Dina Samir Elsaid, Tamer Abd Elhamid Elbedewy, Nema Ali Soliman, Kamal Ali Shalaby, Riham Abdel-Hamid Haroun
Objective
Immune thrombocytopenic purpura (ITP) is an acquired autoimmune disease characterized by reduced platelet counts due to immune system dysregulation caused by many factors, including genetics, autoimmune diseases, infections, and inflammations. Therefore, the current study aimed to evaluate immunological markers such as the expression level of lysosomal associated membrane protein 3 (LAMP-3), also known as CD63, and the expression level of Fc-gamma receptor I (FcγRI), also known as CD64 and also investigate the association of Fc-gamma receptor IIIA (FcγRIIIA) 158 V/F polymorphism to the risk of ITP.
Methods
A total of 180 subjects; 60 ITP patients, 60 patients with thrombocytopenia of other causes and 60 controls were enrolled into our study. The expression level of CD63 was done using reverse transcription quantitative PCR (RTqPCR), while CD64 expression level was done by flow cytometry. The polymorphism of FcγRIIIA 158 V/F gene was analyzed by polymerase chain reaction followed by restriction fragment length polymorphism (PCR-RFLP) analysis. Finally, CD63 and CD64 protein–protein interactions were done by using the STRING online database.
Results
The expression of CD63 was significantly elevated in ITP patients than thrombocytopenia patients and healthy control. Also there was high expression level of CD64 on granulocytes and monocytes from ITP patients than other groups. Receiver operating characteristic curve (ROC curve) analysis of CD63 showed an area under the curve (AUC) revealed of 1.00, sensitivity of 100% and specificity of 100%; while for CD64 on granulocytes, AUC of 0.998 as well as a sensitivity of 96.66% and specificity of 93.33%. Regarding FcγRIIIa 158 V/F polymorphism, all patients and healthy volunteers included in this study showed the wild FF genotype.
Conclusions
The expression of both CD63 and CD64 were significantly increased in ITP patients and could be good biomarkers to diagnose ITP. Additionally, there is no association between FcγRIIIa 158 V/F polymorphism and the risk of ITP disease.
{"title":"Diagnostic Implications of CD63 and CD64 Expression Levels and FcγRIIIA 158 V/F Gene Polymorphism in Primary Immune Thrombocytopenia Adult Patients","authors":"Dina Samir Elsaid, Tamer Abd Elhamid Elbedewy, Nema Ali Soliman, Kamal Ali Shalaby, Riham Abdel-Hamid Haroun","doi":"10.1111/ijlh.14391","DOIUrl":"10.1111/ijlh.14391","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>Immune thrombocytopenic purpura (ITP) is an acquired autoimmune disease characterized by reduced platelet counts due to immune system dysregulation caused by many factors, including genetics, autoimmune diseases, infections, and inflammations. Therefore, the current study aimed to evaluate immunological markers such as the expression level of lysosomal associated membrane protein 3 (LAMP-3), also known as <b>CD63</b>, and the expression level of Fc-gamma receptor I (FcγRI), also known as <b>CD64</b> and also investigate the association of Fc-gamma receptor IIIA (<b>FcγRIIIA</b>) 158 V/F polymorphism to the risk of ITP.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A total of 180 subjects; 60 ITP patients, 60 patients with thrombocytopenia of other causes and 60 controls were enrolled into our study. The expression level of CD63 was done using reverse transcription quantitative PCR (RTqPCR), while CD64 expression level was done by flow cytometry. The polymorphism of FcγRIIIA 158 V/F gene was analyzed by polymerase chain reaction followed by restriction fragment length polymorphism (PCR-RFLP) analysis. Finally, CD63 and CD64 protein–protein interactions were done by using the STRING online database.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The expression of CD63 was significantly elevated in ITP patients than thrombocytopenia patients and healthy control. Also there was high expression level of CD64 on granulocytes and monocytes from ITP patients than other groups. Receiver operating characteristic curve (ROC curve) analysis of CD63 showed an area under the curve (AUC) revealed of 1.00, sensitivity of 100% and specificity of 100%; while for CD64 on granulocytes, AUC of 0.998 as well as a sensitivity of 96.66% and specificity of 93.33%. Regarding FcγRIIIa 158 V/F polymorphism, all patients and healthy volunteers included in this study showed the wild FF genotype.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>The expression of both CD63 and CD64 were significantly increased in ITP patients and could be good biomarkers to diagnose ITP. Additionally, there is no association between FcγRIIIa 158 V/F polymorphism and the risk of ITP disease.</p>\u0000 </section>\u0000 </div>","PeriodicalId":14120,"journal":{"name":"International Journal of Laboratory Hematology","volume":"47 2","pages":"255-265"},"PeriodicalIF":2.2,"publicationDate":"2024-11-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142585424","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
FNU Alnoor, Alexandra Rangel, Matthew Luo, Oscar Silva, Karen M. Chisholm, Dennis O'Malley, Roger Warnke, Jyoti Kumar, Robert S. Ohgami
Castleman Disease (CD) is a rare lymphoproliferative disorder that can be separated into two primary forms: Unicentric Castleman disease (UCD) and multicentric Castleman disease (MCD). UCD is localized, while MCD is systemic. Though UCD generally has a favorable prognosis following surgical resection, more aggressive forms of this disease have been identified, including cases associated with dendritic and spindle cell proliferation. Genetic analysis has deepened our understanding of UCD. Despite advancements in better understanding the pathophysiology of UCD, challenges persist in the diagnosis, management, and treatment due to its rarity and heterogeneity. Here, we review current knowledge on UCD, highlighting the epidemiology, clinical presentation, diagnostic criteria, and treatment options while emphasizing the need for further research and innovation in therapeutic strategies.
