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With the emergence of Alzheimer's disease (AD) disease-modifying therapies, identifying patients who could benefit from these treatments becomes critical. In this study, we evaluated whether a precise blood test could perform as well as established cerebrospinal fluid (CSF) tests in detecting amyloid-β (Aβ) plaques and tau tangles. Plasma %p-tau217 (ratio of phosporylated-tau217 to non-phosphorylated tau) was analyzed by mass spectrometry in the Swedish BioFINDER-2 cohort (n = 1,422) and the US Charles F. and Joanne Knight Alzheimer Disease Research Center (Knight ADRC) cohort (n = 337). Matched CSF samples were analyzed with clinically used and FDA-approved automated immunoassays for Aβ42/40 and p-tau181/Aβ42. The primary and secondary outcomes were detection of brain Aβ or tau pathology, respectively, using positron emission tomography (PET) imaging as the reference standard. Main analyses were focused on individuals with cognitive impairment (mild cognitive impairment and mild dementia), which is the target population for available disease-modifying treatments. Plasma %p-tau217 was clinically equivalent to FDA-approved CSF tests in classifying Aβ PET status, with an area under the curve (AUC) for both between 0.95 and 0.97. Plasma %p-tau217 was generally superior to CSF tests in classification of tau-PET with AUCs of 0.95-0.98. In cognitively impaired subcohorts (BioFINDER-2: n = 720; Knight ADRC: n = 50), plasma %p-tau217 had an accuracy, a positive predictive value and a negative predictive value of 89-90% for Aβ PET and 87-88% for tau PET status, which was clinically equivalent to CSF tests, further improving to 95% using a two-cutoffs approach. Blood plasma %p-tau217 demonstrated performance that was clinically equivalent or superior to clinically used FDA-approved CSF tests in the detection of AD pathology. Use of high-performance blood tests in clinical practice can improve access to accurate AD diagnosis and AD-specific treatments.

Background Aims Methods Results Conclusions Trauma‐induced coagulopathy (TIC) is associated with negative outcomes. Pediatric TIC has been described most often in older children. Children undergo normal developmental hemostasis, but it is unknown how this process impacts the risk of TIC across childhood.To understand variations in coagulation testing and TIC across pediatric age groups.We evaluated testing patterns of coagulation studies at presentation and over the first 72 h of hospitalization by pediatric age group at a large, Level I trauma center, 2015–2020. The frequency of TIC was determined using published, age‐specific reference ranges and controlling for injury severity. We performed subgroup analyses of those with isolated severe traumatic brain injury (TBI) and those who presented directly from the scene of injury.Data from 2409 pediatric patients were available; 333 patients had isolated severe TBI. Children <1 year were least likely to be tested for TIC at presentation and over the first 72 h, even among the most injured. Fibrinogen testing was uncommon, regardless of injury severity. TIC was common: 22% of patients had TIC at presentation and 35% by 72 h. Greater injury severity was associated with TIC. Children 1–4 and 5–9 years had a higher frequency of TIC at presentation and over 72 h compared to older children in the least injured cohort. We saw no difference in frequency of TIC between age groups in the subset with isolated severe TBI. Using age‐specific criteria, patients most often met TIC criteria by INR/PT, followed by platelet count, and least commonly by aPTT. The presence of TIC was associated with in‐hospital mortality (OR 4.10, 95% CI 2.06–8.17).Significant sampling bias exists in clinical data collection among injured children and adolescents. Contrary to previous reports and using age‐specific TIC criteria, younger children are not at lower risk of TIC than older children when controlling for injury severity. [ABSTRACT FROM AUTHOR]

Objective: Point‐of‐care tests (POCTs) are commonly utilized in emergency departments. The purpose of this study was to evaluate accuracy and clinical utility of capillary POCT Hemocue (POCT Hcue) in emergency department setting. Methods: This was a retrospective study. Accident and emergency department attendances ≥18 years old with a capillary POCT Hcue result and a paired venous hemoglobin (Hb) result were eligible. Statistical analyses including Pearson coefficient and Bland–Altman plot were performed to assess the relationship and agreement between capillary POCT Hcue and venous Hb. Results: One hundred and seven patients were included in the analysis. 59% were female. 67% of the patients were from triage category 3. Scatter plot revealed a linear relationship between capillary POCT Hcue and venous Hb, with a correlation coefficient calculated to be 0.95. The mean difference was −0.30 on the Bland–Altman plot with the limits of agreement from −1.83 to +1.22. Conclusion: Capillary POCT Hcue had acceptable agreement with venous Hb in emergency department setting. [ABSTRACT FROM AUTHOR]

Abstract Objective Point‐of‐care tests (POCTs) are commonly utilized in emergency departments. The purpose of this study was to evaluate accuracy and clinical utility of capillary POCT Hemocue (POCT Hcue) in emergency department setting. Methods This was a retrospective study. Accident and emergency department attendances ≥18 years old with a capillary POCT Hcue result and a paired venous hemoglobin (Hb) result were eligible. Statistical analyses including Pearson coefficient and Bland–Altman plot were performed to assess the relationship and agreement between capillary POCT Hcue and venous Hb. Results One hundred and seven patients were included in the analysis. 59% were female. 67% of the patients were from triage category 3. Scatter plot revealed a linear relationship between capillary POCT Hcue and venous Hb, with a correlation coefficient calculated to be 0.95. The mean difference was −0.30 on the Bland–Altman plot with the limits of agreement from −1.83 to +1.22. Conclusion Capillary POCT Hcue had acceptable agreement with venous Hb in emergency department setting.

Circulating miR-371a-3p has excellent performance in the detection of viable (non-teratoma) germ cell tumor (GCT) pre-orchiectomy; however, its ability to detect occult disease is understudied. To refine the serum miR-371a-3p assay in the minimal residual disease setting we compared performance of raw (Cq) and normalized (∆Cq, RQ) values from prior assays, and validated interlaboratory concordance by aliquot swapping. Revised assay performance was determined in a cohort of 32 patients suspected of occult retroperitoneal disease. Assay superiority was determined by comparing resulting receiver-operator characteristic (ROC) curves using the Delong method. Pairwise t-tests were used to test for interlaboratory concordance. Performance was comparable when thresholding based on raw Cq vs. normalized values. Interlaboratory concordance of miR-371a-3p was high, but reference genes miR-30b-5p and cel-miR-39-3p were discordant. Introduction of an indeterminate range of Cq 28-35 with a repeat run for any indeterminate improved assay accuracy from 0.84 to 0.92 in a group of patients suspected of occult GCT. We recommend that serum miR-371a-3p test protocols are updated to (a) utilize threshold-based approaches using raw Cq values, (b) continue to include an endogenous (e.g., miR-30b-5p) and exogenous non-human spike-in (e.g., cel-miR-39-3p) microRNA for quality control, and (c) to re-run any sample with an indeterminate result.

The utilizations of microfluidic chips for single RBC (red blood cell) studies have attracted great interests in recent years to filter, trap, analyze, and release single erythrocytes for various applications. Researchers in this field have highlighted the vast potential in developing micro devices for industrial and academia usages, including lab-on-a-chip and organ-on-a-chip systems. This article critically reviews the current state-of-the-art and recent advances of microfluidics for single RBC analyses, including integrated sensors and microfluidic platforms for microscopic/tomographic/spectroscopic single RBC analyses, trapping arrays (including bifurcating channels), dielectrophoretic and agglutination/aggregation studies, as well as clinical implications covering cancer, sepsis, prenatal, and Sickle Cell diseases. Microfluidics based RBC microarrays, sorting/counting and trapping techniques (including acoustic, dielectrophoretic, hydrodynamic, magnetic, and optical techniques) are also reviewed. Lastly, organs on chips, multi-organ chips, and drug discovery involving single RBC are described. The limitations and drawbacks of each technology are addressed and future prospects are discussed.

