Search

As a result of the population aging, the incidence of both hematologic and non-hematologic diseases of elderly gets higher, requiring bone marrow (BM) aspirations and biopsies be implemented also in the geriatric patients. Our aim in this study is to address BM examination in the geriatric patients aged 85 and over, describing its indications and morbidity and discussing the established diagnoses and outcomes of applied therapies based on BM examinations in comparison to the available literature which is actually limited in number particularly in this patient group. We have retrospectively reviewed the BM aspiration/biopsy results of 114 patients aged ≥ 85 years who were followed-up by hematology department of a university hospital from 2010 to 2020. The patients were selected through the internal data handling system of the hospital using the entry codes corresponding to BM aspiration and biopsy and those at the age of 85 or older were identified. Demographic features, primary diagnosis, any comorbidities, complete blood count (CBC) details, erythrocyte sedimentation rate (ESR), red blood cell indices, C-reactive protein (CRP), serum ferritin, vitamin B12, and folic acid levels, any abnormal results in serum biochemistry testing, the indication(s) for and the result(s) from BM aspiration/biopsy, and the treatments applied based on those result(s) were recorded for each patient as well as the rates of and reasons for mortality. In our cohort of 114 patients with a mean age of 86.3±1.7 (85-93) years, 64.9% (n=74) were males. None of the patients experienced any serious complication during BM aspiration and biopsy. First three indications in our cohort for BM aspiration/biopsy in decreasing order of frequency were cytopenia in 48.2% (n=55), anemia + elevated ESR in 18.4% (n=21), and leukocytosis + anemia + thrombocytopenia in 15.8% (n=18). BM aspiration/biopsy results gave rise to a pathologic or hematologic diagnosis in 85.9% (n=98) and 78.9% (n=90) of patients, respectively. Most frequent hematologic malignancies were myelodysplastic syndrome (MDS), acute myeloid leukemia (AML), and multiple myeloma (MM). Kaplan-Meier analysis revealed hemoglobin (Hb) and LDH levels as prognostic factors with an impact on mortality. Prognostic factors with an impact on mortality based on multivariate stepwise Cox regression analysis, on the other hand, were uric (p= 0.018, hazard ratio (HR)= 1.134, 95% confidence interval (CI) = 1.022-1.258), LDH (p=0.092, HR=1.001, 95% CI= 1.000-1.002), and platelet levels (p=0.007, HR=1.000, 95% CI=1.000-1.000). BM examination should definitely be performed in patients aged ≥ 85 years, particularly in the event of cytopenia, unexplained anemia, and elevated ESR both for diagnostic purposes and to prolong life expectancy through administration of modified therapies depending on the performance status. In such patients uric acid, LDH and platelet levels should be closely followed-up as independent prognostic variables which effect mortality.

The Indomie noodles are an instant noodle sold dried in packets or cups. The noodles are quick and easy to make and can be eaten as a snack or part of the main meal. This study was designed to examine the possible effect of different levels of Indomie noodles on the hematological biochemical profile, organosomatic index and male fertility indices in healthy adult albino rats. In an experimental study, twenty male rats of average weight 115 g (divided into four groups) and twenty female rats of average weight 100 g (divided into four groups). Each group consists of five rats. Group A is the control group and was fed with standard rat feed. In contrast, groups B, C and D were supplied with 25 %, 50 % and 75 % Indomie instant noodles cooked and spiced with the seasoning. The administration was carried out for 8 w. The result showed that the body weight, expressed as growth rate, showed that rats exposed to the 75 % Indomie noodle formulated diets had significantly minimum growth rates than controls and other two different groups. There was a significant increase (p

Clonal hematopoiesis of indeterminate potential (CHIP) is associated with increased risk of cancers and inflammation-related diseases. This phenomenon becomes common in persons aged ≥80 years, in whom the implications of CHIP are not well defined. We performed a mutational screening in 1794 persons aged ≥80 years and investigated the relationships between CHIP and associated pathologies. Mutations were observed in one-third of persons aged ≥80 years and were associated with reduced survival. Mutations in JAK2 and splicing genes, multiple mutations (DNMT3A, TET2, and ASXL1 with additional genetic lesions), and variant allele frequency ≥0.096 had positive predictive value for myeloid neoplasms. Combining mutation profiles with abnormalities in red blood cell indices improved the ability of myeloid neoplasm prediction. On this basis, we defined a predictive model that identifies 3 risk groups with different probabilities of developing myeloid neoplasms. Mutations in DNMT3A, TET2, ASXL1, or JAK2 were associated with coronary heart disease and rheumatoid arthritis. Cytopenia was common in persons aged ≥80 years, with the underlying cause remaining unexplained in 30% of cases. Among individuals with unexplained cytopenia, the presence of highly specific mutation patterns was associated with myelodysplastic-like phenotype and a probability of survival comparable to that of myeloid neoplasms. Accordingly, 7.5% of subjects aged ≥80 years with cytopenia had presumptive evidence of myeloid neoplasm. In summary, specific mutational patterns define different risk of developing myeloid neoplasms vs inflammatory-associated diseases in persons aged ≥80 years. In individuals with unexplained cytopenia, mutational status may identify those subjects with presumptive evidence of myeloid neoplasms.

Background: SARS-CoV-2 infection is characterized by the development and progression of inflammatoryresponses. The exploration of prognostic predictors for patients with COVID-19 is vital for prompt clinicalintervention. Our study aims to explore the predictive value of hematological parameters in categorizationof patients with COVID-19.We aimed to investigate associations between hematological parameters anddisease severity in patients with SARS-CoV-2infection.The red blood cell distribution width (RDW),an indicator of anisocytosis has emerged as a potential tool for risk stratification of critically ill patients.Materials and Methods: Retrospective study after getting approval from Institutional ethics committeewas performed with data obtained from triage OPD in Chengalpattu Medical College & Hospital. Thedemographic, clinical, laboratory profile of COVID 19 positive patients who attended Triage OPD for aperiod of one month were collected. 3000 RT-PCR confirmed COVID positive patients of age group 20to 70 years of both genders were included in the study. COVID 19 positive paediatric cases, antenatal andpostnatal mothers, postoperative cases and sick cases admitted in COVID ICU were excluded from thestudy. Symptoms, associated co-morbidities and severity of COVID 19 were tabulated. Complete BloodCount measured by Automated Sysmex Analyser at the time of reporting to triage was noted. Red bloodcell indices were analysed using SPSS 21.0 version. Results: There was statistically significant increase inRDW and decrease in MCV among patients with co-morbidity and severe illness compared to those withmild disease. There is no statistically significant difference in Red blood cell indices between patients withand without symptoms and patients without co-morbidities. Conclusion: RDW was found to be a screeningtool to identify patients with severe COVID-19 and the results of this study suggest that RDW should be partof routine laboratory assessment and monitoring of COVID-19.

