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This study investigated the use of corrected 17-alpha-hydroxyprogesterone (17-OHP) values to detect congenital adrenal hyperplasia (CAH) in newborn infants. 17-OHP concentrations in blood spots from 913 neonates were measured using a neonatal screening test. A prematurity index was calculated using a scoring system based on gestational age and birth weight. Blood spot 17-OHP concentrations divided by the sum of prematurity scores were defined as the corrected 17-OHP values. Preterm infants (30 wk) and low birth weight infants (1.0 kg) showed 3.9- and 3.8-fold higher blood spot 17-OHP concentrations than normal full term infants. However, no significant differences were observed in the corrected 17-OHP values between the groups. Blood spot 17-OHP levels yielded significant correlations with the prematurity index (r = 0.42, p0.05). Positive results for CAH were obtained in 9.5% (n = 53) and 2.0% (n = 11) of 556 premature infants by the cutoffs of blood spot 17-OHP (15.0 ng/ml) and corrected 17-OHP values (13.0 ng/ml), respectively. Of the 53 positive subjects, 39 (73.6%) converted to negative after 1 to 5 mo without treatment. In summary, blood spot 17-OHP levels are influenced by the prematurity of newborns. Use of corrected 17-OHP values provide limited but helpful information in screening for CAH by reducing the rate of false-positive results, especially in premature infants.

We report a case of chronic myelogenous leukemia displaying a variant Philadelphia translocation t(11;22)(q25;q11.2). Breakpoint 11q25 has not previously been reported. Reverse transcriptase polymerase chain reaction and fluorescence in-situ hybridization demonstrated the BCR/ABL rearrangement.

This study investigated the efficiency of serum soluble transferrin receptor (sTfR) for assessing body iron status at different stages of iron deficiency. Among 72 patients with advanced iron-deficiency anemia (IDA), the sensitivity and specificity of sTfR (at a diagnostic cutoff of 3.24 mg/L) were 70.8% and 90.6%, respectively, with a positive predictive value of 85.0%. Sensitivities of sTfR in patients at the earliest stage of iron deficiency (n=41) and the intermediate stage of iron-deficient erythropoiesis (n=15) were 21.9% and 26.7%, respectively, at the same cutoff value of sTfR. Serum ferritin concentrations averaged 6.7+/-1.9 microg/L in IDA patients with sTfR3.24 mg/L, which were significantly above the values in IDA patients with sTfRor=3.24 mg/L (4.8+/-1.2 microg/L, p0.05). In healthy controls, blood reticulocyte counts were significantly higher in subjects with sTfRor=3.24 mg/L than in those with sTfR3.24 mg/L (0.045+/- 0.013 (10(12)/L) vs 0.034+/- 0.011 (10(12)/L), p0.05]. In conclusion, sTfR level is not a sensitive indicator for the early or intermediate stages of iron deficiency, although sTfR assay can be a useful aid in the diagnosis of advanced IDA. Serum sTfR concentration has significant relationships with blood reticulocyte counts in healthy subjects and with serum ferritin levels in IDA patients.

To investigate the relationships of trace element concentrations vs hematopoiesis and iron parameters, we measured lead, copper, zinc, cadmium, and ferritin levels in 251 healthy adolescents. Concentrations of trace metals were determined by atomic absorption spectrophotometry. There were no significant gender-related differences in serum copper or serum cadmium concentrations. However, blood lead and serum zinc levels were significantly higher in males than females (3.82+/- 1.24 and 118.4 +/- 43.7 microg/dl vs 2.86+/- 1.06 and 83.5+/- 35.2 microg/dl, p0.05, respectively). Subjects with elevated lead and copper concentrations exhibited significantly higher leukocyte counts and significantly lower serum iron levels than those with decreased lead and copper concentrations, but no significant differences were observed in blood erythrocyte counts or hemoglobin levels between the 2 groups. Blood lead concentrations were 2-fold higher in male adolescents with leukocytes9.1 x 10(3)/microl than in those with leukocytes4.3 x 10(3)/microl (5.04+/- 1.67 microg/dl vs 2.51+/- 0.75 microg/dl, p0.05). Leukocyte counts had significant correlations with blood lead (r=0.39, p0.05) and serum copper (r=0.26, p0.05) in males and zinc (r=0.28, p0.05) in females. Serum iron levels were inversely correlated with blood lead and serum copper concentrations but were not correlated with serum zinc or cadmium levels. In short, blood lead and serum copper concentrations have important relationships to leukocyte counts and iron parameters in adolescents.