Simple Summary: Blood tests are commonly requested by doctors.Blood tests are done for many reasons and invesitgating symptoms or monitoring existing conditions are just examples. For instance, blood tests can also be done as part of a routine health checkup to investigate symptoms or monitor existing conditions. For instance, blood tests can also be done as part of a routine health checkup. Some clinical guidelines for doctors include recommendations to investigate for cancer if a blood test indicates results that are lower or higher than normal levels. These recommendations are only helpful for a small number of cancers, such as bowel or pancreatic cancers. A patient can have repeated blood tests, allowing doctors to monitor how blood test results change over time. These changes over time are referred to as 'trends' and may provide doctors with more information than the results of a single blood test. For example, noting a small drop in a steady trend could be more useful than waiting for the blood test to drop below a normal level. Until now, there has been no research regarding whether blood test trends can identify patients who should be investigated for cancer. We aimed to assess this possibility in this research project. Clinical guidelines include monitoring blood test abnormalities to identify patients at increased risk of undiagnosed cancer. Noting blood test changes over time may improve cancer risk stratification by considering a patient's individual baseline and important changes within the normal range. We aimed to review the published literature to understand the association between blood test trends and undiagnosed cancer. MEDLINE and EMBASE were searched until 15 May 2023 for studies assessing the association between blood test trends and undiagnosed cancer. We used descriptive summaries and narratively synthesised studies. We included 29 articles. Common blood tests were haemoglobin (24%, n = 7), C-reactive protein (17%, n = 5), and fasting blood glucose (17%, n = 5), and common cancers were pancreatic (29%, n = 8) and colorectal (17%, n = 5). Of the 30 blood tests studied, an increasing trend in eight (27%) was associated with eight cancer types, and a decreasing trend in 17 (57%) with 10 cancer types. No association was reported between trends in 11 (37%) tests and breast, bile duct, glioma, haematological combined, liver, prostate, or thyroid cancers. Our review highlights trends in blood tests that could facilitate the identification of individuals at increased risk of undiagnosed cancer. For most possible combinations of tests and cancers, there was limited or no evidence. [ABSTRACT FROM AUTHOR]

Introduction: Immature granulocyte percentage (IG%) is an important biomarker for infection control. We observed spurious cases where the IG% was dramatically underestimated on the automated Sysmex XN‐series hehmatology analyzer compared with manual differential. These cases were associated with high values of "Neutrophil Reactivity Intensity" (NEUT‐RI), which should reflect the metabolic activity of the neutrophils. Methods: We conducted a three‐stage study to evaluate whether NEUT‐RI could be utilized to screen for misclassified IG% results defined as the manual differential estimating a 10 percentage points higher IG% compared with the automated Sysmex differential. First, 124 patient samples were selected for 800‐cell manual smear analysis based on their NEUT‐RI values and compared with the automatic Sysmex IG% results. Next, 11 098 routine 110‐cell manual smear analyses were compared with the corresponding Sysmex IG% results. Finally, during a 19‐day period 160 additional patient samples underwent smear based on NEUT‐RI values ≥56 fluorescence intensity (FI) to screen for misclassified results beyond our current smear practice. Results: NEUT‐RI ≥56 predicted IG% misclassification with 91% sensitivity and 88% specificity, but primarily when the internal Sysmex flag "Abnormal WBC Scattergram" was present. 90.1% of misclassified results were identified by this flag. Beyond our existing smear rules including this flag, NEUT‐RI ≥56 FI had a positive predictive value below 1%. Conclusion: Both NEUT‐RI and the internal Sysmex flag "Abnormal WBC Scattergram" work well to identify cases of IG% misclassification. However, in our setting NEUT‐RI ≥56 FI had no meaningful additional predictive capacity to identify misclassifications beyond our current smear rules. [ABSTRACT FROM AUTHOR]

Hypercoagulable disorders are best described as a group of acquired and hereditary conditions that increase the risk for the development of thrombi within veins or arteries. In the setting of an unprovoked venous thromboembolism, common practice in the inpatient setting has been further investigation via a thrombophilia workup to establish an underlying cause. Current Hematology-Oncology guidelines argue against inpatient workup as the results rarely influence inpatient management. Following American Society of Hematology guidelines (Middledorp), the current study found that only 15% (11/72) of patients met appropriate criteria for thrombophilia testing. There was no relationship between appropriate thrombophilia testing and diagnosis of thrombophilia or initiation of anticoagulation. There was a relationship between appropriate thrombophilia testing and Hematology-Oncology consultation. This demonstrates the need for expert consultation if thrombophilia testing is being considered. The current study provides more evidence that a strong recommendation against inpatient testing should be made as testing does not aid in diagnosis or change management and is an overutilization of healthcare resources. [ABSTRACT FROM AUTHOR]

A 7-y-old male Labrador Retriever dog was presented because of acute onset of dark-colored urine after a hunting session the day prior. Moderate hemoglobinemia was observed, associated with transient hemoglobinuria and hematuria with no concurrent evidence of underlying urinary tract disease. The patient's clinical signs resolved within 36 h post-exercise without specific treatment. The concurrent occurrence of exertional hemolysis and hematuria in a dog is uncommon; these conditions are commonly reported separately in human athletes.

The limited performance of guideline-recommended abdominal ultrasound and serum alpha-fetoprotein (AFP) highlights the urgent, unmet need for new biomarkers for more accurate detection of early hepatocellular carcinoma (HCC). To this end, we have conducted a prospective clinical validation study to evaluate the performance of the HelioLiver Test, a multi-analyte blood test combining cell-free DNA methylation patterns, clinical variables, and protein tumor markers. A blinded, multicenter validation study was performed with 247 subjects, including 122 subjects with HCC and 125 control subjects with chronic liver disease. The performance of the HelioLiver Test was compared with AFP and the GALAD score as established HCC surveillance blood tests. The performance of the HelioLiver Test (area under the receiver operating characteristic curve [AUROC] = 0.944) was superior to both AFP (AUROC = 0.851; p < 0.0001) and GALAD (AUROC = 0.899; p < 0.0001). Using a prespecified diagnostic algorithm, the HelioLiver Test showed sensitivities of 85% (95% confidence interval [CI], 78%-90%) for HCC of any stage and 76% (95% CI, 60%-87%) for early stage (American Joint Committee on Cancer [AJCC] I and II) HCC. In contrast, AFP (≥20 ng/mL) alone and the GALAD score (≥-0.63) showed lower sensitivities of 62% (95% CI, 54%-70%) and 75% (95% CI, 67%-82%) for HCC overall, and 57% (95% CI, 40%-71%) and 65% (95% CI, 49%-79%) for early stage (AJCC I and II) HCC, respectively. The specificities of the HelioLiver Test (91%; 95% CI, 85%-95%), AFP (97%; 95% CI, 92%-99%), and the GALAD score (94%; 95% CI, 88%-97%) were similar for control subjects. The HelioLiver Test showed superior performance for HCC detection compared to with both AFP and the GALAD score and warrants further evaluation in HCC surveillance settings.

