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Babitt JL, Eisenga MF, Haase VH, Kshirsagar AV, Levin A, Locatelli F, Małyszko J, Swinkels DW, Tarng DC, Cheung M, Jadoul M, Winkelmayer WC, Drüeke TB. Controversies in optimal anemia management: conclusions from a Kidney Disease: Improving Global Outcomes (KDIGO) Conference. Kidney Int 2021; 99:1280-1295. [PMID: 33839163 DOI: 10.1016/j.kint.2021.03.020] [Citation(s) in RCA: 98] [Impact Index Per Article: 32.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Revised: 03/02/2021] [Accepted: 03/09/2021] [Indexed: 12/11/2022]
Abstract
In chronic kidney disease, anemia and disordered iron homeostasis are prevalent and associated with significant adverse consequences. In 2012, Kidney Disease: Improving Global Outcomes (KDIGO) issued an anemia guideline for managing the diagnosis, evaluation, and treatment of anemia in chronic kidney disease. Since then, new data have accrued from basic research, epidemiological studies, and randomized trials that warrant a re-examination of previous recommendations. Therefore, in 2019, KDIGO decided to convene 2 Controversies Conferences to review the latest evidence, explore new and ongoing controversies, assess change implications for the current KDIGO anemia guideline, and propose a research agenda. The first conference, described here, focused mainly on iron-related issues, including the contribution of disordered iron homeostasis to the anemia of chronic kidney disease, diagnostic challenges, available and emerging iron therapies, treatment targets, and patient outcomes. The second conference will discuss issues more specifically related to erythropoiesis-stimulating agents, including epoetins, and hypoxia-inducible factor-prolyl hydroxylase inhibitors. Here we provide a concise overview of the consensus points and controversies resulting from the first conference and prioritize key questions that need to be answered by future research.
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Affiliation(s)
- Jodie L Babitt
- Nephrology Division, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA.
| | - Michele F Eisenga
- Department of Internal Medicine, Division of Nephrology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Volker H Haase
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA; Department of Molecular Physiology and Biophysics and Program in Cancer Biology, Vanderbilt University School of Medicine, Nashville, Tennessee, USA; Department of Medical Cell Biology, Division of Integrative Physiology, Uppsala University, Uppsala, Sweden
| | - Abhijit V Kshirsagar
- UNC Kidney Center and Division of Nephrology & Hypertension, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Adeera Levin
- Department of Medicine, Division of Nephrology, St. Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Francesco Locatelli
- Department of Nephrology and Dialysis, Alessandro Manzoni Hospital, ASST Lecco, Lecco, Italy
| | - Jolanta Małyszko
- Department of Nephrology, Dialysis, and Internal Medicine, Medical University of Warsaw, Warsaw, Poland
| | - Dorine W Swinkels
- Translational Metabolic Laboratory, Department of Laboratory Medicine, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Der-Cherng Tarng
- Division of Nephrology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | | | - Michel Jadoul
- Cliniques Universitaires Saint Luc, Université Catholique de Louvain, Brussels, Belgium
| | - Wolfgang C Winkelmayer
- Department of Medicine, Section of Nephrology, Selzman Institute for Kidney Health, Baylor College of Medicine, Houston, Texas, USA
| | - Tilman B Drüeke
- Inserm Unit 1018, Team 5, CESP, Hôpital Paul Brousse, Paris-Sud University (UPS), Villejuif, France; Versailles Saint-Quentin-en-Yvelines University (Paris-Ile-de-France-Ouest University, UVSQ), Villejuif, France.
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Cox HD, Miller GD, Manandhar A, Husk JD, Jia X, Marvin J, Ward DM, Phillips J, Eichner D. Measurement of Immature Reticulocytes in Dried Blood Spots by Mass Spectrometry. Clin Chem 2021; 67:1071-1079. [PMID: 33993255 DOI: 10.1093/clinchem/hvab058] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Accepted: 03/23/2021] [Indexed: 11/13/2022]
Abstract
BACKGROUND Immature reticulocytes (IRC) are the first cells to respond to changes in erythropoiesis. For antidoping applications, measurement of IRC may improve detection of blood doping practices. Unfortunately, this small cell population has limited stability in liquid blood samples and is difficult to measure with optimal precision. We developed a method to measure 3 IRC membrane proteins in dried blood spots (DBS) to monitor changes in erythropoiesis. METHODS DBS spots were washed with buffers to remove soluble proteins, membrane proteins remaining in the spot were digested with trypsin, and one peptide for each protein was measured by LC-MS/MS. IRC protein concentration was determined using a DBS single point calibrator. RESULTS Intraassay precision for IRC proteins was between 5%-15%. IRC proteins were stable in DBS for 29 days at room temperature. In a longitudinal study of 25 volunteers, the mean intraindividual variation for 3 IRC proteins was 17%, 20%, and 24% from capillary blood DBS. In comparison, the mean longitudinal variation for IRC counts measured on an automated hematology analyzer was 38%. IRC protein concentration from capillary blood DBS correlated well with venous blood DBS protein concentrations. CONCLUSIONS Measurement of IRC proteins in DBS samples provides a method to measure changes in erythropoiesis with improved analytical sensitivity, stability, and precision. When combined with the inherent advantages of capillary blood collection in the field, this method may substantially improve the detection of blood doping practices.
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Affiliation(s)
- Holly D Cox
- Sports Medicine Research and Testing Laboratory, South Jordan, UT, USA
| | - Geoffrey D Miller
- Sports Medicine Research and Testing Laboratory, South Jordan, UT, USA
| | | | - Jacob D Husk
- Sports Medicine Research and Testing Laboratory, South Jordan, UT, USA
| | - Xuan Jia
- Department of Pathology, Division of Microbiology and Immunology, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - James Marvin
- Flow Cytometry Core Facility, University of Utah Health Sciences Center, Salt Lake City, UT, USA
| | - Diane M Ward
- Department of Pathology, Division of Microbiology and Immunology, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - John Phillips
- Department of Internal Medicine, Division of Hematology and Hematologic Malignancies, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Daniel Eichner
- Sports Medicine Research and Testing Laboratory, South Jordan, UT, USA
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Evaluation of the expression of red blood cell CD36, interleukin-6 and interleukin-8 in sickle cell anemia pediatric patients. Cytokine 2021; 143:155534. [PMID: 33888402 DOI: 10.1016/j.cyto.2021.155534] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2020] [Revised: 01/08/2021] [Accepted: 04/01/2021] [Indexed: 02/02/2023]
Abstract
Sickle cell anemia (SCA) is a complex multisystem disease characterized by acute and chronic inflammation, with alterations in inflammatory cytokines and adhesion molecules. This case-control study was carried out to assess the levels of CD36, immature reticulocytes, interleukin (IL)-6 and IL8 in SCA patients (in crisis and the steady state) and healthy controls. It included 90 children who were 2-18 years old; 60 with SCA and 30 healthy controls. Complete blood count, total reticulocyte count, reticulocyte subpopulations, immature reticulocyte fraction (IRF), percentage of CD36-positive red blood cells (RBCs), IL-6 and IL-8 levels were evaluated. The total white blood cell (WBC) and neutrophil counts, CD36-positive RBCs percentage, IRF, IL-6 and IL-8 levels were significantly higher in crises than in the steady state (P < 0.05). We also found that patients with SCA had significantly higher reticulocyte, WBC and neutrophil counts, fetal hemoglobin, CD36-positive RBCs percentage, IRF, and IL-6 and IL-8 levels than healthy children (P < 0.05). A significant positive linear correlation was reported between IL-6 and neutrophils during crises (Spearman correlation coefficient = 0.397, P = 0.03). These findings suggest that the levels of adhesion molecules and inflammatory markers and IRF, as evidenced by CD36-positive RBCs, IL-6 and IL-8, are elevated in SCA patients, both during steady state and crises, although these elevations are more marked during crises. Further knowledge about these cytokines and adhesion molecules will help in understanding the pathogenesis and improve therapy of SCA.
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Reconciling markedly discordant values of serum ferritin versus reticulocyte hemoglobin content. J Perinatol 2021; 41:619-626. [PMID: 33012780 DOI: 10.1038/s41372-020-00845-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Revised: 09/02/2020] [Accepted: 09/24/2020] [Indexed: 11/08/2022]
Abstract
OBJECTIVE To determine why serum ferritin and reticulocyte hemoglobin (RET-He), drawn to assess neonatal iron sufficiency, sometimes have markedly discordant results. STUDY DESIGN Retrospective records review of five NICUs over 28 months, identifying all patients with a ferritin and RET-He within 48 h. We examined records of all who had marked discordance (one value >95th % reference interval, the other <5th %). RESULTS Of 190 paired ferritin and RET-He measurements, 16 (8%) were markedly discordant. Fifteen of the 16 discordant samples involved a high ferritin and a low RET-He. In these, low MCV and high %Micro-R, and low MCH and high %HYPO-He were present. In total, 8 of the 15 had laboratory or clinical evidence of an inflammatory process and five had suspicion of infection documented. CONCLUSIONS When ferritin and RET-He were discordant, erythrocyte microcytosis and hypochromasia suggested that the RET-He gave the more accurate interpretation; that iron deficiency was likely present.
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55
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Knychala MA, Garrote-Filho MDS, Batista da Silva B, Neves de Oliveira S, Yasminy Luz S, Marques Rodrigues MO, Penha-Silva N. Red cell distribution width and erythrocyte osmotic stability in type 2 diabetes mellitus. J Cell Mol Med 2021; 25:2505-2516. [PMID: 33591627 PMCID: PMC7933938 DOI: 10.1111/jcmm.16184] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Revised: 01/30/2020] [Accepted: 11/07/2020] [Indexed: 12/15/2022] Open
Abstract
This study aimed to investigate the relationship between red cell distribution width (RDW) and erythrocyte osmotic stability in non‐diabetic and diabetic individuals in both sexes. The study sample (N = 122) was constituted by 53 type 2 diabetics (DM) and 69 non‐diabetics (ND), being 21 and 22 men in each group, respectively. The osmotic stability of erythrocytes was obtained by the variation in saline concentration (dX) capable of determining hypoosmotic lysis. Higher RDW values and lower serum iron concentrations were found in the diabetic group when compared to the non‐diabetic volunteers. In the group of diabetic women, RDW was positively correlated with the reticulocyte index, and both RDW and dX were negatively correlated with iron, haemoglobin, transferrin saturation index, mean corpuscular haemoglobin and mean corpuscular haemoglobin concentration. In all the groups studied, RDW was positively correlated with dX, especially in the diabetic group, where the correlation was the strongest. RDW elevation in both women and men with type 2 diabetes mellitus was associated with decreased serum iron indicators. Furthermore, RDW has a similar meaning to dX, as small erythrocytes have less haemoglobin, resulting in both an increase of RDW and dX.
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Affiliation(s)
| | | | | | | | - Sarah Yasminy Luz
- Institute of Biotechnology, Federal University of Uberlândia, Uberlândia, Brazil
| | | | - Nilson Penha-Silva
- Institute of Biotechnology, Federal University of Uberlândia, Uberlândia, Brazil
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56
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Ianni B, McDaniel H, Savilo E, Wade C, Micetic B, Johnson S, Gerkin R. Defining Normal Healthy Term Newborn Automated Hematologic Reference Intervals at 24 Hours of Life. Arch Pathol Lab Med 2021; 145:66-74. [PMID: 33367662 DOI: 10.5858/arpa.2019-0444-oa] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/14/2020] [Indexed: 11/06/2022]
Abstract
CONTEXT.— Automated analyzers have advanced the field of clinical hematology, mandating updated complete blood count (CBC) reference intervals (RIs) to be clinically useful. Contemporary newborn CBC RI publications are mostly retrospective, which some authors have cited as one of their cardinal limitations and recommended future prospective studies. OBJECTIVE.— To prospectively establish accurate hematologic RIs for normal healthy term newborns at 24 hours of life given the limitations of the current medical literature. DESIGN.— This prospective study was conducted at an academic tertiary care center, and hematology samples were collected from 120 participants deemed to be normal healthy term newborns. Distributions were assessed for normality and tested for outliers. Reference intervals were values between the 2.5th percentile and 97.5th percentile. RESULTS.— The novel RIs obtained for this study population are as follows: absolute immature granulocyte count, 80/μL to 1700/μL; immature granulocyte percentage, 0.6% to 6.1%; reticulocyte hemoglobin equivalent, 31.7 to 38.4 pg; immature reticulocyte fraction, 35.9% to 52.8%; immature platelet count, 4.73 × 103/μL to 19.72 × 103/μL; and immature platelet fraction, 1.7% to 9.8%. CONCLUSIONS.— This prospective study has defined hematologic RIs for this newborn population, including new advanced clinical parameters from the Sysmex XN-1000 Automated Hematology Analyzer. These RIs are proposed as the new standard and can serve as a strong foundation for continued research to further explore their value in diagnosing and managing morbidities such as sepsis, anemia, and thrombocytopenia.
