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Adam AS, Cotton F, Cantinieaux B, Benyaich S, Gulbis B. Screening for hereditary spherocytosis in daily practice: what is the best algorithm using erythrocyte and reticulocyte parameters? Ann Hematol 2022; 101:1485-1491. [PMID: 35459963 DOI: 10.1007/s00277-022-04845-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Accepted: 04/15/2022] [Indexed: 11/26/2022]
Abstract
Hereditary spherocytosis (HS) is the most common inherited chronic haemolytic anaemia in Northern Europe. During the last decade, additional erythrocyte and reticulocyte parameters have been developed on last-generation haematology analysers, leading to many publications about their effectiveness as a HS screening tool. For the first time on an independent cohort, we evaluated and compared the effectiveness of six published algorithms for the screening of HS using the UniCel DxH800 (Beckman-Coulter) and the XN-9000 (Sysmex) and determined which algorithm could be the most suitable in our daily clinical practice. A total of 95 EDTA samples were analysed prospectively on both haematology analysers. These included 11 confirmed HS patients and 84 non-HS patients. The specific reticulocyte parameters used on the DxH800 were mean reticulocyte volume, immature reticulocyte fraction and mean sphered cell volume, and on the XN-9000 were hypohaemoglobinised erythrocytes, microcytic erythrocytes and immature reticulocyte fraction. The three algorithms using parameters specific to Beckman-Coulter analysers provided a sensitivity of 100% with various specificities, ranging from 7.1 to 73.8%. The three algorithms published based on the parameters specific to Sysmex showed much lower performances, i.e. out of the 11 patients with HS, between one to five patients were screened as negative for HS. However, 100% sensitivity and specificity were reached using the EMA binding test concomitantly with those three algorithms. The algorithms using reticulocyte and erythrocyte parameters offered by the recent analysers are promising options as a HS first-tier screening tool. Nevertheless, they must be evaluated by each laboratory on their own analyser before implementation.
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Affiliation(s)
- Anne-Sophie Adam
- Department of Clinical Chemistry. LHUB-ULB, Université Libre de Bruxelles (ULB), 322, Rue Haute, 1000, Brussels, Belgium.
| | - Frédéric Cotton
- Department of Clinical Chemistry. LHUB-ULB, Université Libre de Bruxelles (ULB), 322, Rue Haute, 1000, Brussels, Belgium
| | - Brigitte Cantinieaux
- Department of Haematology. LHUB-ULB, Université Libre de Bruxelles (ULB), 322, Rue Haute, 1000, Brussels, Belgium
| | - Sara Benyaich
- Department of Clinical Chemistry. LHUB-ULB, Université Libre de Bruxelles (ULB), 322, Rue Haute, 1000, Brussels, Belgium
| | - Béatrice Gulbis
- Department of Clinical Chemistry. LHUB-ULB, Université Libre de Bruxelles (ULB), 322, Rue Haute, 1000, Brussels, Belgium
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Uman N, Kobbuaklee S, Kansuwan P, Watanaboonyongcharoen P, Polprasert C. Detection of Red Blood Cell Membrane Proteins in Myelodysplastic Syndromes Using Eosin-5-Maleimide (EMA) Staining by Flow Cytometry. Hematol Rep 2022; 14:13-18. [PMID: 35323174 PMCID: PMC8955372 DOI: 10.3390/hematolrep14010003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Revised: 02/16/2022] [Accepted: 02/24/2022] [Indexed: 11/21/2022] Open
Abstract
Background: Eosin-5-Maleimide (EMA)-based flow cytometry binds to red blood cell (RBC) membrane-associated proteins which can be used to detect red blood cell (RBC) membrane disorders. Myelodysplastic syndromes (MDS) are stem cell disorders resulting in ineffective hematopoiesis which is commonly present with anemia and erythroid dysplasia. Objectives: We aimed to study RBC membrane defects in MDS using flow cytometry for EMA staining. Methods: We enrolled anemic patients who were diagnosed with low-risk MDS (R-IPSS score ≤ 3.5), RBC membrane disorders [hereditary spherocytosis (HS) and Southeast Asian ovalocytosis (SAO)], and normal controls. Complete blood count (CBC) and flow cytometry for EMA staining were performed. Results: There were 16 cases of low-risk MDS, 6 cases of RBC membrane disorders, and 15 control cases. Mean fluorescence intensity (MFI) of EMA binding test in the RBC membrane disorders was significantly lower than controls (17.6 vs. 24.3, p < 0.001), but the EMA binding test in the low-risk MDS was not significantly different than the controls (26.5 vs. 24.3, p = 0.08). Conclusion: the RBC membrane defect in low-risk MDS was not demonstrated as having detection ability using EMA binding test with flow cytometry.