{"title":"Unicentric Castleman Disease: Updates and Novel Insights Into Spindle Cell Proliferations and Aggressive Forms of a Localized Disease","authors":"FNU Alnoor, Alexandra Rangel, Matthew Luo, Oscar Silva, Karen M. Chisholm, Dennis O'Malley, Roger Warnke, Jyoti Kumar, Robert S. Ohgami","doi":"10.1111/ijlh.14395","DOIUrl":"10.1111/ijlh.14395","url":null,"abstract":"<p>Castleman Disease (CD) is a rare lymphoproliferative disorder that can be separated into two primary forms: Unicentric Castleman disease (UCD) and multicentric Castleman disease (MCD). UCD is localized, while MCD is systemic. Though UCD generally has a favorable prognosis following surgical resection, more aggressive forms of this disease have been identified, including cases associated with dendritic and spindle cell proliferation. Genetic analysis has deepened our understanding of UCD. Despite advancements in better understanding the pathophysiology of UCD, challenges persist in the diagnosis, management, and treatment due to its rarity and heterogeneity. Here, we review current knowledge on UCD, highlighting the epidemiology, clinical presentation, diagnostic criteria, and treatment options while emphasizing the need for further research and innovation in therapeutic strategies.</p>","PeriodicalId":14120,"journal":{"name":"International Journal of Laboratory Hematology","volume":"47 1","pages":"26-35"},"PeriodicalIF":2.2,"publicationDate":"2024-11-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/ijlh.14395","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142585426","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Christina Karela, Nikolaos J. Tsagarakis, Georgios Oudatzis, Vasileios Xanthopoulos, Maroula Milaiou, Sofia Nikolaou, Vassiliki Zina, Paraskevi Vasileiou, Georgios Karianakis, Theodoros Marinakis, Elpiniki Griva, Georgios Paterakis
<div> <section> <h3> Introduction</h3> <p>Fluorescently labeled aerolysin (FLAER) is widely used for the identification of paroxysmal nocturnal hemoglobinuria (PNH) clones in peripheral blood (PB) samples. However, there are only a few reports on the differential fluorescent intensity of FLAER in normal bone marrow (BM) cell subpopulations. The purpose of this study was to evaluate FLAER expression during normal and pathological hematopoiesis, to map the critical existence of non-PNH FLAER-dim cells.</p> </section> <section> <h3> Methods</h3> <p>A total of 54 BM aspirates were prospectively analyzed with FLAER-based flow cytometric (FC) protocols, during their routine work-up. These were obtained from patients with the following diagnoses: PNH (3), infections/reactive (5), myelodysplastic syndromes (MDS) (7), myelodysplastic/myeloproliferative neoplasms (MDS/MPN) (4), chronic myelogenous leukemia (CML) (3), acute myelogenous leukemia (AML) at diagnosis (20), AML in measurable residual disease (MRD) assessment (7), and B-cell acute lymphoblastic leukemia (B-ALL) in MRD assessment (5). The applied protocols consisted of FLAER, HLA-DR, CD14, CD33, CD34, CD66b, CD38, CD117, CD64, CD45, and FLAER, CD66c, CD14, CD33, CD34, CD66b, CD123, CD16, CD64, and CD45, respectively. FLAER expression was assessed in CD34++/CD38- and CD34+/CD38+ stem cells, CD34-/CD117+/HLA-DR+/CD33+ myeloid precursors, and CD64+/CD14-/HLA-DR+ monocyte precursors but also in mature myeloid cells.</p> </section> <section> <h3> Results</h3> <p>All patients revealed an intermediate FLAER intensity in CD34++/CD38- stem cells, with a discrete FLAER-negative subpopulation observed only in maturing CD34+/CD38+ stem cells of patients with PNH. The lowest FLAER intensity was noticed in CD34-/CD117+/HLA-DR+/CD33+ myeloid precursors, not only in patients with PNH but also in PNH-negative BM aspirates. An ascending FLAER intensity was further observed during monocytic and granulocytic maturation, with a discrete FLAER-negative population in CD64+/CD14-/HLA-DR+ monocyte precursors and maturing neutrophils and monocytes of patients with PNH only. The maturation pattern of FLAER expression was further confirmed in a patient with acute promyelocytic leukemia treated with all-trans retinoic acid (ATRA), where FLAER was concurrently upregulated with CD66b in a consecutive series of PB samples tested over a 20-day-period after diagnosis.</p> </section> <section> <h3> Conclusion</h3> <p>The application of FLAER in PNH-positive and PNH-negative reactive or malignant BM aspirates identified normally expected non-PNH FLAER-dim CD34-/CD117+/HLA-DR+/CD33+ myeloid precursors in all samples.