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Affiliation(s)
- Barbara Ianni
- From the Division of Neonatal Medicine, MEDNAX Services, Inc, Phoenix Perinatal Associates, Phoenix, Arizona.,University of Arizona College of Medicine - Phoenix.,Neonatal Intensive Care Unit, Banner - University Medical Center Phoenix, Phoenix, Arizona (Ianni)
| | - Holly McDaniel
- Laboratory, Banner Desert and Cardons Children's Medical Centers, Laboratory Sciences of Arizona, Mesa (McDaniel)
| | - Elena Savilo
- Laboratory, Banner - University Medical Center Phoenix, Laboratory Sciences of Arizona, Phoenix (Savilo)
| | - Christine Wade
- Clinical Research, Division of Neonatal Medicine, MEDNAX Services, Inc, Phoenix Perinatal Associates, Phoenix, Arizona (Wade, Micetic, Johnson)
| | - Becky Micetic
- Clinical Research, Division of Neonatal Medicine, MEDNAX Services, Inc, Phoenix Perinatal Associates, Phoenix, Arizona (Wade, Micetic, Johnson)
| | - Scott Johnson
- Clinical Research, Division of Neonatal Medicine, MEDNAX Services, Inc, Phoenix Perinatal Associates, Phoenix, Arizona (Wade, Micetic, Johnson)
| | - Richard Gerkin
- Department of Internal Medicine, Banner - University Medical Center Phoenix, Phoenix, Arizona and University of Arizona College of Medicine - Phoenix (Gerkin)
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Savković M, Simić-Ogrizović S, Dopsaj V. Factors associated with hepcidin-25 levels in maintenance hemodialysis patients. Ther Apher Dial 2021; 25:565-574. [PMID: 33403761 DOI: 10.1111/1744-9987.13617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2020] [Revised: 11/25/2020] [Accepted: 12/22/2020] [Indexed: 12/01/2022]
Abstract
This study aimed to investigate the factors that are independently associated with hepcidin-25 and its relationship with doses of erythropoiesis-stimulating agents (ESAs) and intravenous iron in stable maintenance hemodialysis patients (smHD) stratified by ESAs administration. In 103 adult smHD (ESAs therapy (N = 64) and ESAs-free (N = 39)), median values of biologically active hepcidin-25 (chemiluminescent direct ELISA assay) and ferritin levels were significantly higher whereas red blood cell count, hemoglobin, and hematocrit values were lower in ESAs therapy compared to ESAs-free group (P < .001, for all). Our results suggest that ESAs-independent smHD exhibit supposedly normal hepcidin-25 levels and preserved iron homeostasis, with a lower degree of anemia. The results of our multivariable model indicate that hepcidin-25 levels are independently and positively associated with iron stores and inflammation, and inversely with active erythropoiesis, regardless of ESAs administration. Maintenance ESAs and the intravenous iron dose were not related to hepcidin-25 levels.
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Affiliation(s)
- Miljan Savković
- Center of Medical Biochemistry, Clinical Center of Serbia, Belgrade, Serbia
| | - Sanja Simić-Ogrizović
- General Hospital Medigroup, Belgrade, Serbia.,Faculty of Medicine, University of Banja Luka, Banja Luka, Bosnia and Herzegovina
| | - Violeta Dopsaj
- Center of Medical Biochemistry, Clinical Center of Serbia, Belgrade, Serbia.,Department of Medical Biochemistry, University of Belgrade - Faculty of Pharmacy, Belgrade, Serbia
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Agarwal AM, Rets A. Laboratory approach to investigation of anemia with a focus on pyruvate kinase deficiency. Int J Lab Hematol 2021; 42 Suppl 1:107-112. [PMID: 32543069 DOI: 10.1111/ijlh.13200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Revised: 03/16/2020] [Accepted: 03/17/2020] [Indexed: 01/19/2023]
Abstract
Anemia is a major health burden worldwide and affects approximately one-third of world's population. It is not a diagnosis; it is a manifestation of an underlying pathophysiology leading to either decreased hemoglobin (Hb), hematocrit (Hct), or red blood cells (RBCs). Iron deficiency anemia is still the most common cause of anemia worldwide. The symptoms are usually due to the underlying compensatory responses to decrease in oxygen delivery to the tissues. Laboratory investigation should start with complete blood count (CBC), reticulocyte count (RC), and peripheral smear evaluation. Further testing depends on these indices, that is, iron parameters and hemoglobinopathies/thalassemia evaluation in microcytic hypochromic anemia, vitamin B12, and folic acid level in macrocytic anemia. Increased RC denotes adequate bone marrow response and points toward hemolytic process and vice versa. Anemia diagnosis can be complex and confusing for the practicing physician. This review tries to give a practical simplistic approach to the diagnosis, focusing mainly on the basic parameters, that is, CBC, RC, and peripheral smear etc. Moreover, we have also tried to provide an update on the pyruvate kinase deficiency, as there has been recent exciting development in the management of these patients.
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Affiliation(s)
- Archana M Agarwal
- University of Utah-Pathology, Salt Lake City, Utah.,ARUP Laboratories - Pathology, Salt Lake City, Utah
| | - Anton Rets
- University of Utah-Pathology, Salt Lake City, Utah.,ARUP Laboratories - Pathology, Salt Lake City, Utah
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Son YB, Bharti D, Kim SB, Bok EY, Lee SY, Ho HJ, Lee SL, Rho GJ. Hematological patterns and histopathological assessment of Miniature Pigs in the experiments on human mesenchymal stem cell transplantation. Int J Med Sci 2021; 18:1259-1268. [PMID: 33526987 PMCID: PMC7847617 DOI: 10.7150/ijms.53036] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Accepted: 12/18/2020] [Indexed: 12/25/2022] Open
Abstract
Background: Multipotent and immune privileged properties of mesenchymal stem cells (MSCs) were investigated for the treatment of various clinical diseases. For the years, many researches into the animal studies evaluated human stem cell therapeutic capacity related to the regenerative medicine. However, there were limited reports on immune privileged properties of human MSCs in animal studies. The present study investigated hematological and biochemical parameter and lymphocyte subset in mini-pigs following human MSCs transplantation as a means of validation of reliability that influence the animal test results. Methods: The miniature pigs were transplanted with human MSCs seeded with scaffold. After transplantation, all animals were evaluated by CBC, biochemistry and lymphocyte subset test. After 9 weeks, all pigs were sacrificed and organs were histologically analyzed. Results: CBC test showed that levels of RBC were decreased and reticulocyte, WBC and neutrophil were increased in transient state initially after transplantation, but returned to normal value. The proportion of B lymphocyte and cytotoxic T cell were also initially enhanced within the normal range temporarily. The female and male miniature pigs showed normal ranges for blood chemistry assessments. During the 9 weeks post-operative period, the animals showed a continuous increase in body weight and length. Furthermore, no abnormal findings were observed from the histological analysis of sacrificed pigs. Conclusions: Overall, miniature pigs transplanted with human MSCs seeded with scaffold were found to have physiologically similar results to normal animals. This result might be a reliable indicator of the animal experiments using miniature pigs with human MSCs.
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Affiliation(s)
- Young-Bum Son
- Department of Theriogenology and Biotechnology, College of Veterinary Medicine and Research Institute of Life Science, Gyeongsang National University, Jinju, Republic of Korea
| | - Dinesh Bharti
- Department of Theriogenology and Biotechnology, College of Veterinary Medicine and Research Institute of Life Science, Gyeongsang National University, Jinju, Republic of Korea
| | - Saet-Byul Kim
- Department of Theriogenology and Biotechnology, College of Veterinary Medicine and Research Institute of Life Science, Gyeongsang National University, Jinju, Republic of Korea
| | - Eun-Yeong Bok
- Department of Theriogenology and Biotechnology, College of Veterinary Medicine and Research Institute of Life Science, Gyeongsang National University, Jinju, Republic of Korea
| | - Sang-Yeob Lee
- Department of Theriogenology and Biotechnology, College of Veterinary Medicine and Research Institute of Life Science, Gyeongsang National University, Jinju, Republic of Korea
| | - Han-Jang Ho
- Department of Theriogenology and Biotechnology, College of Veterinary Medicine and Research Institute of Life Science, Gyeongsang National University, Jinju, Republic of Korea
| | - Sung-Lim Lee
- Department of Theriogenology and Biotechnology, College of Veterinary Medicine and Research Institute of Life Science, Gyeongsang National University, Jinju, Republic of Korea
| | - Gyu-Jin Rho
- Department of Theriogenology and Biotechnology, College of Veterinary Medicine and Research Institute of Life Science, Gyeongsang National University, Jinju, Republic of Korea
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Beske PH, Wilhelm CM, Harvilchuck JA, Platoff GE, Yeung DT. A Rodent Model of Sulfur Mustard Hematologic Toxicity for the Efficacy Evaluation of Candidate Medical Countermeasures. Mil Med 2020; 187:e106-e115. [PMID: 33346363 DOI: 10.1093/milmed/usaa510] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Revised: 10/15/2020] [Accepted: 12/08/2020] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION While exposure to sulfur mustard (SM) is commonly associated with the production of vesicating dermal, ocular, and respiratory injuries, systemic damage to bone marrow and lymphatic tissue can decrease critical immune cell populations leading to higher susceptibility to life-threatening infection and septicemia. There are currently no approved medical countermeasures for SM-induced myelosuppression. An intravenous SM challenge model was developed in adult rats as a preliminary proof-of-principle platform to evaluate the efficacy of candidate immunostimulants. MATERIALS AND METHODS Adult male and female Sprague Dawley rats were exposed to SM through tail vein injection. Toxicity progression was monitored through clinical observations, body weights, body temperatures, hematology, serum clinical chemistry, and flow cytometry of blood and bone marrow samples. RESULTS Following SM exposure, overt toxicity progression was characterized by weight loss, changes in body temperature, and manifestation of toxic clinical signs (diarrhea, lethargy, hunched posture, rough hair coat, respiratory distress, and death). Drastic alterations in complete blood cell profiles included an early-onset lymphopenia followed by a delayed-onset neutropenia and thrombocytopenia. Only transient changes in serum clinical chemistry parameters were observed. Flow cytometry analysis of circulating blood revealed that B-cells were more predominantly affected by SM exposure than T-cells. Challenge with SM resulted in loss of hematopoietic and mesenchymal stem cell populations in the bone marrow. CONCLUSIONS The small animal model developed in this study replicates many key aspects of human SM exposures and should serve as a relevant, rapid, and cost-effective platform to screen candidate medical countermeasures for SM-induced hematologic toxicity.
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Affiliation(s)
- Phillip H Beske
- Battelle Biomedical Research Center, West Jefferson, OH 43162, USA
| | | | | | - Gennady E Platoff
- National Institutes of Health/National Institute of Allergy and Infectious Diseases - Chemical Countermeasures Research Program, Bethesda, MD 20892, USA
| | - David T Yeung
- National Institutes of Health/National Institute of Allergy and Infectious Diseases - Chemical Countermeasures Research Program, Bethesda, MD 20892, USA
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Kaboré B, Post A, Berendsen MLT, Diallo S, Lompo P, Derra K, Rouamba E, Jacobs J, Tinto H, de Mast Q, van der Ven AJ. Red blood cell homeostasis in children and adults with and without asymptomatic malaria infection in Burkina Faso. PLoS One 2020; 15:e0242507. [PMID: 33253198 PMCID: PMC7703889 DOI: 10.1371/journal.pone.0242507] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Accepted: 11/02/2020] [Indexed: 11/30/2022] Open
Abstract
Asymptomatic malaria infections may affect red blood cell (RBC) homeostasis. Reports indicate a role for chronic hemolysis and splenomegaly, however, the underlying processes are incompletely understood. New hematology analysers provide parameters for a more comprehensive analysis of RBC hemostasis. Complete blood counts were analysed in subjects from all age groups (n = 1118) living in a malaria hyperendemic area and cytokines and iron biomarkers were also measured. Subjects were divided into age groups (<2 years, 2–4, 5–14 and ≥15 years old) and clinical categories (smear-negative healthy subjects, asymptomatic malaria and clinical malaria). We found that hemoglobin levels were similar in smear-negative healthy children and asymptomatic malaria children but significantly lower in clinical malaria with a maximum difference of 2.2 g/dl in children <2 years decreasing to 0.1 g/dl in those aged ≥15 years. Delta-He, presenting different hemoglobinization of reticulocytes and RBC, levels were lower in asymptomatic and clinial malaria, indicating a recent effect of malaria on erythropoiesis. Reticulocyte counts and reticulocyte production index (RPI), indicating the erythropoietic capacity of the bone marrow, were higher in young children with malaria compared to smear-negative subjects. A negative correlation between reticulocyte counts and Hb levels was found in asymptomatic malaria (ρ = -0.32, p<0.001) unlike in clinical malaria (ρ = -0.008, p = 0.92). Free-Hb levels, indicating hemolysis, were only higher in clinical malaria. Phagocytozing monocytes, indicating erythophagocytosis, were highest in clinical malaria, followed by asymptomatic malaria and smear-negative subjects. Circulating cytokines and iron biomarkers (hepcidin, ferritin) showed similar patterns. Pro/anti-inflammatory (IL-6/IL-10) ratio was higher in clinical than asymptomatic malaria. Cytokine production capacity of ex-vivo whole blood stimulation with LPS was lower in children with asymptomatic malaria compared to smear-negative healthy children. Bone marrow response can compensate the increased red blood cell loss in asymptomatic malaria, unlike in clinical malaria, possibly because of limited level and length of inflammation. Trial registration: Prospective diagnostic study: ClinicalTrials.gov identifier: NCT02669823. Explorative cross-sectional field study: ClinicalTrials.gov identifier: NCT03176719.