Mental health disorders are linked to systemic inflammation. Due to high inflammation and mental health disorders in COVID‐19 patients, we aimed to investigate the relationship between blood inflammatory markers such as red cell distribution width to platelet ratio (RPR), platelet‐lymphocyte ratio (PLR), neutrophil/lymphocyte ratio (NLR), red cell distribution width (RDW), white blood cell (WBC), and psychological function in COVID‐19 patients. In the current cross‐sectional study, neuro‐psychological function, and a complete blood count (CBC) were measured on 120 COVID‐19 patients aged >30 years from the Imam Reza Hospital in Mashhad, Iran. Our results showed that anxiety related to MCHC (mean ± SD: 32.71 ± 1.68, p < 0.05), WBC (mean ± SD: 12.23 ± 5.43, p < 0.05), and PLR (median (IQR): 28.72 (15.88–41.31), p < 0.05) significantly. In the stress subgroup, only RPR was associated with stress (p < 0.05). Linear regression between hematological parameters and psychological score indicated that RDW and PLR had a significantly positive association with depression (β = 0.086; p = 0.045 and β = 1.326; p = 0.016, respectively) and anxiety scores (β = 0.100; p = 0.038 and β = 1.356; p = 0.010, respectively). Moreover, a positive correlation was found between PLR and stress (β = 1.102; p = 0.012). This study showed a positive association between depression/anxiety/stress symptoms and levels of hematological inflammatory markers including PLR and RDW. The findings of this study provide novel insights into mental health and physiological markers, underscoring the potential influence of inflammation on mood disorders. Our findings offer exciting prospects for future research and may lead to innovative approaches in the management and treatment of depression, anxiety, and stress. [ABSTRACT FROM AUTHOR]

Abstract Objective Blood‐based biomarkers play a central role in the diagnosis and treatment of critically ill patients, yet none are routinely measured during the intra‐arrest phase of out‐of‐hospital cardiac arrest (OHCA). Our objective was to describe methodological aspects, sources of evidence, and gaps in research surrounding intra‐arrest blood‐based biomarkers for OHCA. Methods We used scoping review methodology to summarize existing literature. The protocol was designed a priori following the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses (PRISMA) Extension for Scoping Reviews. Inclusion criteria were peer‐reviewed scientific studies on OHCA patients with at least one blood draw intra‐arrest. We excluded in‐hospital cardiac arrest and animal studies. There were no language, date, or study design exclusions. We conducted an electronic literature search using PubMed and Embase and hand‐searched secondary literature. Data charting/synthesis were performed in duplicate using standardized data extraction templates. Results The search strategy identified 11,834 records, with 118 studies evaluating 105 blood‐based biomarkers included. Only eight studies (7%) had complete reporting. The median number of studies per biomarker was 2 (interquartile range 1–4). Most studies were conducted in Asia (63 studies, 53%). Only 22 studies (19%) had blood samples collected in the prehospital setting, and only six studies (5%) had samples collected by paramedics. Pediatric patients were included in only three studies (3%). Out of eight predefined biomarker categories of use, only two were routinely assessed: prognostic (97/105, 92%) and diagnostic (61/105, 58%). Conclusions Despite a large body of literature on intra‐arrest blood‐based biomarkers for OHCA, gaps in methodology and knowledge are widespread.

Abstract Mental health disorders are linked to systemic inflammation. Due to high inflammation and mental health disorders in COVID‐19 patients, we aimed to investigate the relationship between blood inflammatory markers such as red cell distribution width to platelet ratio (RPR), platelet‐lymphocyte ratio (PLR), neutrophil/lymphocyte ratio (NLR), red cell distribution width (RDW), white blood cell (WBC), and psychological function in COVID‐19 patients. In the current cross‐sectional study, neuro‐psychological function, and a complete blood count (CBC) were measured on 120 COVID‐19 patients aged >30 years from the Imam Reza Hospital in Mashhad, Iran. Our results showed that anxiety related to MCHC (mean ± SD: 32.71 ± 1.68, p

Introduction: Dengue is an important mosquito-borne viral disease worldwide with increasing emergence in India. It has varied epidemiological factors and presentations; hence, laboratory diagnosis and analysis is extremely essential. This study aims to analyze the alteration of hematological and biochemical parameters in adult patients diagnosed with dengue at a tertiary care hospital. Materials and Methods: A cross-sectional study was done on 729 diagnosed adult cases of dengue over a period of 1 year. Patients with secondary infections and preexisting diseases were excluded from the study. Laboratory data of serological parameters and hematological and biochemical profiles were recorded and analyzed using Epi Info 7.2.5.0 and MedCalc Statistical Software. Results: The study was done from January 2022 to December 2022, consisting of 446 males (61.1%) and 283 females (38.8%). The infection was most prevalent in the 2nd–3rd decades of life. Serological parameters showed 31.4% NS1 positive and 29.4% IgM positive. The peak annual incidence was seen in July–August. Thrombocytopenia was the most commonly deranged parameter seen in 56% of patients and leukopenia was seen in 20.8% of cases. 34.8% of cases had hemoglobin <12 g/dl. Aspartate aminotransferase (AST) and alanine transaminase levels were elevated in 58.5% and 44.3%, respectively. Serum creatinine was raised in 17% of cases. Serum proteins levels were reduced in 34.5%. Activated partial thromboplastin clotting time was elevated in 58.7% cases. Conclusion: This study elucidates the altered laboratory findings in dengue viral infection that could facilitate appropriate management and monitor disease progression to prevent advancement to fatal forms. The following core competencies are addressed in this article: Medical knowledge, Practice-based learning and improvement. [ABSTRACT FROM AUTHOR]

BackgroundObesity is a global pandemic characterized by multiple comorbidities, including cardiovascular and metabolic diseases. The aim of this study was to define the associations between blood donor body mass index (BMI) and RBC measurements of metabolic stress and hemolysis.Study design and methodsThe associations between donor BMI (

Purpose: Although the association between zinc deficiency and olfactory dysfunction is inconclusive, zinc deficiency causes apoptosis of the olfactory ensheathing cells which is involved in olfactory nerve turnover and axon regeneration, thereby suggesting a possible relationship. We investigated the relationship between serum zinc levels and olfactory function in patients with olfactory dysfunction. Methods: Ninety patients who had been diagnosed with post-infectious, posttraumatic, drug-induced, neurological and idiopathic olfactory dysfunction were included. Patients were divided into zinc normal group and zinc deficiency groups according to three reference values for serum zinc levels (60, 65, 70 µg/dL). The results of olfactory tests and patient backgrounds were used to compare the differences between the two groups. Results: There were significantly worse detection and recognition thresholds in the T&T olfactometer and Open Essence (odor identification test) results in the zinc deficiency group (< 60 µg/dL). In addition, significant correlations between olfactory tests (detection/recognition thresholds in the T&T olfactometer and Open Essence results) and serum zinc levels < 65 µg/dL were observed. The zinc deficiency group < 70 µg/dL with idiopathic olfactory dysfunction had significantly worse olfactory tests (detection/recognition thresholds in the T&T olfactometer and Open Essence). In addition, there was a significant correlation between the detection/recognition thresholds in the T&T olfactometer and serum zinc levels in idiopathic olfactory dysfunction. Conclusions: Our findings suggest that zinc deficiency may exacerbate the severity of olfactory dysfunction. Furthermore, idiopathic olfactory dysfunction may be partly caused by zinc deficiency. [ABSTRACT FROM AUTHOR]

Background and objectives: The coronavirus disease 2019 (COVID-19) is caused by severe acute respiratory syndrome coronavirus 2, a newly emergent coronavirus, first recognized in Wuhan, China in December 2019. Early identification of laboratory indicators helps in distinguishing severe patients from mild to moderate counterparts and can facilitate medical interventions, thereby lowering the mortality rate. The present study was done to evaluate the role of hematological parameters and basic coagulation parameters in the assessment of the severity of COVID-19. Methods: This retrospective observational study was done at a tertiary care institute from May 2020 to May 2021. Hematological and coagulation profile was studied in 200 confirmed COVID-19 cases. Data related to age, gender, and clinical features were retrieved from patients’ records. Laboratory findings such as complete blood count neutrophil to lymphocyte ratio, platelet to lymphocyte ratio, and coagulation parameters in different categories were compared. Results: The majority of patients were males (59.5%) and with mild illness (52.5%). Moderate and severe illness was present in 30% and 17.5% of cases, respectively. The frequency of anemia, leucopenia, and thrombocytopenia was 62.5%, 6%, and 5.5%, respectively. Overall neutrophilia was seen in 40.5% of cases, whereas lymphopenia was seen in 39% of cases. Coagulation parameters were also much deranged in moderate and severe cases as compared to mild cases. Conclusion: The hematopoietic and hemostatic systems are significantly affected by COVID-19. Careful evaluation of laboratory parameters assists clinicians in formulating a tailored treatment approach and in predicting disease severity.