{"title":"FLAER Revealed Normally Expected Non-PNH FLAER-Dim Immature Myeloid Cells (CD117+/CD34-) In Bone Marrow Aspirates and Could Be Utilized as a Marker of Hierarchical Hematopoiesis","authors":"Christina Karela, Nikolaos J. Tsagarakis, Georgios Oudatzis, Vasileios Xanthopoulos, Maroula Milaiou, Sofia Nikolaou, Vassiliki Zina, Paraskevi Vasileiou, Georgios Karianakis, Theodoros Marinakis, Elpiniki Griva, Georgios Paterakis","doi":"10.1111/ijlh.14394","DOIUrl":"10.1111/ijlh.14394","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Fluorescently labeled aerolysin (FLAER) is widely used for the identification of paroxysmal nocturnal hemoglobinuria (PNH) clones in peripheral blood (PB) samples. However, there are only a few reports on the differential fluorescent intensity of FLAER in normal bone marrow (BM) cell subpopulations. The purpose of this study was to evaluate FLAER expression during normal and pathological hematopoiesis, to map the critical existence of non-PNH FLAER-dim cells.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A total of 54 BM aspirates were prospectively analyzed with FLAER-based flow cytometric (FC) protocols, during their routine work-up. These were obtained from patients with the following diagnoses: PNH (3), infections/reactive (5), myelodysplastic syndromes (MDS) (7), myelodysplastic/myeloproliferative neoplasms (MDS/MPN) (4), chronic myelogenous leukemia (CML) (3), acute myelogenous leukemia (AML) at diagnosis (20), AML in measurable residual disease (MRD) assessment (7), and B-cell acute lymphoblastic leukemia (B-ALL) in MRD assessment (5). The applied protocols consisted of FLAER, HLA-DR, CD14, CD33, CD34, CD66b, CD38, CD117, CD64, CD45, and FLAER, CD66c, CD14, CD33, CD34, CD66b, CD123, CD16, CD64, and CD45, respectively. FLAER expression was assessed in CD34++/CD38- and CD34+/CD38+ stem cells, CD34-/CD117+/HLA-DR+/CD33+ myeloid precursors, and CD64+/CD14-/HLA-DR+ monocyte precursors but also in mature myeloid cells.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>All patients revealed an intermediate FLAER intensity in CD34++/CD38- stem cells, with a discrete FLAER-negative subpopulation observed only in maturing CD34+/CD38+ stem cells of patients with PNH. The lowest FLAER intensity was noticed in CD34-/CD117+/HLA-DR+/CD33+ myeloid precursors, not only in patients with PNH but also in PNH-negative BM aspirates. An ascending FLAER intensity was further observed during monocytic and granulocytic maturation, with a discrete FLAER-negative population in CD64+/CD14-/HLA-DR+ monocyte precursors and maturing neutrophils and monocytes of patients with PNH only. The maturation pattern of FLAER expression was further confirmed in a patient with acute promyelocytic leukemia treated with all-trans retinoic acid (ATRA), where FLAER was concurrently upregulated with CD66b in a consecutive series of PB samples tested over a 20-day-period after diagnosis.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>The application of FLAER in PNH-positive and PNH-negative reactive or malignant BM aspirates identified normally expected non-PNH FLAER-dim CD34-/CD117+/HLA-DR+/CD33+ myeloid precursors in all samples. ","PeriodicalId":14120,"journal":{"name":"International Journal of Laboratory Hematology","volume":"47 2","pages":"228-235"},"PeriodicalIF":2.2,"publicationDate":"2024-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142549813","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
A. Polizzi, L. P. Dicembre, C. Failla, T. Di Matola, M. Moretti, S. Chiatamone Ranieri, F. Papa, A. M. Cenci, M. Buttarello
Introduction
Hereditary spherocytosis (HS) is a congenital haemolytic disorder, resulting from plasma membrane protein deficiency of red blood cells (RBCs). Typical pathological signs are anemia, jaundice, and splenomegaly; in newborns, jaundice is the main symptom.
Material and Methods
This study focused on the state of art about the HS diagnosis, from traditional to innovative methods, including diagnostic algorithms that can be applied for pediatric and adult patients, for different laboratory diagnostic levels.