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Affiliation(s)
- Berenger Kaboré
- Department of Internal Medicine, Radboud Center for Infectious Diseases, Radboud University Medical Center, Nijmegen, The Netherlands
- IRSS/Clinical Research Unit of Nanoro (CRUN), Nanoro, Burkina Faso
- * E-mail: (BK); (AJV)
| | - Annelies Post
- Department of Internal Medicine, Radboud Center for Infectious Diseases, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Mike L. T. Berendsen
- Department of Internal Medicine, Radboud Center for Infectious Diseases, Radboud University Medical Center, Nijmegen, The Netherlands
- Open Patient Data Explorative Network, Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Salou Diallo
- IRSS/Clinical Research Unit of Nanoro (CRUN), Nanoro, Burkina Faso
| | | | - Karim Derra
- IRSS/Clinical Research Unit of Nanoro (CRUN), Nanoro, Burkina Faso
| | - Eli Rouamba
- IRSS/Clinical Research Unit of Nanoro (CRUN), Nanoro, Burkina Faso
| | - Jan Jacobs
- Department of Clinical Sciences, Institute of Tropical Medicine (ITM), Antwerp, Belgium
- Department of Microbiology and Immunology, University of Leuven (KU Leuven), Leuven, Belgium
| | - Halidou Tinto
- IRSS/Clinical Research Unit of Nanoro (CRUN), Nanoro, Burkina Faso
- Centre Muraz, Bobo-Dioulasso, Burkina Faso
| | - Quirijn de Mast
- Department of Internal Medicine, Radboud Center for Infectious Diseases, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Andre J. van der Ven
- Department of Internal Medicine, Radboud Center for Infectious Diseases, Radboud University Medical Center, Nijmegen, The Netherlands
- * E-mail: (BK); (AJV)
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Davis BH. Assay for "fetal hemoglobin levels" in erythrocytes: Impact of new In Vitro Diagnostics regulation and expanded applications in sickle cell disease management. Am J Hematol 2020; 95:1230-1232. [PMID: 32815659 DOI: 10.1002/ajh.25971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Accepted: 08/17/2020] [Indexed: 11/10/2022]
Affiliation(s)
- Bruce Hewat Davis
- Department of Microbiology University of Porto Faculty of Medicine Porto Portugal
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63
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Severe ineffective erythropoiesis discriminates prognosis in myelodysplastic syndromes: analysis based on 776 patients from a single centre. Blood Cancer J 2020; 10:83. [PMID: 32801296 PMCID: PMC7429953 DOI: 10.1038/s41408-020-00349-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 07/29/2020] [Accepted: 08/03/2020] [Indexed: 12/17/2022] Open
Abstract
The underlying mechanisms and clinical significance of ineffective erythropoiesis in myelodysplastic syndromes (MDS) remain to be fully defined. We conducted the ex vivo erythroid differentiation of megakaryocytic-erythroid progenitors (MEPs) from MDS patients and discovered that patient-derived erythroblasts exhibit precocity and premature aging phenotypes, partially by inducing the pro-aging genes, like ERCC1. Absolute reticulocyte count (ARC) was chosen as a biomarker to evaluate the severity of ineffective erythropoiesis in 776 MDS patients. We found that patients with severe ineffective erythropoiesis displaying lower ARC (<20 × 109/L), were more likely to harbor complex karyotypes and high-risk somatic mutations (p < 0.05). Lower ARCs are associated with shorter overall survival (OS) in univariate analysis (p < 0.001) and remain significant in multivariable analysis. Regardless of patients of lower-risk who received immunosuppressive therapy or higher-risk who received decitabine treatment, patients with lower ARC had shorter OS (p < 0.001). Whereas no difference in OS was found between patients receiving allo-hematopoietic stem cell transplantations (Allo-HSCT) (p = 0.525). Our study revealed that ineffective erythropoiesis in MDS may be partially caused by premature aging and apoptosis during erythroid differentiation. MDS patients with severe ineffective erythropoiesis have significant shorter OS treated with immunosuppressive or hypo-methylating agents, but may benefit from Allo-HSCT.
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64
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Jäger B, Vargas KG, Haller PM, Stojkovic S, Kaufmann CC, Freynhofer M, Quehenberger P, Wagner O, Wojta J, Huber K. Immature cell fractions after cessation of chronic P2Y 12-inhibition in patients with coronary artery diseases. Platelets 2020; 32:815-820. [PMID: 32762577 DOI: 10.1080/09537104.2020.1803252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Changes in circulating cell populations may promote ischemic events that occur soon after discontinuation of P2Y12-inhibition. The aim of the study was to track the course of thrombopoietic and erythropoietic cells in patients with coronary artery diseases (CAD) after planned and physician-driven cessation of chronic P2Y12-inhibition (clopidogrel 75 mg OD, or prasugrel 10 mg OD, or ticagrelor 90 mg BID). Cell fractions were determined in 62 patients at baseline (the last day of P2Y12-inhibitor intake), on day-10, day-30, and day-180 thereafter. Immature platelet fraction (IPF), immature reticulocyte fraction (IRF), reticulocyte hemoglobin content (Ret-Hb) and red blood cell count (RBC) significantly increased from baseline to day-180 (IPF: p = .003; IRF: p = .013; Ret-Hb: p < .001; RBC: p = .044). Platelet count, leucocyte count and immature granulocyte fraction did not change over time (p = .561, p = .869, and p = .161, respectively). Fibrinogen levels significantly declined over time (p = .011), thrombopoietin levels increased in a non-significant manner (p = .379). We did not observe any significant interaction with choice of P2Y12-inhibitor, therefore suggesting a drug class-effect. Our data shows, that discontinuation of dual antiplatelet therapy is associated with raised thrombopoietic and erythropoietic activity in the bone marrow, without significant upregulation of thrombopoietin. This provides further evidence for a direct stimulation of precursor cells by P2Y12-inhibitors.
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Affiliation(s)
- Bernhard Jäger
- Wilhelminenhospital, 3rd Medical Department with Cardiology, Vienna, AT, Austria.,Medical Faculty, Sigmund Freud University, Vienna, AT, Austria
| | - Kris G Vargas
- Wilhelminenhospital, 3rd Medical Department with Cardiology, Vienna, AT, Austria
| | - Paul M Haller
- Wilhelminenhospital, 3rd Medical Department with Cardiology, Vienna, AT, Austria
| | - Stefan Stojkovic
- Department of Cardiology Medical University of Vienna, University Clinic for Internal Medicine II, Vienna, AT, Austria
| | - Christoph C Kaufmann
- Wilhelminenhospital, 3rd Medical Department with Cardiology, Vienna, AT, Austria
| | - Matthias Freynhofer
- Wilhelminenhospital, 3rd Medical Department with Cardiology, Vienna, AT, Austria
| | - Peter Quehenberger
- Department of Laboratory Medicine, Medical University of Vienna, Vienna, AT, Austria
| | - Oswald Wagner
- Department of Laboratory Medicine, Medical University of Vienna, Vienna, AT, Austria
| | - Johann Wojta
- Department of Cardiology Medical University of Vienna, University Clinic for Internal Medicine II, Vienna, AT, Austria
| | - Kurt Huber
- Wilhelminenhospital, 3rd Medical Department with Cardiology, Vienna, AT, Austria.,Medical Faculty, Sigmund Freud University, Vienna, AT, Austria
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65
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Ahmed MM, Ghauri SK, Javaeed A, Rafique N, Hussain W, Khan N. Trends of utilization of Complete Blood Count parameters for patient management among doctors in Azad Kashmir. Pak J Med Sci 2020; 36:999-1004. [PMID: 32704278 PMCID: PMC7372683 DOI: 10.12669/pjms.36.5.1885] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Objective: To determine the trends of utilization of CBC parameters in patient management among doctors in different hospitals in Kashmir, Pakistan. Methodd: A self-administered questionnaire-based survey was carried out amongst doctors working in four hospitals of Kashmir i.e. Combined Military Hospital, Muzaffarabad, Combined Military Hospital, Rawalakot, Abbas Institute of Medical Sciences, Muzaffarabad, and District Hospital, Kotli during August to December 2017. Results: Out of 500 physicians, 217 physicians answered the questionnaire, representing a response rate of 43.4%. Only three of the 11 parameters in the CBC report i.e. hemoglobin, white blood cell count and platelets were selected as frequently or always useful by more than 80% of physicians. Rest of the eight parameters of the CBC were found useful by less than 80% of the physicians. Most agreed that the current format of a CBC report gives adequate information. Conclusion: The present study concludes that majority of the physicians utilize only three of the basic parameters on the complete blood count. An educational intervention can be planned for the physicians to increase their knowledge about the utility of other parameters.
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Affiliation(s)
- Malik Mahmood Ahmed
- Malik Mahmood Ahmed, MBBS, DCP, M.Phil. Azad Jammu & Kashmir Medical College, Muzaffarabad, Azad Kashmir, Pakistan
| | - Sanniya Khan Ghauri
- Dr. Sanniya Khan Ghauri, MBBS, MRCEM. Department of Emergency Medicine, Shifa International Hospital, Islamabad, Pakistan
| | - Arslaan Javaeed
- Dr. Arslaan Javaeed, MBBS, M.Phil., MHPE, MHR. Poonch Medical College, Rawalakot, Azad Kashmir, Pakistan
| | - Nazish Rafique
- Nazish Rafique, BS Clinical Laboratory Sciences, Faculty of Allied Health Science, AJK University, Azad Kashmir, Pakistan
| | - Wajid Hussain
- Wajid Hussain, BS Clinical Laboratory Sciences, Faculty of Allied Health Science, AJK University, Azad Kashmir, Pakistan
| | - Nasir Khan
- Nasir Khan, BS Clinical Laboratory Sciences, Faculty of Allied Health Science, AJK University, Azad Kashmir, Pakistan
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66
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Dzirba TA, Moss MDF, Dionisio LM. Assessment of Reticulocyte hemoglobin content in infants in intensive care unities. Int J Lab Hematol 2020; 42:e180-e184. [PMID: 32558240 DOI: 10.1111/ijlh.13233] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Revised: 04/13/2020] [Accepted: 04/18/2020] [Indexed: 11/29/2022]
Affiliation(s)
| | - Mariane de Faria Moss
- Hospital Universitário Regional dos Campos Gerais, Ponta Grossa, Brazil.,Universidade Estadual de Ponta Grossa, Ponta Grossa, Brazil
| | - Laura Mattana Dionisio
- Hospital Universitário Regional dos Campos Gerais, Ponta Grossa, Brazil.,Universidade Estadual de Ponta Grossa, Ponta Grossa, Brazil
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67
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Kumar U, Chandra H, Gupta AK, Singh N, Chaturvedi J. Role of Reticulocyte Parameters in Anemia of First Trimester Pregnancy: A Single Center Observational Study. J Lab Physicians 2020; 12:15-19. [PMID: 32792789 PMCID: PMC7419173 DOI: 10.1055/s-0040-1713585] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/29/2022] Open
Abstract
Introduction The diagnosis of anemia in pregnancy should be early to prevent complications to mother and baby. It should be simple and safe, and therefore feasibility of reticulocyte parameters may prove beneficial in this regard. Newer reticulocyte parameters have not been studied extensively especially in pregnancy. The present study was conducted to evaluate reticulocyte hemoglobin content (Ret-He), immature reticulocyte fraction, and reticulocyte count and to compare them with serum ferritin, mean corpuscular volume (MCV), and mean corpuscular hemoglobin (MCH) in assessment anemia in pregnancy. Material and Methods Prospective study included first trimester pregnant females where hemoglobin, MCV, and MCH were categorized and statistically analyzed with serum ferritin and reticulocyte parameters. Results The study included 155 first trimester pregnant females showing statistical difference in Ret-He between all categories of hemoglobin and MCV ( p < 0.05). ROC curve analysis using MCV < 83 fl and MCH <27 pg showed that area under curve for Ret-He at cutoff of 27.8 ng/mL was 0.93 (95% confidence interval 0.90-0.98, sensitivity 93%, specificity 83%). The cutoff of 27.2 ng/mL Ret-He for the diagnosis of iron deficiency anemia has specificity of 86%, sensitivity 71%, positive predictive value 0.39, and likelihood ratio of 5.1. Conclusion Ret-He is a feasible and easily available parameter which may be helpful in differentiating between microcytic hypochromic and normocytic normochromic anemia along with frank and borderline anemia in first trimester pregnant females. This in turn is essential to initiate an early therapy so as to prevent the maternal and fetal complications.
