Logistic-Nomogram model based on red blood cell parameters to differentiate thalassemia trait and iron deficiency anemia in southern region of Fujian Province, China.

BACKGROUND: Differentiation between thalassemia trait (TT) and iron deficiency anemia (IDA) is challenging and costly. This study aimed to construct and evaluate a model based on red blood cell (RBC) parameters to differentiate TT and IDA in the southern region of Fujian Province, China. METHODS: RBC parameters of 364 TT patients and 316 IDA patients were reviewed. RBC parameter-based Logistic-Nomogram model to differentiate between TT and IDA was constructed by multivariate logistic regression analysis plus nomogram, and then compared with 22 previously reported differential indices. RESULTS: The patients were randomly selected to a training cohort (nTT = 248, nIDA = 223) and a validation cohort (nTT = 116, nIDA = 93). In the training cohort, multivariate logistic regression analysis identified RBC count, mean corpuscular hemoglobin (MCH), and MCH concentration (MCHC) as independent parameters associated with TT susceptibility. A nomogram was plotted based on these parameters, and then the RBC parameter-based Logistic-Nomogram model g (µy ) = 1.92 × RBC count-0.51 × MCH + 0.14 × MCHC-39.2 was devised. The area under the curve (AUC) (95% CI) was 0.95 (0.93-0.97); sensitivity and specificity at the best cutoff score (120.24) were 0.93 and 0.89, respectively; the accuracy was 0.91. In the validation cohort, the RBC parameter-based Logistic-Nomogram model had AUC (95% CI) of 0.95 (0.91-0.98); sensitivity and specificity were 0.92 and 0.87, respectively; accuracy was 0.90. Moreover, compared with 22 reported differential indices, the RBC parameter-based Logistic-Nomogram model showed numerically higher AUC, net reclassification index, and integrated discrimination index (all p < 0.001). CONCLUSION: The RBC parameter-based Logistic-Nomogram model shows high performance in differentiating patients with TT and IDA from the southern region of Fujian Province.

[Feasibility of Preheating at 41 ℃ to Correct Red Blood Cell Parameters in the Presence of High-titer Cold Agglutinins].

Objective To explore the feasibility of preheating in 41 ℃ water bath for 30 minutes to correct the red blood cell parameters in the specimens containing high-titer cold agglutinins(CAs). Methods Two specimens containing high-titer CAs were selected during work,and the parameters of complete blood count at room temperature or after preheating in 37 ℃ or 41 ℃ water bath were compared.The smears were stained,and the distribution of red blood cells was observed with a microscope.Further,74 specimens without CAs were collected for complete blood count,and then the test results at room temperature and after preheating at 41 ℃ were compared. Results At room temperature,the specimens containing high-titer CAs showed significantly reduced red blood cell count(RBC)and hematocrit(HCT),abnormally increased mean corpuscular hemoglobin(MCH)and mean cell hemoglobin concentration(MCHC),abnormal percents of hemoglobin(HGB)and RBC,and aggregation of a large number of red blood cells.After being preheated at 37 ℃ for a certain time,the specimens demonstrated obviously improved parameters while still aggregation of a small number of red blood cells.After being preheated at 41 ℃ for 30 minutes,the specimens showed significantly increased RBC,normal HCT,MCH,and MCHC,and evenly distributed red blood cells.The 74 specimens without CAs showed the comparability was ≥80% between room temperature and preheating at 41 ℃ for 30 minutes or 60 minutes. Conclusion We can preheat the specimens containing high-titer CAs in a water bath at 41 ℃ to obtain accurate red blood cell parameters.

Association of thalassemia, hemoglobinopathies, and vitamin D levels with lipid profile in adults: Community-based research in southern Thai population.