Results
The first erythrocyte parameters used for HS diagnosis were the mean corpuscular hemoglobin concentration (MCHC), mean corpuscular volume (MCV), and red blood cell distribution width (RDW); nowadays new parameters are used in blood cell counter. Advia analyzers (Siemens Medical Solutions) supply the hyper-dense cell percentage (% Hyper), which reflects the red blood cells hyperchromia. Sysmex instruments (i.e. XT-4000i, XE-5000, XN-Series) provide the MicroR, that is the percentage of erythrocytes smaller than 60 fL, Hypo-He, which is the percentage of erythrocytes with a content of hemoglobin less than 17 pg and % Hyper-He, which represents the percentage of RBC with cellular hemoglobin content higher than 49 pg. CELL-DYN Sapphire (Abbott Diagnostics) introduced the HPR parameter (% HPR), which represents the erythrocytes with hemoglobin > 410 g/L. Beckman Coulter instruments supply the mean sphered corpuscular volume (MSCV), which is the average volume of all erythrocytes, including mature erythrocytes and reticulocytes. Other reference tests for screening and diagnosis of HS are the acidified glycerol lysis test (AGLT), the eosin-5-maleimide (EMA) binding test and genetic testing by next-generation sequencing.
Conclusions
The diagnostic workup of hereditary spherocytosis could be improved thanks to all the available tests, including new molecular tools. However, it requires synergy between clinicians and laboratory staff, evaluating clinical manifestations, all available data related to the disease and the prognosis to fill the diagnostic gaps in the near future.
{"title":"Overview on Hereditary Spherocytosis Diagnosis","authors":"A. Polizzi, L. P. Dicembre, C. Failla, T. Di Matola, M. Moretti, S. Chiatamone Ranieri, F. Papa, A. M. Cenci, M. Buttarello","doi":"10.1111/ijlh.14376","DOIUrl":"10.1111/ijlh.14376","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Hereditary spherocytosis (HS) is a congenital haemolytic disorder, resulting from plasma membrane protein deficiency of red blood cells (RBCs). Typical pathological signs are anemia, jaundice, and splenomegaly; in newborns, jaundice is the main symptom.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Material and Methods</h3>\u0000 \u0000 <p>This study focused on the state of art about the HS diagnosis, from traditional to innovative methods, including diagnostic algorithms that can be applied for pediatric and adult patients, for different laboratory diagnostic levels.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The first erythrocyte parameters used for HS diagnosis were the mean corpuscular hemoglobin concentration (MCHC), mean corpuscular volume (MCV), and red blood cell distribution width (RDW); nowadays new parameters are used in blood cell counter. Advia analyzers (Siemens Medical Solutions) supply the hyper-dense cell percentage (% Hyper), which reflects the red blood cells hyperchromia. Sysmex instruments (i.e. XT-4000i, XE-5000, XN-Series) provide the MicroR, that is the percentage of erythrocytes smaller than 60 fL, Hypo-He, which is the percentage of erythrocytes with a content of hemoglobin less than 17 pg and % Hyper-He, which represents the percentage of RBC with cellular hemoglobin content higher than 49 pg. CELL-DYN Sapphire (Abbott Diagnostics) introduced the HPR parameter (% HPR), which represents the erythrocytes with hemoglobin > 410 g/L. Beckman Coulter instruments supply the mean sphered corpuscular volume (MSCV), which is the average volume of all erythrocytes, including mature erythrocytes and reticulocytes. Other reference tests for screening and diagnosis of HS are the acidified glycerol lysis test (AGLT), the eosin-5-maleimide (EMA) binding test and genetic testing by next-generation sequencing.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>The diagnostic workup of hereditary spherocytosis could be improved thanks to all the available tests, including new molecular tools. However, it requires synergy between clinicians and laboratory staff, evaluating clinical manifestations, all available data related to the disease and the prognosis to fill the diagnostic gaps in the near future.</p>\u0000 </section>\u0000 </div>","PeriodicalId":14120,"journal":{"name":"International Journal of Laboratory Hematology","volume":"47 1","pages":"18-25"},"PeriodicalIF":2.2,"publicationDate":"2024-10-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/ijlh.14376","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142523967","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Ana Paula Porto Rödel, Yasmin Machado Fernandes, João Victor Brisolara, José Antonio Mainardi De Carvalho, Rafael Noal Moresco
Introduction
Estimating patient risk before heart surgery (HS) is crucial. Perioperative inflammation is associated with several complications and mortality. This study investigated blood cell count inflammatory indices (BCCII) to predict risks, including neutrophil-to-lymphocyte ratio (NLR), derivate NLR (DNLR), neutrophil-to-platelet-lymphocyte ratio (NLPR), lymphocyte-to-monocyte ratio, platelet-to-lymphocyte ratio (PLR), Systemic Inflammatory Index (SII), Systemic Inflammatory Reaction Index (SIRI), and Aggregate Index of Systemic Inflammation (AISI).
Methods
Data from a cohort of patients undergoing on-pump HS at a single center in Brazil were retrospectively analyzed. Data were obtained from medical records and a laboratory analyzer, and SPSS version 20.0 was used for index calculations and statistical analyses.
