures the spaces that are formed between the aggregated erythrocytes. A significant (p = 0.01) reduction in the degree of erythrocyte adhesiveness/aggregation was noted in patients with acute myocardial infarction who received thrombolysis as opposed to individuals with Braunwald Class IIIB unstable angina who had normal fibrinogen concentrations. No change was found in the Westergren erythrocyte sedimentation rate, which is an indirect method to detect changes in aggregability of red blood cells. The present study shows the superiority of using a direct measurement of red blood cell adhesiveness/aggregation. This extremely rapid, cheap and almost bedside methodology to detect changes in erythrocyte adhesiveness/aggregation might be useful to detect changes of hemorheological relevance following thrombolysis.

Superiority of a functional leukocyte adhesiveness/aggregation test over the white blood cell count to discriminate between mild and significant inflammatory response in patients with acute bacterial infections.

Electronic cell counters may underestimate the white blood cell count (WBCC) in the presence of aggregated leukocytes. In the present study we focused on the possibility of using a functional, as opposed to an anatomic, count to circumvent this eventual underestimation. A model of bacterial infection was used because of the importance of leukocytosis in the physician's clinical decision-making process. There were 35 patients with low C-reactive protein (CRP) concentrations (0.5-4.9 mg/dL), 45 with intermediate (5-9.9 mg/dL), and 120 with relatively high (>10 mg/dL) CRP concentrations. A significant (P=0.008) difference was noted between the state of leukocyte adhesiveness/aggregation in the peripheral blood of individuals with low CRP concentrations (3.5%+/-4.3%) and those with high CRP concentrations (7.4%+/-8%), while there was no significant difference in the respective number of WBCs per cubic millimeter (cmm) (11,600 +/- 5,500 and 14,000 +/- 7,200, respectively). We raise the possibility that a functional test might be superior over an anatomic count in patients with acute bacterial infection and a significant acute phase response.

The erythrocyte adhesiveness/aggregation test to reveal real-time information of rheological relevance in patients with familial and primary hypercholesterolemia before and following plasma exchange.

We applied an erythrocyte adhesiveness/aggregation test (EAAT) to a model of plasma exchange in individuals with familial and primary hypercholesterolemia. The significant (p < 0.0001) reduction in the concentration of fibrinogen by 56%, globulins by 48%, and cholesterol by 53% corresponded to the expected significant (p < 0.0001) reduction in the degree of erythrocyte adhesiveness/aggregation in the peripheral venous blood. By virtue of its being a real-time, simple, very-low-cost, and essentially bedside technique, the EAAT might have the potential of disclosing information of rheological relevance immediately before, during, as well as following apheretical procedures administered to patients with an impaired rheological profile.

The usefulness of an inflammation meter to detect the presence of infection/inflammation in elderly patients.

BACKGROUND: Medical personnel who work in small geriatric institutions most frequently do not have access to realtime laboratory facilities. METHODS: In order to present a new method to determine the presence of an inflammatory response and for the assessment of its intensity, 118 patients aged 77 +/- 6 years with various bacterial infections were evaluated as well as 129 elderly individuals with various stressful conditions but no acute infections who served as controls. The leukocyte and erythrocyte adhesiveness/aggregation tests were performed by using a simple slide test and image analysis. The availability of the CD11b/CD18 and CD62L antigen on the leukocytes' surface was measured by whole blood flow cytometry, and the quantitative C-reactive protein by using laser nephelometry and specific antihuman C-reactive protein antibodies. RESULTS: A significant difference was noted between patients and controls for all variables obtained by the slide test and image analysis. In addition, a highly significant correlation was noted between the number of leukocytes counted on the slides and white blood cell count, between the leukocyte adhesiveness/aggregation test and quantitative C-reactive protein, and between the degree of erythrocyte adhesiveness/aggregation and either the Westergren sedimentation or fibrinogen concentration. CONCLUSIONS: By using our low-cost and real-time slide test, any medical or paramedical personnel can get relevant information regarding the presence of an acute phase response at the point of care.

Reduced acute phase response to differentiate between viral and bacterial infections in children.

The objective of this study was to document the reduced acute phase response that appears in children with viral as opposed to bacterial infections. The white blood cell count (WBCC), the erythrocyte sedimentation rate (ESR), and leukocyte and erythrocyte adhesiveness/aggregation were determined in 36 children with acute bacterial infection, 29 children with viral infection, and 19 controls. A significant reduced WBCC, ESR, and leukocyte and erythrocyte adhesiveness/aggregation was noted in the children with acute viral infection as opposed to those with bacterial infection: 10,800 +/- 3600 and 20,000 +/- 10,000 cells/cm2, 29 +/- 21 and 53 +/- 35 mm Hg, 23 +/- 9 and 41 +/- 15%, and 3.4 +/- 5.1 and 9.8 +/- 13.6 microns, respectively. The results indicate that a reduced acute phase response can be observed in children with an acute viral infection. This can have diagnostic implications and pathophysiological consequences in terms of less flow impairment in the microcirculation due to less red and white blood cell aggregation.