To investigate the relationships of apoptosis with obesity and lipid parameters, we measured serum soluble APO-1 (sAPO-1) concentrations, body mass index (BMI), and serum lipid profiles in 176 healthy adults. Serum sAPO-1 levels were measured by enzyme immunoassay. There were no significant differences in mean sAPO-1 concentrations between men and women, nor between subjects with and without obesity. However, women with high-density lipoprotein cholesterol (HDL-C)50.2 mg/dl exhibited significantly higher sAPO-1 concentrations than those with HDL-C50.2 mg/dl (ie, 45.6 +/- 10.4 pg/ml vs 31.5 +/- 11.3 pg/ml, p0.05). Serum sAPO-1 concentrations averaged 46.8 +/- 10.7 pg/ml in women with serum triglyceride137.4 mg/dl, which was significantly above the mean value (32.6 +/- 12.0 pg/ml, p0.05) in those with serum triglyceride137.4 mg/dl. Men with elevated sAPO-1 concentrations showed significantly higher waist-to-hip ratio (WHR) and total body fat (TBF) compared to those with diminished sAPO-1 levels, although no differences were noted in mean values of lipid profiles between the 2 groups of men. Serum sAPO-1 concentrations correlated significantly with HDL-C (r = - 0.41, p0.05) and triglyceride (r = 0.35, p0.05) in women and WHR (r = 0.25, p0.05) and TBF (r = 0.21, p0.05) in men. In conclusion, serum sAPO-1 appears to have an important relationship to serum lipid levels and body adiposity in healthy adults.

To investigate the relationships of tumor necrosis factor (TNF)-related apoptosis-inducing ligand (TRAIL), anthropometric variables, and lipid parameters, we measured serum TRAIL concentrations, body mass index (BMI), total body fat (TBF), and serum lipid profiles in 207 healthy adults. There were no significant differences in serum TRAIL concentrations between men and women, nor between elderly persons and middle-aged subjects. However, men with TBF 16.4 kg (75th per centile) exhibited significantly higher serum TRAIL concentrations than those with TBF 11.2 kg (25th per centile) (69.7 +/- 15.1 pg/ml vs 50.2 +/- 14.3 pg/ml, p0.05). Serum TRAIL concentration averaged 76.2 +/- 16.1 pg/ml in women with low-density lipoprotein cholesterol (LDL-C) 165 mg/dl (75th per centile), which was significantly above the values (53.1 +/- 12.9 pg/ml, p0.05) in those with LDL-C 117 mg/dl (25th per centile), although no differences were observed on the basis of TBF (75th percentile vs 25th percentile). Serum TRAIL concentrations correlated significantlywithTBF (r = 0.31, p0.05) and lean body mass (r = -0.26, p0.05) in men and LDL-C (r = 0.32, p0.05) and total cholesterol (r = 0.21, p0.05) in women. In conclusion, serum TRAIL concentrations are associated with serum lipid levels and body adiposity in healthy adults, but are unrelated to a subject's age or gender.

This study investigated the associations between serum insulin-like growth factor-I (IGF-I) concentrations and erythropoietic activities in relation to body iron status. Serum IGF-I concentrations, free erythrocyte protoporphyrin (FEP), hemograms, and serum iron markers were measured in 71 female adolescents, age 14 to 17 yr. No significant differences were observed in hemograms, iron parameters, or FEP between the subjects with IGF-I681.2 ng/ml and IGF-I 681.2 ng/ml. However, blood hemoglobin and serum iron concentrations averaged 13.4 +/- 0.8 g/dl and 93.7 +/- 41.2 microg/dl in the subjects with IGF-I809 ng/ml, which were above the values in those with IGF-I523 ng/ml (12.3 +/- 0.9 g/dl and 50.5 +/- 30.8 microg/dl, p0.05, respectively). On the other hand, FEP was significantly lower in the adolescents with IGF-I809 ng/ml than in those with IGF-I523 ng/ml (38.9 +/- 16.2 microg/dl vs 63.4 +/- 23.1 microg/dl, p0.05). Prevalences of iron deficiency or iron deficiency anemia were 3- or 5-fold higher in the subjects with IGF-I523 ng/ml, compared to those with IGF-I809 ng/ml. Serum IGF-I correlated significantly with FEP (r = -0.45, p0.05) and serum iron concentrations (r = 0.40, p0.05) in iron deficient subjects. In summary, IGF-I seems to have an important relationship to iron metabolism and protoporphyrin synthesis in adolescents.