The widespread use of tris(1,3-dichloro-2-propyl) phosphate (TDCIPP) as a flame retardant has led to its release to the environment. Thus, the toxicological effects of TDCIPP on humans and animals are of importance. For better understanding of its potential toxicities, TDCIPP (250, 500, or 650 mg/kg/day) or vehicle control was administrated orally to adult male Wistar-Imamichi rats for 7 days. After the final administration of compounds, organ weights, histopathology, blood biochemistry, and hematology were examined. Hepatic toxicity was observed at doses ≥ 500 mg/kg/day of TDCIPP, and renal toxicity was observed at 650 mg/kg/day. The anti-androgenic activity of TDCIPP was previously confirmed in vitro and in vivo, but weights of epididymis, an androgen-dependent organ, were not affected by TDCIPP treatment in adults. Serum alkaline phosphatase activity was significantly decreased in all TDCIPP-treated rats independent of dose. Hemoglobin concentration, hematocrit, red blood cell count, and reticulocyte count were decreased in all TDCIPP-treated rats, but mean corpuscular volume, total iron-binding capacity, and serum iron were normal, suggesting that renal anemia was caused by TDCIPP. Together with previous reports on effects of anti-androgenic substances on red blood cell indices, anemia caused by TDCIPP could be due to its anti-androgenic activity. These considerations will contribute to further assessment of the toxicity of the compound.

The measurement of RBC indices is of particular importance as an indirect intermediate component of the recovery process after exposure to hypoxia, ischemia, hypothermia in patients with traumatic disease due to polytrauma. The aimof this study was to evaluate the parameters of the morphologic state of red blood cells as a reaction of patients with traumatic disease. Materials and methods.A prospective study was carried out evaluation of 120 patients suffering from polytrauma. The patients were divided into 3 groups according to the principle of using additional substances as a part of IC. The parameters of morphologic state of red blood cells were studied. Results and discussion.The course of acute and early periods of traumatic disease has accompanied variability morphological forms of red blood cells, as evidenced by a decrease in MCV and RDW increased levels of the 3rd to 5th day. The optimized therapy used in the treatment of patients, has a positive effect on the parameters of red blood cells, contributes to a better recovery of red blood cells after hypoxia resulting multiple trauma. Conclusion.The study has demonstrated variations in the morphologic properties of red blood cells in the acute and early period of traumatic disease, as confirmed by pathological changes of the erythrocyte indices. The administration of the proposed therapy with the use of D-fructose-1.6-diphosphate sodium salt of hydrate has a positive effect on the parameters of red blood cells, contributes to a better recovery after hypoxia resulting multiple trauma. Given this, the calculations of the red blood cell indices may carry additional diagnostic information, which allows identify trends for not obvious pathological changes and quality of treatment.

Background Ordinal health longitudinal response variables have distributions that make them unsuitable for many popular statistical models that assume normality. We present a multilevel growth model that may be more suitable for medical ordinal longitudinal outcomes than are statistical models that assume normality and continuous measurements. Methods The data is from an ongoing prospective cohort study conducted amongst adult women who are HIV-infected patients in Kwazulu-Natal, South Africa. Participants were enrolled into the acute infection, then into early infection subsequently into established infection and afterward on cART. Generalized linear multilevel models were applied. Results Multilevel ordinal non-proportional and proportional-odds growth models were presented and compared. We observed that the effects of covariates can’t be assumed identical across the three cumulative logits. Our analyses also revealed that the rate of change of immune recovery of patients increased as the follow-up time increases. Patients with stable sexual partners, middle-aged, cART initiation, and higher educational levels were more likely to have better immunological stages with time. Similarly, patients having high electrolytes component scores, higher red blood cell indices scores, higher physical health scores, higher psychological well-being scores, a higher level of independence scores, and lower viral load more likely to have better immunological stages through the follow-up time. Conclusion It can be concluded that the multilevel non-proportional-odds method provides a flexible modeling alternative when the proportional-odds assumption of equal effects of the predictor variables at every stage of the response variable is violated. Having higher clinical parameter scores, higher QoL scores, higher educational levels, and stable sexual partners were found to be the significant factors for trends of CD4 count recovery.

Alpha- and β-thalassemias and abnormal hemoglobin (Hb) are common in tropical countries. These abnormal globin genes in different combinations lead to many thalassemic diseases including three severe thalassemia diseases, i.e., homozygous β-thalassemia, β-thalassemia/Hb E, and Hb Bart’s hydrops fetalis. Laboratory diagnosis of thalassemia requires a number of tests including red blood cell indices and Hb and DNA analyses. Thalassemic red blood cell analysis with an automated hematology analyzer is a primary screening for thalassemia since microcytosis and decreased Hb content of red blood cells are hallmarks of all thalassemic red blood cells. However, these two red blood cell indices cannot discriminate between thalassemia trait and iron deficiency or between α- and β-thalassemic conditions. Today, Hb analysis may be carried out by either automatic high-performance liquid chromatography (HPLC) or capillary zone electrophoresis (CE) system. These two systems give both qualitative and quantitative analysis of Hb components and help to do thalassemia prenatal and postnatal diagnoses within a short period. Both systems have a good correlation, but the interpretation under the CE system should be done with caution because Hb A2 is clearly separated from Hb E. In case of α-thalassemia gene interaction, it can affect the amount of Hb A2/E. Thalassemia genotypes can be characterized by the intensities between alpha-/beta-globin chains or alpha-/beta-mRNA ratios. However, those are presumptive diagnoses. Only DNA analysis can be made for specific thalassemia mutation diagnosis. Various molecular techniques have been used for point mutation detection in β-thalassemia and large-deletion detection in α-thalassemia. All of these techniques have some advantages and disadvantages. Recently, screening for both α- and β-thalassemia genes by next-generation sequencing (NGS) has been introduced. This technique gives an accurate diagnosis of thalassemia that may be misdiagnosed by other conventional techniques. The major limitation for using NGS in the screening of thalassemia is its cost which is still expensive. All service labs highly recommend to select the technique(s) they are most familiar and most economic one for their routine use.

Objective Panic disorder (PD) is associated with changes in platelet and red blood cell (RBC) indices. However, the diagnostic or predictive value of these indices is unknown. This study assessed the diagnostic and discriminating value of platelet and RBC indices in patients with PD. Materials and Methods In this cross-sectional study including patients with PD (n = 98) and healthy controls (n = 102), we compared the following blood indices: mean platelet volume (MPV), platelet distribution width (PDW), and RBC distribution width (RDW). The receiver operating characteristic (ROC) curve was used to calculate the area under the ROC curve (AUC), sensitivity, specificity, and likelihood ratio for the platelet and RBC indices. Results Statistically significant increase in PDW (17.01 ± 0.91 vs. 14.8 ± 2.06; p < 0.0001) and RDW (16.56 ± 2.32 vs. 15.12 ± 2.43; p < 0.0001) levels were observed in patients with PD. PDW and mean corpuscular hemoglobin concentration had larger AUC (0.89 and 0.74, respectively) and Youden’s index (0.65 and 0.39, respectively), indicating their higher predictive capacity as well as higher sensitivity in discriminating patients with PD from healthy controls. Conclusion PDW can be considered a “good” diagnostic or predictive marker in patients with PD.

Mean values of hematological parameters are currently used in the clinical laboratory settings to characterize red blood cell properties. Those include red blood cell indices, osmotic fragility test, eosin 5-maleimide (EMA) test, and deformability assessment using ektacytometry to name a few. Diagnosis of hereditary red blood cell disorders is complemented by identification of mutations in distinct genes that are recognized "molecular causes of disease." The power of these measurements is clinically well-established. However, the evidence is growing that the available information is not enough to understand the determinants of severity of diseases and heterogeneity in manifestation of pathologies such as hereditary hemolytic anemias. This review focuses on an alternative approach to assess red blood cell properties based on heterogeneity of red blood cells and characterization of fractions of cells with similar properties such as density, hydration, membrane loss, redox state, Ca2+ levels, and morphology. Methodological approaches to detect variance of red blood cell properties will be presented. Causes of red blood cell heterogeneity include cell age, environmental stress as well as shear and metabolic stress, and multiple other factors. Heterogeneity of red blood cell properties is also promoted by pathological conditions that are not limited to the red blood cells disorders, but inflammatory state, metabolic diseases and cancer. Therapeutic interventions such as splenectomy and transfusion as well as drug administration also impact the variance in red blood cell properties. Based on the overview of the studies in this area, the possible applications of heterogeneity in red blood cell properties as prognostic and diagnostic marker commenting on the power and selectivity of such markers are discussed.