Bovine leukosis is one of the most common infectious diseases of farm animals, causing significant economic damage due to a decrease in production of livestock products, premature culling and slaughter of cows and servicing bulls. The disease needs special attention and control on behalf of the on-farm veterinarians and zootechnicians. The article briefly describes epizootic situation on bovine leukosis in the Russian Federation in 2004–2020. It also includes a report on the disease situation in “Sibirskaya Niva” LLC (the Irkutsk Oblast) for 2015–2021 and assesses effectiveness of health support and disease prevention measures taken on the farm. The paper gives a brief description of the agricultural establishment: its zoosanitary status as well as zootechnical, veterinary, therapeutic and preventive measures (disinsection, deratization, vaccination). Based on the data obtained, we found the ultimate cause of bovine leukosis on the farm: presumably, these were crossbred animals brought into the farm. In order to eradicate the disease, “Sibirskaya Niva” LLC has developed a plan on health support and disease prevention, which includes veterinary, zootechnical and economic measures. Thus, due to the actions taken from 2015 to 2019, the number of infected cows and heifers reduced by 6.42 and 2.78 times, correspondingly. At the same time, the overall number of infected animals decreased by 9.9%. Task-oriented measures taken by the state veterinary services made it possible to steadily reduce the number of infected animals by 2020. The comprehensive approach embracing the farm peculiarities has proven to be effective to quickly eliminate bovine leukosis, as the above-mentioned agricultural establishment exemplified it.

Renal failure is relatively common in children presenting to the emergency department, suggesting that the assumption of normal renal function is not always valid. Although some computed tomography (CT) scans necessitate the use of intravenous contrast, one should probably consider whether a blood test is necessary to assess the patient’s renal function and possibly consider other imaging modalities before proceeding. With no pediatric-specific guidelines and no validated pediatric prevention strategies, further research is needed to establish clear recommendations for contrast-enhanced exams in stable and unstable pediatric patients with unknown renal function.

BACKGROUND AND OBJECTIVES: Currently, HTLV screening is not performed in South Africa (SA). This report describes an economic assessment (budget impact and cost-effectiveness) of implementing different HTLV screening strategies. METHODS: A modified version of the Alliance of Blood Operators risk-based decision-making framework was used to assess the risk and consequences of HTLV in the blood supply in SA. We developed a deterministic model of the cost and consequences of four screening strategies: none, universal, all donors once and first time donors only assuming a transfusion-transmission (TT) efficiency of 10% and a manifestation of clinical disease of 6%. RESULTS: Unscreened blood results in 3·55 symptomatic TT-HTLV cases and a total healthcare cost of Rand (R)3 446 950 (US Dollars (USD)229 800) annually. Universal screening would cost R24 000 000 (USD1 600 000) per annum and prevent 3·54 (99·8%) symptomatic TT-HTLV cases in the first year and 0·55 (98·4%) symptomatic TT-HTLV cases in the second year at a cost per TT-HTLV prevented of R6 780 000 (USD450 000) in year one and R43 254 000 (USD2 890 000) in year two. Screening all donors once would cost R16,200,000 (USD1 080 000) or R4 600 000 (USD306 000) per symptomatic TT-HTLV infection prevented in year one. Total costs decrease to R5 100 000 (USD340 000) in year 2 but the cost per TT-HTLV prevented increases to R10 700 000 (USD713 333). CONCLUSION: This analysis contributed to the decision not to implement HTLV screening as the healthcare budget and particularly the budget for blood transfusion in SA is insufficient to provide appropriate treatment. Arguably, available resources can be more efficiently utilized in other healthcare programs.

Background: Evaluating women with symptoms suggestive of coronary artery disease (CAD) remains challenging. A blood-based precision medicine test yielding an age/sex/gene expression score (ASGES) has shown clinical validity in the diagnosis of obstructive CAD. We assessed the effect of the ASGES on the management of women with suspected obstructive CAD in a community-based registry. Materials and Methods: The prospective PRESET (A Registry to Evaluate Patterns of Care Associated with the Use of Corus® CAD in Real World Clinical Care Settings) Registry (NCT01677156) enrolled 566 patients presenting with symptoms suggestive of stable obstructive CAD from 21 United States primary care practices from 2012 to 2014. Demographics, clinical characteristics, and referrals to cardiology or further functional and/or anatomical cardiac studies after ASGES testing were collected for this subgroup analysis of women from the PRESET Registry. Patients were followed for 1-year post-ASGES testing. Results: This study cohort included 288 women with a median age 57 years. The median body mass index was 29.2, with hyperlipidemia and hypertension present in 48% and 43% of patients, respectively. Median ASGES was 8.5 (range 1-40), with 218 (76%) patients having low (≤15) ASGES. Clinicians referred 9% (20/218) low ASGES versus 44% (31/70) elevated ASGES women for further cardiac evaluation (odds ratio 0.14, p

ObjectiveTo describe fetomaternal hemorrhage (FMH) during second-trimester dilation and evacuation (D&E) to evaluate if Rhesus-immune globulin (RhIG) 100 mcg (used in the United Kingdom) and 300 mcg (used in the United States) provide adequate prophylaxis.Study designWe conducted an exploratory prospective descriptive study of women undergoing D&E between 15 weeks 0 days and 23 weeks 6 days of gestation. Enrolled participants had Kleihauer-Betke testing on specimens obtained before and after D&E. We assessed the main outcome measures of FMH in mL suggesting need for more than 100 mcg and 300 mcg RhIG (FMH of 10 mL and 30 mL fetal whole blood, respectively) and association of postprocedure FMH with demographic characteristics and procedure-related variables.ResultsThe 300 participants had a mean gestational age of 19 weeks 6 days±2 weeks 2 days. The median preprocedure FMH was 0 mL (range 0-50 mL) with 2 (0.67%) women exceeding 10 mL (19 mL and 50 mL). The median postprocedure FMH was 1 mL (range 0-60 mL). Almost all participants had postprocedure FMH 98% of women and in all cases

BackgroundClinicians often use population-based reference intervals (RIs) when interpreting patient results. However, this method can present problems if the analyte in question has wide variability from person to person.MethodsWe examined the biological variation of routine hematologic markers in 82 white non-Hispanic men every 6 months during a 30-year period, to determine the usefulness of population-based RIs and age-related decline of hematological markers.ResultsMany of these markers showed significant person-to-person differences (index of individuality

Introduction: Microcytosis and hypochromia result from deficient hemoglobin synthesis in red blood cells and are easily detected in a complete blood count test. These conditions are mainly due to iron nutritional deficiency, but may also result from some genetic diseases, such as thalassemia. The aim of this study was to determine the contribution of β- and α-thalassemia to these abnormal hematological phenotypes in a representative sample of adult individuals living in Portugal who participated in the first Portuguese National Health Examination Survey (INSEF). Material and Methods: Among the 4808 INSEF participants, 204 had microcytosis, hypochromia or both. The corresponding 204 DNAs were screened for changes in the β-globin gene by next-generation sequencing and Sanger sequencing. In addition, α-thalassemia deletions within the α-globin cluster were investigated by Gap-PCR and multiplex ligation-dependent probe amplification. Results: In this selected subgroup of INSEF participants, 54 had α-thalassemia (26%), predominantly caused by the -α3.7kb deletion, and 22 were β-thalassemia carriers (11%) mainly due to point mutations in the β-globin gene previously known in Portugal. Conclusion: Thalassemia trait is a frequent cause of microcytosis or hypochromia in Portugal since this genetic condition was found in 37% of the investigated cases.