This study investigated the associations of soluble transferrin receptor (sTfR), log ferritin, the ratio of sTfR to log ferritin (sTfR-F index), and the log of the ratio of sTfR to ferritin [log(sTfR/F)] vs. reticulocyte production during iron deficiency.Fluorescent intensity of reticulocytes, immature reticulocyte fraction (IRF), reticulocyte maturity index (RMI), sTfR, and serum ferritin were measured in 149 adolescents.There were no significant differences in reticulocyte parameters between the iron deficiency anemia (IDA) subjects with sTfRor =4.9 mg/l and those with sTfR4.9 mg/l. However, IDA subjects with log ferritin0.73 microg/l exhibited significantly higher mean values for IRF and RMI, compared to those with log ferritinor =0.73 microg/l (2.75+/-1.36% vs. 1.45+/-1.01%, p0.05; 2.76+/-1.31% vs. 1.46+/-1.09%, p0.05). In the non-IDA group, reticulocytes averaged 0.97+/-0.31% in subjects with sTfRor =2.1 mg/l, which were significantly above the values in those with sTfR2.1 mg/l (0.72+/-0.16%, p=0.005), but no significant differences were observed in reticulocyte parameters between the subjects with log ferritinor =1.35 microg/l and those with log ferritin1.35 microg/l. Correlation coefficients of log ferritin vs. RMI (r=-0.41) were higher than those of sTfR, sTfR-F index, and log(sTfR/F) vs. RMI (r=0.24, r=0.30, and r=0.28, respectively) in IDA subjects.Reticulocytopoiesis is more closely associated with log ferritin value than with sTfR concentrations in IDA patients, although sTfR significantly reflects erythropoietic activity in non-IDA subjects.

To investigate whether any significant differences exist in the prevalence of osteoporosis in relation to ABO blood groups, 227 postmenopausal women were evaluated for bone mineral density (BMD), body composition, and anthropometric variables. There were no significant differences in age, anthropometric parameters, or body composition between women with O blood type and those with non-O blood types. However, lumbar spine and proximal femur BMDs in subjects with blood type O averaged 0.87+/-0.13 g/cm2 and 0.76+/-0.12 g/cm2, respectively, which were significantly above the values in those with non-O blood types (0.72+/-0.11 g/cm2 and 0.61+/-0.09 g/cm2, p0.05, respectively). Among the ABO blood groups, the women with blood type AB showed the lowest BMDs (0.71+/-0.10 g/cm2 and 0.59+/-0.09 g/cm2) in the lumbar spine and proximal femur. The prevalences of osteoporosis in the proximal femur and lumbar spine averaged 2.3- and 1.7-fold higher in women with blood type AB than in those with blood type O. Thus, ABO blood group status seems to have a significant relationship to the prevalence of osteoporosis in postmenopausal women.

To investigate the association between respiratory function and basal metabolic rate (BMR), pulmonary function indices and BMR were measured in 251 elderly persons using a spirometer and a body composition analyzer. Forced vital capacity (FVC) and forced expiratory volume in one second (FEV1) were more strongly correlated with BMR (r = 0.48 and r = 0.43, p0.01) than with lean body mass (r = 0.36 and r = 0.35, p0.01) and waist-to-hip ratio (r = -0.29 and r = -0.32, p0.01) in elderly men. FVC and FEV1 in elderly men with BMRor = 1390 kcal/day averaged 4.05 +/- 0.56 L and 3.19 +/- 0.45 L, which were significantly above the values (3.54 +/- 0.51 L and 2.80 +/- 0.42 L, p0.01) in men with BMR1390 kcal/ day. Prevalences of the subjects with elevated FVC or FEV1 were significantly higher in the group of men with BMRor = 1390 kcal/day than in those with BMR1390 kcal/day (66.0% and 68.0% vs 28.3% and 33.9%, p0.01). No significant differences were observed between the postmenopausal women with BMRor = 1135 kcal/day and those with BMR1135 kcal/day. In summary, respiratory function is more closely associated with BMR in elderly persons, compared to lean body mass, waist-to-hip ratio, or body fat mass, and these associations are stronger in men than in women.

Erythropoietic activities and immature reticulocyte production were investigated in a total of 157 patients (81 men, 76 women, median age = 42 yr, range = 23 to 65 yr) with acute lymphoid leukemia (ALL, n = 31), acute myeloid leukemia (AML, n = 39), or non-Hodgkin's lymphoma (NHL, n = 87), based on assays of the hemogram, red cell indices, reticulocyte subpopulations, and intramedullary erythroid precursors. There were no significant differences in red blood cell (RBC) counts, blood hemoglobin levels, or erythroid precursors between ALL and AML patients. Reticulocytes in AML patients averaged 1.7 +/- 0.8%, which was higher than in patients with ALL (0.8 +/- 0.3%, p0.01); the proportion of high-fluorescence reticulocytes (HFR) averaged 4-fold higher in AML versus ALL (p0.01) and the reticulocyte maturity index (RMI) was higher in AML (20.8 +/- 8.3%) versus ALL (12.4 +/- 6.5%, p0.01). The RMI was higher in NHL patients with bone marrow (BM) involvement (15.6 +/- 9.4%), compared to those without BM involvement (4.3 +/- 2.1%, p0.01). The proportion of HFR averaged 11-fold higher in NHL with BM involvement versus NHL without BM involvement. In summary, erythropoietic activity is significantly more active in patients with AML compared to ALL and in patients with NHL with BM involvement, compared to NHL without BM involvement.