15Pág., The objective of this study was to investigate the metabolic and osmotic effects of different doses of glycerol or a glycerol - propylene glycol mixture in Sarda sheep with the aim to identify those able to beneficially modify ewe's metabolic status without harmful changes in red blood cell (RBC) indices. Thereafter, the selected doses were tested for their effects on ewe's ovarian activity during an induced follicular phase and compared to the effects of a hormonal treatment with equine chorionic gonadotrophin (eCG)., This study was financed by a doctoral grant from the Italian Ministry of Education, University and Research (Programma Operativo Nazionale Ricerca e Innovazione 2014–2020 - CCI 2014IT16M2OP005 - Fondo Sociale Europeo, Azione I.1 “Dottorati Innovativi con caratterizzazione Industriale). The funding institution financed laboratory analysis, the dietary treatments, and FDS. The funding institution had no role in the design of the study; in the collection, analysis, and interpretation of data; or in the writing of the manuscript.

As anemia remains a major public health problem in Ghana, we examined the effect of dietary intakes, and antenatal care (ANC) practices on red cell indices and anemia prevalence during the pregnancy continuum for 415 women. Dietary history was taken using the Food and Agriculture Organization minimum dietary diversity indicator for women (MDD-W). Intake of &ge, 5 food groups was a proxy for micronutrient adequacy. Odds for anemia and meeting the MDD-W were estimated using ordinal and binary logistic regressions respectively. Intakes of 41.4% were micronutrient inadequate. At any time point in pregnancy, 54.4% were anemic (mild = 31.1%, moderate = 23.1%, severe = 0.2%) with 10%-point variation across the first (57.3%), second (56.4%) and third (53.3%) trimesters and pre-delivery (47.7%), 27.8% were anemic throughout pregnancy while 17.1% were never anemic. Morphologically, microcytic (79.4%) and hypochromic (29.3%) anemia were most prevalent, indicating nutritional deficiencies. Planning the pregnancy was a significant determinant for meeting the MDD-W. Overall, adolescence, poor diet, suboptimum ANC and underweight were associated with moderate and severe anemia. In specific time-points, dietary counselling, malaria, iron-folic acid supplementation, sickle cell disease and preeclampsia were observed. Decline of anemia during pregnancy suggests the positive impact of ANC services and supports strengthening education on dietary diversification during ANC.

Background: Clonal hematopoiesis of indeterminate potential (CHIP) is associated with increased risk of cancers and inflammation-related diseases. The phenomenon becomes very common in oldest-old individuals, in whom the implications of CHIP are not well defined. Here we investigate the relationships between CHIP and associated pathologies in people aged >80 years. Methods: We performed a mutational screening in 1794 oldest-old individuals enrolled in two population-based studies (“Health_&_Anemia” and “Monzino_80+”). Findings: Clonal mutations were observed in one third of oldest-old individuals and were associated with reduced survival and increased risk of cancers. Mutations in JAK2 and splicing genes (SF3B1, SRSF2, U2AF1, ZRSR2), multiple mutations (DNMT3A, TET2, ASXL1) combined with additional genetic lesions) and variant allele frequency ≥0.14 had positive predictive value for myeloid neoplasms. Combining mutation profiles with abnormalities in red blood cell indices improved the ability of myeloid neoplasm prediction. On this basis, we defined a predictive model that identifies 3 risk groups with different probabilities of developing myeloid neoplasms. Mutations in DNMT3A, TET2, ASXL1 or JAK2 (most occurring as single lesion) were associated with coronary heart disease and rheumatoid arthritis. Cytopenia (most including anemia) was a common finding in oldest-old population (>20%), the underlying cause remaining unexplained in 30% of cases. Among individuals with unexplained cytopenia, the presence of highly-specific mutation patterns was associated with a myeloid neoplasms-like phenotype and a probability of survival comparable to that of myeloid neoplasms. Accordingly, 7.5% of oldest-old subjects with cytopenia had presumptive evidence of myeloid neoplasm. Interpretation: Specific mutational patterns define different risk of developing cancers vs. inflammatory-associated diseases in oldest-old population. In individuals with unexplained cytopenia, mutational status may identify those subjects with presumptive evidence of myeloid neoplasms. Trial Registration: (ClinicalTrials.gov number:NCT03907553) Funding: Supported by European Union; Cariplo Foundation, Italy; Italian Association for Cancer Research; Italian Ministry of Health and Research. Declaration of Interests: The Authors declare no competing interests. Ethics Approval Statement: Study procedures were in accordance with the Declaration of Helsinki. Ethics Committees of Humanitas Research Hospital and Mario Negri Pharmacological Institute, Milan Italy approved the study. Written informed consent was obtained prior to blood sampling.

The most commonly performed blood test is complete blood cell count. This test includes hemoglobin, white blood cell count, platelet count, and detailed red blood cell indices. Automated complete blood count also give information for "differential" which gives information about percentages and absolute numbers of different subgroups of white blood cells. This test is necessary in diagnosing anemia, hematological cancers, infections, acute hemorrhagic states, allergies, and immunodeficiencies. Also it is used for monitoring side effects of certain drugs. A pediatrician is frequently challenged for evaluating complete blood count as a part patient's assessment. An enhanced and complete understanding of this laboratory test is essential for providing quality care of sick and normal children. Here in this paper, we want to share key laboratory interpretation strategies for complete blood count and some clues for differentiating normal from deviations and true problems.

