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Stauffer E, Pichon AP, Champigneulle B, Furian M, Hancco I, Darras A, Robach P, Brugniaux JV, Nader E, Connes P, Verges S, Kaestner L. Making a virtue out of an evil: Are red blood cells from chronic mountain sickness patients eligible for transfusions? Am J Hematol 2024; 99:1407-1410. [PMID: 38622808 DOI: 10.1002/ajh.27317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2024] [Revised: 03/18/2024] [Accepted: 03/22/2024] [Indexed: 04/17/2024]
Abstract
We investigated highlanders, permanently living at an altitude of 5100 m and compared Chronic Mountain Sickness (CMS) patients with control volunteers. While we found differences in systemic parameters such as blood oxygen content, hematocrit, hemoglobin concentration, and blood viscosity, the mechanical and rheological properties of single red blood cells did not differ between the two investigated groups.
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Affiliation(s)
- Emeric Stauffer
- Laboratoire Interuniversitaire de Biologie de la Motricité (LIBM) EA7424, Team "Vascular Biology and Red Blood Cell", Université Claude Bernard Lyon 1, Université de Lyon, Lyon, France
- Explorations Fonctionnelles Respiratoires, Médecine du sport et de l'Activité Physique, Hospices Civils de Lyon, Hôpital Croix Rousse, Lyon, France
| | | | | | - Michaël Furian
- Pulmonary Division, University Hospital Zurich, Zurich, Switzerland
| | - Ivan Hancco
- Instituto de Investigation de la Universidad San Martín de Porres, Centro de Investigation en Medicina de Altura (CIMA), Facultad de Medicina Human, Universidad de San Martin de Porres, Lima, Peru
| | - Alexis Darras
- Experimental Physics, Saarland University, Saarbrücken, Germany
| | - Paul Robach
- Université Grenoble Alpes, Inserm, CHU Grenoble Alpes HP2, Grenoble, France
- National School for Mountain Sports, Site of the National School for Skiing and Mountaineering (ENSA), Chamonix, France
| | - Julien V Brugniaux
- Université Grenoble Alpes, Inserm, CHU Grenoble Alpes HP2, Grenoble, France
| | - Elie Nader
- Laboratoire Interuniversitaire de Biologie de la Motricité (LIBM) EA7424, Team "Vascular Biology and Red Blood Cell", Université Claude Bernard Lyon 1, Université de Lyon, Lyon, France
| | - Philippe Connes
- Laboratoire Interuniversitaire de Biologie de la Motricité (LIBM) EA7424, Team "Vascular Biology and Red Blood Cell", Université Claude Bernard Lyon 1, Université de Lyon, Lyon, France
| | - Samuel Verges
- Université Grenoble Alpes, Inserm, CHU Grenoble Alpes HP2, Grenoble, France
| | - Lars Kaestner
- Experimental Physics, Saarland University, Saarbrücken, Germany
- Theoretical Medicine and Biosciences, Saarland University, Homburg, Germany
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Iolascon A, Andolfo I, Russo R, Sanchez M, Busti F, Swinkels D, Aguilar Martinez P, Bou-Fakhredin R, Muckenthaler MU, Unal S, Porto G, Ganz T, Kattamis A, De Franceschi L, Cappellini MD, Munro MG, Taher A. Recommendations for diagnosis, treatment, and prevention of iron deficiency and iron deficiency anemia. Hemasphere 2024; 8:e108. [PMID: 39011129 PMCID: PMC11247274 DOI: 10.1002/hem3.108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2024] [Revised: 04/16/2024] [Accepted: 05/27/2024] [Indexed: 07/17/2024] Open
Abstract
Iron is an essential nutrient and a constituent of ferroproteins and enzymes crucial for human life. Generally, nonmenstruating individuals preserve iron very efficiently, losing less than 0.1% of their body iron content each day, an amount that is replaced through dietary iron absorption. Most of the iron is in the hemoglobin (Hb) of red blood cells (RBCs); thus, blood loss is the most common cause of acute iron depletion and anemia worldwide, and reduced hemoglobin synthesis and anemia are the most common consequences of low plasma iron concentrations. The term iron deficiency (ID) refers to the reduction of total body iron stores due to impaired nutrition, reduced absorption secondary to gastrointestinal conditions, increased blood loss, and increased needs as in pregnancy. Iron deficiency anemia (IDA) is defined as low Hb or hematocrit associated with microcytic and hypochromic erythrocytes and low RBC count due to iron deficiency. IDA most commonly affects women of reproductive age, the developing fetus, children, patients with chronic and inflammatory diseases, and the elderly. IDA is the most frequent hematological disorder in children, with an incidence in industrialized countries of 20.1% between 0 and 4 years of age and 5.9% between 5 and 14 years (39% and 48.1% in developing countries). The diagnosis, management, and treatment of patients with ID and IDA change depending on age and gender and during pregnancy. We herein summarize what is known about the diagnosis, treatment, and prevention of ID and IDA and formulate a specific set of recommendations on this topic.