Clinical decision-making in emergency medicine is under constant pressure from demand and performance requirements, with blood tests being a fundamental part of this. However, the preanalytical process has received little attention. Therefore, this study aimed to investigate the quality of preanalytical phase processes in European emergency departments (EDs) from the perspectives of the three main providers: clinicians, nurses, and laboratory specialists. This online survey, distributed among European EDs and laboratories, was supported by the European Society for Emergency Nursing (EUSEN), European Society for Emergency Medicine (EuSEM), and the European Federation of Clinical Chemistry and Laboratory Medicine (EFLM). The size of the centres, the European region, the responder's profession and the country's economic condition were used as co-variables. We included 376 responses from all ED-related professions from 306 European centres. In 66.9% of all ED visits, at least one blood test was performed. Tests were requested mostly by nurses (44.6%) using electronic Order/Entry systems (65.4%). Only a minority (19%) reported not using laboratory quality indicators (QIs). Most responders defined the TAT starting point "when the laboratory receives the sample" (66.1%), defining the goal to be "less than 60 min" (69.9%), but only 42.4% of the centres estimated achieving this goal. Our survey illustrates the current situation on preanalytical blood sample processing in European EDs from the clinical and laboratory perspectives. The results emphasise the importance of the IT infrastructure and QI usage in this process and highlight some differences between European regions. [ABSTRACT FROM AUTHOR]

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Background: C-reactive protein (CRP) is a key laboratory biomarker for anti-inflammatory treatment initiation. Unfortunately, biochemical blood analyzers are not always easily accessible in medical institutions located far from major regional health facilities. Aim: To develop an approach for inflammatory status estimation based on blood test results in patients with COVID-19 in cases with limited laboratory equipment availability. Methods: The present retrospective study included 423 patients (male 54.6%; female 45.4%; mean age 59.1 years) receiving hospital treatment due to COVID-19 in Medical Research and Educational Center of Lomonosov Moscow State University from April 21st to June 13th 2020. All patients donated blood for full biochemistry and hematology testing and underwent chest computer tomography (CT). Results: CRP levels (60 mg/L) qualitative estimation model was developed based on hematologic test results. It included erythrocyte sedimentation rate and neutrophils to lymphocytes ratio. According to the results of Receiver Operating Characteristic (ROC) analysis present model was characterized by sensitivity of 70.2%, specificity of 74.6%, and area under the ROC-curve of 0.781. Comparison of key clinical parameters reflecting COVID-19 severity, such as length of hospitalization, lung damage at CT (hospital admission and discharge), revealed statistically significant difference between groups with routinely measured CRP levels 60 mg/L and 60 mg/L for all the above-mentioned parameters (p 0.05). These differences remained significant when measured CRP levels were substituted with estimated CRP values, indicating interchangeability of these approaches to CRP levels determination, regarding clinically important parameters. Conclusions: Presented model for inflammatory status estimation based on hematologic test results might be used to overcome clinical challenges in cases with limited laboratory equipment availability.

Background/Aim. Coronavirus disease 2019 (COVID-19) is a predominantly respiratory disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The aim of this study was to determine whether there were parameters that could predict the development of a severe clinical picture and fatal outcomes in COVID-19 patients. Methods. The study involved 632 patients treated at the Clinic for Infectious Diseases, University Clinical Center Kragujevac, from June 2020 to February 2021. All patients were divided into two groups according to the need for oxygen therapy (Sat 02 < 94 %). Results. Our results showed that high body mass i ndex (BMI) was singled out as a risk factor for the development of a severe clinical picture (BMI, ORadjusted = 1.263; 95% CI = 1.117 – 1.427; p < 0.001). Prothrombin time (ORadjusted = 1.170; 95% CI = 1.004 - 1.364; p = 0.045), as well as low albumin values (ORadjusted = 0.878; 95% CI = 0.804 - 0.958; p = 0.003), had a predictive signifi-cance for the development of a severe clinical picture. Fac-tors that were of predictive importance in patients with fatal outcomes were C-reactive protein (CRP) (ORadjusted = 1.010; 95% CI = 1.001 – 1.019; p = 0.031), lactate dehydrogenase (LDH) (ORadjusted = 1.004; 95% CI = 1.001 – 1.006; p = 0.002), and X-ray of the lungs (ORadjusted = 1.394; 95% CI = 1.170 – 1.661; p < 0.001). Conclusion. The study showed that routine, clinical laboratory parameters can be important in the early detection of patients with a potentially severe clinical picture and fatal outcomes. In patients with a mild clinical picture, CRP, LDH, ferritin, and serum albumin levels may timely indicate disease progression. Monitoring these parameters is of essential importance for the timely clinical assessment of patients with COVID-19 and, thus, the prompt application of adequate therapeutic protocols in the treatment of these patients.

A 29-year-old woman was referred for new-onset diabetes mellitus after her glycosylated haemoglobin (HbA1c) was found to be 10.2%. Three years earlier, the patient's HbA1c-measured by the same clinical laboratory-had been 5.5%. The newer HbA1c was discordant with fasting glucose levels and a lack of diabetes-associated symptoms. The laboratory reported that their assay methodology remained unchanged and also that no haemoglobin variants were detected. Further investigation, however, revealed, first, that the patient carried a haemoglobin alpha chain mutation (Hb Wayne) that can sometimes cause assay interference and, second, that although the laboratory's assay methodology had not changed, their assay instrument had. Depending on assay methodology, haemoglobin variants can cause HbA1c assay interference and the presence of these variants may not be detected by the performing laboratory. Interference may not only be dependent on assay methodology but also on the assay instrument used.

Antigen-specific CD4 and CD8 T cells are important components of the immune response to Mycobacterium tuberculosis, yet little information is currently known regarding how the breadth, specificity, phenotype, and function of M. tuberculosis-specific T cells correlate with M. tuberculosis infection outcome in humans. To facilitate evaluation of human M. tuberculosis-specific T cell responses targeting multiple different Ags, we sought to develop a high throughput and reproducible T cell response spectrum assay requiring low blood sample volumes. We describe here the optimization and standardization of a microtiter plate-based, diluted whole blood stimulation assay utilizing overlapping peptide pools corresponding to a functionally diverse panel of 60 M. tuberculosis Ags. Using IFN-γ production as a readout of Ag specificity, the assay can be conducted using 50 μl of blood per test condition and can be expanded to accommodate additional Ags. We evaluated the intra- and interassay variability, and implemented testing of the assay in diverse cohorts of M. tuberculosis-unexposed healthy adults, foreign-born adults with latent M. tuberculosis infection residing in the United States, and tuberculosis household contacts with latent M. tuberculosis infection in a tuberculosis-endemic setting in Kenya. The M. tuberculosis-specific T cell response spectrum assay further enhances the immunological toolkit available for evaluating M. tuberculosis-specific T cell responses across different states of M. tuberculosis infection, and can be readily implemented in resource-limited settings. Moreover, application of the assay to longitudinal cohorts will facilitate evaluation of treatment- or vaccine-induced changes in the breadth and specificity of Ag-specific T cell responses, as well as identification of M. tuberculosis-specific T cell responses associated with M. tuberculosis infection outcomes.

Background and objectives: The coronavirus disease 2019 (COVID-19) is caused by severe acute respiratory syndrome coronavirus 2, a newly emergent coronavirus, first recognized in Wuhan, China in December 2019. Early identification of laboratory indicators helps in distinguishing severe patients from mild to moderate counterparts and can facilitate medical interventions, thereby lowering the mortality rate. The present study was done to evaluate the role of hematological parameters and basic coagulation parameters in the assessment of the severity of COVID-19. Methods: This retrospective observational study was done at a tertiary care institute from May 2020 to May 2021. Hematological and coagulation profile was studied in 200 confirmed COVID-19 cases. Data related to age, gender, and clinical features were retrieved from patients’ records. Laboratory findings such as complete blood count neutrophil to lymphocyte ratio, platelet to lymphocyte ratio, and coagulation parameters in different categories were compared. Results: The majority of patients were males (59.5%) and with mild illness (52.5%). Moderate and severe illness was present in 30% and 17.5% of cases, respectively. The frequency of anemia, leucopenia, and thrombocytopenia was 62.5%, 6%, and 5.5%, respectively. Overall neutrophilia was seen in 40.5% of cases, whereas lymphopenia was seen in 39% of cases. Coagulation parameters were also much deranged in moderate and severe cases as compared to mild cases. Conclusion: The hematopoietic and hemostatic systems are significantly affected by COVID-19. Careful evaluation of laboratory parameters assists clinicians in formulating a tailored treatment approach and in predicting disease severity. [ABSTRACT FROM AUTHOR]