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Affiliation(s)
- Utpal Kumar
- Department of Pathology and Laboratory Medicine, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Harish Chandra
- Department of Pathology and Laboratory Medicine, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Arvind Kumar Gupta
- Department of Pathology and Laboratory Medicine, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Neha Singh
- Department of Pathology and Laboratory Medicine, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Jaya Chaturvedi
- Department of Obstetrics and Gynecology, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
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68
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Bracho FJ, Osorio IA. Evaluation of the Reticulocyte Production Index in the Pediatric Population. Am J Clin Pathol 2020; 154:70-77. [PMID: 32270177 DOI: 10.1093/ajcp/aqaa020] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
OBJECTIVES Since hematologic values vary with age in children, we evaluated the agreement between the "traditional" reticulocyte production index (RPI) and an RPI by age (RPI/A)-adjusted normal values. METHODS A retrospective, observational, and analytical study was performed on CBCs of children with anemia younger than 18 years. The agreement and clinical repercussions of the RPI values were analyzed with an RPI/A developed with theoretical values for different ages. RESULTS A total of 5,503 tests were analyzed and no systematic error between the two indices was found; however, there were significant proportional differences at higher values that resulted in lower RPI/A in children younger than 15 days and higher RPI/A in children aged 15 days and older. No agreement was observed at any age. The proportion of arregenerative anemia diagnosed using RPI/A was higher in children younger than 15 days and lower in those 15 days and older. CONCLUSIONS RPI is not an adequate tool for evaluating the erythropoietic capacity of bone marrow in the pediatric population. The disagreement between the results can be explained by the difference in normal hematologic values between children and adults.
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Affiliation(s)
- Fernando J Bracho
- Laboratory of Hematology, Luis Calvo Mackenna Hospital, Santiago, Chile
| | - Ignacio A Osorio
- Laboratory of Hematology, Luis Calvo Mackenna Hospital, Santiago, Chile
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69
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Reticulocyte count and its parameters: comparison of automated analyzers, flow cytometry, and manual method. J Hematop 2020. [DOI: 10.1007/s12308-020-00395-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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70
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Evaluation of Anti-Cytotoxic and Anti-Genotoxic Effects of Nigella sativa through a Micronucleus Test in BALB/c Mice. Nutrients 2020; 12:nu12051317. [PMID: 32384595 PMCID: PMC7284975 DOI: 10.3390/nu12051317] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Revised: 04/22/2020] [Accepted: 04/24/2020] [Indexed: 12/19/2022] Open
Abstract
Nigella sativa (N. sativa) is a medicinal plant used for its therapeutic pharmacological effects such as anti-inflammatory, antioxidant, anticancer, antidiabetic, and immunomodulation. This study explored the anti-cytotoxic and anti-genotoxic effect of N. sativa through a micronucleus test (MNT) of BALB/c mice peripheral blood. Using 6-to-8-week-old healthy male BALB/c mice, four groups were formed: (1) Control (sterile water), single-dose 2 mg/kg/intraperitoneal (i.p); (2) N. sativa oil, 500 mg/kg/24 h/7 days/i.p; (3) Cisplatin (CP), single-dose 2 mg/kg/subcutaneous (s.c); (4) N. sativa + CP with their respective dosage. When evaluating polychromatic erythrocytes (PCE), a biomarker of cytotoxicity, the group treated with N. sativa + CP experienced an increase in the frequency of PCE, which demonstrated the recovery of bone marrow and modulation of cell proliferation. The analysis of micronucleated polychromatic erythrocytes (MNPCE), an acute genotoxicity biomarker, showed similar frequency of MNPCE within the groups except in CP, but, in the N. sativa + CP group, the frequency of MNPCE decreased and then regulated. Finally, the frequency of micronucleated erythrocytes (MNE), a biomarker of genotoxicity, the supplementation of N. sativa oil did not induce genotoxic damage in this model. Thus, we conclude that N. sativa has both cytoprotective, genoprotective effects and modulates cell proliferation in BALB/c mice.
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71
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Rössler J, Hegemann I, Schoenrath F, Seifert B, Kaserer A, Spahn GH, Falk V, Spahn DR. Efficacy of quadruple treatment on different types of pre-operative anaemia: secondary analysis of a randomised controlled trial. Anaesthesia 2020; 75:1039-1049. [PMID: 32342498 DOI: 10.1111/anae.15062] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/21/2020] [Indexed: 12/16/2022]
Abstract
In patients with pre-operative anaemia undergoing cardiac surgery, combination treatment with intravenous iron, subcutaneous erythropoietin alpha, vitamin B12 and oral folic acid reduces allogeneic blood product transfusions. It is unclear if certain types of anaemia particularly benefit from this treatment. We performed a post-hoc analysis of anaemic patients from a randomised trial on the 'Effect of ultra-short-term treatment of patients with iron deficiency or anaemia undergoing cardiac surgery'. We used linear regression analyses to examine the efficacy of a combination anaemia treatment compared with placebo on the following deficiencies, each representing a part of the combination treatment: ferritin and transferrin saturation; endogenous erythropoietin; holotranscobalamine; and folic acid in erythrocytes. Efficacy was defined as change in reticulocyte count from baseline to the first, third and fifth postoperative days and represented erythropoietic activity in the immediate peri-operative recovery phase. In all 253 anaemic patients, iron deficiency was the most common cause of anaemia. Treatment significantly increased reticulocyte count in all regression analyses on postoperative days 1, 3 and 5 (all p < 0.001). Baseline ferritin and endogenous erythropoietin were negatively associated with change in reticulocyte count on postoperative day 5, with an unstandardised regression coefficient B of -0.08 (95%CI -0.14 to -0.02) and -0.14 (95%CI -0.23 to -0.06), respectively. Quadruple anaemia treatment was effective regardless of the cause of anaemia and its effect manifested early in the peri-operative recovery phase. The more pronounced a deficiency was, the stronger the subsequent boost to erythropoiesis may have been.
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Affiliation(s)
- J Rössler
- Institute of Anesthesiology, University of Zurich and University Hospital Zurich, Zurich, Switzerland
| | - I Hegemann
- Department of Medical Oncology and Haematology, University of Zurich and University Hospital Zurich, Zurich, Switzerland
| | - F Schoenrath
- Department of Cardiothoracic and Vascular Surgery, German Heart Centre Berlin, German Centre for Cardiovascular Research, Berlin, Germany
| | - B Seifert
- Department of Biostatistics, Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Switzerland
| | - A Kaserer
- Institute of Anesthesiology, University of Zurich and University Hospital Zurich, Zurich, Switzerland
| | - G H Spahn
- Institute of Anesthesiology, University of Zurich and University Hospital Zurich, Zurich, Switzerland
| | - V Falk
- Department of Cardiothoracic and Vascular Surgery, German Heart Centre Berlin, German Centre for Cardiovascular Research, Berlin, Germany.,Department of Cardiothoracic Surgery, Charité - Universitätsmedizin Berlin, Germany.,Department of Health Science and Technology, Swiss Federal Institute of Technology, Zürich, Switzerland
| | - D R Spahn
- Institute of Anesthesiology, University of Zurich and University Hospital Zurich, Zurich, Switzerland
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72
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Larruzea Ibarra A, Muñoz Marín L, Perea Durán G, Torra Puig M. Evaluation of immature platelet fraction in patients with myelodysplastic syndromes. Association with poor prognosis factors. Clin Chem Lab Med 2020; 57:e128-e130. [PMID: 30352024 DOI: 10.1515/cclm-2018-0784] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Accepted: 09/30/2018] [Indexed: 12/13/2022]
Affiliation(s)
- Alex Larruzea Ibarra
- Specialist in Clinical Chemistry, Clinical Laboratory, Parc Taulí Hospital Universitari, Institut d'Investigació i Innovació Parc Taulí I3PT, Universitat Autònoma de Barcelona, Sabadell, Spain, Phone: +34678831873
| | - Luz Muñoz Marín
- Clinical Laboratory, Parc Taulí Hospital Universitari, Institut d'Investigació i Innovació Parc Taulí I3PT, Universitat Autònoma de Barcelona, Sabadell, Spain
| | - Granada Perea Durán
- Clinical Laboratory, Parc Taulí Hospital Universitari, Institut d'Investigació i Innovació Parc Taulí I3PT, Universitat Autònoma de Barcelona, Sabadell, Spain
| | - Montserrat Torra Puig
- Clinical Laboratory, Parc Taulí Hospital Universitari, Institut d'Investigació i Innovació Parc Taulí I3PT, Universitat Autònoma de Barcelona, Sabadell, Spain
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73
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Mack S, Vassallo RR. Component residual white blood cell counting made easy? Transfusion 2020; 60:4-6. [PMID: 31898350 DOI: 10.1111/trf.15642] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Accepted: 12/04/2019] [Indexed: 11/26/2022]
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74
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Du R, Bei H, Jia L, Huang C, Chen Q, Wang J, Wu F, Chen J, Bo H. A low-cost, accurate method for detecting reticulocytes at different maturation stages based on changes in the mitochondrial membrane potential. J Pharmacol Toxicol Methods 2020; 101:106664. [DOI: 10.1016/j.vascn.2019.106664] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Revised: 11/20/2019] [Accepted: 11/21/2019] [Indexed: 12/15/2022]
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75
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Parodi E, Romano F, Ramenghi U. How We Use Reticulocyte Parameters in Workup and Management of Pediatric Hematologic Diseases. Front Pediatr 2020; 8:588617. [PMID: 33344383 PMCID: PMC7746543 DOI: 10.3389/fped.2020.588617] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Accepted: 11/13/2020] [Indexed: 11/25/2022] Open
Affiliation(s)
- Emilia Parodi
- Pediatric Hematology, Department of Pediatric and Public Health Sciences, University of Torino, Turin, Italy
| | - Francesca Romano
- Postgraduate School of Pediatrics, University of Torino, Turin, Italy
| | - Ugo Ramenghi
- Pediatric Hematology, Department of Pediatric and Public Health Sciences, University of Torino, Turin, Italy.,Postgraduate School of Pediatrics, University of Torino, Turin, Italy
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76
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Chaudhury A, Miller GD, Eichner D, Higgins JM. Single-cell modeling of routine clinical blood tests reveals transient dynamics of human response to blood loss. eLife 2019; 8:48590. [PMID: 31845889 PMCID: PMC6917488 DOI: 10.7554/elife.48590] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Accepted: 11/08/2019] [Indexed: 12/31/2022] Open
Abstract
Low blood count is a fundamental disease state and is often an early sign of illnesses including infection, cancer, and malnutrition, but our understanding of the homeostatic response to blood loss is limited, in part by coarse interpretation of blood measurements. Many common clinical blood tests actually include thousands of single-cell measurements. We present an approach for modeling the unsteady-state population dynamics of the human response to controlled blood loss using these clinical measurements of single-red blood cell (RBC) volume and hemoglobin. We find that the response entails (1) increased production of new RBCs earlier than is currently detectable clinically and (2) a previously unrecognized decreased RBC turnover. Both component responses offset the loss of blood. The model provides a personalized dimensionless ratio that quantifies the balance between increased production and delayed clearance for each individual and may enable earlier detection of both blood loss and the response it elicits.
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Affiliation(s)
- Anwesha Chaudhury
- Center for Systems Biology and Department of Pathology, Massachusetts General Hospital, Boston, United States.,Department of Systems Biology, Harvard Medical School, Boston, United States
| | - Geoff D Miller
- Sports Medicine Research and Testing Laboratory, Salt Lake City, United States
| | - Daniel Eichner
- Sports Medicine Research and Testing Laboratory, Salt Lake City, United States
| | - John M Higgins
- Center for Systems Biology and Department of Pathology, Massachusetts General Hospital, Boston, United States.,Department of Systems Biology, Harvard Medical School, Boston, United States
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77
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Malczewska-Lenczowska J, Surała O, Orysiak J, Turowski D, Szczepańska B, Tomaszewski P. Utility of Novel Hypochromia and Microcythemia Markers in Classifying Hematological and Iron Status in Male Athletes. Nutrients 2019; 11:nu11112767. [PMID: 31739525 PMCID: PMC6893463 DOI: 10.3390/nu11112767] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Revised: 11/04/2019] [Accepted: 11/11/2019] [Indexed: 01/01/2023] Open
Abstract
In athletes, no reliable indices exist for an unambiguous evaluation of hematological and iron status. Therefore, the utility of some new red blood cell (RBC) parameters was explored in 931 elite male athletes aged 13–35 years. To diagnose iron status, the values of ferritin and soluble transferrin receptor (sTfR), total iron binding capacity (TIBC), and basic blood morphology were determined in blood. The new hematological markers included among others: mean cellular hemoglobin content in reticulocytes (CHr), percentage of erythrocytes (HYPOm) and reticulocytes (HYPOr) with decreased cellular hemoglobin concentration, percentage of erythrocytes (LowCHm) and reticulocytes (LowCHr) with decreased cellular hemoglobin content, mean volume of reticulocytes (MCVr), and percentage of erythrocytes with decreased volume (MICROm). Despite adverse changes in reticulocyte hypochromia indices (CHr, LowCHr, HYPOr; p < 0.001) in the iron depletion state, the area under the receiver operating characteristic curve (AUC-ROC) values calculated for them were relatively low (0.539–0.722). In iron-deficient erythropoiesis (IDE), unfavorable changes additionally concern microcythemia indices in both reticulocytes and erythrocytes (MCVr, MCV, MICROm, and red cell volume distribution width—RDW), with especially high values of AUC-ROC (0.947–0.970) for LowCHm, LowCHr, and CHr. Dilutional sports anemia was observed in 6.1% of athletes. In this subgroup, only hemoglobin concentration (Hb), hematocrit (Hct), and RBC (all dependent on blood volume) were significantly lower than in the normal group. In conclusion, the diagnostic utility of the new hematology indices was not satisfactory for the detection of an iron depletion state in athletes. However, these new indices present high accuracy in the detection of IDE and sports anemia conditions.