Results
In total, 444 surgeries were performed, and 40 in-hospital deaths occurred. Except for PLR, all other indexes were independent predictors of death after multivariate adjustment (all p < 0.05). Discrimination performance was absent for PLR and AISI, and NLR, NLPR, and DNLR demonstrated the best area under the receiver operating characteristic curve (AUC > 0.7; all p < 0.0001). For survivors (n = 404), all indexes exhibited a correlation with the length of hospital stay (all p < 0.03), and NLR, NLPR, and DNLR were predictors (p < 0.026) of poor operative outcomes (acute myocardial infarction, cerebrovascular attack, cardiac arrest, low cardiac output, prolonged mechanical ventilation, renal failure, and sepsis).
Conclusions
All BCCII scores were associated with length of hospital stay. Apart from PLR, all indexes were independent predictors of in-hospital mortality. Accuracy was highest for NLR, NLPR, and DNLR; for survivors, these three factors were good predictors of poor operative outcomes.
{"title":"Role of Preoperative Inflammatory Blood Cell Indexes as a Postoperative Risk Predictor Among Patients Undergoing On-Pump Cardiac Surgery","authors":"Ana Paula Porto Rödel, Yasmin Machado Fernandes, João Victor Brisolara, José Antonio Mainardi De Carvalho, Rafael Noal Moresco","doi":"10.1111/ijlh.14390","DOIUrl":"10.1111/ijlh.14390","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Estimating patient risk before heart surgery (HS) is crucial. Perioperative inflammation is associated with several complications and mortality. This study investigated blood cell count inflammatory indices (BCCII) to predict risks, including neutrophil-to-lymphocyte ratio (NLR), derivate NLR (DNLR), neutrophil-to-platelet-lymphocyte ratio (NLPR), lymphocyte-to-monocyte ratio, platelet-to-lymphocyte ratio (PLR), Systemic Inflammatory Index (SII), Systemic Inflammatory Reaction Index (SIRI), and Aggregate Index of Systemic Inflammation (AISI).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Data from a cohort of patients undergoing on-pump HS at a single center in Brazil were retrospectively analyzed. Data were obtained from medical records and a laboratory analyzer, and SPSS version 20.0 was used for index calculations and statistical analyses.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>In total, 444 surgeries were performed, and 40 in-hospital deaths occurred. Except for PLR, all other indexes were independent predictors of death after multivariate adjustment (all <i>p</i> < 0.05). Discrimination performance was absent for PLR and AISI, and NLR, NLPR, and DNLR demonstrated the best area under the receiver operating characteristic curve (AUC > 0.7; all <i>p</i> < 0.0001). For survivors (<i>n</i> = 404), all indexes exhibited a correlation with the length of hospital stay (all <i>p</i> < 0.03), and NLR, NLPR, and DNLR were predictors (<i>p</i> < 0.026) of poor operative outcomes (acute myocardial infarction, cerebrovascular attack, cardiac arrest, low cardiac output, prolonged mechanical ventilation, renal failure, and sepsis).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>All BCCII scores were associated with length of hospital stay. Apart from PLR, all indexes were independent predictors of in-hospital mortality. Accuracy was highest for NLR, NLPR, and DNLR; for survivors, these three factors were good predictors of poor operative outcomes.</p>\u0000 </section>\u0000 </div>","PeriodicalId":14120,"journal":{"name":"International Journal of Laboratory Hematology","volume":"47 1","pages":"87-92"},"PeriodicalIF":2.2,"publicationDate":"2024-10-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142515359","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
<p>Lipemic samples are challenging for diagnostic laboratories, as lipids are likely to interfere in spectrophotometric methods by altering sample turbidity. Such samples can occur when blood is taken after a meal or following the infusion of parenteral lipid emulsions. In these cases, resampling may resolve this issue [<span>1</span>]. Nevertheless, lipemia can result from certain conditions (familial hypertriglyceridemia, pancreatitis, treatment with protease inhibitors, etc.), where resampling is ineffective.</p><p>Some authors have suggested that high speed centrifugation (over 10 000 g) could mitigate this interference [<span>2, 3</span>]. One recent study examined whether such a method could be used for coagulation tests such as PT, aPTT, fibrinogen [<span>4</span>], for instance. Although most suppliers indicate that lipids are likely to interfere with anti-Xa (AXA) activity, the effect of such a process on this assay has not been evaluated yet to our best knowledge.</p><p>In this study, approved by the institutional ethics board (CE-2024-34), samples from inpatients at University Hospital of Strasbourg (France) were included between December 2023 and March 2024. Inclusion criteria were as follows: patients over 18 years old anticoagulated with unfractioned heparin (UFH), low molecular weight heparin (LMWH), apixaban or rivaroxaban. Underaged patients and those with visibly lipemic samples were excluded, to ensure that only non lipemic reference samples were included. Patient blood was drawn into Vacutainer glass citrated tubes (Becton Dickinson, Franklin Lakes, USA) or Vacutest PET citrated tubes (Kima, Padua, Italy), with 0.109 of trisodium citrate. Platelet-poor plasma (PPP) was prepared by centrifugation at 2500 g for 10 min at 20°C. For high-speed centrifugation (HSC), aliquots of 1.5 mL of PPP were centrifuged at 11 000 g for 10 min in a high speed centrifuge Mikro 200R (Andreas Hettich, Tuttlingen, Germany). As the lipid fraction was found in the supernatant, the aqueous phase of PPP was carefully collected at the bottom of the tube for measurements.