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Background and objectives: Differential diagnosis between clonal lymphocytosis (CL) and reactive lymphocytosis (RL) is often established through blood smear examination but with some limitations. We aimed to evaluate ability of clinical data and extended-cells blood count (CBC) parameters to discriminate CL from RL and to establish a decision-making algorithm for moderate lymphocytosis in adults. Methods: A total of 85 samples were collected from adults with absolute lymphocytescount of >5G/l. The samples were divided into RL group (n=34) and newly diagnosed CL group (n=51).Demographic data, CBC parameters including high fluorescence lymphocytes cells percentage (HFLC%) and abnormal lymphocytes or blasts (’AbnLym/BL’’) morphological flag were evaluated for each study group. New threshold for discriminating parameters were determined using receiver operating characteristic (ROC) curves and used in an algorithm for moderate lymphocytosis. Results: Age, high lymphocytes count and the presence of the ’AbnLym/BL’’ flag and low HFLC% were predictor of malignant lymphocytosis. Age threshold of 62.5 years and absolute lymphocytes count of > 10.47 G/l were highly effective in CL detection with area under the ROC curve of 0.9 and 0.99, respectively. In addition, HFLC% showed an area under the ROC curve of 0.71. Considering ALC threshold of 10.47 G/l alone, a sensitivity of 96.7% and a specificity of 100 % were achieved. For moderate lymphocytosis ranging between 5 and 10.47G/l, no false positive or negative result was detected when we considered both the proposed ALC and age cut-offs. Conclusion: A combination threshold for ALC and age appears to be helpful for screening CL, especially in moderate lymphocytosis for both laboratory and clinical routine practice. [ABSTRACT FROM AUTHOR]

Introduction: Platelet count is crucial for clinical decision. In cases of microcytosis, platelet count based on impedance technique (PLT-I) may overestimate platelet count., Aim: To compare PLT-I with platelet count using the optical technique (PLT-O) and establish a Mean Corpuscular Volume (MCV) threshold for considering PLT-O., Methods: A prospective analytical study conducted over two months involved blood samples collected in standard K2 EDTA tubes for complete blood count analysis, revealing microcytosis (MCV<80 fL). PLT-O analysis in channel-Ret mode was performed using the Sysmex-XN1000 (Sysmex Corporation, Kobe, Japan). Percentage of fragmented red cells (FRC%) and percentage of microcytic red cells (Micro-R%) were recorded. Blood smears stained with May-Grünwald-Giemsa were examined for potential interfering particles., Results: A strong correlation was observed between the two techniques for all platelet values as well as for PLT <150 x 109/L (correlation coefficient r = 0.971, 95% CI: [0.956-0.982]; P<10-3 and r = 0.90, 95% CI: [0.79-0.95]; P< 10-3). The Bland-Altman plot revealed a bias of 16.53 x 109/L between the two methods, with agreement limits between -55.8 and 88.8 x 109/L. A threshold MCV value indicating the use of the optical method, with a cut-off at 72.9fL, demonstrated promising performance consistent with literature findings. However, less favorable performance was observed with Micro-R%., Conclusion: Impedance could be employed in routine practice. However, for MCV<72.9 fL or in the presence of schizocytes, the hemogram validation procedure may incorporate the use of PLT-O.

Introduction: Massive transfusion (MT) is a life-saving therapy in situations of major hemorrhage awaiting radical haemostatic treatment. Poor management and control of this therapy may, however, compromise the patient's vital prognosis. The main aim of our study was to take stock of massive transfusion practices in Tunisia. The secondary aim was to propose a massive transfusion protocol., Methods: An analytical observational study based on a questionnaire was conducted. We targeted physicians brought in their clinical practice to use MT., Results: A total of 124 clinicians responded to the questionnaire. The majority (62%) were anesthesiologists or emergency physicians. More than half of the participants were residents (51%). The use of MT based on a clinical or biological score was only found for a minority (13%). The initial order was for the majority of participants (N=69) made up of red blood cell concentrates (RBC) and fresh frozen plasma (FFP). The FFP: RBC ratio was1:2 for 51% of the participants. A higher ratio was adopted by the rest. Respectively 23.5% and 9.6% of participants transfused platelets and fibrinogen concentrates without waiting for the result of biology. The use of tranexamic acid was systematically advocated by 60.5% of clinicians. The majority (86.3%) adopted a restrictive transfusion strategy (target hemoglobin between 7 and 9 g/dl). The latter was more adopted by the youngest physicians (92.1% of residents versus 55.6% of professors; p=0.008)., Conclusions: The professional practices of MT in Tunisia are heterogeneous. Given the lack of a clear institutionalized procedure which frames this therapy, a MT protocol has thus been proposed.