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Affiliation(s)
- Jadwiga Malczewska-Lenczowska
- Department of Nutrition Physiology and Dietetics, Institute of Sport, National Research Institute, Trylogii 2/16, 01-982 Warsaw, Poland; (O.S.); (J.O.); (B.S.)
- Correspondence: ; Tel.: +48-22-569-99-00
| | - Olga Surała
- Department of Nutrition Physiology and Dietetics, Institute of Sport, National Research Institute, Trylogii 2/16, 01-982 Warsaw, Poland; (O.S.); (J.O.); (B.S.)
| | - Joanna Orysiak
- Department of Nutrition Physiology and Dietetics, Institute of Sport, National Research Institute, Trylogii 2/16, 01-982 Warsaw, Poland; (O.S.); (J.O.); (B.S.)
| | - Dariusz Turowski
- Department of Biochemistry, Institute of Sport, National Research Institute, Trylogii 2/16, 01-982 Warsaw, Poland;
| | - Beata Szczepańska
- Department of Nutrition Physiology and Dietetics, Institute of Sport, National Research Institute, Trylogii 2/16, 01-982 Warsaw, Poland; (O.S.); (J.O.); (B.S.)
| | - Paweł Tomaszewski
- Department of Biometry, Józef Piłsudski University of Physical Education, Marymoncka 34, 00-968 Warsaw, Poland
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78
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Kaptoge S, Di Angelantonio E, Moore C, Walker M, Armitage J, Ouwehand WH, Roberts DJ, Danesh J, Thompson SG. Longer-term efficiency and safety of increasing the frequency of whole blood donation (INTERVAL): extension study of a randomised trial of 20 757 blood donors. Lancet Haematol 2019; 6:e510-e520. [PMID: 31383583 PMCID: PMC7029279 DOI: 10.1016/s2352-3026(19)30106-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Revised: 05/23/2019] [Accepted: 05/29/2019] [Indexed: 02/09/2023]
Abstract
BACKGROUND The INTERVAL trial showed that, over a 2-year period, inter-donation intervals for whole blood donation can be safely reduced to meet blood shortages. We extended the INTERVAL trial for a further 2 years to evaluate the longer-term risks and benefits of varying inter-donation intervals, and to compare routine versus more intensive reminders to help donors keep appointments. METHODS The INTERVAL trial was a parallel group, pragmatic, randomised trial that recruited blood donors aged 18 years or older from 25 static donor centres of NHS Blood and Transplant across England, UK. Here we report on the prespecified analyses after 4 years of follow-up. Participants were whole blood donors who agreed to continue trial participation on their originally allocated inter-donation intervals (men: 12, 10, and 8 weeks; women: 16, 14, and 12 weeks). They were further block-randomised (1:1) to routine versus more intensive reminders using computer-generated random sequences. The prespecified primary outcome was units of blood collected per year analysed in the intention-to-treat population. Secondary outcomes related to safety were quality of life, self-reported symptoms potentially related to donation, haemoglobin and ferritin concentrations, and deferrals because of low haemoglobin and other factors. This trial is registered with ISRCTN, number ISRCTN24760606, and has completed. FINDINGS Between Oct 19, 2014, and May 3, 2016, 20 757 of the 38 035 invited blood donors (10 843 [58%] men, 9914 [51%] women) participated in the extension study. 10 378 (50%) were randomly assigned to routine reminders and 10 379 (50%) were randomly assigned to more intensive reminders. Median follow-up was 1·1 years (IQR 0·7-1·3). Compared with routine reminders, more intensive reminders increased blood collection by a mean of 0·11 units per year (95% CI 0·04-0·17; p=0·0003) in men and 0·06 units per year (0·01-0·11; p=0·0094) in women. During the extension study, each week shorter inter-donation interval increased blood collection by a mean of 0·23 units per year (0·21-0·25) in men and 0·14 units per year (0·12-0·15) in women (both p<0·0001). More frequent donation resulted in more deferrals for low haemoglobin (odds ratio per week shorter inter-donation interval 1·19 [95% CI 1·15-1·22] in men and 1·10 [1·06-1·14] in women), and lower mean haemoglobin (difference per week shorter inter-donation interval -0·84 g/L [95% CI -0·99 to -0·70] in men and -0·45 g/L [-0·59 to -0·31] in women) and ferritin concentrations (percentage difference per week shorter inter-donation interval -6·5% [95% CI -7·6 to -5·5] in men and -5·3% [-6·5 to -4·2] in women; all p<0·0001). No differences were observed in quality of life, serious adverse events, or self-reported symptoms (p>0.0001 for tests of linear trend by inter-donation intervals) other than a higher reported frequency of doctor-diagnosed low iron concentrations and prescription of iron supplements in men (p<0·0001). INTERPRETATION During a period of up to 4 years, shorter inter-donation intervals and more intensive reminders resulted in more blood being collected without a detectable effect on donors' mental and physical wellbeing. However, donors had decreased haemoglobin concentrations and more self-reported symptoms compared with the initial 2 years of the trial. Our findings suggest that blood collection services could safely use shorter donation intervals and more intensive reminders to meet shortages, for donors who maintain adequate haemoglobin concentrations and iron stores. FUNDING NHS Blood and Transplant, UK National Institute for Health Research, UK Medical Research Council, and British Heart Foundation.
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Affiliation(s)
- Stephen Kaptoge
- Department of Public Health and Primary Care, Strangeways Research Laboratory, Cambridge, UK; NIHR Blood and Transplant Research Unit in Donor Health and Genomics, Strangeways Research Laboratory, Cambridge, UK; NIHR Cambridge Biomedical Research Centre, Addenbrooke's Hospital, Cambridge, UK; British Heart Foundation Cambridge Centre for Research Excellence, Addenbrooke's Hospital, Cambridge, UK
| | - Emanuele Di Angelantonio
- Department of Public Health and Primary Care, Strangeways Research Laboratory, Cambridge, UK; NIHR Blood and Transplant Research Unit in Donor Health and Genomics, Strangeways Research Laboratory, Cambridge, UK; NHS Blood and Transplant, Cambridge, UK; Oxford, UK; NIHR Cambridge Biomedical Research Centre, Addenbrooke's Hospital, Cambridge, UK; British Heart Foundation Cambridge Centre for Research Excellence, Addenbrooke's Hospital, Cambridge, UK
| | - Carmel Moore
- Department of Public Health and Primary Care, Strangeways Research Laboratory, Cambridge, UK; NIHR Blood and Transplant Research Unit in Donor Health and Genomics, Strangeways Research Laboratory, Cambridge, UK; NIHR Cambridge Biomedical Research Centre, Addenbrooke's Hospital, Cambridge, UK; British Heart Foundation Cambridge Centre for Research Excellence, Addenbrooke's Hospital, Cambridge, UK
| | - Matthew Walker
- Department of Public Health and Primary Care, Strangeways Research Laboratory, Cambridge, UK; NIHR Blood and Transplant Research Unit in Donor Health and Genomics, Strangeways Research Laboratory, Cambridge, UK; NIHR Cambridge Biomedical Research Centre, Addenbrooke's Hospital, Cambridge, UK; British Heart Foundation Cambridge Centre for Research Excellence, Addenbrooke's Hospital, Cambridge, UK
| | - Jane Armitage
- Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, and MRC Population Health Research Unit, University of Oxford, Oxford, UK
| | - Willem H Ouwehand
- Department of Haematology, University of Cambridge, Cambridge Biomedical Campus, Cambridge, UK; NHS Blood and Transplant, Cambridge, UK; Oxford, UK; British Heart Foundation Cambridge Centre for Research Excellence, Addenbrooke's Hospital, Cambridge, UK
| | - David J Roberts
- NIHR Blood and Transplant Research Unit in Donor Health and Genomics, Strangeways Research Laboratory, Cambridge, UK; NIHR Oxford Biomedical Research Centre-Haematology Theme and Radcliffe Department of Medicine, University of Oxford, John Radcliffe Hospital, Oxford, UK; NHS Blood and Transplant, Cambridge, UK; Oxford, UK
| | - John Danesh
- Department of Public Health and Primary Care, Strangeways Research Laboratory, Cambridge, UK; NIHR Blood and Transplant Research Unit in Donor Health and Genomics, Strangeways Research Laboratory, Cambridge, UK; NIHR Cambridge Biomedical Research Centre, Addenbrooke's Hospital, Cambridge, UK; British Heart Foundation Cambridge Centre for Research Excellence, Addenbrooke's Hospital, Cambridge, UK.
| | - Simon G Thompson
- Department of Public Health and Primary Care, Strangeways Research Laboratory, Cambridge, UK; NIHR Blood and Transplant Research Unit in Donor Health and Genomics, Strangeways Research Laboratory, Cambridge, UK; NIHR Cambridge Biomedical Research Centre, Addenbrooke's Hospital, Cambridge, UK; British Heart Foundation Cambridge Centre for Research Excellence, Addenbrooke's Hospital, Cambridge, UK
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Resveratrol reduces store-operated Ca 2+ entry and enhances the apoptosis of fibroblast-like synoviocytes in adjuvant arthritis rats model via targeting ORAI1-STIM1 complex. Biol Res 2019; 52:45. [PMID: 31426853 PMCID: PMC6699118 DOI: 10.1186/s40659-019-0250-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2019] [Accepted: 08/01/2019] [Indexed: 01/29/2023] Open
Abstract
Background Resveratrol was reported to trigger the apoptosis of fibroblast-like synoviocytes in adjuvant arthritis rats but the subcellular mechanism remains unclear. Since ER stress, mitochondrial dysfunction and oxidative stress were involved in the effects of resveratrol with imbalance of calcium bio-transmission, store operated calcium entry (SOCE), a novel intracellular calcium regulatory pathway, may also participate in this process. Results In the present study, Resveratrol was found to suppress ORAI1 expression of a dose dependent manner while have no evident effects on STIM1 expressive level. Besides, resveratrol had no effects on ATP or TG induced calcium depletion but present partly dose-dependent suppression of SOCE. On the one hand, microinjection of ORAI1 overexpressed vector in sick toe partly counteracted the therapeutic effects of resveratrol on adjuvant arthritis and serum inflammatory cytokine including IL-1, IL-6, IL-8, IL-10 and TNF-α. On the other hand, ORAI1 SiRNA injection provided slight relief to adjuvant arthritis in rats. In addition, ORAI1 overexpression partly diminished the alleviation of hemogram abnormality induced by adjuvant arthritis after resveratrol treatment while ORAI1 knockdown presented mild resveratrol-like effect on hemogram in rats model. Conclusion These results indicated that resveratrol reduced store-operated Ca2+ entry and enhanced the apoptosis of fibroblast-like synoviocytes in adjuvant arthritis rats model via targeting ORAI1–STIM1 complex, providing a theoretical basis for ORAI1 targeted therapy in future treatment with resveratrol on rheumatoid arthritis.![]() Electronic supplementary material The online version of this article (10.1186/s40659-019-0250-7) contains supplementary material, which is available to authorized users.
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A 4-Week Repeated Oral Dose Toxicity Study of Ssanghwa-Tang in Crl:CD Sprague Dawley Rats. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2019; 2019:2135351. [PMID: 31223325 PMCID: PMC6541986 DOI: 10.1155/2019/2135351] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Accepted: 05/02/2019] [Indexed: 11/30/2022]
Abstract
Ssanghwa-tang (SHT), a traditional herbal formula, has been widely used to recover fatigue or consumptive disease after an illness. Along with much attention to herbal formula, the concerns about the safety and toxicity have arisen. To establish the safety information, SHT was administrated in Crl:CD Sprague Dawley rats at a daily dose of 0, 1000, 2000, and 5000 mg/kg for 4 weeks. During the test periods, we examined the mortality, clinical observation, body weight change, food consumption, organ weights, hematology, serum biochemistry, and urinalysis parameters. No changes of mortality and necropsy findings occurred in any of the groups during the experimental period. In either sex of rats treated with SHT at 5000 mg/kg/day, changes were observed in food intake, reticulocyte, total bilirubin, some urinalysis parameters, and relative organ weights. The results indicated that SHT did not induce toxic effects at a dose level up to 2000 mg/kg in rats. This dosage was considered no observed adverse effect level (NOAEL) and was appropriate for a 13-week subchronic toxicity study.