Patients with emerging anosmia may be asymptomatic carriers of coronavirus disease 2019 infection requiring self-isolation; otherwise, there are risks of facilitating the spread of the disease.This study aims to evaluate the loss of smell with visual analogue scale and to determine the relationship between the loss of smell and blood parameters.All patients' coronavirus disease 2019 swab cultures were polymerase chain reaction positive and pneumonia was found in computed tomographies consistent with oronavirus disease 2019. The study was conducted on 114 patients hospitalized between 01.11.2020 and 31.12.2020 in the Otorhinolaryngology coronavirus disease 2019 Service of University of Health Sciences Adana City Training and Research Hospital and followed up by us.A score of 10 indicates that the olfactory function is completely normal in all patients undergoing visual analogue scale, and a score of 0 indicates that they cannot smell anything. Patients who received visual analogue scale scored 10 points were categorized as Group 1 and others as Group 2. Statistical significance level was determined as p < 0.05. A statistically significant difference was found between Group 1 and Group 2 in terms of visual analogue scale smell score, neutrophil, lymphocyte, neutrophil–lymphocyte ratio. Visual analogue scale smell score, neutrophil count, neutrophil–lymphocyte ratio value were found to be lower in Group 2 and lymphocyte count was found to be higher. Neutrophil, lymphocyte, neutrophil/lymphocyte ratio, platelet, platelet/lymphocyte ratio, which are also used in nasal diseases, may be used to detect loss of smell, predict, and even determine the prognosis of loss of smell if supported by further studies. [ABSTRACT FROM AUTHOR]

To explore the value of blood routine examination indexes in the differential diagnosis of immunoglobulin A vasculitis (IgAV) with abdominal involvement and appendicitis in children. Forty-seven patients with IgAV and abdominal involvement, 95 cases with appendicitis, and 48 healthy children were enrolled in this study. Demographic and laboratory data were retrospectively recorded from medical files. The levels of serum percentage of lymphocytes (LYM%), percentage of eosinophils (E%), red cell volume distribution width (RDW) and platelet (PLT) count were higher, while blood cells (WBC) count, percentage of neutrophils (N%), percentage of monocytes (M%), mean platelet volume (MPV), platelet distribution width and C-reactive protein were lower in the group of IgAV with abdominal involvement compared to appendicitis group (P < 0.05). Multivariate logistic regression analysis showed LYM% (odds ratio (OR) = 1.34, P = 0.001) and RDW (OR = 2.96, P = 0.045) were independent risk factors for IgAV with abdominal involvement. N% (OR = 1.270, P = 0.006) and MPV (OR = 51.15, P = 0.042) were independently associated with appendicitis. Using receiver operating characteristic analysis, the optimal cut-off values (sensitivity and specificity) respectively were 42.17% (95.7%, 100.0%) for LYM%, 12.65% (83.0%, 83.2%) for RDW, 61.5% (91.6%, 97.9%) for NE% and 10.1fL (78.9%, 75.4%) for MPV, with the AUC values of 0.989, 0.881, 0.985, 0.810, respectively. Blood routine examination indices, especially the N%, LYM%, RDW, and MPV, can be used for simple differential diagnosis of IgAV with abdominal involvement and appendicitis. [ABSTRACT FROM AUTHOR]

This study aimed to analyze laboratory and radiological imaging results in the prediction of treatment strategy in patients with deep neck infections. Eighty-three patients (55 (66.3%) men, mean age: 38.2±14.5 years) were included in the study. Patients were divided into three groups according to the treatment strategy: group 1 received only antibiotic treatment, group 2 underwent abscess drainage with needle puncture in addition to antibiotic treatment, and group 3 underwent surgical drainage with antibiotic treatment. Laboratory outcomes, imaging methods, duration of hospital stay, treatment strategy, and clinical outcomes were analyzed.According to the laboratory results, complete blood count values did not vary among the three groups, but C reactive protein (CRP) and erythrocyte sedimentation rate (ESR) values were higher in group 3 (p<0.01). Based on receiver operating characteristic (ROC) analysis, the cut-off levels for CRP and ESR associated with the need for surgical drainage were 133 mg/L and 42.5, respectively. According to radiological imaging results, the number of involved neck spaces was significantly different among the three groups (p=0.03), and group 3 had more spaces involved when compared with groups 1 and 2 (p=0.04). Gas formation in the neck tissues was noted in 10 patients in group 3 and 5 patients in groups 1 and 2 (p=0.02). ESR and CRP levels were higher in patients who underwent surgical drainage. In patients with deep neck space infections, the involvement of two or more neck spaces and gas formation on radiological images might indicate surgical drainage as a treatment strategy. [ABSTRACT FROM AUTHOR]

Background/Aim. Coronavirus disease 2019 (COVID-19) is a predominantly respiratory disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The aim of this study was to determine whether there were parameters that could predict the development of a severe clinical picture and fatal outcomes in COVID-19 patients. Methods. The study involved 632 patients treated at the Clinic for Infectious Diseases, University Clinical Center Kragujevac, from June 2020 to February 2021. All patients were divided into two groups according to the need for oxygen therapy (Sat 02 < 94 %). Results. Our results showed that high body mass i ndex (BMI) was singled out as a risk factor for the development of a severe clinical picture (BMI, ORadjusted = 1.263; 95% CI = 1.117 -- 1.427; p < 0.001). Prothrombin time (ORadjusted = 1.170; 95% CI = 1.004 - 1.364; p = 0.045), as well as low albumin values (ORadjusted = 0.878; 95% CI = 0.804 - 0.958; p = 0.003), had a predictive significance for the development of a severe clinical picture. Factors that were of predictive importance in patients with fatal outcomes were C-reactive protein (CRP) (ORadjusted = 1.010; 95% CI = 1.001 -- 1.019; p = 0.031), lactate dehydrogenase (LDH) (ORadjusted = 1.004; 95% CI = 1.001 -- 1.006; p = 0.002), and X-ray of the lungs (ORadjusted = 1.394; 95% CI = 1.170 -- 1.661; p < 0.001). Conclusion. The study showed that routine, clinical laboratory parameters can be important in the early detection of patients with a potentially severe clinical picture and fatal outcomes. In patients with a mild clinical picture, CRP, LDH, ferritin, and serum albumin levels may timely indicate disease progression. Monitoring these parameters is of essential importance for the timely clinical assessment of patients with COVID-19 and, thus, the prompt application of adequate therapeutic protocols in the treatment of these patients. [ABSTRACT FROM AUTHOR]

Background: The number of blood tests done in primary care has been increasing over the past 20 years. Some estimates suggest that up to one-quarter of these tests may not have been needed. This could lead to a cascade effect of further investigations, appointments, or referrals, as well as anxiety for patients, increased workload, and costs to the health service. To better understand the impact and sequelae of blood tests on patients, it is necessary to know why blood tests are requested and what is done with the results. Aim: To explore who orders blood tests and why, and how test results are actioned in primary care. Design & setting: Retrospective audit of electronic health records in general practices across the UK. Method: The Primary care Academic CollaboraTive (PACT), a UK-wide network of primary care health professionals, will be utilised to collect data from individual practices. PACT members will be asked to review the electronic health records of 50 patients who had recent blood tests in their practice, and manually extract anonymised data on who requested the test, the indication, the result, and subsequent actions. Data will also be collected from PACT members to assess the feasibility of the collaborative model. Conclusion: PACT offers a unique opportunity to extract clinical data which cannot otherwise be obtained. Understanding the indications for tests will help identify priority areas for research to optimise testing and patient safety in primary care. [ABSTRACT FROM AUTHOR]