This study explored the frequency of lipid-lowering drug use in the thalassemia population and investigated the association of thalassemia, hemoglobinopathies, and serum 25(OH)D levels with lipid profile and red blood cell parameters. A combination of cross-sectional and community-based studies was conducted with 615 participants from the southern Thai population. Thalassemia and hemoglobinopathies were diagnosed using hemoglobin analysis and polymerase chain reaction-based methods to genotype globin genes. Biochemical parameters such as lipid profile, fasting blood sugar (FBS), and serum 25(OH)D levels were assessed using standard enzymatic methods and electrochemiluminescence immunoassays. Differences in the means of hematological and biochemical parameters between the thalassemia and non-thalassemia groups were compared and analyzed. A significantly lower frequency of lipid-lowering drug use was observed in the thalassemia group. Thalassemia, with clearly defined abnormalities in red blood cells, is associated with a 4.72-fold decreased risk of taking lipid-lowering drugs. Among thalassemia participants, the total cholesterol (TC) and low-density lipoprotein cholesterol (LDL-C) levels were significantly lower than those in non-thalassemia participants. The prevalence of hypovitaminosis D in carriers of thalassemia and/or hemoglobinopathies in the southern Thai population was 53 % in females and 21 % in males. The highest lipid profile was observed in samples without thalassemia and hypovitaminosis D. The genetics of thalassemia and hemoglobinopathies with obviously abnormal red blood cells could explain the variable lipid levels, in addition to lipid metabolism-related genes and environmental factors. However, the effect of thalassemia on lipid levels in each population may differ according to its prevalence. A larger sample size is required to confirm this association, especially in countries with a high prevalence of thalassemia.

Are Adults Over 18 Years of Age with Anaemia More Likely to Develop Chronic Periodontitis Than Adults Without Anaemia? - A Systematic Review and Meta-Analysis.

Aims and Objectives: Periodontitis is a chronic disease affecting the supporting tissues of the teeth and exhibits bidirectional relation with systemic diseases. This study aims to determine the association between chronic periodontitis and erythrocyte functional measures: total red blood cells (RBCs), hemoglobin (Hb) concentration, mean corpuscular volume (MCV), and mean corpuscular hemoglobin concentration (MCHC) by systematic review and meta-analysis. Materials and Methods: A systematic search of the electronic databases PUBMED, OVID, Embase, Web on Science, and Google Scholar was undertaken from inception to July 2022. English language studies that evaluated the erythrocyte functional measures in periodontitis and health were selected. Other review reports, letters/opinion articles, studies without a definition of periodontitis, and the concomitant presence of systemic conditions (diabetes, kidney disease, cancer) were excluded. Two reviewers determined full-text eligibility in a blinded process. Meta-Essentials software was used to generate forest plots and to determine heterogeneity and publication bias. Results: Twenty-six studies involving 1082 patients with chronic periodontitis and 980 healthy controls were analyzed. Pooled results showed lower Hb concentration (Hedges' g = -1.16; 95% confidence intervals [CI], -1.7 to -0.62), RBC counts (Hedges' g = -0.85; 95% CI, -1.31 to -0.38) and packed cell volume (-0.56; 95% CI, -1.02 to -0.11) in patients with chronic periodontitis. Conclusion: This meta-analysis showed a decreasing trend in the hematological parameters, including hemoglobin concentration, number of erythrocytes, and hematocrit in patients with chronic periodontitis compared to healthy controls.

Evaluation of the Alinity hq Automated Hematologic Analyzer and Determination of Reference Ranges for Novel Red Blood Cell Parameters.

OBJECTIVE: We evaluated the performance of the Alinity hq automated analyzer (Abbott Laboratories, Diagnostics Division, Hematology, Santa Clara, CA, USA). In addition, we determined the reference ranges for the red blood cell (RBC) research parameters. METHOD: The precision and stability of the instrument were measured for all complete blood count (CBC) parameters. We compared the CBC results between the Alinity hq and the DxH800 (Beckman Coulter, Miami, FL, USA) and the ADVIA 2120 (Siemens Healthcare Diagnostics, Tarrytown, NY, USA). The white blood cell (WBC) differential results were verified by manual differential counts. We determined the reference ranges of RBC research parameters among healthy adults. RESULTS: The Alinity hq analyzer demonstrated good within-run and between-day precision for all CBC parameters. The calculated correlation coefficients (r) indicated that Alinity hq-determined values of WBC, RBC, platelet (PLT) counts, hemoglobin (HGB), hematocrit (HCT), and mean corpuscular volume (MCV) were in very good concordance (r>0.95) when compared with results from the DxH800 and the ADVIA 2120. The Alinity hq WBC differential counts were comparable with the manual differential counts, and the results of neutrophil counts by Alinity hq correlated well. Lymphocyte and monocyte count correlated well in samples without blasts. CONCLUSIONS: The Alinity hq presented good analytical performance and showed good correlation compared with other hematology analyzers and manual differential counts.