We investigated whether hypercholesterolemia influenced the values of mean corpuscular volume (MCV) and erythrocyte sedimentation rate (ESR).A total of 463 nonanemic elderly persons were evaluated regarding red cell indices, ESR, and ESR-related parameters, such as fibrinogen, albumin, and C-reactive protein (CRP).There were no significant differences in MCV between elderly men with and without hypercholesterolemia (/=240 mg/dl) nor between the subjects with a marked increase of serum cholesterol concentrations (/=260 mg/dl) and with severely lowered cholesterol concentrations (155 mg/dl). ESR in elderly men with hypercholesterolemia averaged 12.3+/-6.8 mm/h, which were significantly higher than in those without hypercholesterolemia (6.0+/-4.7 mm/h, p0.01). ESR averaged threefold higher in the elderly men with serum cholesterol concentration/=260 mg/dl versus those with serum cholesterol concentrations155 mg/dl, although no significant differences were observed in fibrinogen, albumin, and CRP values between the two groups. Serum cholesterol concentrations were higher in elderly men with ESR/=15.0 mm/h (248.9+/-43.5 mg/dl), compared to those with ESR2.0 mm/h (199.5+/-31.7 mg/dl, p0.01). Serum cholesterol concentrations showed no associations with red cell indices but correlated significantly with ESR in elderly men (r=0.24, p0.01) and postmenopausal women (r=0.21, p0.01).Hypercholesterolemia does not appear to influence MCV but significantly accelerates ESR, especially in elderly men.

Background: To investigate whether nitric oxide (NO) production correlates with laboratory parameters of disease activity in patients with rheumatoid arthritis (RA), we measured serum nitrates and nitrites (NOx) concentrations, rheumatoid factor (RF), C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), and serum iron markers in 115 RA patients. Methods: Serum NOx concentrations were determined after reduction of nitrates to nitrites using the Griess reaction. Serum transferrin receptor (sTfR) and serum ferritin were assayed using an enzyme immunoassay and a chemiluminescence method. Correlation coefficients of CRP, ESR, and RF vs. NOx concentrations were assessed. Results: Serum NOx concentrations averaged 208.3±126.8 μmol/l in RA patients without iron deficiency (n=72) and 267.9±148.4 μmol/l in RA patients with iron deficiency (n=43), which were significantly higher than those of healthy controls (32.7±14.3 μmol/l, p

To investigate the associations between obesity and serum hepatic enzyme activities, we measured total body fat (TBF), body mass index (BMI), and hepatic biochemical parameters in 732 apparently healthy adults. TBF was assessed using a body fat analyzer. Serum activities of alanine and aspartate aminotransferase (ALT and AST), gamma-glutamyl transferase (GGT), alkaline phosphatase (ALP), and lactate dehydrogenase (LD) were determined by standard spectrophotometric methods. Mean activities (+/- SD) of serum ALT and AST in men with high fatness were 51.2 +/- 12.6 U/L and 32.9 +/- 9.2 U/L, which were significantly higher than those in men with low fatness (23.5 +/- 7.4 U/L and 22.5 +/- 7.8 U/L, p0.01). Of 147 men with high fatness, 56 (38.1%) had serum ALT levels above the upper limit of normal, whereas only 9.5% (31/328) of men with low or desirable fatness showed elevated serum ALT activities (p0.01). Serum ALT, AST, and GGT activities correlated significantly with TBF in both overweight men and women. Among subjects having high TBF, those with fatty liver showed significantly higher incidence of elevated hepatic enzymes, compared to those without fatty liver. In short, elevated serum hepatic enzyme activities are associated with TBF and a high prevalence of fatty liver is observed in subjects with elevated TBF.

