International journal of laboratory hematology最新文献

Objective: To assess the significance of cell population data parameters (CPD) in dengue positive individuals.

Methodology: A retrospective cross-sectional study was conducted at the National Institute of Blood Disease and Bone Marrow Transplantation (NIBD and BMT), Karachi, Pakistan from July 2022 to September 2022 (in a period of 3 months of peak dengue fever outbreak). Dengue fever is a viral infection that is transmitted from mosquitoes to humans. It is more prevalent in tropical and subtropical environments. A total of 389 individuals, who presented with febrile illness at the NIBD clinics, were screened for dengue and malaria with Complete Blood Count (CBC), Dengue nonstructural protein 1 (NS1) antigen test and Malaria Parasite Immunochromatographic test (MP-ICT). Whole blood samples were collected and analyzed for CBC on Sysmex XN hematology analyzers. All 65 CPD and standard CBC parameters were analyzed. Statistical analysis was performed using SPSS version 25.0. Descriptive analysis of all the parameters was performed and a p value < 0.001 was considered significant. Positive and negative correlation was also evaluated within the parameters to assess their significance. Furthermore, cut-off values of CPD parameters were evaluated plotting their receiver operating characteristic (ROC) curves.

Results: Out of the 389 febrile patients, 137 were diagnosed as dengue-positive. Descriptive analysis for mean and median values of parameters revealed statistically significant difference for seven parameters (namely WBC, PLT-F, NEUT, LYMP, MONO, HFLC, and LY-WY) in the comparison of the two groups which were then further assessed for positive and negative correlation. Multivariate logistic regression analysis revealed High Fluorescence Lymphocyte Count (HFLC) to be the distinguishing parameter among dengue positive and negative cases. Compared to all the CPD parameters of our data set, the area under curve for lymphocytes cell size and the width of dispersion (LY-WZ) displayed a borderline value of 0.582.

Conclusion: Sysmex XN hematology analyzers can provide extensive information about CPD parameters, allowing for the prompt differentiation among febrile illnesses and dengue infection. HFLC and other significant parameters demonstrate promise as rapid, adjunctive diagnostic tools. Further research is needed to validate these findings and optimize the clinical utility of CPD parameters in dengue management.

Introduction: NUP98 rearrangements are rare in acute leukemias and portend a poor prognosis.

Methods: This study explored clinicopathologic and molecular features of five patients with NUP98 rearranged (NUP98-r) acute leukemias, including three females and two males with a median age of 34 years.

Results: NUP98 fusion partners were associated with distinctive leukemia characteristics and biology. Three patients had NUP98::NSD1-r acute myeloid leukemia (AML, all cytogenetically cryptic and with concomitant FLT3-ITD) and unfavorable prognoses (in two patients), one patient had NUP98::HOXA9-r AML with morphologic and immunophenotypic features resembling acute promyelocytic leukemia, and lastly, one patient had previously underreported NUP98::MLLT1-r B/T mixed phenotype acute leukemia. After a median follow-up of 24.7 months, median overall survival was 30 months and three of five patients (60%) remained in complete remission at the last follow-up.

Conclusion: Our study expands the clinical and molecular spectrum of NUP98-r acute leukemias and recommends FISH testing for NUP98 rearrangement on those leukemia cases without recurrent gene rearrangements and/or normal karyotype followed by molecular confirmation to improve timely diagnosis and clinical management.

Introduction: For complete blood count, ethylenediaminetetraacetic acid (EDTA) is universally used and has been recognized as the most robust anticoagulant. However, it may lead to pseudothrombocytopenia (PTCT), due to the formation of platelet clumps, which is currently followed by resampling on sodium citrate. Other possible anticoagulants are citrate theophylline adenosine dipyridamole (CTAD) and MgSO₄. These anticoagulants were compared here for resolution of PTCT and platelet count values and stability.

Methods: Paired blood samples were used to compare the four anticoagulants. First, samples containing clumps on EDTA were compared to samples collected on sodium citrate (335), CTAD (31), or MgSO₄ (160). For platelet counts, compared series were of respectively, 168, 191, and 87, paired to PTCT-free EDTA samples. Finally, platelet count stability was evaluated over 2-24 h.

Results: MgSO₄, followed by CTAD, was the most efficient to avoid platelet clump formation, while sodium citrate performed poorly. Regarding platelet count, significantly lower values were obtained with sodium citrate (p < 0.0001), with more samples (35% vs. 6.5%) below the 150 × 10⁹/L threshold. Conversely, CTAD yielded similar values as EDTA, while higher counts were observed with MgSO₄ (p = 0.008). Finally, platelet count stability began to decrease at 4 h for sodium citrate, while the other anticoagulants were stable for at least 8 h, up to 12 h for MgSO4 and 24 h for EDTA.

Conclusions: This real-life study confirms that sodium citrate should no longer be used to improve platelet counts in patients with platelet clumps, CTAD, if available, and MgSO₄ being much better alternatives.

Background: Acute lymphoblastic leukemia (ALL) is a leading cause of death among pediatric malignancies. Early diagnosis of ALL is crucial for minimizing misdiagnosis, improving survival rates, and ensuring the implementation of precise treatment plans for patients.