Hematological Adaptations to Post-Exercise Sauna Bathing With No Fluid Intake: A Randomized Cross-Over Study.

Purpose: Sauna bathing is recommended to improve the sports training process, yet empirical evidence confirming its effectiveness is still inconclusive. We examined the effects of post-exercise sauna bathing on hematological adaptations and exercise capacity in healthy men. Methods: Thirteen physical education students participated in randomized cross-over study: two, 4-week interventions, with 10-week washout. The interventions involved 3 times per week 60-min stationary cycling either with 30-min of post-exercise sauna bathing (89 ± 3°C, 10 ± 2% RH) or without; no fluid was ingested during both exercise and sauna sessions. Before and after both interventions, participants were tested for total hemoglobin mass (tHb-mass), intravascular volumes, erythropoietin, ferritin, red blood cell parameters with reticulocyte fractions, along with maximal/peak and submaximal variables in a graded exercise test (GXT). Results: Regardless of intervention type, tHb-mass increased (p = .014) whereas ferritin concentration decreased (p = .027); however, changes in tHb-mass were within the range of typical error (<1.8%). Absolute and relative values of maximal power and power at gas exchange threshold, as well as peak oxygen uptake (all p < .010), also increased irrespective of intervention type. Conclusions: The use of post-exercise sauna bathing with fluid intake restrictions does not provide any additional benefits in tested variables over endurance training alone. Thus, further evidence is required before recommendations to utilize this post-exercise conditioning strategy are deemed valid.

An online alpha-thalassemia carrier discrimination model based on random forest and red blood cell parameters for low HbA2 cases.

BACKGROUND: Since screening of α-thalassemia carriers by low HbA2 has a low positive predictive value (PPV), the PPV was as low as 40.97% in our laboratory, other more effective screening methods need to be devised. This study aimed at developing a machine learning model by using red blood cell parameters to identify α-thalassemia carriers from low HbA2 patients. METHODS: Laboratory data of 1213 patients with low HbA2 used for modeling was randomly divided into the training set (849 of 1213, 70%) and the internal validation set (364 of 1213, 30%). In addition, an external data set (n = 399) was used for model validation. Fourteen machine learning methods were applied to construct a discriminant model. Performance was evaluated with accuracy, sensitivity, specificity, etc. and compared with 7 previously published discriminant function formulae. RESULTS: The optimal model was based on random forest with 5 clinical features. The PPV of the model was more than twice the PPV of HbA2, and the model had a high negative predictive value (NPV) at the same time. Compared with seven formulae in screening of α-thalassemia carriers, the model had a better accuracy (0.915), specificity (0.967), NPV (0.901), PPV (0.942) and area under the receiver operating characteristic curve (AUC, 0.948) in the independent test set. CONCLUSION: Use of a random forest-based model enables rapid discrimination of α-thalassemia carriers from low HbA2 cases.

Red Blood Cell Parameters and Their Correlation with Glycemic Control Among Type 2 Diabetic Adult Patients in Eastern Ethiopia: A Comparative Cross-Sectional Study.

Background: Diabetes has been proposed to inflict an insult on the hematopoietic milieu marked by changes in hematological indices including red blood cell parameters. Thus, this study aimed to assess the red blood cell parameters and their correlation with glycemic control in type 2 diabetic adult patients in comparison with apparently healthy individuals. Methods: A comparative cross-sectional study was conducted at the chronic illness clinic of Hiwot Fana Comprehensive Specialized University Hospital from May 20 to July 10, 2022. A total of 220 (110 type 2 diabetic patients and 110 controls) study participants were selected by a simple random sampling technique. Five milliliters of venous blood were collected by the vacutainer blood collection technique. Red blood cell parameters and blood glucose levels were determined using UniCel DxH 800 and Biosystems A25 analyzers, respectively. Independent sample t-test and Pearson correlation test were used for the data analysis. P-value <0.05 was considered statistically significant. Results: Statistically significant difference was observed in RBC parameters of T2DM patients and the control group. The mean RBC count, Hgb, Hct (P < 0.001), and MCHC (P = 0.002) in patients with type 2 diabetes was significantly lower than in the control group. However, the mean of RDW was significantly increased in type 2 diabetic patient groups than in the control group (P < 0.001). The mean RBC count, Hct, and Hgb in patients with good glycemic control were significantly higher than the patients with poor glycemic control. Besides, a statistically significant negative correlation was observed between glycemic control and RBC count, Hgb, and Hct level in diabetic patients. Conclusion: In this study, a statistically significant difference was observed in red blood cell parameters of type 2 diabetic patients compared to the control group. A significant negative correlation was noted between glycemic control and RBC parameters in type 2 diabetic patients. Therefore, evaluation of RBC parameters should be considered for better management of patients with type 2 diabetes mellitus.