</p><p>First, to ensure that HSC would not interfere on this assay, AXA activity was measured on PPP of patients anticoagulated with UFH, LMWH, apixaban or rivaroxaban before and after HSC, on a STA-R Max analyzer with STA Liquid anti-Xa (both Diagnostica Stago, Asnières-sur-Seine, France).</p><p>Second, to determine whether such a process could effectively mitigate the interference due to lipemia, aliquots of 1.5 mL of PPP were spiked with lipids using 25 μL of Smoflipid 200 mg/mL (Fresenius Kabi, Sèvres, France) to achieve TG levels ≥ 6.9 g/L (manufacturer's established cut-off for TG interference). AXA was then measured before spiking, after spiking and after HSC. Triglycerids (TG) were measured after spiking and after HSC on a Dimension Vista 1500 analyzer with Trig Flex (both Siemens, Erlangen, Germany).</p><p>Wilcoxon tests were carried out to compare AXA and triglyceridemia. A <i>
{"title":"Mitigating Lipemia Interference in Anti-Xa Activity Measurement Through High-Speed Centrifugation","authors":"Agathe Herb, Clément Ousteland, Cléo Proch, Jordan Wimmer, Laurent Mauvieux, Laurent Sattler","doi":"10.1111/ijlh.14393","DOIUrl":"10.1111/ijlh.14393","url":null,"abstract":"<p>Lipemic samples are challenging for diagnostic laboratories, as lipids are likely to interfere in spectrophotometric methods by altering sample turbidity. Such samples can occur when blood is taken after a meal or following the infusion of parenteral lipid emulsions. In these cases, resampling may resolve this issue [<span>1</span>]. Nevertheless, lipemia can result from certain conditions (familial hypertriglyceridemia, pancreatitis, treatment with protease inhibitors, etc.), where resampling is ineffective.</p><p>Some authors have suggested that high speed centrifugation (over 10 000 g) could mitigate this interference [<span>2, 3</span>]. One recent study examined whether such a method could be used for coagulation tests such as PT, aPTT, fibrinogen [<span>4</span>], for instance. Although most suppliers indicate that lipids are likely to interfere with anti-Xa (AXA) activity, the effect of such a process on this assay has not been evaluated yet to our best knowledge.</p><p>In this study, approved by the institutional ethics board (CE-2024-34), samples from inpatients at University Hospital of Strasbourg (France) were included between December 2023 and March 2024. Inclusion criteria were as follows: patients over 18 years old anticoagulated with unfractioned heparin (UFH), low molecular weight heparin (LMWH), apixaban or rivaroxaban. Underaged patients and those with visibly lipemic samples were excluded, to ensure that only non lipemic reference samples were included. Patient blood was drawn into Vacutainer glass citrated tubes (Becton Dickinson, Franklin Lakes, USA) or Vacutest PET citrated tubes (Kima, Padua, Italy), with 0.109 of trisodium citrate. Platelet-poor plasma (PPP) was prepared by centrifugation at 2500 g for 10 min at 20°C. For high-speed centrifugation (HSC), aliquots of 1.5 mL of PPP were centrifuged at 11 000 g for 10 min in a high speed centrifuge Mikro 200R (Andreas Hettich, Tuttlingen, Germany). As the lipid fraction was found in the supernatant, the aqueous phase of PPP was carefully collected at the bottom of the tube for measurements.</p><p>First, to ensure that HSC would not interfere on this assay, AXA activity was measured on PPP of patients anticoagulated with UFH, LMWH, apixaban or rivaroxaban before and after HSC, on a STA-R Max analyzer with STA Liquid anti-Xa (both Diagnostica Stago, Asnières-sur-Seine, France).</p><p>Second, to determine whether such a process could effectively mitigate the interference due to lipemia, aliquots of 1.5 mL of PPP were spiked with lipids using 25 μL of Smoflipid 200 mg/mL (Fresenius Kabi, Sèvres, France) to achieve TG levels ≥ 6.9 g/L (manufacturer's established cut-off for TG interference). AXA was then measured before spiking, after spiking and after HSC. Triglycerids (TG) were measured after spiking and after HSC on a Dimension Vista 1500 analyzer with Trig Flex (both Siemens, Erlangen, Germany).</p><p>Wilcoxon tests were carried out to compare AXA and triglyceridemia. A <i>","PeriodicalId":14120,"journal":{"name":"International Journal of Laboratory Hematology","volume":"47 2","pages":"336-339"},"PeriodicalIF":2.2,"publicationDate":"2024-10-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/ijlh.14393","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142484182","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Suhyeon Woo, Bohyun Kim, Nam Hun Heo, Min-Sun Kim, Young Ahn Yoon, Young-Jin Choi
Objectives
This study aimed to determine a definition for significant platelet clumping (PC) and evaluate the performance of the Sysmex XN instrument for detecting platelet clumps.