This study investigated the associations between serum transferrin receptor (sTfR) concentrations and erythropoietic activities during 3 stages of iron deficiency in humans. Serum iron markers, fluorescent intensity of reticulocytes, and sTfR concentrations were measured in 227 prepubescent children, age 9 to 12 yr. Reticulocyte subpopulations were analyzed by flow cytometry and sTfR concentrations were measured by enzyme immunoassay. Mean values of middle-fluorescence reticulocytes (MFR), reticulocyte maturity index (RMI), and sTfR concentrations were significantly higher in iron-deficiency anemia subjects than in healthy controls. Reticulocyte subpopulations increased gradually, as body iron status diminished; the mean values of MFR and RMI in subjects with serum ferritin concentrations4.0 microg/L were 3-fold higher than those in healthy controls (p0.01). Correlation coefficients of MFR and RMI vs log ferritin values (r = 0.43 and r = 0.42) were higher than those of MFR and RMI vs sTfR concentrations (r = 0.24 and r = 0.27) in iron-deficiency anemia subjects. In summary, iron deficiency leads to increased production of immature reticulocytes. Erythropoietic activity is more closely associated with log ferritin values than with sTfR concentrations in iron-deficiency anemia.

To investigate the effects of storage temperature on the responsiveness to agonists of human platelets prepared from stored blood, we measured the aggregability and acid-base status of platelets from 96 healthy subjects before and after storage of whole blood at 4 degrees C and room temperature (RT) up to 48 hr. After 24 hr storage at 4 degrees C, there were no significant differences in agonist-induced platelet aggregability, compared to fresh specimens. When blood was kept at RT for 24 hr, all of the platelet samples showed non-responsiveness (20% aggregability) to epinephrine and 70% (67/96) revealed impaired responsiveness (20 to 60% aggregability) to adenosine diphosphate (ADP); there were no samples that showed impaired- or non-responsiveness to collagen or ristocetin. Among the 67 samples that showed impaired responsiveness to ADP after RT storage, 62 (93%) exhibited the loss of a secondary wave of aggregation in response to ADP. After storage of blood at RT for 48 hr (pH 6.81 +/- 0.06), mean values of maximal platelet aggregability to epinephrine, ADP, collagen, and ristocetin were 8%, 16%, 19%, and 70%, which were significantly lower than the corresponding mean values after storage of blood at 4 degrees C for 48 hr (pH 7.04 +/- 0.04) (ie, 66%, 69%, 102%, and 91%, p0.01). In summary, refrigerated storage of human blood improves the stability of platelet responsiveness to agonists. Storage at RT causes platelet non-responsiveness to epinephrine and disturbs the release reaction of endogenous ADP.

To investigate the effects of high temperature on hematologic parameters of human blood, we assessed complete blood cell counts, red cell indices, and platelet aggregability in 72 adult blood samples after exposure to varying degrees of temperature. There were no significant differences in erythrocyte counts, hemoglobin concentration, or mean corpuscular hemoglobin (MCH) between pre- and post-treated groups when blood samples were treated at 50 degrees C for 5 min. Under the same conditions, however, mean corpuscular volume (MCV) and hematocrit became significantly higher in the post-treated group (p0.01). A dramatic increase was observed in the numbers of platelets and eosinophils measured by electronic counter: the mean numbers of platelets and eosinophils in the post-treated group (2,978.2 x 109/L and 5.58 x 10(9)/L) were significantly higher than those for the pre-treated group (246.6 x 10(9)/L and 0.15 x 10(9)/L, p0.01). Platelet clumps of varying size were seen in EDTA-anticoagulated blood after exposure to 46 degrees C for 90 sec; however, these clumps were not detected in citrate-, heparinized-, or washed EDTA-anticoagulated blood. Platelet aggregability to various agonists was profoundly decreased after treating the blood at 43 degrees C for 5 min. In summary, this study shows that critical changes of hematologic parameters occur when blood is exposed to 50 degrees C, and that the anticoagulating property of EDTA is altered upon exposure to high temperature.

In recent years, the platelet concentrates obtained from single donors by automated thrombapheresis has been widely used. During the whole apheresis procedure, the platelets are under shear stress, and alterations in the biocompatibility of surface may give a change in platelet function [1]. Some reports have shown that extracorporeal blood circulation increases platelet reactivity in healthy donors [2,3]. In contrast, several investigators demonstrated that in vitro recirculation of fresh human blood in an extracorporeal circuit diminished platelet function and decreased the number of glycoprotein antigenic sites on the platelet surface [4,5]. The influence of thrombapheresis on donors’ platelet function is still debated upon, and epidemiological studies on this impact in the broader population are limited. Hence, in this study, we made an attempt to investigate whether thrombapheresis leads to altered responsiveness to various agonists in platelet from healthy donors who showed normal aggregability before thrombapheresis.