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Affiliation(s)
- Navavee Uman
- Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok 10230, Thailand
| | - Sirorat Kobbuaklee
- Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok 10230, Thailand
- Research Unit in Translational Hematology, Chulalongkorn University, Bangkok 10230, Thailand
| | - Patsita Kansuwan
- Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok 10230, Thailand
| | - Phandee Watanaboonyongcharoen
- Department of Clinical Pathology, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok 10230, Thailand
| | - Chantana Polprasert
- Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok 10230, Thailand
- Research Unit in Translational Hematology, Chulalongkorn University, Bangkok 10230, Thailand
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Mijwil MM, Aggarwal K. A diagnostic testing for people with appendicitis using machine learning techniques. MULTIMEDIA TOOLS AND APPLICATIONS 2022; 81:7011-7023. [PMID: 35095329 PMCID: PMC8785023 DOI: 10.1007/s11042-022-11939-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Revised: 09/09/2021] [Accepted: 01/03/2022] [Indexed: 05/07/2023]
Abstract
Appendicitis is a common disease that occurs particularly often in childhood and adolescence. The accurate diagnosis of acute appendicitis is the most significant precaution to avoid severe unnecessary surgery. In this paper, the author presents a machine learning (ML) technique to predict appendix illness whether it is acute or subacute, especially between 10 and 30 years and whether it requires an operation or just taking medication for treatment. The dataset has been collected from public hospital-based citizens between 2016 and 2019. The predictive results of the models achieved by different ML techniques (Logistic Regression, Naïve Bayes, Generalized Linear, Decision Tree, Support Vector Machine, Gradient Boosted Tree, Random Forest) are compared. The covered dataset are 625 specimens and the total of the medical records that are applied in this paper include 371 males (60.22%) and 254 females (40.12%). According to the dataset, the records consist of 318 (50.88%) operated and 307 (49.12%) unoperated patients. It is observed that the random forest algorithm obtains the optimal result with an accurately predicted result of 83.75%, precision of 84.11%, sensitivity of 81.08%, and the specificity of 81.01%. Moreover, an estimation method based on ML techniques is improved and enhanced to detect individuals with acute appendicitis.
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Affiliation(s)
- Maad M. Mijwil
- Computer Techniques Engineering Department, Baghdad College of Economic Sciences University, Baghdad, Iraq
| | - Karan Aggarwal
- Electronics and Communication Engineering Department, Maharishi Markandeshwar (Deemed to be University), Mullana, Ambala, India
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Yippee like 4 (Ypel4) is essential for normal mouse red blood cell membrane integrity. Sci Rep 2021; 11:15898. [PMID: 34354145 PMCID: PMC8342551 DOI: 10.1038/s41598-021-95291-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Accepted: 07/22/2021] [Indexed: 11/08/2022] Open
Abstract
The YPEL family genes are highly conserved across a diverse range of eukaryotic organisms and thus potentially involved in essential cellular processes. Ypel4, one of five YPEL family gene orthologs in mouse and human, is highly and specifically expressed in late terminal erythroid differentiation (TED). In this study, we investigated the role of Ypel4 in murine erythropoiesis, providing for the first time an in-depth description of a Ypel4-null phenotype in vivo. We demonstrated that the Ypel4-null mice displayed a secondary polycythemia with macro- and reticulocytosis. While lack of Ypel4 did not affect steady-state TED in the bone marrow or spleen, the anemia-recovering capacity of Ypel4-null cells was diminished. Furthermore, Ypel4-null red blood cells (RBC) were cleared from the circulation at an increased rate, demonstrating an intrinsic defect of RBCs. Scanning electron micrographs revealed an ovalocytic morphology of Ypel4-null RBCs and functional testing confirmed reduced deformability. Even though Band 3 protein levels were shown to be reduced in Ypel4-null RBC membranes, we could not find support for a physical interaction between YPEL4 and the Band 3 protein. In conclusion, our findings provide crucial insights into the role of Ypel4 in preserving normal red cell membrane integrity.