BACKGROUND: Iron deficiency anaemia (IDA) is a common finding among patients with chronic kidney disease (CKD) and a major contributor to the high morbidity, mortality and poor quality of life associated with the disease. Assessment of iron deficiency anaemia has become routine in the evaluation of patients with CKD and iron studies such as serum ferritin, total iron binding capacity and transferrin saturation are recommended as standard diagnostic work up. However, in Nigeria and other low and middle income countries (LMICs) where most patients pay out of pocket, only few patients could afford iron studies, in addition to other cost of care. It is therefore imperative to find and establish the utility of other relatively affordable markers of iron deficiency among patients in LMICs. In studies done within the general population, the percentage of hypochromic red blood cells (PHRC), RBC indices and reticulocyte haemoglobin concentration (CHr) have been shown to predict iron deficiency. However, the usefulness of these in CKD patients had not been established. Thus, we determined the utility of PHRC and RBC indices among patients with CKD. METHODS: this is a cross sectional survey of 157 participants with CKD and 157 apparently healthy controls. The patients with CKD were individuals receiving care at the renal unit of the University College Hospital, Ibadan. Clinical data were collected using standard care report forms and information obtained were demographic details, aetiologies of CKD, dialysis status, symptoms of iron deficiency anaemia, modalities of anaemia treatments and other medications. Blood samples were collected for iron studies, full blood count, red blood cell (RBC) indices, peripheral blood film for PHRC, plasma highly sensitive C- reactive protein, serum electrolytes, urea and creatinine. Data was analyzed using SPSS version 23. RESULTs: a total of 314 participants were enrolled in the study, half of them were patients with CKD while the remaining half were controls without CKD. The mean age for cases and controls were [a href=´#ref45.5±14.4 vs 46.1±15.5 years respectively´45.5±14.4 vs 46.1±15.5 years respectively/aa href=´#ref p = 0.72´ p = 0.72/a ] =a href=´#refwhile females were 57% vs 60.1%´while females were 57% vs 60.1% /a, a href=´#ref p = 0.06´ p 0.06/a]. The prevalence of IDA using iron studies [a href=´#ref67 (42.6%) vs 33 (21.0%)´67 (42.6%) vs 33 (21.0%)/a,a href=´#ref p = 0.01 p =0.01/a], RBC indices [a href=´#ref46 (29.3%) vs 25 (15.9%)´46 (29.3%) vs 25 (15.9%) /a,a href=´#ref p = 0.002´= p 0.002/a], and PHRC [a href=´#ref48 (30.5%) vs 32 (20.4%)´48 (30.5%) vs 32 (20.4%)/a, a href=´#ref p = 0.038´= p =0.038=/a]. The sensitivity and specificity of RBC indices and PHRC as surrogate markers of iron deficiency anaemia were [a href=´#ref73.8% ; 92.0%´73.8% ; 92.0% /a ] and [a href=´#ref80.0% ; 92.3%´=80.0% ; 92.3%/a,a href=´#ref´/a] respectively. CONCLUSION: this study confirmed that the 3 methods of diagnosis of iron deficiency anaemia vis-a-vis iron studies (Serum ferritin and TSAT), RBC indices and percentage hypochromic RBC, all demonstrated high prevalence of iron deficiency anaemia among patients with CKD. While RBC indices and percentage hypochromic RBC are reliable and highly specific surrogate markers of iron deficiency anaemia among individuals with CKD.

Anemia is a major cause of morbidity and mortality worldwide and can be defined as a decreased quantity of circulating red blood cells (RBCs). The epidemiological studies suggested that one-third of the world’s population is affected with anemia. Anemia is not a disease, but it is instead the sign of an underlying basic pathological process. However, the sign may function as a compass in the search for the cause. Therefore, the prediagnosis revealed by thorough investigation of this sign should be supported by laboratory parameters according to the underlying pathological process. We expect that this review will provide guidance to clinicians with findings and laboratory tests that can be followed from the initial stage in the anemia search.

ImportanceAlzheimer’s disease is the leading cause of disability and healthy life years lost. However, to date, there are no proven causal and modifiable risk factors, or effective interventions.ObjectiveWe aimed to identify: a) factors modified by prodromal Alzheimer’s disease pathophysiology and b) causal risk factors for Alzheimer’s disease. We identified factors modified by Alzheimer’s disease using a phenome-wide association study (PheWAS) on the Alzheimer’s disease polygenic risk score (PRS) (p≤5×10-8), stratified by age tertiles. We used two-sample bidirectional Mendelian randomization (MR) to estimate the causal effects of identified risk factors and correlates on liability for Alzheimer’s disease.Design, setting, and participants334,968 participants of the UK Biobank aged 39 to 72 years old (111,656 in each tertile) met our eligibility criteria.ExposuresStandardized weighted PRS for Alzheimer’s disease at p≤5×10-8.Main outcomes and measuresAll available phenotypes in UK Biobank, including data on health and lifestyle, as well as samples from urine, blood and saliva, at the time of analysis.ResultsGenetic liability for Alzheimer’s disease was associated with red blood cell indices and cognitive measures at all ages. In the middle and older age tertiles, ages 53 and above, higher genetic liability for Alzheimer’s disease was adversely associated with medical history (e.g. atherosclerosis, use of cholesterol-lowering medications), physical measures (e.g. body fat measures), blood cell indices (e.g. red blood cell distribution width), cognition (e.g. fluid intelligence score) and lifestyle (e.g. self-reported moderate activity). In follow-up analyses using MR, there was only evidence that education, fluid intelligence score, hip circumference, forced vital capacity, and self-reported moderate physical activity were likely to be causal risk factors for Alzheimer’s disease.Conclusion and relevanceGenetic liability for Alzheimer’s disease is associated with over 160 phenotypes, some as early as age 39 years. However, findings from MR analyses imply that most of these associations are likely to be a consequence of prodromal disease or selection, rather than a cause of the disease.

Background: Mild cognitive impairment (MCI) represents an intermediate and modifiable stage between normal aging and dementia. There is an urgent need for simple, non-invasive testing of MCI by blood biomarkers. Objective: This study aimed to retrospectively evaluate the association of red blood cell (RBC) indices with MCI, and select the best hematologic characteristic for detection of MCI in elderly Chinese. Methods: Matched case-control study was carried out with 85 pairs of MCI subjects and healthy controls. The matching criteria was age, gender and education attainment. All samples were analyzed for RBC indices, including hemoglobin (HGB), hematocrit (HCT), mean corpuscular volume (MCV), mean corpuscular hemoglobin concentration (MCHC) and red cell distribution width-standard deviation (RDW-SD). A conditional logistic regression model was used to evaluate the association between RBC indices and MCI. The diagnostic efficacy of the biomarkers was evaluated by receiver operating characteristics (ROC). Results: Among all RBC indices, there were significant differences in HGB (124.82 ± 7.89 vs. 133.93 ± 4.52, P < 0.001) and RDW-SD (45.29 ± 2.03 vs. 41.34 ± 4.41, P < 0.001) between two groups. In the logistic regression model, after adjustment for lifestyle factors and comorbidities, significant statistically associations have been found between higher HGB and lower risk of MCI (adjusted OR: 0.831; 95% CI: 0.773-0.893), higher RDW-SD and a higher risk of MCI (adjusted OR: 1.575; 95% CI: 1.326- 1.872). ROC analysis suggested that the largest area under the ROC curve (AUC) was found with the combination of HGB and RDW-SD (AUC = 0.842), followed by HGB(AUC = 0.795), and finally by modest RDW-SD (AUC = 0.777). Combination of HGB 43.4 fL yielded a sensitivity of 92% and a specificity of 89%, overall diagnosis efficiency of which were better than HBG and RDW-SD alone. Conclusion: Lower HGB and higher RDW-SD alone were significantly found to be associated with increased risk of MCI, and offered modest sensitivity and specificity as a diagnostic marker. The combination of HGB and RDW-SD was more sensitive and had higher classification accuracy for differentiating MCI from healthy controls. Further prospective research is needed to clarify whether HGB in combination with RDW-SD may be a potential diagnostic tool for early diagnosis of AD.

Background: This study aimed at determining the prevalence and morphological types of anaemia, among children under-five years, who had full blood count (FBC) investigation done at the laboratory of the Volta regional hospital. Methodology: This was a retrospective study of archival FBC test results data for children below 5 years in the laboratory, between1st July to 31st December 2015. The FBC results comprised of the hemoglobin (Hb) concentration and the red blood cell indices. Obtained data were analyzed using SPSS version 20.0. Results: A total 451 children were sampled. Anaemia prevalence in this study was 55.0% (248/451) and most of the children suffered from moderate anaemia (42%) (104/248) with mild and severe anaemia being 34% (84/248) and 24% (60/248) respectively. Children with microcytic hypochromic anaemia were 52%, (130/248), while those with normocytic normochromic were 25% (63/248). Conclusion: Anaemia was found in more than half of the children under-five years and microcytic hypochromic anaemia was the commonest morphological type of anaemia. There is need for a multi-disciplinary approach to elucidate the etiology of anaemia in children under-five years.