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Affiliation(s)
- Achille Iolascon
- Dipartimento di Medicina Molecolare e Biotecnologie Mediche Università degli Studi di Napoli Federico II Napoli Italy
- CEINGE Biotecnologie Avanzate Franco Salvatore Napoli Italy
| | - Immacolata Andolfo
- Dipartimento di Medicina Molecolare e Biotecnologie Mediche Università degli Studi di Napoli Federico II Napoli Italy
- CEINGE Biotecnologie Avanzate Franco Salvatore Napoli Italy
| | - Roberta Russo
- Dipartimento di Medicina Molecolare e Biotecnologie Mediche Università degli Studi di Napoli Federico II Napoli Italy
- CEINGE Biotecnologie Avanzate Franco Salvatore Napoli Italy
| | - Mayka Sanchez
- Department of Basic Sciences, Iron metabolism: Regulation and Diseases Universitat Internacional de Catalunya (UIC) Barcelona Spain
| | - Fabiana Busti
- Department of Medicine, Section of Internal Medicine and Azienda Ospedaliera Universitaria Integrata of Verona, EuroBloodNEt Referral Center for Iron Disorders, Policlinico G.B. Rossi University of Verona Verona Italy
| | - Dorine Swinkels
- Department of Laboratory Medicine, Translational Metabolic Laboratory (TML 830) Radboud University Medical Center Nijmegen The Netherlands
| | - Patricia Aguilar Martinez
- Department of Hematological Biology, Reference Center on Rare Red Cell Disorders Montpellier University Hospital Montpellier France
| | - Rayan Bou-Fakhredin
- Department of Clinical Sciences and Community Health University of Milan Milan Italy
| | - Martina U Muckenthaler
- Molecular Medicine Partnership Unit European Molecular Biology Laboratory Heidelberg Germany
- Translational Lung Research Center Heidelberg (TLRC), German Center for Lung Research (DZL), University of Heidelberg Heidelberg Germany
- German Centre for Cardiovascular Research, Partner Site Heidelberg Germany
| | - Sule Unal
- Department of Pediatric Hematology Hacettepe University Ankara Turkey
| | - Graça Porto
- HematologyServiço de Imuno-hemoterapia, CHUdSA-Centro Hospitalar Universitário de Santo António Porto Portugal
| | - Tomas Ganz
- Department of Medicine David Geffen School of Medicine at UCLA Los Angeles California USA
| | - Antonis Kattamis
- Division of Pediatric Hematology-Oncology, First Department of Pediatrics, National & Kapodistrian University of Athens "Aghia Sophia" Children's Hospital Athens Greece
| | - Lucia De Franceschi
- Department of Medicine University of Verona & AOUI Verona, Policlinico GB Rossi Verona Italy
| | - Maria Domenica Cappellini
- Department of Clinical Sciences and Community University of Milan, Cà Granda Foundation IRCCS Maggiore Policlinico Hospital Milan Italy
| | - Malcolm G Munro
- Department of Obstetrics and Gynecology David Geffen School of Medicine Los Angeles California USA
| | - Ali Taher
- Division of Hematology-Oncology, Department of Internal Medicine American University of Beirut Medical Center Beirut Lebanon
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Mantadaki AE, Linardakis M, Tsakiri M, Baliou S, Fragkiadaki P, Vakonaki E, Tzatzarakis MN, Tsatsakis A, Symvoulakis EK. Benefits of Quercetin on Glycated Hemoglobin, Blood Pressure, PiKo-6 Readings, Night-Time Sleep, Anxiety, and Quality of Life in Patients with Type 2 Diabetes Mellitus: A Randomized Controlled Trial. J Clin Med 2024; 13:3504. [PMID: 38930033 PMCID: PMC11205103 DOI: 10.3390/jcm13123504] [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: 05/19/2024] [Revised: 06/09/2024] [Accepted: 06/12/2024] [Indexed: 06/28/2024] Open