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Urrechaga E, Hoffmann JJML. Assessment of iron-restricted erythropoiesis in chronic renal disease: evaluation of Abbott CELL-DYN Sapphire mean reticulocyte hemoglobin content (MCHr). Scandinavian Journal of Clinical and Laboratory Investigation 2019; 79:363-367. [DOI: 10.1080/00365513.2019.1622149] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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Shi XQ, Yue SJ, Tang YP, Chen YY, Zhou GS, Zhang J, Zhu ZH, Liu P, Duan JA. A network pharmacology approach to investigate the blood enriching mechanism of Danggui buxue Decoction. JOURNAL OF ETHNOPHARMACOLOGY 2019; 235:227-242. [PMID: 30703496 DOI: 10.1016/j.jep.2019.01.027] [Citation(s) in RCA: 87] [Impact Index Per Article: 17.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Revised: 01/21/2019] [Accepted: 01/26/2019] [Indexed: 06/09/2023]
Abstract
ETHNOPHARMACOLOGICAL RELEVANCE Danggui buxue Decoction (DBD) has been frequently used to treat with blood deficiency, which consisted of Danggui (DG) and Huangqi (HQ) at a ratio of 1:5. Accumulating evidence showed that blood deficiency in traditional Chinese medicine (TCM) was similar to anemia in modern medicine. AIM OF THE STUDY The purpose of this study was to explore its therapeutic mechanism of with network pharmacology approach. MATERIALS AND METHODS We explored the chemical compounds of DBD and used compound ADME screening to identify the potential compounds. Targets for the therapeutic actions of DBD were obtained from the PharmMapper, Swiss, SEA and STITCH. GO analysis and pathway enrichment analysis was performed using the DAVID webserver. Cytoscape was used to visualize the compound-target-pathway network for DBD. The pharmacodynamics and crucial targets were also validated. RESULTS Thirty-six potential active components in DBD and 49 targets which the active components acted on were identified. 47 KEGG pathways which DBD acted on were also come to light. And then, according to KEGG pathway annotation analysis, only 16 pathways seemed to be related to the blood nourishing effect of DBD, such as PI3K-AKT pathway, and so on. Only 32 targets participated in these 16 pathways and they were acted on by 29 of the 36 active compounds. Whole pharmacodynamic experiments showed that DBD had significant effects to blood loss rats. Furthermore, DBD could promote the up-regulation of hematopoietic and immune related targets and the down-regulation of inflammatory related targets. Significantly, with the results of effective rate, molecular docking and experimental validation, we predicted astragaloside IV in HQ, senkyunolide A and senkyunolide K in DG might be the major contributing compounds to DBD's blood enriching effect. CONCLUSION In this study, a systematical network pharmacology approach was built. Our results provided a basis for the future study of senkyunolide A and senkyunolide K as the blood enriching compounds in DBD. Furthermore, combined network pharmacology with validation experimental results, the nourishing blood effect of DBD might be manifested by the dual mechanism of enhancing immunity and promoting hematopoiesis.
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Affiliation(s)
- Xu-Qin Shi
- Jiangsu Collaborative Innovation Center of Chinese Medicinal Resources Industrialization and Jiangsu Key Laboratory for High Technology Research of Traditional Chinese Medicine Formulae and Key Laboratory of Chinese Medicinal Resources Recycling Utilization, State Administration of Traditional Chinese Medicine, Nanjing University of Chinese Medicine, Nanjing 210023, Jiangsu Province, China
| | - Shi-Jun Yue
- Jiangsu Collaborative Innovation Center of Chinese Medicinal Resources Industrialization and Jiangsu Key Laboratory for High Technology Research of Traditional Chinese Medicine Formulae and Key Laboratory of Chinese Medicinal Resources Recycling Utilization, State Administration of Traditional Chinese Medicine, Nanjing University of Chinese Medicine, Nanjing 210023, Jiangsu Province, China; Key Laboratory of Shaanxi Administration of Traditional Chinese Medicine for TCM Compatibility, Shaanxi University of Chinese Medicine, Xi'an 712046, Shaanxi Province, China
| | - Yu-Ping Tang
- Jiangsu Collaborative Innovation Center of Chinese Medicinal Resources Industrialization and Jiangsu Key Laboratory for High Technology Research of Traditional Chinese Medicine Formulae and Key Laboratory of Chinese Medicinal Resources Recycling Utilization, State Administration of Traditional Chinese Medicine, Nanjing University of Chinese Medicine, Nanjing 210023, Jiangsu Province, China; Key Laboratory of Shaanxi Administration of Traditional Chinese Medicine for TCM Compatibility, Shaanxi University of Chinese Medicine, Xi'an 712046, Shaanxi Province, China.
| | - Yan-Yan Chen
- Jiangsu Collaborative Innovation Center of Chinese Medicinal Resources Industrialization and Jiangsu Key Laboratory for High Technology Research of Traditional Chinese Medicine Formulae and Key Laboratory of Chinese Medicinal Resources Recycling Utilization, State Administration of Traditional Chinese Medicine, Nanjing University of Chinese Medicine, Nanjing 210023, Jiangsu Province, China; Key Laboratory of Shaanxi Administration of Traditional Chinese Medicine for TCM Compatibility, Shaanxi University of Chinese Medicine, Xi'an 712046, Shaanxi Province, China
| | - Gui-Sheng Zhou
- Jiangsu Collaborative Innovation Center of Chinese Medicinal Resources Industrialization and Jiangsu Key Laboratory for High Technology Research of Traditional Chinese Medicine Formulae and Key Laboratory of Chinese Medicinal Resources Recycling Utilization, State Administration of Traditional Chinese Medicine, Nanjing University of Chinese Medicine, Nanjing 210023, Jiangsu Province, China
| | - Jing Zhang
- Jiangsu Collaborative Innovation Center of Chinese Medicinal Resources Industrialization and Jiangsu Key Laboratory for High Technology Research of Traditional Chinese Medicine Formulae and Key Laboratory of Chinese Medicinal Resources Recycling Utilization, State Administration of Traditional Chinese Medicine, Nanjing University of Chinese Medicine, Nanjing 210023, Jiangsu Province, China
| | - Zhen-Hua Zhu
- Jiangsu Collaborative Innovation Center of Chinese Medicinal Resources Industrialization and Jiangsu Key Laboratory for High Technology Research of Traditional Chinese Medicine Formulae and Key Laboratory of Chinese Medicinal Resources Recycling Utilization, State Administration of Traditional Chinese Medicine, Nanjing University of Chinese Medicine, Nanjing 210023, Jiangsu Province, China
| | - Pei Liu
- Jiangsu Collaborative Innovation Center of Chinese Medicinal Resources Industrialization and Jiangsu Key Laboratory for High Technology Research of Traditional Chinese Medicine Formulae and Key Laboratory of Chinese Medicinal Resources Recycling Utilization, State Administration of Traditional Chinese Medicine, Nanjing University of Chinese Medicine, Nanjing 210023, Jiangsu Province, China
| | - Jin-Ao Duan
- Jiangsu Collaborative Innovation Center of Chinese Medicinal Resources Industrialization and Jiangsu Key Laboratory for High Technology Research of Traditional Chinese Medicine Formulae and Key Laboratory of Chinese Medicinal Resources Recycling Utilization, State Administration of Traditional Chinese Medicine, Nanjing University of Chinese Medicine, Nanjing 210023, Jiangsu Province, China
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Hervé J, Terenina E, Haurogné K, Bacou E, Kulikova E, Allard M, Billon Y, Bach JM, Mormède P, Lieubeau B. Effects of divergent selection upon adrenocortical activity on immune traits in pig. BMC Vet Res 2019; 15:71. [PMID: 30832653 PMCID: PMC6398250 DOI: 10.1186/s12917-019-1809-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2018] [Accepted: 02/19/2019] [Indexed: 01/22/2023] Open
Abstract
Background The sustainability of farming and animal welfare requires the reconsideration of current selection schemes. In particular, implementation of new selection criteria related to animal health and welfare should help to produce more robust animals and to reduce anti-microbial use. The hypothalamo-pituitary-adrenocortical (HPA) axis plays a major role in metabolic regulation and adaptation processes and its activity is strongly influenced by genetic factors. A positive association between HPA axis activity and robustness was recently described. To explore whether selecting pigs upon HPA axis activity could increase their robustness, a divergent selection experiment was carried out in the Large White pig breed. This allowed the generation of low (HPAlo) and high (HPAhi) responders to adrenocorticotropic hormone administration. Results In this study, we compared 23 hematologic and immune parameters of 6-week-old, HPAlo and HPAhi piglets and analysed their response to a low dose of lipopolysaccharide (LPS) two weeks later. At six weeks of age, HPAhi piglets displayed greater red blood cell and leucocyte number including CD8α+ γδ cells, cytotoxic T lymphocytes, naive T helper (Th) cells and B lymphocytes as compared to HPAlo individuals. The ability of blood cells to secrete TNFα in response to LPS ex vivo was higher for HPAhi pigs. At week eight, the inflammatory response to the LPS in vivo challenge was poorly affected by the HPA axis activity. Conclusions Divergent selection upon HPA axis activity modulated hematologic and immune parameters in 6-week-old pigs, which may confer an advantage to HPAhi pigs at weaning. However, HPAlo and HPAhi piglets did not exhibit major differences in the parameters analysed two weeks later, i. e. in 8-week-old pigs. In conclusion, chronic exposure to high cortisol levels in HPAhi pigs does not negatively impact immunity. Electronic supplementary material The online version of this article (10.1186/s12917-019-1809-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Julie Hervé
- IECM, INRA, Oniris, La Chantrerie, CS 40706, F-44307, Nantes Cedex 3, France.
| | - Elena Terenina
- GenPhySE, Université de Toulouse, INRA, INPT, ENVT, F-31326, Castanet-Tolosan, France.
| | - Karine Haurogné
- IECM, INRA, Oniris, La Chantrerie, CS 40706, F-44307, Nantes Cedex 3, France
| | - Elodie Bacou
- IECM, INRA, Oniris, La Chantrerie, CS 40706, F-44307, Nantes Cedex 3, France
| | - Elizaveta Kulikova
- Federal Research Center, Institute of Cytology and Genetics, Siberian Branch of Russian Academy of Sciences, Novosibirsk, Russian Federation, 630090
| | - Marie Allard
- IECM, INRA, Oniris, La Chantrerie, CS 40706, F-44307, Nantes Cedex 3, France
| | - Yvon Billon
- GenESI, INRA, Le Magneraud, F-17700, Saint-Pierre-d'Amilly, France
| | - Jean-Marie Bach
- IECM, INRA, Oniris, La Chantrerie, CS 40706, F-44307, Nantes Cedex 3, France
| | - Pierre Mormède
- GenPhySE, Université de Toulouse, INRA, INPT, ENVT, F-31326, Castanet-Tolosan, France
| | - Blandine Lieubeau
- IECM, INRA, Oniris, La Chantrerie, CS 40706, F-44307, Nantes Cedex 3, France
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Hesselink L, Bastian OW, Heeres M, ten Berg M, Huisman A, Hoefer IE, van Solinge WW, Koenderman L, van Wessem KJP, Leenen LPH, Hietbrink F. An increase in myeloid cells after severe injury is associated with normal fracture healing: a retrospective study of 62 patients with a femoral fracture. Acta Orthop 2018; 89:585-590. [PMID: 30080430 PMCID: PMC6202765 DOI: 10.1080/17453674.2018.1501974] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Background and purpose-Nonunion is common in femoral fractures. Previous studies suggested that the systemic immune response after trauma can interfere with fracture healing. Therefore, we investigated whether there is a relation between peripheral blood cell counts and healing of femur fractures. Patients and methods-62 multi-trauma patients with a femoral fracture presenting at the University Medical Centre Utrecht between 2007 and 2013 were retrospectively included. Peripheral blood cell counts from hematological analyzers were recorded from the 1st through the 14th day of the hospital stay. Generalized estimating equations were used to compare outcome groups. Results-12 of the 62 patients developed nonunion of the femoral fracture. The peripheral blood-count curves of total leukocytes, neutrophils, monocytes, lymphocytes, and platelets were all statistically significantly lower in patients with nonunion, coinciding with significantly higher CRP levels during the first 2 weeks after trauma in these patients. Interpretation-Patients who developed femoral nonunion after major trauma demonstrated lower numbers of myeloid cells in the peripheral blood than patients with normal fracture healing. This absent rise of myeloid cells seems to be related to a more severe post-traumatic immune response.