BACKGROUND AND OBJECTIVE: Thrombocytosis is not an uncommon finding in hemograms of children with an incidence of 6%–15% among hospitalized children. This study aims to determine the etiology of thrombocytosis and analyze various platelet parameters in children attending our hospital. MATERIALS AND METHODS: A prospective observational study was carried out in a tertiary care center in Odisha, in eastern part of India, for 6 months from July 2016 to December 2016. All children of age group 1–14 years of age attending pediatrics and other pediatric super specialty outdoors and/or admitted to indoors and whose complete blood counts (CBC) were done were included in the study. The CBC parameters such as hemoglobin, red blood cell indices, and platelet indices (platelet distribution width [PDW], mean platelet volume [MPV], platelet large cell ratio [P-LCR]) were noted. RESULTS: Out of 2500 hemograms done in pediatrics age group, 272 (10.8%) patients showed thrombocytosis. About 99.6% of cases were of secondary thrombocytosis. Only one case of primary thrombocytosis was encountered. The most common cause of secondary thrombocytosis was infection (39.5%) alone followed by iron deficiency anemia (14.1%). With increasing platelet counts, a decrease in MPV, P-LCR, and PDW was noted which was statistically significant (P < 0.05). CONCLUSION: Thrombocytosis is not rare (10.8%) in children. Secondary thrombocytosis is common and predominatly attributed to infection.

Background: Red palm oil (RPO) is antioxidant rich oil extracted from palm tree (Elaeis guineensis) fruit. It is used as an antiatherogenic, antihypertensive, anticancer, antidiabetic and to prevent vitamin A deficiency. In traditional medicine practices, RPO is given to an individual who is suspected to have ingested a poisonous substance. Industrial exposure of carbon tetrachloride (CCl4), an environmental/industrial toxicant, is found more among individuals who work in resin and refrigerant manufacturing companies. Purpose: This study was carried out to evaluate the protective effect of RPO against CCl4 toxicity in rats. The study was also conducted to give insight on the concentrations of RPO that can abate this toxicant. Methods: The experimental Wistar rats were randomly grouped and treated as follows: Group 1 served as normal control, group 2- negative control, groups 3, 4 and 5 received daily 2, 4, 6 mL/kg RPO respectively for 14 days. Thirty (30) min after the 14th day treatment with RPO, the rats in groups 2-5 received intraperitoneally a single dose of 1 mL/kg CCl4 diluted in olive oil. After 24 h of CCl4 administration, the rats were humanely sacrificed; blood, liver and kidney were collected. Hepatorenal, lipid, antioxidant and haematological indices were evaluated and liver and kidney histopathology were examined. Results: The rats treated with RPO had significant (P < 0.05) increase in the packed cell volume, haemoglobin and platelet, and dose dependently decreased in the alanine aminotransferase, aspartate aminotransferase and alkaline phosphatase activities when compared to the negative control. Except the urea value of the negative control, no significant effects (p>0.05) were observed in the kidney function parameters. There were observable significant increases (P < 0.05) in glutathione (GSH), superoxide dismutase (SOD), catalase (CAT) levels in RPO-treated groups when compared to the negative control. Conclusions: Pretreatment with RPOhas a protective effect against CCl4 toxicity by increasing GSH, SOD, CAT and decreased malondialdehyde levels, and increased red blood cell indices. This shows that RPO has a potential to abate the toxic effect of carbon tetrachloride on hepatorenal as well as haematopoietic organs in Wistar rats.

Background: Red blood cell(RBC) histogram provide an idea about morphological changes of red blood cells in hematological disorders. Peripheral smear examination findings are usually correlated with complete blood cell counts by automated analyzer. To known the utility and advantage of red cell histogram and correlation of microscopic examination of peripheral smear with automated histogram pattern. Methods: Blood sample was collected from 220 anemia patients in ethylene diamine tetra acetic acid (EDTA) tubes for peripheral smear examination and ran in Beckman coulter LH 780 automated hematology analyzer for obtaining histogram, complete blood count includes hemoglobin, total leucocyte count, Platelet count, red blood cell indices and red cell distribution width. This study was undertaken for a period of one month of November 2016 in department of pathology, central laboratory, narayana medical college & hospital, Nellore. Results: This study of histograms of 220 different types of anemia consisted predominantly females 154 (70%) , and males 64(30%) . Maximum cases of anemia were noted in 30-40 years of age range. Microcytic hypo chromic anemia was the most common (63.63%) followed by normocytic normochromic anemia (19.4%), macrocytic hypochromic anemia (2.2%), dimorphic anemia (12.72%) and pancytopenia (1.8%). Left shifted curve and broad base mostly seen in microcytic anemia, right shift curve seen in macrocytic anemia and bimodal peak mostly seen in dimorphic anemia. Conclusion: Histogram can be used as an important screening test for hematology and can become a new parameter in the diagnosis of anemia though peripheral examination remains the definitive diagnostic test for evaluation. DOI: 10.21276/APALM.1468

application/pdf, Theileria orientalis often causes clinical anemia in cattle. In the present study, the red blood cell (RBC) indices of cattle, as measured in T. orientalis-endemic regions of Hokkaido, Japan, were analyzed. In comparison with the non-infected animals, the mean values for RBC counts, hematocrit, and hemoglobin concentration (HGB) were lower in T. orientalis-infected Holstein and Hereford cattle but not in Japanese Shorthorn and Angus, suggesting that the hemolysis induced by T. orientalis is not pronounced in the later. Anemic animals (HGB < 8 g/dl) were detected only in Holstein and Hereford, and the anemia rate was higher for Holstein than that for Hereford. The mean corpuscular volume (MCV) and mean corpuscular hemoglobin (MCH) values in the T. orientalis-infected but non-anemic animals were significantly higher than those for the non-infected Hereford, but not for the Holstein, suggesting that the host response to hemolysis influenced anemia development. To clarify this phenomenon, three Holstein calves experimentally infected with T. orientalis were monitored for the parasitemia and RBC indices. Among the infected animals, a calf with low parasitemia had elevated MCV and MCH values, but lacked anemia. In contrast, despite elevated MCV and MCH values, HGB in the calf with high parasitemia dropped to a low value. These findings indicate that the cattle breed, parasitemia level, and host response may influence anemia development in T. orientalis-infected cattle.

BACKGROUND Genomewide association studies have reported alleles in the ABO locus to be associated with ferritin levels. These studies warrant the investigation of a possible association between the ABO blood group and ferritin levels. We aimed to explore if ABO blood group is associated with iron stores expressed as ferritin levels. STUDY DESIGN AND METHODS Ferritin levels were measured at least once for 30,595 Danish Blood Donor Study participants. Linear regression analyses were performed with the ABO blood group as explanatory variable and adjusted for age, number of donations 3 years before the ferritin measurement, and time since latest donation. In addition, a subanalysis was performed on 15,280 individuals in which further adjustments for body mass index, smoking status, and C-reactive protein levels were possible. Furthermore, logistic regression analyses were performed to determine if ABO blood group was associated with a ferritin level of less than 15 ng/mL. RESULTS Non-O blood group donors had lower ferritin levels than blood group O donors, regardless of sex. Accordingly, risk of ferritin level of less than 15 ng/mL was increased for individuals with non-O blood group compared with O blood group. In subanalyses similar associations were observed, albeit in women the association between blood group and risk of a ferritin level below 15 ng/mL was no longer significant. ABO blood group was not associated with red blood cell indices such as mean cell volume and mean cell hemoglobin content. CONCLUSION Donors with non-O blood group have lower ferritin levels than donors with other blood groups.