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Fermo E, Vercellati C, Bianchi P. Screening tools for hereditary hemolytic anemia: new concepts and strategies. Expert Rev Hematol 2021; 14:281-292. [PMID: 33543663 DOI: 10.1080/17474086.2021.1886919] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
INTRODUCTION Hereditary hemolytic anemias are a group of rare and heterogeneous disorders due to abnormalities in structure, metabolism, and transport functions of erythrocytes; they may overlap in clinical and hematological features making differential diagnosis difficult, particularly in mild and atypical forms. AREAS COVERED In the present review, the main tools currently adopted in routine hematologic investigation for the diagnosis of hereditary hemolytic anemias are described, together with the new diagnostic approaches that are being to be developed in the next future. Available recommendations in this field together with a systematic review through MEDLINE, EMBASE, and PubMED for publications in English from 2000 to 2020 in regards to diagnostic aspects of hereditary hemolytic anemias have been considered. EXPERT OPINION The recent development of specific molecules and treatments for hereditary hemolytic anemias and the increased interest in translational research raised the attention on differential diagnosis and the demand for novel diagnostic assays and devices. Automatic blood cell analyzers, omic-approaches including NGS technologies, and development of new automated tools based on artificial neural networks definitely represent the future strategies in this field.
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Affiliation(s)
- Elisa Fermo
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico Milano, UOC Ematologia, UOS Fisiopatologia Delle Anemie, Milan, Italy
| | - Cristina Vercellati
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico Milano, UOC Ematologia, UOS Fisiopatologia Delle Anemie, Milan, Italy
| | - Paola Bianchi
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico Milano, UOC Ematologia, UOS Fisiopatologia Delle Anemie, Milan, Italy
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Sottiaux J, Favresse J, Chevalier C, Chatelain B, Jacqmin H, Mullier F. Evaluation of a hereditary spherocytosis screening algorithm by automated blood count using reticulocytes and erythrocytic parameters on the Sysmex XN‐series. Int J Lab Hematol 2019; 42:e88-e91. [DOI: 10.1111/ijlh.13125] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Revised: 10/13/2019] [Accepted: 10/21/2019] [Indexed: 11/29/2022]
Affiliation(s)
- Jean‐Yves Sottiaux
- Department of Laboratory Medicine Namur Thrombosis and Hemostasis Center (NTHC) Namur Research Institute for Life Sciences (NARILIS) CHU UCL Namur Université catholique de Louvain Yvoir Belgium
| | - Julien Favresse
- Department of Laboratory Medicine Namur Thrombosis and Hemostasis Center (NTHC) Namur Research Institute for Life Sciences (NARILIS) CHU UCL Namur Université catholique de Louvain Yvoir Belgium
| | - Charles Chevalier
- Hematology Unit Department of Clinical Biology CHU Charleroi Lodelinsart Belgium
| | - Bernard Chatelain
- Department of Laboratory Medicine Namur Thrombosis and Hemostasis Center (NTHC) Namur Research Institute for Life Sciences (NARILIS) CHU UCL Namur Université catholique de Louvain Yvoir Belgium
| | - Hugues Jacqmin
- Department of Laboratory Medicine Namur Thrombosis and Hemostasis Center (NTHC) Namur Research Institute for Life Sciences (NARILIS) CHU UCL Namur Université catholique de Louvain Yvoir Belgium
| | - François Mullier
- Department of Laboratory Medicine Namur Thrombosis and Hemostasis Center (NTHC) Namur Research Institute for Life Sciences (NARILIS) CHU UCL Namur Université catholique de Louvain Yvoir Belgium