Effect of nickel on red blood cell parameters and on serum vitamin B12, folate and homocysteine concentrations during pregnancy with and without anemia.

BACKGROUND: Research to date suggests that nickel affects not only the metabolism of vitamin B12 but also folates and thus may affect hematopoiesis processes. OBJECTIVE: The aim of the study was to examine the relationship of nickel (Ni) status to red blood cell (RBC) parameters and serum vitamin B12, folate and homocysteine concentrations in the course of normal pregnancy and in pregnant women with anemia. METHODS: The study included fifty-three pregnant women recruited to the study from the Lower Silesia region of Poland, 17 % of whom developed anemia. Nickel concentration was determined in urine, whole blood and food samples by atomic absorption spectrometry. At the same time as the food and urine samples were taken, blood was also collected for the determination of RBC parameters and serum vitamin B12, homocysteine and folate concentrations. RESULTS: The median reported Ni intake, and the urinary and whole blood nickel contents for the studied pregnant women for the first trimester were respectively - 162.46 µg/day, 3.98 µg/L and 3.32 µg/L; for the second trimester - 110.48 µg/day, 6.86 µg/L and 1.04 µg/L; and for the third trimester - 132.20 µg/day, 3.41 µg/L and 0.70 µg/L. With regard to Ni concentration in whole blood (p = 0.0204) and in urine (p = 0.0003), the differences in the values for individual trimesters were statistically significant. The whole blood Ni level was significantly higher (9.28 vs 3.62 µg/L, p = 0.0114), while the concentration of homosysteine was significantly lower (4.09 vs 5.04 µmol/L, p = 0.0165) in pregnant women with anemia compared to those without anemia. The whole blood Ni concentration was negatively correlated with almost all RBC parameters in non-anemic pregnant women. CONCLUSIONS: Ni status changes with the development of normal pregnancy, and in the case of anemia, an increase in Ni concentration in whole blood is observed. The demonstrated correlations between the Ni status in pregnant women and RBC parameters as well as serum vitamin B12 and folate concentrations suggest that nickel is associated with the methionine-folate cycle, iron homeostasis and bacterial synthesis of vitamin B12 in humans.

Reference intervals of red blood cell parameters and platelet count for healthy adults in Japan.

Although it is known that red blood cell (RBC) parameters and platelet count depend on ethnicity and sex, their reference intervals in healthy Asian populations are limited. The aim of this study was to establish reference intervals for RBC parameters and platelet count for healthy adults in Japan. A total of 750 healthy adults (447 women and 303 men; median age 40 years (18-67 years) at seven Japanese centers who participated in regular medical checkups entered this study. Their RBC parameters and platelet count were measured using automated hematocytometers. The reference intervals of the RBC parameters and platelet count according to sex in healthy adults were determined. There was an age-specific decrease in RBC counts and an age-specific increase in mean corpuscular volume in men. This study emphasizes the need to consider sex and age in the clinical use of reference intervals of RBC parameters.

Evaluation of Red Blood Cell Parameters as a Biomarker for Long-Term Glycemic Control Monitoring Among Type 2 Diabetic Patients in Southwest Ethiopia: A Cross-Sectional Study.