Abstract
Background: Diabetes is a rapidly growing global morbidity issue with high prevalence, and the associated dysglycemia leads to complications. Patients with type 2 diabetes mellitus (T2DM) often experience elevated anxiety levels, affecting their quality of life and diabetes management. This study investigated quercetin, a nutraceutical and potential senolytic with antioxidant activity, to detect its possible positive effect on the bio-clinical measurements and routine health of patients with T2DM. Methods: This prospective randomized controlled trial (RCT) investigated the clinical usefulness of quercetin in patients with T2DM receiving non-insulin medications. One hundred participants were stratified by age and sex (1:1) and randomized to control (n = 50) or intervention (n = 50) groups. The control received standard care only, while the intervention received 500 mg quercetin daily for 12 weeks, followed by an 8-week washout and a final consecutive 12-week supplementation period (total: 32 weeks), as adjunct to their usual care. Comprehensive health assessments, including blood analyses, were conducted at baseline and study termination. Quality of life and anxiety were assessed using the 36-item Short Form Health Survey (SF-36) and Short Anxiety Screening Test (SAST-10). Results: Eighty-eight patients with T2DM concluded the trial. Compared with the control, glycated hemoglobin (HbA1c) levels showed a significant decrease (Δ%-change: -4.0% vs. 0.1%, p = 0.011). Quercetin also significantly improved PiKo-6 readings (FEV1: 5.6% vs. -1.5%, p = 0.002), systolic blood pressure (-5.0% vs. -0.2%, p = 0.029), night-time sleep (11.6% vs. -7.3%, p < 0.001), anxiety levels (SAST-10) (-26.2% vs. 3.3%, p < 0.001), and quality of life (SF-36) (both physical and mental components, p < 0.001). Conclusions: Based on the current open-label study, quercetin appears to be a promising supplement for T2DM, providing lifestyle and care support. Further research is warranted to shift this potential from clinical usefulness and feasibility to multidisciplinary evidence.
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Affiliation(s)
- Aikaterini E. Mantadaki
- Clinic of Social and Family Medicine, Department of Social Medicine, School of Medicine, University of Crete, 70013 Heraklion, Greece; (M.L.); (E.K.S.)
| | - Manolis Linardakis
- Clinic of Social and Family Medicine, Department of Social Medicine, School of Medicine, University of Crete, 70013 Heraklion, Greece; (M.L.); (E.K.S.)
| | - Maria Tsakiri
- Iatrica, Local Unit of Lab Analysis and Diagnostics Network, 71303 Heraklion, Greece;
| | - Stella Baliou
- Laboratory of Toxicology, Medical School, University of Crete, 71003 Heraklion, Greece or (S.B.); (P.F.); (E.V.); (M.N.T.); (A.T.)
| | - Persefoni Fragkiadaki
- Laboratory of Toxicology, Medical School, University of Crete, 71003 Heraklion, Greece or (S.B.); (P.F.); (E.V.); (M.N.T.); (A.T.)