Zinc (Zn) supplementation adversely affects iron status in animal and adult human studies, but few trials have included young infants. The objective of this study was to determine the effects of Zn and multivitamin (MV) supplementation on infant hematologic and iron status. In a double-blind RCT, Tanzanian infants were randomized to daily, oral Zn, MV, Zn and MV or placebo treatment arms at the age of 6 weeks of life. Hemoglobin concentration (Hb) and red blood cell indices were measured at baseline and at 6, 12 and 18 months of age. Plasma samples from 589 infants were examined for iron deficiency (ID) at 6 months. In logistic regression models, Zn treatment was associated with greater odds of ID (odds ratio (OR) 1.8 (95% confidence interval (CI) 1.0–3.3)) and MV treatment was associated with lower odds (OR 0.49 (95% CI 0.3–0.9)). In Cox models, MV was associated with a 28% reduction in risk of severe anemia (hazard ratio (HR)=0.72 (95% CI 0.56–0.94)) and a 26% reduction in the risk of severe microcytic anemia (HR=0.74 (0.56–0.96)) through 18 months. No effects of Zn on risk of anemia were seen. Infants treated with MV alone had higher mean Hb (9.9 g/dl (95% CI 9.7–10.1)) than those given placebo (9.6 g/dl (9.4–9.8)) or Zn alone (9.6 g/dl (9.4–9.7)). MV treatment improved iron status in infancy, whereas Zn worsened iron status but without an associated increase in risk for anemia. Infants in long-term Zn supplementation programs at risk for ID may benefit from screening and/or the addition of a MV supplement.

Chronic kidney disease is a condition in which the kidney fails to function adequately. End-stage renal disease is the terminal stage of chronic renal failure where there is an irreversible progressive deterioration in renal function which can be substituted by hemodialysis (HD), peritoneal dialysis (PD), or renal transplantation. Both types of dialysis can cause side effects on the blood components. The objectives of this study was to find the changes in the complete blood counts, red blood cell indices, and peripheral blood smear in post hemodialysis patients and to compare the changes with respect to pre-dialysis status. We conducted a hospital-based cross-sectional study for a period of 3 years and a total of 120 patients undergoing dialysis. Blood samples were collected before and within 2 h post dialysis; complete hemogram and peripheral smear examination results were recorded and compared by Student t test. There was moderate degree of anemia in both pre- and post dialysis patients, and also, there was an increase in the severity of anemia after hemodialysis in many patients. The type of anemia was normocytic normochromic. There was a statistically significant decrease in total leukocyte count and platelet count (p

Meta-analyses and Mendelian randomization (MR) may clarify the associations of smoking, blood cells and myeloproliferative neoplasms (MPN). We investigated the association of smoking with blood cells in the Danish General Suburban Population Study (GESUS, n = 11 083), by meta-analyses (including GESUS) of 92 studies (n = 531 741) and MR of smoking variant CHRNA3 (rs1051730[A]) in UK Biobank, and with MPN in a meta-analysis of six studies (n (total/cases):1 425 529/2187), totalling 2 307 745 participants. In the meta-analysis the random-effects standardized mean difference (SMD) in current smokers versus non-smokers was 0·82 (0·75–0·89, P = 2·0 * 10−108) for leukocytes, 0·09 (−0·02 to 0·21, P = 0·12) for erythrocytes, 0·53 (0·42–0·64, P = 8·0 * 10−22) for haematocrit, 0·42 (0·34–0·51, P = 7·1 * 10−21) for haemoglobin, 0·19 (0·08–0·31, P = 1·2 * 10−3) for mean corpuscular haemoglobin (MCH), 0·29 (0·19–0·39, P = 1·6 * 10−8) for mean corpuscular volume (MCV), and 0·04 (−0·04 to 0·13, P = 0·34) for platelets with trends for ever/ex-/current smokers, light/heavy smokers and female/male smokers. Analyses presented high heterogeneity but low publication bias. Per allele in CHRNA3, cigarettes per day in current smokers was associated with increased blood cell counts (leukocytes, neutrophils), MCH, red cell distribution width (RDW) and MCV. The pooled fixed-effects odds ratio for MPN was 1·44 [95% confidence interval (CI): 1·33–1·56; P = 1·8 * 10−19; I2 = 0%] in current smokers, 1·29 (1·15–1·44; P = 8·0 * 10−6; I2 = 0%) in ex-smokers, 1·49 (1·26–1·77; P = 4·4 * 10−6; I2 = 0%) in light smokers and 2·04 (1·74–2·39, P = 2·3 * 10−18; I2 = 51%) in heavy smokers compared with non-smokers. Smoking is observationally and genetically associated with increased leukocyte counts and red blood cell indices (MCH, MCV, RDW) and observationally with risk of MPN in current and ex-smokers versus non/never-smokers.

Detection of hematopoietic activity in horses is a challenge due to the lack of cells carrying reticulocyte markers such as RNA remnants or CD71 in the circulation. In this study, we fractionated equine red cells according to their density and analyzed the cells forming low (L), medium (M), and high (H) density fractions for markers of aging such as membrane loss, oxidation, and alterations in the intracellular free Ca2+ levels. Cells forming L and M fraction were highly heterogeneous in projected areas and shapes, and had higher propensity to swell in response to hypo-osmotic challenge than the cells from the H fraction. The densest cells were deprived of band 3 protein compared to the cells within L or M fraction. Furthermore, the equine red cells from the H fraction were hyper-oxidized compared to the cells within M and L fractions as follows from an increase in autofluorescence characteristic for oxidized damaged hemoglobin and from thiol oxidation as detected using monobromobimane. The lightest cells showed lower free thiol content compared to the red blood cells from the M fraction, but did not contain oxidized hemoglobin. Finally, the majority of red blood cells forming L, M, and H fraction prominently differed from each other in intracellular free Ca2+ levels and its distribution within the cells. Based on the obtained findings, we suggest that intraerythrocytic Ca2+ levels and its subcellular distribution, eosin-5-maleimide binding test for band 3 abundance, and autofluorescence of cells along with the changes in red blood cell indices, distribution width and creatine levels may become potential markers of regenerative erythropoiesis in horses. Validation of the power of these potential markers of red cell aging is pending.

Objectives: Non-anemic individuals may have undetected subclinical iron deficiency (SID). The aims of this study were to determine the prevalence of SID and identify the associated factors for SID. In addition, the screening performance of red blood cell (RBC) indices for SID in health check-ups was assessed. Methods: This study was conducted with 16,485 non-anemic health examinees (3,567 males and 12,918 females) who underwent tests for iron variables (serum iron, total iron-binding capacity, ferritin, and iron saturation) at 16 health-promotion centers in 13 cities in Korea between January 2017 and June 2018. SID was defined as a decreased ferritin level (Results: The prevalence rates of SID were 0.6 and 3.3% in males and females, respectively. In terms of age and sex, SID was most prevalent in males aged ≥70 years (7.8%) and females aged 15–49 years (7.6%). There were significant differences in the hemoglobin (Hb) level, white blood cell count, platelet count, mean corpuscular volume, mean corpuscular Hb (MCH), and RBC distribution width (RDW) between the SID and non-SID groups (p < 0.001). The factors associated with SID in males were older age (odds ratio, OR, 1.069, 95% confidence interval, CI, 1.03–1.109, p = 0.004), lower Hb (OR 0.58, 95% CI 0.345–0.976, p = 0.04), lower MCH (OR 0.433, 95% CI 0.298–0.629, p < 0.001), and higher RDW (OR 1.374, 95% CI 1.001–1.887, p = 0.049), while in females they were lower body mass index (BMI; OR 0.929, 95% CI 0.895–0.963, p < 0.001) and younger age (OR 0.954, 95% CI 0.945–0.963, p < 0.001), as well as lower Hb, lower MCH, and higher RDW. The AUC for the MCH (0.877, 95% CI 0.793–0.960 in males; 0.872, 95% CI 0.853–0.890 in females) indicates that the MCH at cut-offs of 29.2 and 29.3 pg are the best discriminators of SID in males and females, respectively (p < 0.001). Conclusions: Reproductive-age females with a lower BMI and elderly males are high-risk groups for SID. MCH is a reliable RBC index for the screening of SID. For the population with defined risk factors, including females with lower BMI and elderly males, screening for SID is needed to prevent the development of anemia.