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Affiliation(s)
- Lillian Hesselink
- Department of Trauma Surgery, University Medical Center Utrecht, Utrecht; ,Correspondence:
| | - Okan W Bastian
- Department of Trauma Surgery, University Medical Center Utrecht, Utrecht;
| | - Marjolein Heeres
- Department of Trauma Surgery, University Medical Center Utrecht, Utrecht;
| | - Maarten ten Berg
- Department of Clinical Chemistry and Hematology, University Medical Center Utrecht, Utrecht;
| | - Albert Huisman
- Department of Clinical Chemistry and Hematology, University Medical Center Utrecht, Utrecht;
| | - Imo E Hoefer
- Department of Clinical Chemistry and Hematology, University Medical Center Utrecht, Utrecht;
| | - Wouter W van Solinge
- Department of Clinical Chemistry and Hematology, University Medical Center Utrecht, Utrecht;
| | - Leo Koenderman
- Laboratory for Translational Immunology and Department of Respiratory Medicine, University Medical Center Utrecht Wilhelmina Children’s Hospital, Utrecht, The Netherlands
| | | | - Luke P H Leenen
- Department of Trauma Surgery, University Medical Center Utrecht, Utrecht;
| | - Falco Hietbrink
- Department of Trauma Surgery, University Medical Center Utrecht, Utrecht;
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Khan SM, Agha MA. Mean cell volume of reticulocyte-A new parameter for diagnosing sub-clinical cobalamin deficiency in blood donors. Int J Lab Hematol 2018; 41:e1-e4. [PMID: 30006950 DOI: 10.1111/ijlh.12899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Sualeh Muslim Khan
- Dow Medical College, Dow University of Health Sciences, Karachi, Pakistan
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86
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Beneitez Pastor D. Uso del hierro intravenoso en la clínica actual. Med Clin (Barc) 2018; 150:188-190. [DOI: 10.1016/j.medcli.2017.05.025] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2017] [Accepted: 05/25/2017] [Indexed: 11/16/2022]
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Buoro S, Carobene A, Seghezzi M, Manenti B, Dominoni P, Pacioni A, Ceriotti F, Ottomano C, Lippi G. Short- and medium-term biological variation estimates of red blood cell and reticulocyte parameters in healthy subjects. ACTA ACUST UNITED AC 2018; 56:954-963. [DOI: 10.1515/cclm-2017-0902] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2017] [Accepted: 11/22/2017] [Indexed: 11/15/2022]
Abstract
Abstract
Background:
The integrated evaluation of traditional and innovative red blood cell (RBC) and reticulocyte parameters is a rapid, inexpensive and non-invasive diagnostic tools for differential diagnosis and follow-up of anemia and other pathological conditions needing bone marrow erythropoiesis assessment. Therefore, estimating the biological variation (BV) of these parameters is essential for evaluating the analytical performance of hematological analyzers, and for enabling accurate data interpretation and appropriate clinical management. This study aims to define short- and medium-term BV estimates and reference change value (RCV) of RBC and reticulocyte parameters.
Methods:
Twenty-one healthy volunteers participated in the assessment of medium-term BV (blood sampling once/week, five consecutive weeks) and 22 volunteers in the assessment of short-term BV (blood sampling once/day, five consecutive days) using Sysmex XN. Outlier analysis was performed before CV-ANOVA, to determine BV estimates with confidence intervals (CI).
Results:
Medium- and short-term within-subject BV were between 0.3% and 16.4% and 0.2%–10.4% (MCH and IRF), respectively, whereas medium and short-term between-subjects BV ranged between 0.9% and 66.6% (MCHC and Micro-R) and 1.4%–43.6% (MCHC and IRF), respectively. The RCVs were similar for all parameters in both arms of the study, except for hemoglobin, RDW-CV and MCV.
Conclusions:
This study allowed for estimating the BV of many RBC and reticulocyte parameters, some of which have not been currently explored. For RBC, hemoglobin, RDW-CV and MCV it seems advisable to use RCV calculated according to monitoring time and/or differentiated by sex. As regards analytical goals, we suggest using the most stringent targets found in the short-term arm of this study.
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Affiliation(s)
- Sabrina Buoro
- Clinical Chemistry Laboratory , Papa Giovanni XXIII Hospital , Piazza OMS , 1 – 24127 Bergamo , Italy , Phone: (+039) 0352674550, Fax: (+039) 0352674939
| | - Anna Carobene
- Medical Laboratory Service, San Raffaele Hospital , Milan , Italy
| | - Michela Seghezzi
- Clinical Chemistry Laboratory , Papa Giovanni XXIII Hospital , Bergamo , Italy
| | - Barbara Manenti
- Clinical Chemistry Laboratory , Papa Giovanni XXIII Hospital , Bergamo , Italy
| | - Paola Dominoni
- Clinical Chemistry Laboratory , Papa Giovanni XXIII Hospital , Bergamo , Italy
| | | | - Ferruccio Ceriotti
- Central Laboratory , Fondazione IRCCS Ca’ Granda, Ospedale Maggiore Policlinico , Milan , Italy
| | | | - Giuseppe Lippi
- Section of Clinical Biochemistry , University of Verona , Verona , Italy
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Takagi C, Ono K, Matsuo H, Nagano N, Nojima Y. Higher reticulocyte counts are associated with higher mortality rates in hemodialysis patients: a retrospective single-center cohort study. RENAL REPLACEMENT THERAPY 2017. [DOI: 10.1186/s41100-016-0084-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Pfeiffer CM, Looker AC. Laboratory methodologies for indicators of iron status: strengths, limitations, and analytical challenges. Am J Clin Nutr 2017; 106:1606S-1614S. [PMID: 29070545 PMCID: PMC5701713 DOI: 10.3945/ajcn.117.155887] [Citation(s) in RCA: 123] [Impact Index Per Article: 17.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Biochemical assessment of iron status relies on serum-based indicators, such as serum ferritin (SF), transferrin saturation, and soluble transferrin receptor (sTfR), as well as erythrocyte protoporphyrin. These indicators present challenges for clinical practice and national nutrition surveys, and often iron status interpretation is based on the combination of several indicators. The diagnosis of iron deficiency (ID) through SF concentration, the most commonly used indicator, is complicated by concomitant inflammation. sTfR concentration is an indicator of functional ID that is not an acute-phase reactant, but challenges in its interpretation arise because of the lack of assay standardization, common reference ranges, and common cutoffs. It is unclear which indicators are best suited to assess excess iron status. The value of hepcidin, non-transferrin-bound iron, and reticulocyte indexes is being explored in research settings. Serum-based indicators are generally measured on fully automated clinical analyzers available in most hospitals. Although international reference materials have been available for years, the standardization of immunoassays is complicated by the heterogeneity of antibodies used and the absence of physicochemical reference methods to establish "true" concentrations. From 1988 to 2006, the assessment of iron status in NHANES was based on the multi-indicator ferritin model. However, the model did not indicate the severity of ID and produced categorical estimates. More recently, iron status assessment in NHANES has used the total body iron stores (TBI) model, in which the log ratio of sTfR to SF is assessed. Together, sTfR and SF concentrations cover the full range of iron status. The TBI model better predicts the absence of bone marrow iron than SF concentration alone, and TBI can be analyzed as a continuous variable. Additional consideration of methodologies, interpretation of indicators, and analytic standardization is important for further improvements in iron status assessment.
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Affiliation(s)
| | - Anne C Looker
- National Center for Health Statistics, Centers for Disease Control and Prevention, Atlanta, GA
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90
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Cox HD, Miller GD, Lai A, Cushman D, Eichner D. Detection of autologous blood transfusions using a novel dried blood spot method. Drug Test Anal 2017; 9:1713-1720. [DOI: 10.1002/dta.2323] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2017] [Revised: 10/02/2017] [Accepted: 10/04/2017] [Indexed: 12/16/2022]
Affiliation(s)
- Holly D. Cox
- Sports Medicine Research and Testing Laboratory Salt Lake City UT USA 84108
| | - Geoffrey D. Miller
- Sports Medicine Research and Testing Laboratory Salt Lake City UT USA 84108
- University of Utah School of MedicineDivision of Physical Medicine and Rehabilitation Salt Lake City UT USA 84112
| | - Auriella Lai
- Sports Medicine Research and Testing Laboratory Salt Lake City UT USA 84108
| | - Dan Cushman
- University of Utah School of MedicineDivision of Physical Medicine and Rehabilitation Salt Lake City UT USA 84112
| | - Daniel Eichner
- Sports Medicine Research and Testing Laboratory Salt Lake City UT USA 84108
- University of Utah School of MedicineDivision of Physical Medicine and Rehabilitation Salt Lake City UT USA 84112
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91
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Gencoglan G, Inanir I, Miskioglu M, Gunduz K. Evaluation of sequential effect of isotretinoin on the haematological parameters in patients with acne vulgaris. Cutan Ocul Toxicol 2017; 37:139-142. [PMID: 28743196 DOI: 10.1080/15569527.2017.1359837] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
PURPOSE Isotretinoin is the most effective drug for acne with some side effects. Few studies exist regarding the effects of isotretinoin on haematological parameters with different results. Mostly, baseline values with a single value during or at the end of the treatment were compared. In this study, we aimed to determine the differences in haematological parameters during isotretinoin treatment until reaching the cumulative dose of 120 mg/kg. MATERIALS AND METHODS The study included 118 patients with moderate-to-severe acne vulgaris. Patients with preexisting liver disease, anaemia, iron deficiency, abnormal liver function tests, thrombocytopenia/thrombocytosis or hyperlipidaemia were excluded. Laboratory monitoring for haematological parameters was performed at baseline and monthly during treatment. Parameters at the baseline, at the first and second months and at the end of the therapy were taken into account. RESULTS According to general linear model analysis, platelets and plateletcrit increased at the first month of the treatment and then decreased to baseline. White blood cells and neutrophils decreased at the first month, then increased to baseline value at the second month, and were found to be decreased again at the end of the treatment. Mean corpuscle volume was found to be increased at the end of the treatment. Other parameters in CBC did not show statistically significant differences. CONCLUSIONS Although some changes occur in haematological parameters during isotretinoin therapy, all of these changes remain within the normal range. Evaluating the spot values at any time during treatment may cause misinterpretations.
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Affiliation(s)
- Gulsum Gencoglan
- a Department of Dermatology, Faculty of Medicine , Celal Bayar University , Manisa , Turkey
| | - Isil Inanir
- a Department of Dermatology, Faculty of Medicine , Celal Bayar University , Manisa , Turkey
| | - Mine Miskioglu
- b Department of Hematology, Faculty of Medicine , Celal Bayar University , Manisa , Turkey
| | - Kamer Gunduz
- a Department of Dermatology, Faculty of Medicine , Celal Bayar University , Manisa , Turkey
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92
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Abstract
Blood sampling in children is a challenging task, and to extract maximum possible information from these 'precious' samples, the modern-day automated hematology analyzers have been aided with much technological advancement. Various novel blood cell parameters are now available to narrow down the differential diagnoses. However, only few of these are available for routine clinical reporting. Knowledge about their interpretation and reference ranges can prove useful in challenging situations.
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93
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Cai J, Wu M, Ren J, Du Y, Long Z, Li G, Han B, Yang L. Evaluation of the Efficiency of the Reticulocyte Hemoglobin Content on Diagnosis for Iron Deficiency Anemia in Chinese Adults. Nutrients 2017; 9:E450. [PMID: 28468320 PMCID: PMC5452180 DOI: 10.3390/nu9050450] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2017] [Revised: 04/16/2017] [Accepted: 04/26/2017] [Indexed: 12/27/2022] Open
Abstract
Our aim was to evaluate the cut-off value and efficiency of using reticulocyte hemoglobin content as a marker to diagnose iron deficiency anemia in Chinese adults. 140 adults who needed bone marrow aspiration for diagnosis at the hematology department of the Peking Union Medical College Hospital were enrolled according to the inclusive and exclusive criteria. Venous blood samples were collected to detect complete blood count, including hemoglobin, reticulocyte hemoglobin content, hematocrit, mean cellular volume, corpuscular hemoglobin concentration, hemoglobin content, free erythrocyte protoporphyrin; iron indexes of serum ferritin, serum transferrin receptor, and unsaturated iron-binding capacity; and inflammation markers of C-reactive protein and α-acid glycoprotein. Bone marrow samples were obtained for the bone marrow iron staining, which was used as the standard for the evaluation of iron status in this study. Subjects were divided into three groups according to hemoglobin levels and bone marrow iron staining results: the IDA (iron deficiency anemia) group, the NIDA (non-iron deficiency anemia) group, and the control group. The differences of the above-mentioned indexes were compared among the three groups and the effect of inflammation was also considered. The cut-off value of reticulocyte hemoglobin content was determined by receiver operation curves. The IDA group (n = 56) had significantly lower reticulocyte hemoglobin content, mean cellular volume, corpuscular hemoglobin concentration, hemoglobin content, and serum ferritin; and higher free erythrocyte protoporphyrin, unsaturated iron-binding capacity, and serum transferrin receptor (p < 0.05) compared with the NIDA group (n = 38) and control group (n = 46). Hematocrit, serum ferritin, and unsaturated iron-binding capacity were significantly affected by inflammation while reticulocyte hemoglobin content and other parameters were not. The cut-off value of reticulocyte hemoglobin content for diagnosing iron deficiency anemia was 27.2 pg, with a sensitivity of 87.5% and a specificity of 92.9%. The cut-off values for mean cellular volume, serum ferritin, and serum transferrin receptor were 76.6, 12.9, and 4.89 mg/L, respectively. Reticulocyte hemoglobin content had the largest area under the curve of 0.929, while those for mean cellular volume, serum ferritin, serum transferrin receptor were 0.922, 0.887, and 0.900, respectively. Reticulocyte hemoglobin content has a high sensitivity and specificity in the diagnosis of iron deficiency anemia, and its comprehensive diagnostic efficacy is better than other traditional indicators-such as serum ferritin and serum transferrin receptor.