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Ciepiela O, Nowak M, Wrońska M, Adamowicz‐Salach A, Kotuła I. Eosin‐5’‐maleimide binding test—Do we use appropriate reference values to detect hereditary spherocytosis in neonates? Int J Lab Hematol 2018; 41:e57-e60. [DOI: 10.1111/ijlh.12958] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Revised: 11/05/2018] [Accepted: 11/06/2018] [Indexed: 12/15/2022]
Affiliation(s)
- Olga Ciepiela
- Department of Laboratory Diagnostics Medical University of Warsaw Warsaw Poland
- Department of Laboratory Diagnostics and Clinical Immunology of Developmental Age Medical University of Warsaw Warsaw Poland
| | - Magdalena Nowak
- Students Scientific Group at Department of Laboratory Diagnostics and Clinical Immunology of Developmental Age Medical University of Warsaw Warsaw Poland
| | - Małgorzata Wrońska
- Students Scientific Group at Department of Laboratory Diagnostics and Clinical Immunology of Developmental Age Medical University of Warsaw Warsaw Poland
| | - Anna Adamowicz‐Salach
- Department of Pediatrics, Hematology and Oncology Medical University of Warsaw Warsaw Poland
| | - Iwona Kotuła
- Department of Laboratory Diagnostics and Clinical Immunology of Developmental Age Medical University of Warsaw Warsaw Poland
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Ciepiela O. Old and new insights into the diagnosis of hereditary spherocytosis. ANNALS OF TRANSLATIONAL MEDICINE 2018; 6:339. [PMID: 30306078 DOI: 10.21037/atm.2018.07.35] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Hereditary spherocytosis (HS) belongs to the group of congenital hemolytic anemias resulting from plasma membrane protein deficiency. When diagnosed too late, HS bares the risk of long-term complications including gall stones and severe anemia. Here, there are discussed advances in HS screening and diagnostics, with a particular focus on methodologies, most of which are available in clinical laboratories worldwide.
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Affiliation(s)
- Olga Ciepiela
- Department of Laboratory Diagnostics, Medical University of Warsaw, Warsaw, Poland
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Peng GX, Yang WR, Jing LP, Zhang L, Zhou K, Li Y, Ye L, Li Y, Li JP, Fan HH, Song L, Zhao X, Wu ZJ, Yang Y, Xiong YZ, Wang HJ, Zhang FK. [Correlation of the degree of band 3 protein absence on erythrocyte membrane by eosin-5'-maleimide binding test and clinical phenotype in hereditary spherocytosis]. ZHONGHUA XUE YE XUE ZA ZHI = ZHONGHUA XUEYEXUE ZAZHI 2017; 38:537-541. [PMID: 28655100 PMCID: PMC7342980 DOI: 10.3760/cma.j.issn.0253-2727.2017.06.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/11/2017] [Indexed: 12/24/2022]
Abstract
Objective: To investigate the relationship between the eosin-5'-maleimide (EMA) binding test and the clinical severity of hereditary spherocytosis (HS). Methods: A total of 258 un-splenectomize HS patients were consecutively enrolled. Correlation of hemoglobin concentration, hemolytic parameters, compensating erythropoiesis and the EMA binding test were evaluated. Results: 258 (128 male and 130 female) patients were included in this study, including 91 compensatory hemolysis patients, 53 patients with mild anemia, 78 patients with moderate anemia and 36 patients with severe anemia. The median age at diagnosis was 23 (2-70) years. The median decreased fluorescence intensity of EMA binding test was 29.97% (16.09%-47.34%) and the average intensity was (29.70±6.28) % of 258 HS patients. The decreased EMA binding fluorescence intensity correlated with MCV (r=-0.343, P<0.001) and MCHC (r=0.223, P<0.001). There was no relationship between EMA fluorescence intensity and absolute reticulocyte count (r=0.080, P=0.198) , reticulocyte percentile (r=-0.015, P=0.813) , IBIL levels (r=-0.009, P=0.902) , HGB levels (r=-0.067, P=0.280). Evaluated as a quartile variable, EMA fluorescence intensity was not correlated with anemia severity (C=0.150, P=0.746). Conclusion: EMA binding test does not related to anemia levels and has no major clinical implications for disease severity in HS.