Iron deficiency anemia (IDA) is the most common form of anemia worldwide, with highest burden in developing countries. The assays used in detecting iron deficiency comprise of red blood cell indices such as Mean Corpuscular Hemoglobin and Mean Corpuscular Volume, serum ferritin, soluble transferrin receptor (STfR) and STfRL-index. Each of these assessment tools has its drawback(s). This study was conducted to assess IDA diagnostic inter-rater agreements between red cell indices, serum ferritin, STfR and STfLF-Index. A cross sectional descriptive study using systematic random sampling of eligible secondary school students in Misau LGA, Bauchi State, Nigeria. Complete Blood Count with cellular indices, serum ferritin and STfR assays were conducted. Data was analyzed using SPSS version 23.0. Proportions were compared using Z-tests of proportions. Cohen’s Un-weighted kappa analyses were used to assess pairwise agreements in the ability of STfLF-Index, serum ferritin, STfR and red cell indices to classify participants into IDA and non-IDA. Level of significance was set at P≤0.05. A total of 210 participants were enrolled in the study with females constituting 153 (72.9%). STfLF-Index, STfR, serum ferritin levels and red cell indices revealed that 130/210 (61.9%), 160/210(76.2%), 7/210 (3.3%) and 112/210 (53.3%) respectively had iron deficiency. STfR revealed a significantly higher percentage of students with iron deficiency compared to serum ferritin, STfLF-Index and red cell indices. Assessment of iron deficiency showed concurrence between STfR and STfLF-Index. STfR and STfLF-Index have similar ability in classifying iron status.

In the above article [1] , the funding information should read “This work was supported in part by the Basic Science Research Program through the National Research Foundation of Korea (NRF) funded by the Ministry of Education under Grant NRF-2019R1A2C1006159, and in part by the Ministry of Science and ICT (MSIT), South Korea, under the Information Technology Research Center (ITRC) support program supervised by the Institute for Information Communications Technology Promotion (IITP), under Grant IITP-2020-2016-0-00313.”

Objective To evaluate the repercussions of recent changes to the cut-offs used in the first screening step of the pre-marital screening programme for thalassaemia prevention in Iran. Methods The profiles of 984 subjects referred to a genetic laboratory, and the tests of 242 parents of children with thalassaemia major were assessed for red blood cell (RBC) indices, haemoglobin (Hb) A2 levels and results of Hb electrophoresis. Results Of 407 suspected thalassaemia minor (STM) cases, 18 proved positive for thalassaemia minor on molecular analysis (18/407, confidence interval 2.6–6.9%). If the revised screening cut-offs had been used to determine who would undergo molecular analysis, two of these cases would not have been identified. Only 4.4% of suspected cases with lower than normal RBC indices (mean corpuscular volume Conclusion The thalassaemia major prevention programme is performed in two separate steps. One step involves the screening of subjects and identification of β-thalassaemia minor, suspected cases for thalassaemia minor (STM), and normal subject groups. The other step concerns the identification of thalassaemia minor in the STM group. Changing the cut-offs at the first screening step does not result in significant improvement from an economic view, and is associated with significant risk at the second screening step.

Objectives: The present study aims to evaluate the serum cobalamin in Helicobacter pylori (H. pylori) infected patients. Study Design: Case control study. Place and Duration: Department of Medicine, Isra University Hospital Hyderabad from March 2013- April 2014. Methodology: A sample of 109 subjects including Helicobacter pylori positive subjects and controls were selected according to study criteria. Centrifugation of blood was performed at 4000 rpm for 10 minutes and sera were stored at -20 o C. Blood sera were used for H. pylori serological testing. Blood counting was performed on hematoanalyzer. Cobas e411 analyzer was used for detection of cobalamin. 64 kD H. pylori antigens was detected by ELISA. The data was entered into SPSS version 21.0. (IBM, Incorporation, USA) A 2-tailed p-value of ≤0.05 was considered significant for statistical analysis. Results: Of total 109, 54.1% (n=59) were H. pylori seropositive cases and others were controls i.e. 45.9% (n=50). Cases and controls showed cobalamin levels of 290±49.3 vs. 351±32.9 pg/ml respectively (p=0.0001). Red blood cell indices were found to show statistically significant difference between cases and controls (p=0.001). Conclusion: Serum cobalamin deficiency was noted in both Helicobacter pylori positive and controls, however deficiency was more pronounced in Helicobacter pylori positive subjects.

Background: Anemia is a common complication of human immunodeficiency virus (HIV) infection. The role of iron, Vitamin B12, and folate deficiencies, which are otherwise most common causes of anemia, is not well-established in HIV patients. Several studies in India have shown that severe immunodeficiency is associated with higher grade of anemia, but correlation of CD4 cell counts with severity of anemia is not well-documented. Aims: The aims of the present study were: To estimate the point prevalence of anemia in HIV patients, to analyze the causative role of iron, Vitamin B12, and folate deficiencies in anemic HIV patients, and correlating the degree of severity of anemia with CD4 cell counts. Materials and Methods: This study was a cross-sectional study. The study group enrolled 103 consecutive HIV patients attending medical emergency, medical outpatient department, medical wards, and anti-retroviral therapy (ART) center at a tertiary care medical center in North India. Study participation consisted of a single visit during which relevant data, including medical history, current medications, CD4 T-lymphocyte count, complete hemogram with red blood cell indices, peripheral smear picture, iron studies, serum Vitamin B12, serum folate and bone marrow studies, were recorded on a case report form. Anemia was classified according to the World Health Organization criteria. Data analysis was carried out using Microsoft Excel and Statistical Package for the Social Sciences software. Results: 86.4% (89/103) patients were found to be anemic. There was no significant difference in prevalence of anemia in ART-naive patients from those who were on ART (P > 0.05). Pearson's correlation had shown a highly significant positive correlation of hemoglobin and CD4 cell counts in male patients (r = 0.418) as well as female patients (r = 0.565). Normocytic normochromic was the most common type of anemia in males (46%) as well as females (42%). Significant iron deficiency (P = 0.022) was observed in 42.85% of the patients having microcytic hypochromic anemia. Significant Vitamin B12 and folate deficiencies were observed in patients having macrocytic anemia (47.05%, P = 0.003 and 35.29%, P = 0.012, respectively). Conclusions: This study shows that anemia is highly prevalent in HIV patients and severity of anemia increases with decrease in CD4 cell counts. Nutritional deficiencies play a significant role in causing anemia in these patients.