Background: Examining the distribution of biochemical and haematological tests in different age groups of rural population is necessary to ensure that health care facilities are equipped to address the prevalent health conditions and manage age-related illness effectively. Hence, this study is aimed at seeing the distributions of blood biochemical and haematological parameters in rural population., Methods: This cross-sectional study investigated the distribution of 26 different haematological and biochemical parameters in longitudinal cohort study (Srinivaspura Aging, NeuoSenescence and COGnition - SANSCOG), from the villages of Srinivaspura, Kolar district, India. A total of 2592 participants (1240 males and 1352 females), aged ≥45 years who are cognitively healthy were included for the analysis. Mean, 2.5 th , 5 th , 25 th , 50 th , 75 th , 95 th and 97.5 th percentiles were calculated for the entire sample. Additionally, median and percentiles were determined for both gender and age categories (45-54, 55-64, 65-74, and ≥75 years)., Results: We observed the distinct distributions of various haematological and biochemical parameters, with elevated levels of glycaemic, lipid, liver, and thyroid parameters., Conclusion: Findings revealed the notable variations from the established reference ranges, indicating the potential undiagnosed cases and highlighting the gaps in health awareness and health seeking behaviour., Competing Interests: Declaration of conflicting interestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Understanding the genetic basis of routinely-acquired blood tests can provide insights into several aspects of human physiology. We report a genome-wide association study of 42 quantitative blood test traits defined using Electronic Healthcare Records (EHRs) of ~50,000 British Bangladeshi and British Pakistani adults. We demonstrate a causal variant within the PIEZO1 locus which was associated with alterations in red cell traits and glycated haemoglobin. Conditional analysis and within-ancestry fine mapping confirmed that this signal is driven by a missense variant - chr16-88716656-G-T T - which is common in South Asian ancestries (MAF 3.9%) but ultra-rare in other ancestries. Carriers of the T allele had lower mean HbA1c values, lower HbA1c values for a given level of random or fasting glucose, and delayed diagnosis of Type 2 Diabetes Mellitus. Our results shed light on the genetic basis of clinically-relevant traits in an under-represented population, and emphasise the importance of ancestral diversity in genetic studies., (© 2024. The Author(s).)

Background: Early recognition of sepsis by the EMS (Emergency Medical Services), along with communicating this concern to the emergency department, could improve patient prognosis and outcome. Knowledge is limited about the performance of sepsis identification screening tools in the EMS setting. Research is also limited on the effectiveness of prehospital use of blood tests for sepsis identification. Integrating blood analyses with screening tools could improve sepsis identification, leading to prompt interventions and improved patient outcomes., Aim: The aim of the present study is firstly to evaluate the performance of various screening tools for sepsis identification in the EMS setting and secondly to assess the potential improvement in accuracy by incorporating blood analyses., Methods: This is a retrospective observational cohort study. The data were collected from prehospital and hospital medical records in Region Halland. Data on demographics, vital signs, blood tests, treatment, and outcomes were collected from patients suspected by EMS personnel of having infection. The data were analysed using Student's t-test. Sensitivity, specificity, positive predictive value, negative predictive value and odds ratio were used to indicate accuracy and predictive value., Results: In total, 5,405 EMS missions concerning 3,225 unique patients were included. The incidence of sepsis was 9.8%. None of the eleven tools included had both high sensitivity and specificity for sepsis identification. White blood cell (WBC) count was the blood analysis with the highest sensitivity but the lowest specificity for identifying sepsis. Adding WBC, C-reactive protein (CRP) or lactate to the National Early Warning Score (NEWS) increased the specificity to > 80% but substantially lowered the sensitivity., Conclusions: Identifying sepsis in EMS settings remains challenging, with existing screening tools offering limited accuracy. CRP, WBC, and lactate blood tests add minimal predictive value in distinguishing sepsis or determining non-conveyance eligibility., (© 2024. The Author(s).)

Background: In primary care, health professionals use blood tests to investigate nonspecific presentations to inform referral decisions. Reference ranges for the commonly used blood tests in western countries were developed in predominately White populations, and so may perform differently when applied to non-White populations. Knowledge of ethnic variation in blood test results in healthy/general populations could help address ethnic inequalities in cancer referral for diagnosis and outcomes., Objective: This systematic review explored evidence of ethnic differences in the distribution of selected blood test results among healthy/general populations to inform future research aimed at addressing inequalities in cancer diagnosis., Methods: We searched PubMed and EMBASE to identify studies reporting measures of haemoglobin, MCV, calcium, albumin, platelet count, and CRP in nondiseased adults from at least 2 different ethnic groups. Two reviewers independently screened studies, completed data extraction and quality assessment using an adapted Newcastle-Ottawa scale. Participants were stratified into White, Black, Asian, Mixed, and Other groups. Data were synthesised narratively and meta-analyses were conducted where possible., Results: A total of 47 papers were included. Black men and women have lower average values of haemoglobin, MCV, and albumin, and higher average values of CRP relative to their White counterparts. Additionally, Black men have lower average haemoglobin than Asian men, whereas Asian women have lower average CRP values when compared with White women., Conclusions: There is evidence of ethnic differences in average values of haemoglobin, MCV, CRP, and albumin in healthy/general populations. Further research is needed to explore the reasons for these differences. Systematic review registration: CRD42021274580., (© The Author(s) 2024. Published by Oxford University Press.)

Purpose: Response assessment of classical Hodgkin lymphoma (cHL) with positron emission tomography-computerized tomography (PET-CT) is standard of care in well-resourced settings but unavailable in most African countries. We aimed to investigate correlations between changes in PET-CT findings at interim analysis with changes in blood test results in pediatric patients with cHL in 17 South African centers., Methods: Changes in ferritin, lactate dehydrogenase (LDH), erythrocyte sedimentation rate (ESR), albumin, total white cell count (TWC), absolute lymphocyte count (ALC), and absolute eosinophil count were compared with PET-CT Deauville scores (DS) after two cycles of doxorubicin, bleomycin, vinblastine, and dacarbazine in 84 pediatric patients with cHL. DS 1-3 denoted rapid early response (RER) while DS 4-5 denoted slow early response (SER). Missing values were imputed using the k-nearest neighbor algorithm. Baseline and follow-up blood test values were combined into a single difference variable. Data were split into training and testing sets for analysis using Python scikit-learn 1.2.2 with logistic regression, random forests, naïve Bayes, and support vector machine classifiers., Results: Random forest analysis achieved the best validated test accuracy of 73% when predicting RER or SER from blood samples. When applied to the full data set, the optimal model had a predictive accuracy of 80% and a receiver operating characteristic AUC of 89%. The most predictive variable was the differences in ALC, contributing 21% to the model. Differences in ferritin, LDH, and TWC contributed 15%-16%. Differences in ESR, hemoglobin, and albumin contributed 11%-12%., Conclusion: Changes in low-cost, widely available blood tests may predict chemosensitivity for pediatric cHL without access to PET-CT, identifying patients who may not require radiotherapy. Changes in these nonspecific blood tests should be assessed in combination with clinical findings and available imaging to avoid undertreatment.

Objectives: This study aims to evaluate the prognostic value of emergency blood test results in patients with acute ischaemic stroke., Methods: We evaluated 592 prospectively patients with neuroimaging-confirmed ischaemic stroke admitted to our stroke unit between 2015 and 2018. We gathered emergency blood test results and calculated the neutrophil-to-lymphocyte ratio and the neutrophil-to-platelet ratio (neutrophils × 1.000/platelets). The association between blood test results and functional prognosis (as measured with the modified Rankin Scale) and such complications as haemorrhagic transformation was evaluated by logistic regression analysis. The additional predictive value of blood test parameters was assessed with receiver operating characteristic curves and the net reclassification index., Results: An neutrophil-to-lymphocyte ratio ≥ 3 at admission was associated with a two-fold increase in the risk of functional dependence at 3 months (OR: 2.24; 95% CI: 1.35-3.71) and haemorrhagic transformation (OR: 2.11; 95% CI: 1.09-4.05), while an neutrophil-to-lymphocyte ratio ≥ 3.86 resulted in an increase of 2.4 times in the risk of mortality at 3 months (OR: 2.41; 95% CI: 1.37-4.26) after adjusting for the traditional predictors of poor outcomes. Patients with neutrophil-to-platelet ratio ≥ 32 presented 3 times more risk of haemorrhagic transformation (OR: 3.17; 95% CI: 1.70-5.92) and mortality at 3 months (OR: 3.07; 95% CI: 1.69-5.57). Adding these laboratory parameters to standard clinical-radiological models significantly improved discrimination and prognostic accuracy., Conclusions: Basic blood test parameters provide important prognostic information for stroke patients and should therefore be analysed in combination with standard clinical and radiological parameters to optimise ischaemic stroke management., (Copyright © 2022 Sociedad Española de Neurología. Published by Elsevier España, S.L.U. All rights reserved.)