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Affiliation(s)
- G X Peng
- Institute of Hematology and Blood Diseases Hospital, CAMS & PUMC, Tianjin 300020, China
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10
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Advances in laboratory diagnosis of hereditary spherocytosis. ACTA ACUST UNITED AC 2017; 55:944-948. [DOI: 10.1515/cclm-2016-0738] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2016] [Accepted: 09/29/2016] [Indexed: 11/15/2022]
Abstract
AbstractAmong the red cell membrane disorders, hereditary spherocytosis (HS) is one of the most common causes of inherited hemolytic anemia. HS results from the deficiency or dysfunction of red blood cell membrane proteins, such as α spectrin, β spectrin, ankyrin, anion channel protein (Band-3 protein), protein 4.1 and protein 4.2. Conventionally, HS diagnosis is established through a series of tests, which include spherocytes identification in peripheral smear, reticulocyte count, osmotic fragility, etc. Currently, different hematological analyzers provide erythrocyte indicators that estimate the presence of spherocytes and correlate that with HS, which can be useful for disease screening. The most traditional method is the osmotic fragility (OF) test, which is labor-intensive and time-consuming to perform and presents low sensitivity and specificity values. Thus, new methods have been developed for HS diagnosis, such as flow cytometry. Current guidelines recommend the use of flow cytometry as a screening test for HS diagnosis using the eosin-5′-maleimide (EMA) binding test. Thus, HS diagnosis is the result of a collaboration between clinicians and laboratories, who should take into account the family history and the exclusion of other causes of secondary spherocytosis.
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Agarwal AM, Liew MA, Nussenzveig RH, Sangle N, Heikal N, Yaish H, Christensen R. Improved harmonization of eosin-5-maleimide binding test across different instruments and age groups. CYTOMETRY PART B-CLINICAL CYTOMETRY 2015; 90:512-516. [PMID: 26384602 DOI: 10.1002/cyto.b.21326] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/11/2015] [Revised: 09/01/2015] [Accepted: 09/11/2015] [Indexed: 11/11/2022]
Abstract
BACKGROUND The eosin-5'maleimide (EMA) binding test has been studied extensively for the detection of hereditary spherocytosis (HS). Its performance characteristics have been compared to NaCl-based or glycerol lysis-based red cell osmotic fragility tests and cryohemolysis. HS samples are also better identified when both mean channel fluorescence (MCF) of EMA relative to controls and the coefficient of variation (CV) are analyzed. METHODS We looked at 65 normal controls including 30 adults 25-65 years old and 35 newborns and 12 HS cases. In addition to the MCF and the CV, we used a side scatter (SSC) vs. EMA fluorescence gate or "footprint" to depict where normal erythrocytes should appear. Erythrocytes that have reduced band 3 protein appear outside of the footprint. RESULTS In our study, newborn data did not cluster with the samples from working age individuals. The MCF and the CVs of normal newborns were higher than normal adult group. However, the footprint data of normal samples relative to their controls was around 99.5% for each group, because the footprint was moved to fit the pattern of the normal. CONCLUSIONS The inclusion of footprint parameter will help in better standardization as well as implementation of this test across different age groups as well as different instruments. © 2015 International Clinical Cytometry Society.
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Affiliation(s)
- Archana M Agarwal
- Department of Pathology, University of Utah, Salt Lake City, Utah, 84112.,Associated Regional and University Pathologists (ARUP) Laboratories, Salt Lake City, Utah, 84108
| | - Michael A Liew
- Associated Regional and University Pathologists (ARUP) Laboratories, Salt Lake City, Utah, 84108
| | - Roberto H Nussenzveig
- Associated Regional and University Pathologists (ARUP) Laboratories, Salt Lake City, Utah, 84108
| | - Nikhil Sangle
- Department of Pathology and Laboratory Medicine, Dental Sciences Building, Western University, London, Ontario, Canada
| | - Nahla Heikal
- Department of Pathology, University of Utah, Salt Lake City, Utah, 84112.,Associated Regional and University Pathologists (ARUP) Laboratories, Salt Lake City, Utah, 84108
| | - Hassan Yaish
- Division of Hematology/Oncology, Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, Utah
| | - Robert Christensen
- Divisions of Neonatology and Hematology Oncology, University of Utah School of Medicine, Salt Lake City, Utah
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