OBJECTIVE: The main aim of this study was to assess red blood cell parameters as a biomarker for long-term glycemic monitoring among T2 DM patients. METHODS: Facility-based cross-sectional study through a consecutive sampling technique was conducted among 124 T2 DM patients at the chronic illness follow-up clinic of Jimma Medical Center (JMC) from July 27 to August 31, 2020. A structured questionnaire was used to collect socio-demographic and clinical-related data. Five milliliters of the blood specimen were collected from each eligible T2 DM patient. Glycated hemoglobin (HbA1c) and red blood cell parameters were determined by Cobas 6000 and DxH 800 fully automated analyzers, respectively. Data were entered into EpiData software version 3.1 and exported to SPSS 25 version for analysis. Independent t-test and Pearson's correlation coefficient were used to address the research questions. A P-value <0.05 was considered statistically significant. RESULTS: The mean age of study participants was 51.84± 11.6 years. Moreover, 60.5% of T2 DM patients were in poor glycemic control. There was a significant mean difference between good and poor glycemic controlled T2 DM patients in red blood cell count (4.79±0.5 vs 4.38±0.8), hemoglobin (14.13±1.4 vs 13.60±1.6), mean corpuscular volume (89.52±4.7 vs 92.62±7.5), mean corpuscular hemoglobin (29.63±1.6 vs 30.77±2.9), and red cell distribution width (13.68±1.1 vs 14.63±1.2) respectively. Red blood cell count was inversely correlated (r=-0.280, p=0.002) with HbA1c while mean corpuscular volume (r=0.267, p=0.003), mean corpuscular hemoglobin (r=0.231, p=0.010), and red cell distribution width (r= 0.496, p=0.000) were positively correlated with level of HbA1c. CONCLUSION: Red cell count, mean corpuscular volume, mean corpuscular hemoglobin, and red cell distribution width could be useful indicators to monitor the glycemic status of T2 DM patients instead of HbA1c, though large prospective studies should be considered.

Hematological parameters and red blood cell morphological abnormality of Glucose-6-Phosphate dehydrogenase deficiency co-inherited with thalassemia.

OBJECTIVE/BACKGROUND: Glucose-6-phosphate dehydrogenase (G-6-PD) deficiency and thalassemia are genetically independent hemolytic disorders. Co-inheritance of both disorders may affect red blood cell pathology to a greater extent than normally seen in either disorder alone. This study determines the prevalence and evaluates hematological changes of G-6-PD deficiency and thalassemia co-inheritance. METHODS: G-6-PD deficiency was screened from 200 male thalassemia blood samples using a fluorescent spot test. Hematological parameters and red blood cell morphology were evaluated among G-6-PD deficiency/thalassemia co-inheritance, G-6-PD deficiency alone, thalassemia alone, and normal individuals. RESULTS: G-6-PD deficiency was detected together with hemoglobin (Hb) E heterozygote, Hb E homozygote, ß-thalassemia trait, and ß-thalassemia/Hb E, α-thalassemia-2 trait, and Hb H disease. Hb level, hematocrit, mean cell volume, and mean cell Hb of G-6-PD deficiency co-inherited with asymptomatic thalassemia carriers show significantly lower mean values compared to carriers with only the same thalassemia genotypes. Higher mean red blood cell distribution width was observed in G-6-PD deficiency co-inherited with Hb E heterozygote, as with numbers of hemighost cells in G-6-PD deficiency/thalassemia co-inheritance compared to those with either disorder. Apart from Hb level, hematological parameters of co-inheritance disorders were not different from individuals with a single thalassemia disease. CONCLUSION: G-6-PD deficiency co-inherited with thalassemia in males was present in 10% of the participants, resulting in worsening of red blood cell pathology compared with inheritance of thalassemia alone.

Erythrocytes and Platelets: A Critical Analysis of their Ontogenic Relationship through Automated Parameters.