Methods: In this study, we propose a multi-modal deep neural network-based framework for early and efficient screening of ALL. Both white blood cell (WBC) scattergrams and complete blood count (CBC) are employed for ALL detection. The dataset comprises medical data from 233 patients with ALL, 283 patients with infectious mononucleosis (IM), and 183 healthy controls (HCs).

Results: The combination of CBC data with WBC scattergrams achieved an accuracy of 98.43% in fivefold cross-validation and a sensitivity of 96.67% in external validation, demonstrating the efficacy of our method. Additionally, the area under the curve (AUC) of this model surpasses 0.99, outperforming well-trained medical technicians.

Conclusions: To the best of our knowledge, this framework is the first to incorporate WBC scattergrams with CBC data for ALL screening, proving to be an efficient method with enhanced sensitivity and specificity. Integrating this framework into the screening procedure shows promise for improving the early diagnosis of ALL and reducing the burden on medical technicians. The code and dataset are available at https://github.com/cvi-szu/ALL-Screening.

Introduction: Accurate platelet (PLT) counting is crucial for disease diagnosis and treatment, especially under the condition of thrombocytopenia and platelet transfusion. A few PLT counting approaches have been established including impedance and fluorescent methods. The impedance PLT counting (PLT-I) approach could be interfered by small non-PLT particles in the blood, such as RBC/WBC fragments, microcytes, bacteria, and cryoglobulins. The fluorescent PLT counting methods provide a more accurate but rather costly option. Thus, it is highly desirable to develop a new economic-friendly approach with accurate platelet count. In this study, we introduced a novel hybrid PLT counting (PLT-H) strategy to combine the count of smaller-sized PLTs from impedance channel and larger-sized PLTs from conventional white blood cell (WBC) channel to realize a low-cost PLT count with high accuracy.

Methods: Blood samples with different PLT levels and no significant interfering factors (confirmed by blood smear) were collected. The PLTs were counted with BC-6800Plus (PLT-I) and compared with the PLT counts from the CD41/CD61 immunoplatelet (immunoPLT) reference method using Beckman Coulter FC-500 flow cytometer. In addition, the morphology and internal structure of PLT treated with hemolytic agents of conventional WBC channel was observed with phase contrast microscopy and electron microscopy. Then the counting accuracy of PLT-H was assessed by comparing PLT count results between BC-720 (PLT-H) and the CD41/CD61 immunoPLT reference method.

Results: By comparing PLT-I with immunoPLT, it was found that the impedance PLT counting result will not be interfered by small non-PLT particles when the size of PLT smaller than 10 fL. For large PLT (> 10 fL), PLT count in conventional WBC channel shows good correlations with immunoPLT. Furthermore, after treated with hemolytic agents the PLT still preserves an intact cellular structure and swells slightly, while RBCs are lysis and disappeared upon hemolytic treatment. Lastly, the novel PLT-H result exhibits a good correlation with immunoPLT with a high correlation factor (r = 0.9911).

Conclusions: The new PLT counting method PLT-H achieves high accuracy in blood samples with low-cost, and it provide a novel strategy of combining traditional methods for high accurate counting in hematology laboratories.

Introduction: Disseminated intravascular coagulation (DIC) is associated with acute leukemia. DIC prevalence and clinical consequences are complex and varies across acute leukemia subtypes. The International Society of Thrombosis and Hemostasis (ISTH) scoring system is used for the detection of overt DIC.

Methods: Children of both sexes (1 day-18 years) with acute leukemia, suspected to have DIC and referred to hematology laboratory were included in the study. DIC score was calculated according to ISTH guidelines from laboratory values obtained within 24 h of admission and repeated after 2 weeks. The DIC cases were classified into overt DIC if ISTH score ≤ 5 and non-overt if ISTH score > 5.

Results: Sixty-two children diagnosed with acute leukemia and having the clinical and laboratory diagnostic features of DIC along with 48 age-matched healthy controls participated in the study. DIC was more frequently diagnosed in cases of AML (66.13%) compared to ALL (33.87%). Cases with T-ALL had DIC (19.4%) more frequently than B-ALL type (14.5%). Similarly, children with M5, M2, and M3 had DIC more frequently (16.1%, 15.58% and 14.28%, respectively) compared to other AML types. Overt DIC was observed in 71% of DIC cases with acute leukemia while non-overt DIC was diagnosed in 29% of them. Follow-up for 14 days of non-overt cases showed that 12 out of 18 patients progressed from non-overt to overt DIC with a significant increase in D-dimer and a decline in platelets count. The incidence of bleeding (35.4%) was higher than thrombosis (19.4%) among acute leukemia patients with DIC. An ISTH score ≤ 5 predicted increased intensive care unit (ICU) admission, death and end organ dysfunction with odds ratio of 4.28, 6.77, and 6.67, respectively. Based on receiver-operator analysis of DIC cases classified as overt and non-overt DIC based on ISTH score, D-Dimer was excellent predictor of overt DIC with the high sensitivity and specificity.

Conclusion: ISTH score predicts death, ICU admission and organ dysfunction in children with acute leukemia. D-Dimer is an excellent predictor of overt DIC in acute leukemia.