To investigate the relationships between obesity and serum lipid concentrations, we measured eight anthropometric parameters, body mass index (BMI), total body fat (TBF), and serum lipid profiles in 790 apparently healthy adolescents. TBF was assessed using a body fat analyzer. Serum concentrations of triglyceride, total cholesterol, and low- or high-density lipoprotein-cholesterol (LDL-C or HDL-C) were determined by standard enzymatic procedures. There were no significant differences in serum lipid concentrations between obese adolescents (BMIor = 95th percentile) and lean adolescents (BMI5th percentile), nor between overweights (BMI25 kg/m2) and underweights (BMI19 kg/m2). However, serum lipid concentrations were significantly higher in males with TBF37% (TBF95th percentile) than in males with TBF6% (TBF5th percentile; p0.01). Serum lipid concentrations were more strongly correlated with TBF than with BMI. Correlation coefficients between serum lipid concentrations and TBF were higher in males than in females for cholesterol (r = 0.37 vs 0.23), triglycerides (r = 0.29 vs 0.27), HDL-C (r = -0.34 vs 0.12), and LDL-C (r = 0.24 vs 0.15). In short, compared to BMI, TBF reflects serum lipid concentrations more closely. During adolescence, the association between TBF and serum lipid concentrations is stronger in males than in females.

To investigate the changes in nitric oxide (NO) production during and after normal pregnancy and in pregnancies complicated by preeclampsia, we measured serum nitrates and nitrites (NOx) concentrations and serum iron markers in 347 subjects. Serum NOx concentrations were determined after reduction of nitrates to nitrites using the Griess reaction. Serum iron and serum ferritin were assayed using an automatic chemical analyzer and a chemiluminescence method. Serum NOx concentrations were significantly higher in the first trimester (117.3 +/- 31.4 microM) than in nonpregnant women (23.8 +/- 7.1 microM). High NOx concentrations persisted throughout normal pregnancy, irrespective of serum ferritin concentrations, and returned to nonpregnant levels by 9-12 wk postpartum. Mean NOx concentrations in preeclamptic women were 43.1 +/- 12.7 microM, which were significantly lower than those in the gestation age-matched normal pregnant women (249.7 +/- 51.3 microM). In summary, NO production increases with advancing gestation during normal pregnancy and decreases in preeclampsia, regardless of serum ferritin concentrations. Elevated NOx concentrations during pregnancy return to normal within 12 wk after delivery.

Making a morphologic distinction between hypocellular refractory anemia (hypo RA) and aplastic anemia (AA) is difficult. To investigate the significance of hemoglobin F-containing erythroblasts (F-blasts) and p53 expression in making the distinction between hypo RA and acquired AA, we immunohistochemically assessed F-blasts and p53 in bone marrow specimens from 16 patients with hypo RA, 31 patients with acquired AA, and 15 hematologically normal individuals. F-blast production was elevated in 87.5% (14/16) of patients with hypo RA, but in only 3.2% (1/31) of patients with AA (P < .01). p53 was over-expressed in 75.0% (12/16) of hypo RA patients and in 6.4% (2/31) of AA patients (P < .01). The mean contents of F-blasts and p53-positive cells in patients with hypo RA were 6.31% ± 3.27% and 7.54% ± 4.36%, respectively, of all bone marrow cells, which were significantly higher than for patients with AA (0.35% ± 0.46% and 0.58% ± 1.29%, P < .01). In conclusion, a high prevalence of elevated F-blast production is noted in hypo RA, suggesting that the assessment of F-blasts in bone marrow can be used as an additional tool for differentiating hypo RA from acquired AA.

We investigated whether the anatomic distribution of hematopoietic cells determines the type of hemoglobin produced in patients with extramedullary hematopoiesis (EMH). Fetal hemoglobin (HbF) production is not restricted to fetal erythropoietic organs during EMH. A shift of erythropoiesis to fetal hematopoietic organs in EMH does not necessarily induce HbF synthesis in adulthood.

To investigate the relationship between the fetal hemoglobin-containing erythroblasts (F blasts) and apoptosis in myelodysplastic syndromes (MDS), we immunohistochemically assessed F blasts, F cells, and apoptosis in 137 patients with MDS. A marked increase in the number of F blasts in the bone marrow was identified in 116 of 137 patients (84.7%), and the number of F cells was elevated in 54 patients (39.4%). Among the erythroblasts stained by anti-glycophorin C antibody, the mean percentage of F blasts was 14.63 +/- 9.17% in MDS, which was significantly higher than that in non-MDS patients with stress erythropoiesis (4.82 +/- 3.35%, P0.01), although there were no significant differences in the number of F cells between these groups. In particular, 62 of the 137 MDS patients (45.3%) had an apparent increase in F blasts but no elevation of F cells. The apoptotic rate was significantly higher in the patients with a F blast/F cell (Fb/Fc) ratioor=5.0 than in those with a Fb/Fc ratio1.0 (P0.01). The results indicate that F cell precursors are incapable of maturing into functioning end-stage F cells, presumably owing to apoptotic cell death. The measurement of F blasts in the bone marrow is needed for the precise evaluation of fetal-type erythropoiesis in MDS.