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Affiliation(s)
- Jie Cai
- The Key Laboratory of Trace Element Nutrition, National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, 29 Nan Wei Road, Xicheng District, Beijing 100050, China.
| | - Meng Wu
- The Key Laboratory of Trace Element Nutrition, National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, 29 Nan Wei Road, Xicheng District, Beijing 100050, China.
| | - Jie Ren
- Health and Family Planning Supervision Institution of Chaoyang, Panjiayuan Huawei 25, Chaoyang District, Beijing 100021, China.
| | - Yali Du
- Department of Hematology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China.
| | - Zhangbiao Long
- Department of Hematology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China.
| | - Guoxun Li
- Department of General Surgery, Tianjin People's Hospital, 190, Jieyuan Road, Hongqiao District, Tianjin 300121, China.
| | - Bing Han
- Department of Hematology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China.
| | - Lichen Yang
- The Key Laboratory of Trace Element Nutrition, National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, 29 Nan Wei Road, Xicheng District, Beijing 100050, China.
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94
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Abstract
Anemia is among the most common medical problems and clinical and laboratory evaluation need to be approached logically. The complete blood count with red cell indices offers clues to diagnosis. Many anemias have characteristic red cell morphology. The reticulocyte count serves as a useful screen for hemolysis or blood loss. Testing for specific causes of the anemia is performed. Occasionally, examination of the bone marrow is required for diagnosis. Molecular testing is increasingly being use to aid the diagnostic process. This article reviews diagnostic tests for anemia and suggests a rational approach to determining the etiology of a patient's anemia.
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Affiliation(s)
- Michael J Cascio
- Department of Pathology, Oregon Health and Science University, 3181 SW Sam Jackson Park Road, MC L-471, Portland, OR, 97239, USA
| | - Thomas G DeLoughery
- Division of Hematology/Medical Oncology, Department of Medicine, Knight Cancer Institute, Oregon Health and Science University, MC L586, 3181 Southwest Sam Jackson Park Road, Portland, OR 97239, USA; Division of Laboratory Medicine, Department of Pathology, Oregon Health and Science University, Hematology L586, 3181 Southwest Sam Jackson Park Road, Portland, OR 97201-3098, USA.
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95
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Lorenz L, Peter A, Arand J, Springer F, Poets CF, Franz AR. Reference Ranges of Reticulocyte Haemoglobin Content in Preterm and Term Infants: A Retrospective Analysis. Neonatology 2017; 111:189-194. [PMID: 27842321 DOI: 10.1159/000450674] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2016] [Accepted: 09/08/2016] [Indexed: 11/19/2022]
Abstract
BACKGROUND Despite iron supplementation, some preterm infants develop iron deficiency (ID). The optimal iron status parameter for early detection of ID has yet to be determined. OBJECTIVE To establish reference ranges for reticulocyte haemoglobin content (Ret-He) in preterm and term infants and to identify confounding factors. METHODS Retrospective analyses of Ret-He and complete blood count in infants with a clinically indicated blood sample obtained within 24 h after birth. RESULTS Mean (SD) Ret-He was 30.7 (3.0) pg in very preterm infants with a gestational age (GA) of <30 weeks (n = 55), 31.2 (2.6) pg in moderately preterm infants (GA 30-36 weeks, n = 241) and 32.0 (3.2) pg in term infants (GA ≥37 weeks, n = 216). The 2.5th percentile of Ret-He across all GA groups was 25 pg, with a weak correlation between Ret-He and GA (r = 0.18). Moreover, only weak/no correlations were found between Ret-He and C-reactive protein (r = 0.18), interleukin 6 (IL-6) (r = 0.03) and umbilical artery pH (r = -0.07). There was a slight variation in Ret-He with mode of delivery [normal vaginal delivery: 32.3 (3.2) pg, secondary caesarean section (CS): 31.4 (3.0) pg, instrumental delivery: 31.3 (2.7) pg and elective CS: 31.2 (2.8) pg]. CONCLUSION GA at birth has a negligible impact on Ret-He, and the lower limit of the normal reference range in newborns within 24 h after birth can be set to 25 pg. Moreover, Ret-He seems to be a robust parameter which is not influenced by perinatal factors within the first 24 h after birth.
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Affiliation(s)
- Laila Lorenz
- Department of Neonatology, University Children's Hospital, Tübingen University Hospital, Tübingen, Germany
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96
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Lorenz L, Peter A, Arand J, Springer F, Poets CF, Franz AR. Reticulocyte Haemoglobin Content Declines More Markedly in Preterm than in Term Infants in the First Days after Birth. Neonatology 2017; 112:246-250. [PMID: 28704831 DOI: 10.1159/000477124] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2017] [Accepted: 04/27/2017] [Indexed: 11/19/2022]
Abstract
BACKGROUND Reticulocyte haemoglobin content, i.e., the reticulocyte equivalent (Ret-He), seems to be a promising parameter for the detection of iron deficiency (ID) in neonates because it can be obtained as part of a reticulocyte count, with no additional blood loss and at no extra cost. Due to the short life span of reticulocytes, Ret-He reflects current iron availability for erythropoiesis more accurately than other common erythrocyte indices. OBJECTIVE We aimed to evaluate postnatal changes in Ret-He within the first days after birth in term and preterm infants with the hypothesis that preterm infants experience a more pronounced postnatal reduction in Ret-He when compared to term infants. METHODS We conducted retrospective analyses of clinically indicated blood samples. Paired t test and mixed regression modelling were used. RESULTS In total, 805 blood samples obtained from 207 term and 295 preterm infants were analysed. Ret-He decreased by 1.5 pg per day (regression coefficient [95% CI] -1.5 [-1.8 to -1.2] pg, p < 0.0001). This drop was more significant in preterm infants (regression coefficient -2.2 [-2.6 to -1.8] pg, p < 0.0001) than in term infants (regression coefficient -0.8 [-1.3 to -0.2] pg, p < 0.01, pinteraction < 0.0001). CONCLUSION Ret-He declined within the first days after birth. The observed changes with postnatal age were more pronounced in preterm than in term infants. Further studies are needed to evaluate if these changes are due to developing ID or other causes.
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Affiliation(s)
- Laila Lorenz
- Department of Neonatology, University Children's Hospital of Tübingen, Tübingen, Germany
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98
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Rhodes MM, Koury ST, Kopsombut P, Alford CE, Price JO, Koury MJ. Stress reticulocytes lose transferrin receptors by an extrinsic process involving spleen and macrophages. Am J Hematol 2016; 91:875-82. [PMID: 27194638 DOI: 10.1002/ajh.24421] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2016] [Revised: 05/12/2016] [Accepted: 05/16/2016] [Indexed: 11/06/2022]
Abstract
As they mature into erythrocytes during normal erythropoiesis, reticulocytes lose surface transferrin receptors before or concurrently with reticulin. Exosome release accounts for most of the loss of transferrin receptors from reticulocytes. During erythropoietic stress, reticulocytes are released early from hematopoietic tissues and have increased reticulin staining and transferrin receptors. Flow cytometry of dually stained erythrocytes of mice recovering from phlebotomy demonstrated delayed loss of reticulin and transferrin receptors during in vitro maturation compared to in vivo maturation, indicating that an in vivo process extrinsic to the reticulocytes facilitates their maturation. Splenectomy or macrophage depletion by liposomal clodronate inhibited in vivo maturation of reticulocytes and increased the numbers of reticulin-negative, transferrin receptor-positive cells during and after recovery from phlebotomy. This reticulin-negative, transferrin receptor-positive population was rarely found in normal mice. Transmission electron microscopy demonstrated that the reticulin-negative, transferrin receptor-positive cells were elongated and discoid erythrocytes, but they had intracellular and surface structures that appeared to be partially degraded organelles. The results indicate that maturation of circulating stress reticulocytes is enhanced by an extrinsic process that occurs in the spleen and involves macrophage activity. Complete loss of reticulin with incomplete loss of surface transferrin receptors in this process produces a reticulin-negative, transferrin receptor-positive erythrocyte population that has potential utility for detecting prior erythropoietic stresses including bleeding, hemolysis and erythropoietin administration, even after recovery has been completed. Am. J. Hematol. 91:875-882, 2016. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Melissa M. Rhodes
- Departments of Pediatrics; Vanderbilt University Medical Center; Nashville Tennessee
| | - Stephen T. Koury
- Department of Biotechnical and Clinical Laboratory Sciences; University of Buffalo; Buffalo New York
| | - Prapaporn Kopsombut
- Departments of Medicine; Vanderbilt University Medical Center; Nashville Tennessee
| | - Catherine E. Alford
- Laboratory Service; VA Tennessee Valley Healthcare System; Nashville Tennessee
| | - James O. Price
- Laboratory Service; VA Tennessee Valley Healthcare System; Nashville Tennessee
| | - Mark J. Koury
- Departments of Medicine; Vanderbilt University Medical Center; Nashville Tennessee
- Medical Service, VA Tennessee Valley Healthcare System; Nashville Tennessee
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Assessment of blood sample stability for complete blood count using the Sysmex XN-9000 and Mindray BC-6800 analyzers. Rev Bras Hematol Hemoter 2016; 38:225-39. [PMID: 27521861 PMCID: PMC4997904 DOI: 10.1016/j.bjhh.2016.05.010] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2016] [Revised: 05/16/2016] [Accepted: 05/30/2016] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Different hematological analyzers have different analytical performances that are often reflected in the criteria for sample stability of the complete blood count. This study aimed to assess the stability of several hematological parameters using the XN-9000 Sysmex and BC-6800 Mindray analyzers. METHODS The impact of storage at room temperature and 4°C was evaluated after 2, 4, 6, 8, 24, 36 and 48h using ten normal and 40 abnormal blood samples. The variation from the baseline measurement was evaluated by the Steel-Dwass-Critchlow-Fligner test and by Bland-Altman plots, using quality specifications and critical difference as the total allowable variation. RESULTS Red blood cells and reticulocyte parameters (i.e. hematocrit, mean corpuscular volume, mean corpuscular hemoglobin concentration, red blood cell distribution width, immature reticulocyte fractions, low-fluorescence reticulocytes, middle-fluorescence reticulocytes, high fluorescence mononuclear cells) showed less stability compared to leukocyte and platelet parameters (except for monocyte count and mean platelet volume). The bias for hematocrit, mean corpuscular volume, mean corpuscular hemoglobin concentration and red blood cell distribution width coefficient of variation was higher than the critical difference after 8h using both analyzers. CONCLUSION Blood samples measured with both analyzers do not show analytically significant changes in up to 2h of storage at room temperature and 4°C. However, the maximum time for analysis can be extended for up to 8h when the bias is compared to the critical difference.
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100
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Absolute Reticulocyte Count and Reticulocyte Hemoglobin Content as Predictors of Early Response to Exclusive Oral Iron in Children with Iron Deficiency Anemia. Anemia 2016; 2016:7345835. [PMID: 27092272 PMCID: PMC4820635 DOI: 10.1155/2016/7345835] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2015] [Revised: 03/02/2016] [Accepted: 03/03/2016] [Indexed: 11/25/2022] Open
Abstract
We report data regarding kinetic of response to oral iron in 34 iron deficiency anemia children. Twenty-four/34 patients (70.5%) reached reference value of hemoglobin (Hb) concentration for age and sex at day + 30 from the beginning of treatment (complete early responders (CERs)), and 4/34 (12%) reached an Hb concentration at least 50% higher than the original (partial early responders (PERs)). CHr at T1 (within 7 days from the beginning of treatment) was significantly different in the different groups (22.95 in CERs versus 18.41 in other patients; p = 0.001; 22.42 in early responders versus 18.07 in NERs; p = 0.001). Relative increase of CHr from T0 to T1 resulted significantly higher in CERs than in other patients (0.21 versus 0.11, p = 0.042) and in early responders than in NERs (0.22 versus 0.004, p = 0.006). Multivariate logistic models revealed a higher probability of being a complete early responder due to relative increase of ARC from T0 to T1 [OR (95% CI) = 44.95 (1.54–1311.98)] and to CHr at T1 [OR (95% CI) =3.18 (1.24–8.17)]. Our preliminary data confirm CHr as early and accurate predictor of hematological response to oral iron.
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