Blood tests are vital to prevention, diagnosis, and management of chronic diseases. Despite this, it can be challenging to construct a comprehensive view of the clinical importance of blood testing because relevant literature is typically fragmented across different disease areas and patient populations. This lack of collated evidence can also make it difficult for primary care providers to adhere to best practices for blood testing across different diseases and guidelines. Thus, this review article synthesizes the recommendations for, and importance of, blood testing across several common chronic conditions encountered in primary care and internal medicine, including cardiovascular diseases, diabetes mellitus, chronic kidney disease, vitamin D deficiency, iron deficiency, and rheumatoid arthritis. Future research is needed to continue improving chronic disease management through clearer dissemination and awareness of clinical guidelines among providers, and better access to blood testing for patients (e.g., via pre-visit laboratory testing)., Competing Interests: Conflicts of Interest Imelda Cabalar received consulting fees from Becton, Dickinson and Company, was on the Advisory Board for Gilead Sciences in January 2020, and served as a Consultant for Cardinal Health in March 2020. Thu Le received consulting fees from Becton, Dickinson and Company and served on the Advisory Board for Mineralys in September 2023. Abigail Silber and Matthew O'Hara are employed by Trinity Life Sciences and received consulting fees from Becton, Dickinson and Company. Bilal Abdallah and Monisha Parikh are employed by Becton, Dickinson and Company. Robert Busch received consulting fees from Becton, Dickinson and Company, is on the Speaker Bureau for Novo Nordisk, Eli Lilly, Amgen, and AstraZeneca, provides research support for Novo Nordisk, Eli Lilly, and Corcept Pharmaceuticals, and is on the Advisory Board for Novo Nordisk., (Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.)

Background: Lead exposure levels are closely linked to human health and can cause damage to multiple organ systems, including the blood system and liver. However, due to insufficient evidence, the effects of lead exposure on hematological and biochemical indices have not been fully established., Objective: This study aims to explore the blood lead levels of permanent residents in Jiangxi Province and analyze the factors affecting blood lead levels and the impact of blood lead levels on hematological and biochemical indices., Methods: We conducted a cross-sectional study including questionnaires, health examinations, and blood sample examinations on 720 randomly selected permanent residents (3-79 years) in Jiangxi Province in 2018. The blood lead levels were measured using inductively coupled plasma mass spectrometry. Routine hematological and biochemical tests were determined by qualified medical institutions using automated hematology analyzers and biochemistry analyzers., Results: The geometric mean of blood lead concentration in permanent residents of Jiangxi Province was 20.45 μg/L. Gender, age, annual household income, smoking, and hypertension were the influencing factors for blood lead levels. For each 1 μg/L increase in blood lead, the risks of elevated red blood cell count (from low to high), platelet volume distribution width, alkaline phosphatase (from low to high), and cholesterol increased by 2.4, 1.6, 3.6, and 2.3%, respectively, whereas the risks of elevation of direct bilirubin and total bilirubin both decreased by 1.7%., Conclusion: The blood lead level in permanent residents of Jiangxi Province is higher than the national average. Higher blood lead levels were found in men than in women; blood lead levels were positively correlated with age but negatively correlated with annual household income; smoking and hypertension are risk factors for elevated blood lead; and blood lead levels affect routine hematological and biochemical markers such as red blood cell count, platelet volume distribution width, direct bilirubin, total bilirubin, alkaline phosphatase, and cholesterol., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 He, Fu, Fu, Song, Huang, Wang, Lu and Wu.)

Objectives: To compare the hematologic, blood chemistry, and coagulation test results between two blood sampling methods via central venous access devices (CVADs) and venipuncture., Method: The authors searched PubMed, Embase, Cochrane, Web of Science, and the Cumulative Index to Nursing and Allied Health Literature (CINAHL) for controlled studies that compared the differences in hematologic, blood chemistry, and coagulation test results between venipuncture and CVADs from the date of database establishment to July 2022. Two researchers independently performed the literature screening, data extraction, and quality assessment. The standardized mean difference was used as the effect size for continuous variables and a 95% confidence interval was provided. The random-effects model was used for an I 2  > 50%, otherwise the fixed-effects model was used. Sources of heterogeneity were determined by subgroup analysis or sensitivity analysis, as indicated., Results: This review ultimately identified 17 studies for systematic review, of which 12 were selected for meta-analysis. A total of 541 adult participants were included in the meta-analysis. With the exception of the activated partial thromboplastin time, there were no significant differences in hematologic, blood chemistry, and coagulation test results between blood sampling via venipuncture and CVADs., Conclusions: The results of this study provide substantial evidence that blood sampling via venipuncture and CVADs had equal reliability in most laboratory tests. Serial blood sampling via CVADs will reduce the risk of bleeding episodes and pain at the blood collection site, and safety for healthcare professionals., Competing Interests: Declaration of conflicting interestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Background: Pathology testing is a very common investigation in the intensive care unit (ICU). Many tests are ordered on a routine basis rather than for a specific clinical indication, resulting in potential patient harm and unnecessary financial and environmental costs., Objective: The objective of this study was to determine whether a multifaceted intervention based on the principles of education, audit, and feedback can result in a decrease in unnecessary pathology tests without a commensurate increase in adverse patient outcomes and to measure this decrease in terms of the associated reduction in environmental and financial costs., Methods: A before and after quality improvement project was conducted between 2017 and 2019 across four ICUs in three 12-month phases, divided according to baseline, intervention implementation, and follow-up. Local clinician champions from each site partnered with the project coordinating centre to develop and implement a range of interventions based on the principles of education, audit, and feedback. Data were collected for the number of pathology tests performed and the clinical characteristics of patients admitted to a participating ICU across the three phases., Results: A total of 196 323 arterial blood gases and 460 258 other tests across eight categories were performed on the 22 210 patients admitted to participating ICUs during the project. A decrease in testing was observed across all but one category, with the greatest reduction seen in arterial blood gases (31.2% reduction in tests per bed-day). Across all categories, this equated to a mean reduction of 1.8 tCO 2 e (tonnes of carbon dioxide equivalent), a potential estimated total saving of Australian dollar $918 497.50. No increase in adverse clinical outcomes was observed., Conclusion: A multifaceted intervention based on the principles of education, audit, and feedback can produce a significant decrease in the number of unnecessary pathology tests performed. This reduction translates to substantial environmental and financial savings without any associated increase in adverse patient outcomes., (Copyright © 2024 Australian College of Critical Care Nurses Ltd. All rights reserved.)

Background: The number of blood tests done in primary care has been increasing over the past 20 years. Some estimates suggest that up to one-quarter of these tests may not have been needed. This could lead to a cascade effect of further investigations, appointments, or referrals, as well as anxiety for patients, increased workload, and costs to the health service. To better understand the impact and sequelae of blood tests on patients, it is necessary to know why blood tests are requested and what is done with the results. Aim: To explore who orders blood tests and why, and how test results are actioned in primary care. Design & setting: Retrospective audit of electronic health records in general practices across the UK. Method: The Primary care Academic CollaboraTive (PACT), a UK-wide network of primary care health professionals, will be utilised to collect data from individual practices. PACT members will be asked to review the electronic health records of 50 patients who had recent blood tests in their practice, and manually extract anonymised data on who requested the test, the indication, the result, and subsequent actions. Data will also be collected from PACT members to assess the feasibility of the collaborative model. Conclusion: PACT offers a unique opportunity to extract clinical data which cannot otherwise be obtained. Understanding the indications for tests will help identify priority areas for research to optimise testing and patient safety in primary care.