INTRODUCTION: Erythrocytes and platelets share an intimate development history, due to which special interest is centered on their relationship. Mature Red Blood Cells (RBCs) and platelets show a similar physiological rhythm, and are concurrently involved in numerous pathologic states. AIM: To identify subtle relationships between various RBC and platelet parameters with an objective to analyse if a linear correlation co-exists between and among them in physiological/pathological states. MATERIALS AND METHODS: A prospective analysis of 1250 EDTA blood samples was conducted. The five RBC parameters (RBC count, HCT, MCV, RDW, Hb) and four platelet parameters (platelet count, PCT, MPV, PDW) obtained from each case were statistically analysed for linear dependence. RESULTS: A statistically significant direct linear relationship was found between RDW with platelet count and PCT. A statistically significant inverse linear relationship was noticed between the following parameters: i) HCT with platelet count and PCT; ii) MCV with platelet count and PCT; iii) Haemoglobin and platelet count. CONCLUSION: A linear correlation, either direct or inverse, was seen among various parallel RBC and platelet parameters.

Prognostic significance of red cell distribution width and other red cell parameters in patients with chronic heart failure during two years of follow-up.

BACKGROUND: Studies published during the last decade seem to indicate red blood cell parameters as inexpensive, rapidly available, and simple tools for the assessment of prognosis in patients with chronic heart failure (CHF). AIM: To evaluate the prognostic value of red cell parameters determined in a routine blood count in patients with CHF. METHODS: The study group included 165 patients with the New York Heart Association (NYHA) class II-IV CHF hospitalised in the 2nd Department of Cardiology in Bydgoszcz. On the first day of hospitalisation, all patients in the study group underwent a complete blood count with an assessment of haemoglobin (Hb) level, mean corpuscular volume (MCV), mean corpuscular haemoglobin (MCH), mean corpuscular haemoglobin concentration (MCHC) and red blood cell distribution width (RDW). Follow-up was carried over 24 months by phone calls every 3 months. RESULTS: MCV, MCH and MCHC were not shown to be significant predictors of mortality in CHF patients at 1 and 2 years of follow-up. In univariate analysis at 1-year follow-up, the following variables were significantly associated with the occurrence of the study endpoint: Hb level (p = 0.022; HR = 0.80), RDW (p = 0.004; HR = 1.257), and N-terminal pro-B-type na-triuretic peptide (NT-proBNP) level (p = 0.0001; HR = 1). At 2 years of follow-up, the following variables were significantly associated with the occurrence of the study endpoint: left ventricular ejection fraction (p = 0.018; HR = 0.956), NYHA class (p = 0.007; HR = 0.378), RDW (p = 0.044; HR = 1.175), and NT-proBNP level (p < 0.001; HR = 1). Multivariate analysis for 1-year follow-up showed that RDW and NT-proBNP level were independent significant predictors of mortality, while NT-proBNP level (p = 0.006; HR = 1) and NYHA class (p = 0.024; HR = 0.439) were significant predictors of mortality at 2 years of follow-up. Based on receiver operating characteristic curve analysis, the cut-off RDW was 15.00% (AUC = 0.63; 0.523-0.737), at 12 months of follow-up and 14.00% (AUC = 0.6; 0.504-0.697), at 24 months of follow-up. The cut-off for Hb level was 13.9 g/dL (AUC = 0.662; 0.553-0.77), at 12 months of follow-up and 12.2 g/dL (AUC = 0.581; 0.482-0.681), at 24 months of follow-up. CONCLUSIONS: Baseline RDW and Hb level in patients hospitalised with the diagnosis of NYHA class II-IV CHF seem to be important predictors of mortality in this population. Among the red blood cell parameters, only RDW was shown to be an independent prognostic factor at 1 year of follow-up but it appeared to lose its significance during longer-term follow-up.

Assessment of red blood cell parameters and peripheral smear at different temperatures in case of cold agglutination disease.

Cold agglutination disease (CAD) is characterized by an auto-antibody which is able to agglutinate red blood cells (RBCs) at temperatures lower than that of the body, and subsequently to activate the complement system responsible for lysis of RBCs. Patients show hemolytic anemia of varying degrees of severity, which arise or worsen upon exposure to low temperatures. We describe a case who presented with fever and symptoms of asthenia. His investigations yielded bizarre RBC parameters which led to suspicion of a rare CAD, which was confirmed on reviewing RBC parameters, peripheral smear and direct Coomb's test at different temperatures. Hence, we suggest assessment of bizarre RBC parameters and peripheral smear can help in laboratory testing and diagnosis of CAD. It should also not pose embarrassment in laboratory testing to the pathologist for making an early and accurate diagnosis, thus emphasizing the need for an early treatment of CAD.