Chromobacterium violaceum is a gram-negative rod and is isolated from soil and water in tropical and subtropical regions. The species have pigmented and nonpigmented colony types. Infections caused by nonpigmented strains are rare. We report on two cases of infection caused by both pigmented and nonpigmented strains of C. violaceum . Two 24-year-old Korea Airline stewardesses were admitted to Inha University Hospital, Inchon, South Korea, on 9 August 1997, 3 days after an airplane accident in Guam. Both had multiple lacerations on exposed parts of their bodies. There was swelling, tenderness, and pus discharge. The wounds contained many small fragments of stones and weeds. A pigmented strain was isolated from the left hand and a nonpigmented strain was isolated from the left knee of one patient. For the other patient only a nonpigmented strain was isolated from a foot wound. The nonpigmented colonies from the left-knee and the left-foot wounds did not produce any pigment even after an extended period of incubation. The biochemical characteristics were the same for each strain except for oxidase and indole reactions. The pigmented strain was oxidase negative and indole positive, whereas the nonpigmented strains were oxidase positive and indole negative. The patients were successfully treated by debridement and with appropriate antibiotics.

Dear Editor, We read with interest the comments of Dr. Koulaouzidis [1] regarding the results of our study, which was recently reported on the usefulness of the combination index of serum-soluble transferrin receptor (sTfR) and mean corpuscular hemoglobin (MCH) to differentiate coexisting iron deficiency in patients with end-stage renal disease (ESRD) [2]. First, Dr. Koulaouzidis raised a question as to why the sTfR value was used instead of the sTfR-F index (the ratio of sTfR to log ferritin) to evaluate iron deficiency in patients with chronic renal failure. In fact, the sTfR-F index has been suggested as a good estimate of body iron status [3]. Several investigators reported that the sTfR-F index is an additional biochemical marker for identification of irondeficient erythropoiesis [4]. In our study, however, the sTfR-F index was not superior to sTfR value in the correlation coefficients with serum iron (r=−0.22 vs. r=−0.24) and transferrin saturation (r=−0.23 vs. r=−0.27) in the patients with ESRD. The sTfR-F index may reflect the erythropoietic activity, but it seems to depend on the body iron status of subject populations. The relationships between the sTfR-F index and erythropoietic parameters are fairly different from each other between healthy individuals and iron-deficient anemic subjects [5]. In the preliminary test of our study, similar findings were also observed in the patients with rheumatoid arthritis. On the basis of these results, we selected the sTfR value rather than sTfR-F index as an indicator of iron status in the patients with ESRD. Secondly, Dr. Koulaouzidis made a comment on the low cut-off level of sTfR, which was used to diagnose iron deficiency in our study, and emphasized the importance of the normal reference value of sTfR that was obtained from the healthy controls. However, it is likely that there are large differences in sTfR production between healthy subjects and the patients with ESRD, especially under the condition of suppressed erythropoiesis. It is hard to apply the reference intervals of healthy subjects for the patients with chronic renal failure. In our study, mean values of sTfR in the patients with ESRD (1.50±0.97 mg/l) were significantly lower than those in age-matched healthy controls (2.13±0.51 mg/l, p

Infection-associated plasmacytosis is not uncommon; however, marked plasmacytosis in both peripheral blood and bone marrow that mimicks plasma cell leukemia is a very rare condition. We encountered a case of extreme plasmacytosis associated with Klebsiella pneumoniae sepsis in an aplastic anemia patient. A 42-year-old man presented with high fever of 5 days' duration. Hematological analysis revealed severe neutropenia and thrombocytopenia; his white blood cell count was 900/mm(3), with 26% of plasma and plasmacytoid cells in peripheral blood. Bone marrow biopsy and aspiration showed 25% cellularity with marked plasmacytosis (80%), highly suggestive of plasma cell leukemia. On the eighth hospital day, K. pneumoniae was identified in blood and sputum cultures. Fever improved after switching antibiotics, although his hematological condition worsened. His bone marrow cellularity (plasma cell proportion) progressively decreased: the values were 25% (80%), 10% (26%), 10% (11%), and < 10% (< 4%) on the 8th, 30th, 60th, and 90th hospital day, respectively. His plasmacytosis was extremely severe but was confirmed to be reactive with polyclonality. The present case represents the first report of strong suspicion of K. pneumoniae sepsis-associated marked plasmacytosis in an aplastic anemia patient.