Methods
For part 1, 372 specimens with a ‘PLT_clump?’ flag in XN-9000 were classified into five groups according to the average number of PCs. We compared the initial platelet count (measured by XN-9000 using impedance method) and corrected platelet count (counted optically or re-analyzed by XN-9000 using vortexed or re-collected sample) of each group. For part 2, 1000 specimens with a PC flag divided into three subgroups {group N (PC = 0), Y (PC ≥ 1), and Z (microscopic fibrin clot)} and additional two groups {group S (PC(+) specimens without any flag and with flags of other categories) and group NC (negative control)} were collected. Positive predictive value (PPV), negative predictive value (NPV), sensitivity and specificity of PC detection of XN-9000 were obtained and the platelet counts and four indices (PDW, MPV, P_LCR, and PCT) of groups NC, N, Y, Z, and S were compared to detect PC more precisely.
Results
In part 1, all groups showed significant difference between the initial and corrected platelet counts. In part 2, PPV, NPV, prevalence, sensitivity, and specificity were 41.5%, 56.5%, 43.4%, 2.18%, and 98.3%, respectively. The platelet counts and four indices showed statistical differences for detecting PCs, and especially PDW and P_LCR were significantly smaller in group Z than group N or Y.
Conclusions
We suggest the definition of significant PC by the presence of at least three platelets. In addition, utilizing platelet-related indices should be developed to improve the efficiency of the PC detection.
研究目的本研究旨在确定明显血小板聚集（PC）的定义，并评估 Sysmex XN 仪器检测血小板聚集的性能：第一部分：根据 PC 的平均数量，将 372 份在 XN-9000 中带有 "PLT_clump? "标志的标本分为五组。我们比较了每组的初始血小板计数（XN-9000 使用阻抗法测量）和校正血小板计数（XN-9000 使用涡旋或重新采集的样本进行光学计数或重新分析）。第二部分收集了 1000 份带有 PC 标志的标本，分为三个亚组{N 组（PC = 0）、Y 组（PC ≥ 1）和 Z 组（显微镜下纤维蛋白凝块）}，以及另外两组{S 组（无任何标志和带有其他类别标志的 PC(+) 标本）和 NC 组（阴性对照）}。得出 XN-9000 检测 PC 的阳性预测值（PPV）、阴性预测值（NPV）、灵敏度和特异性，并比较 NC、N、Y、Z 和 S 组的血小板计数和四项指数（PDW、MPV、P_LCR 和 PCT），以更精确地检测 PC：结果：在第一部分中，所有组的初始血小板计数和校正血小板计数均有显著差异。在第二部分中，PPV、NPV、患病率、敏感性和特异性分别为 41.5%、56.5%、43.4%、2.18% 和 98.3%。血小板计数和四项指数在检测 PC 方面存在统计学差异，尤其是 Z 组的 PDW 和 P_LCR 明显小于 N 组或 Y 组：结论：我们建议以至少出现三个血小板来定义明显的 PC。结论：我们建议以至少出现三个血小板来定义明显的 PC，此外，应开发利用血小板相关指数来提高 PC 的检测效率。
{"title":"Definition of Significant Platelet Clumping: Should We Review All Samples With a Platelet Clumping Flag From Automated Hematology Analyzer?","authors":"Suhyeon Woo, Bohyun Kim, Nam Hun Heo, Min-Sun Kim, Young Ahn Yoon, Young-Jin Choi","doi":"10.1111/ijlh.14387","DOIUrl":"10.1111/ijlh.14387","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>This study aimed to determine a definition for significant platelet clumping (PC) and evaluate the performance of the Sysmex XN instrument for detecting platelet clumps.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>For part 1, 372 specimens with a ‘PLT_clump?’ flag in XN-9000 were classified into five groups according to the average number of PCs. We compared the initial platelet count (measured by XN-9000 using impedance method) and corrected platelet count (counted optically or re-analyzed by XN-9000 using vortexed or re-collected sample) of each group. For part 2, 1000 specimens with a PC flag divided into three subgroups {group N (PC = 0), Y (PC ≥ 1), and Z (microscopic fibrin clot)} and additional two groups {group S (PC(+) specimens without any flag and with flags of other categories) and group NC (negative control)} were collected. Positive predictive value (PPV), negative predictive value (NPV), sensitivity and specificity of PC detection of XN-9000 were obtained and the platelet counts and four indices (PDW, MPV, P_LCR, and PCT) of groups NC, N, Y, Z, and S were compared to detect PC more precisely.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>In part 1, all groups showed significant difference between the initial and corrected platelet counts. In part 2, PPV, NPV, prevalence, sensitivity, and specificity were 41.5%, 56.5%, 43.4%, 2.18%, and 98.3%, respectively. The platelet counts and four indices showed statistical differences for detecting PCs, and especially PDW and P_LCR were significantly smaller in group Z than group N or Y.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>We suggest the definition of significant PC by the presence of at least three platelets. In addition, utilizing platelet-related indices should be developed to improve the efficiency of the PC detection.