The status of heavy metal buildup in commercial and non-commercial ponds of Nile tilapia ( Oreochromis niloticus) and its effect on fish health was evaluated. Pond water and tilapia meat were examined for Pb, As, cadmium Cd and Cu using flame atomic absorption spectrometry; and Hg through manual cold-vapor atomic absorption spectrometry. Standard methods in hematology were applied to estimate red and white blood cell function of fish in relation to heavy metal accumulation. The results revealed significantly higher Cu content in pond water of a commercial farm compared to the Cu content of water from a non-commercial farm, while similar levels of Hg and Pb were recorded. Tilapia meat from commercial ponds had significantly higher Pb and lower levels of Cu compared to meat from a non-commercial farm. Similar levels of Hg were observed in tilapia meat obtained from farms while tilapia meat from non-commercial ponds had significantly higher Cu. Neither As nor Cd were detected in the farms. Hematological evaluation revealed comparable counts of total red blood cell. Red blood cell indices such as hematocrit and mean corpuscular volume were significantly higher in tilapia from the commercial ponds. The amount of hemoglobin per red blood cell was smilar in tilapia from the farms while mean corpuscular hemoglobin concentration was significantly higher in tilapia from the non-commercial farm. Total white blood cell and eosinophil counts of tilapia were similar in the farms. Tilapia from the commercial ponds had significantly high neutrophil and monocyte counts while tilapia from the non-commercial ponds had significantly high lymphocyte counts. The hematological evaluation indicate relationship of cellular components of fish blood and heavy metal accretion from the aquatic environment by Nile tilapia.

Background: β-thalassemia is one of the most widespread diseases in the world, including Iran. In this study, we reported, for the first time, a 290-bp β-globin gene deletion in the south of Iran. Methods: Four individuals from three unrelated families with Arabic ethnic background were studied in Khuzestan Province. Red blood cell indices and hemoglobin analysis were carried out according to the standard methods. Genomic DNA was obtained from peripheral blood cells by salting out procedures. β-globin gene amplification, multiplex ligation-dependent probe amplification (MLPA), and DNA sequencing were performed. Results: The PCR followed by sequencing and MLPA test of the β-globin gene confirmed the presence of a 290-bp deletion in the heterozygous form, along with -88C>A mutation. All the individuals had elevated hemoglobin A2 and normal fetal hemoglobin levels. Conclusions: This mutation causes β0-thalassemia and can be highly useful for prenatal diagnosis in compound heterozygous condition with different β-globin gene mutations.

PurposeThe pregnancy cohort was established to examine the prevalence and variety of haemoglobinopathies in a high-risk group of pregnant women.ParticipantsThe pregnancy cohort is located in the Department of Obstetrics and Antenatal Care, University Hospital of Basel. The pregnant women were recruited in the first trimester between June 2015 and May 2019. Family origin questionnaires were used to screen pregnant women for the risk of a haemoglobin variant. Based on the questionnaire, pregnant women were divided into two groups: women with a high risk and women with a low risk of a haemoglobin variant. In women with a high risk, red blood cell indices, iron status and chromatography were conducted.Findings to date1785 pregnant women were recruited. Out of the 1785 women, 929 were identified as a part of the high-risk group. Due to the missing data of 74 pregnant women with a high risk, the final analysis was conducted in the remaining 855 women. The prevalence of haemoglobinopathies in the high-risk group was 14.5% (124/855).Future plansThis cohort will be used to: (1) implement the screening in prenatal care in Basel; (2) recommend the screening among pregnant women with a high risk of a haemoglobin variant in Switzerland; (3) improve prenatal and neonatal care in patients with a haemoglobin variant; (4) examine adverse pregnancy outcomes in women with a haemoglobin variant and (5) reduce maternal and neonatal morbidity and mortality in the future.Trial registration numberClinicalTrials.gov Registry (NCT04029142).

Hemoglobin D is a relatively rare disease first reported in 1951. We present the first reported case of Hemoglobin DC disease. This is a case of a Hemoglobinopathy with DC disease in a woman with a previous diagnosis of Hemoglobin SC disease. A 19-year-old woman presented to the Adult Hematology clinic at a tertiary care hospital in Northwest Louisiana for transition of care from Pediatric Hematology for a diagnosis of Hemoglobin SC disease diagnosed at the age 4. Historical data suggested no avascular necrosis, acute chest syndrome, and very few episodes of pain crisis. She has never taken hydroxyurea. Laboratory work showed persistently normal hemoglobin and white blood cell counts. All sickle cell preparations in the past were negative. Computerized tomography scan of the abdomen was reviewed and showed a spleen grossly normal in size and appearance. Given the incongruent clinical picture for sickle cell disease, repeat hemoglobinopathy evaluation with Capillary electrophoresis and confirmatory acid electrophoresis (to differentiate hemoglobins that co-migrate with Hemoglobin S) showed a probable double heterozygote for Hemoglobin D and C with suspected coexistent alpha thalassemia minor based on red blood cell indices. This case confirms the importance of the required confirmatory method to ensure a correct diagnosis since a misdiagnosis can lead to numerous adverse clinical or psychological effects for patients.

A high red cell distribution width (RDW) and low hemoglobin level increase the risk of arterial ischemic stroke (AIS), mostly in adults. The mechanisms related to AIS remain unknown. A total of 233 subjects (90 patients and 143 healthy controls [HC]) were enrolled. The mean(SD) age in patients and HC was 9.5(3.8) and 11.4(1.8) years, respectively. We found increased odds ratios (ORs) for large vessel and small vessel subtypes in patients without underlying diseases with a mean corpuscular volume (MCV)80 fL (OR: 5.4, 95%CI 1.8-16.3 and 2.8, 95%CI 1.2-7.2), mean corpuscular hemoglobin levels27 pg (OR: 2.9, 95%CI 1.0-6.7 and 2.6, 95%CI 1.0-6.7), and RDW15% (OR: 5.5, 95%CI 1.3-24.5 and 2.7, 95%CI 1.0-7.3). RBC indices showed significant correlations with TM levels. Therefore, low MCV and MCH levels, and a high RDW were risk factors for AIS and associated with TM levels in this population.

Background Studies have shown that low haemoglobin and anaemia are associated with poor cognition, and anaemia is known to be associated with Alzheimer’s disease (AD), but the mechanism of this risk is unknown. Here, we first seek to confirm the association between cognition and anaemia and secondly, in order to further understand the mechanism of this association, to estimate the direction of causation using Mendelian randomisation. Methods Two independent cohorts were used in this analysis: AddNeuroMed, a longitudinal study of 738 subjects including AD and age-matched controls with blood cell measures, cognitive assessments and gene expression data from blood; and UK Biobank, a study of 502,649 healthy participants, aged 40–69 years with cognitive test measures and blood cell indices at baseline. General linear models were calculated using cognitive function as the outcome with correction for age, sex and education. In UK Biobank, SNPs with known blood cell measure associations were analysed with Mendelian randomisation to estimate direction of causality. In AddNeuroMed, gene expression data was used in pathway enrichment analysis to identify associations reflecting biological function. Results Both sample sets evidence a reproducible association between cognitive performance and mean corpuscular haemoglobin (MCH), a measure of average mass of haemoglobin per red blood cell. Furthermore, in the AddNeuroMed cohort, where longitudinal samples were available, we showed a greater decline in red blood cell indices for AD patients when compared to controls (p values between 0.05 and 10−6). In the UK Biobank cohort, we found lower haemoglobin in participants with reduced cognitive function. There was a significant association for MCH and red blood cell distribution width (RDW, a measure of cell volume variability) compared to four cognitive function tests including reaction time and reasoning (p