Blood lead concentrations and body iron status were investigated in 279 children. Blood lead concentrations showed no increase during iron depletion phase (stage I) but markedly increased from the phase of iron deficient erythropoiesis (stage II). Increased blood lead concentrations in anaemic subjects significantly decreased after iron supplementation.

장우리·최종원·남정현·문연숙·김진주·김정희·임대현 Woo Ri Jang, M.D., Jong Weon Choi, M.D., Chung Hyun Nahm, M.D., Yeon Sook Moon, M.D., Jin Ju Kim, M.D., Jeong Hee Kim, M.D., Dae Hyun Lim, M.D. 인하대학교 의과대학 진단검사의학교실, 소아청소년과학교실 Departments of Laboratory Medicine and Pediatrics, College of Medicine, Inha University, Incheon, Korea 원저 Lab Med Online Vol. 2, No. 1: 20-27, January 2012 http://dx.doi.org/10.3343/lmo.2012.2.1.4 임상화학

The common laboratory tests for evaluating iron status are serum iron, total iron-binding capacity, transferrin saturation, and ferritin (1). However, ferritin is one of the acute phase reactants, and its concentration is influenced by various clinical conditions (2). Even mild upper respiratory infections are associated with an increase in serum ferritin (3). Examination of stainable iron in bone marrow is the gold standard for iron depletion; however, this procedure is invasive and is not feasible for the evaluation of all children suspected of iron deficiency. Measurement of the soluble transferrin receptor (sTfR) recently has been introduced as a new diagnostic tool for the evaluation of iron status (2)(4). The sTfR concentration reflects the functional iron status of the body and the rate of erythropoiesis in bone marrow (4). Measurement of sTfR is valuable in physiologic conditions in which iron stores are relatively depleted, and such situations are encountered regularly in children and adolescents (5)(6). Children are in a period of continuing growth; therefore, their reference intervals for many analytes are different from those for adults and may show age-related changes. Because comparative age-related data for sTfR in healthy individuals are limited, we investigated the age-related differences in sTfR from neonate to adult. A total of 849 apparently healthy nonanemic subjects were investigated for sTfR and hematologic and iron markers. …

Background: Iron deficiency (ID) in Korean adolescents still remains a problem. This study aimed to assess the prevalence of iron status and investigate the relationship between the iron status and obesity. Methods: Hematological examinations were performed on apparently healthy 12~14 year old students (M:F=451:442) living in Incheon during September, 2004. ID was defined as a serum ferritin concentration

The serum transferrin receptor (sTfR) is thought a sensitive and quantitative parameter of tissue iron deficiency as well as an indicator of erythropoietic activity. This study was aimed at the verification of a hypothesis that sTfR is a general indicator of erythropoiesis regardless whatever the cause is. A total of 173 patients in heterogeneous diseases who underwent bone marrow study as a workup for anemia were measured for sTfR, reticulocyte maturity index (RMI), erythroid element proportion of bone marrow cells, and other hematologic parameters (hemoglobin, hematocrit, mean corpuscular volume, mean corpuscular hemoglobin concentration, red cell distribution width, absolute reticulocyte count). By immunoenzymometric method sTfR was measured using IDeATMcTfR kids (Orion Diagnostica, Orion, Finland). Reticulocyte count and proportion was measured manually by one expert examiner after standard blood smear and stain. Reticulocyte subpopulation was automatically analyzed by flow cytometry using R-3000 TM (Sysmex, TOA, Japan). RMI was calculated from the equation of (medium fluorescent reticulocyte fraction + high fluorescent reticulocyte fraction) X 100 / low fluorescent reticulocyte fraction. Correlation analysis was done among the variables including sTfR, RMI, erythroid element proportion of bone marrow cells, and other hematologic parameters using SAS 6.12 soft ware. The analysis was carried out for the whole 173 patients to see the general trends and repeated for 4 groups of disease category, arbitrarily divided to group 1 (n=33, iron deficiency or or disease with no predisposition to anemia of chronic disease), group 2 (n=53, hematologic malignancies), group 3 (n=44, solid tumors), and group 4 (n=43, chronic or infectious disease) to see if the trends may be affected by specific diseases. The results showed a solid correlation of sTfR with RMI as well as erythroid precursors in bone marrow, not only in the whole patient population (e.g. sTfR vs RMI, R=0.587, p=0.0001) but also in individual groups (e.g. sTfR vs RMI, R=0.48, p=0.005 in group 1, R=0.69, p=0.0001 in group 2, R=0.58, p=0.0001 in group 3, R=0.81, p=0.0001 in group 4). These findings indicated the significance of sTfR is valid under any clinical setting as a universal indicator of hematopoietic activity. The sTfR can be used as a useful parameter for monitoring of erythropoiesis in a variety disease.