</p>\u0000 </section>\u0000 </div>","PeriodicalId":14120,"journal":{"name":"International Journal of Laboratory Hematology","volume":"47 1","pages":"79-86"},"PeriodicalIF":2.2,"publicationDate":"2024-10-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11725553/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142484181","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Negative Expression of CD117 Predicted Inferior OS and PFS in Acute Promyelocytic Leukemia","authors":"Jiangjun Yuan, Qiong Wang","doi":"10.1111/ijlh.14380","DOIUrl":"10.1111/ijlh.14380","url":null,"abstract":"","PeriodicalId":14120,"journal":{"name":"International Journal of Laboratory Hematology","volume":"47 1","pages":"193-194"},"PeriodicalIF":2.2,"publicationDate":"2024-10-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142484183","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Hachem Zakaria Bouarroudj, Michaël Hardy, Thomas Lecompte, François Mullier
{"title":"Preanalytical Conditions Impact Fibrin Monomers but Not D-Dimer: A Study With Rigorous Comparisons of a Broad Range of Simulated Conditions","authors":"Hachem Zakaria Bouarroudj, Michaël Hardy, Thomas Lecompte, François Mullier","doi":"10.1111/ijlh.14385","DOIUrl":"10.1111/ijlh.14385","url":null,"abstract":"","PeriodicalId":14120,"journal":{"name":"International Journal of Laboratory Hematology","volume":"47 2","pages":"330-335"},"PeriodicalIF":2.2,"publicationDate":"2024-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142484184","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Deepak K. Mishra, Asish Rath, Mayur Parihar, Sushant S. Vinarkar, Anirban Kundu
There have been considerable advances in diagnosing and treating bleeding disorders. But the scenario remains dismal in resource-constrained settings in low and lower-middle-income countries (LMICs). Seventy-five percent of the patients with inherited bleeding disorders do not get diagnosed in LMICs. In resource-constrained settings, infectious disease and malignancies take the major focus. Bleeding disorders do not get prioritised in LMICs, and this leads to underdiagnoses and suboptimal treatment. There are various challenges like financial status, inadequacy of health care infrastructure, lack of patient registry and lack of awareness across medical staff, general population and government stakeholders. The lack of skilled laboratory personnel and laboratory infrastructure for optimal bleeding disorder diagnosis adds on to the problem. World Federation of Hemophilia (WFH) has been at the forefront in developing strategies to overcome some of these inadequacies; however, more active participation of the stakeholders including patients, medical professionals and policy makers is the need of the hour. This review highlights the different challenges in LMICs in diagnosing bleeding disorders, the gap between high-income countries and LMICs and the possible strategies in closing the gap.
{"title":"Current Diagnosis of Bleeding Disorders in Lower Income Countries","authors":"Deepak K. Mishra, Asish Rath, Mayur Parihar, Sushant S. Vinarkar, Anirban Kundu","doi":"10.1111/ijlh.14377","DOIUrl":"10.1111/ijlh.14377","url":null,"abstract":"<p>There have been considerable advances in diagnosing and treating bleeding disorders. But the scenario remains dismal in resource-constrained settings in low and lower-middle-income countries (LMICs). Seventy-five percent of the patients with inherited bleeding disorders do not get diagnosed in LMICs. In resource-constrained settings, infectious disease and malignancies take the major focus. Bleeding disorders do not get prioritised in LMICs, and this leads to underdiagnoses and suboptimal treatment. There are various challenges like financial status, inadequacy of health care infrastructure, lack of patient registry and lack of awareness across medical staff, general population and government stakeholders. The lack of skilled laboratory personnel and laboratory infrastructure for optimal bleeding disorder diagnosis adds on to the problem. World Federation of Hemophilia (WFH) has been at the forefront in developing strategies to overcome some of these inadequacies; however, more active participation of the stakeholders including patients, medical professionals and policy makers is the need of the hour. This review highlights the different challenges in LMICs in diagnosing bleeding disorders, the gap between high-income countries and LMICs and the possible strategies in closing the gap.</p>","PeriodicalId":14120,"journal":{"name":"International Journal of Laboratory Hematology","volume":"47 1","pages":"36-40"},"PeriodicalIF":2.2,"publicationDate":"2024-10-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/ijlh.14377","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142402502","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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