| | - Elena Vakonaki
- Laboratory of Toxicology, Medical School, University of Crete, 71003 Heraklion, Greece or (S.B.); (P.F.); (E.V.); (M.N.T.); (A.T.)
| | - Manolis N. Tzatzarakis
- Laboratory of Toxicology, Medical School, University of Crete, 71003 Heraklion, Greece or (S.B.); (P.F.); (E.V.); (M.N.T.); (A.T.)
| | - Aristidis Tsatsakis
- Laboratory of Toxicology, Medical School, University of Crete, 71003 Heraklion, Greece or (S.B.); (P.F.); (E.V.); (M.N.T.); (A.T.)
| | - Emmanouil K. Symvoulakis
- Clinic of Social and Family Medicine, Department of Social Medicine, School of Medicine, University of Crete, 70013 Heraklion, Greece; (M.L.); (E.K.S.)
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Rockfield SM, Turnis ME, Rodriguez-Enriquez R, Bathina M, Ng SK, Kurtz N, Becerra Mora N, Pelletier S, Robinson CG, Vogel P, Opferman JT. Genetic ablation of Immt induces a lethal disruption of the MICOS complex. Life Sci Alliance 2024; 7:e202302329. [PMID: 38467404 PMCID: PMC10927357 DOI: 10.26508/lsa.202302329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Revised: 02/29/2024] [Accepted: 03/01/2024] [Indexed: 03/13/2024] Open
Abstract
The mitochondrial contact site and cristae organizing system (MICOS) is important for crista junction formation and for maintaining inner mitochondrial membrane architecture. A key component of the MICOS complex is MIC60, which has been well studied in yeast and cell culture models. However, only one recent study has demonstrated the embryonic lethality of losing Immt (the gene encoding MIC60) expression. Tamoxifen-inducible ROSA-CreERT2-mediated deletion of Immt in adult mice disrupted the MICOS complex, increased mitochondria size, altered cristae morphology, and was lethal within 12 d. Pathologically, these mice displayed defective intestinal muscle function (paralytic ileus) culminating in dehydration. We also identified bone marrow (BM) hypocellularity in Immt-deleted mice, although BM transplants from wild-type mice did not improve survival. Altogether, this inducible mouse model demonstrates the importance of MIC60 in vivo, in both hematopoietic and non-hematopoietic tissues, and provides a valuable resource for future mechanistic investigations into the MICOS complex.
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Affiliation(s)
- Stephanie M Rockfield
- https://ror.org/02r3e0967 Department of Cell and Molecular Biology, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Meghan E Turnis
- https://ror.org/02r3e0967 Department of Cell and Molecular Biology, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Ricardo Rodriguez-Enriquez
- https://ror.org/02r3e0967 Department of Cell and Molecular Biology, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Madhavi Bathina
- https://ror.org/02r3e0967 Department of Cell and Molecular Biology, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Seng Kah Ng
- https://ror.org/02r3e0967 Department of Cell and Molecular Biology, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Nathan Kurtz
- https://ror.org/02r3e0967 Electron Microscopy, Department of Cellular Imaging Shared Resources, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Nathalie Becerra Mora
- https://ror.org/02r3e0967 Electron Microscopy, Department of Cellular Imaging Shared Resources, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Stephane Pelletier
- https://ror.org/02r3e0967 Transgenic Core Facility, Department of Immunology, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Camenzind G Robinson
- https://ror.org/02r3e0967 Electron Microscopy, Department of Cellular Imaging Shared Resources, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Peter Vogel
- https://ror.org/02r3e0967 Comparative Pathology Core, Pathology Department, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Joseph T Opferman
- https://ror.org/02r3e0967 Department of Cell and Molecular Biology, St. Jude Children's Research Hospital, Memphis, TN, USA
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Rao RB. Biomarkers of Brain Dysfunction in Perinatal Iron Deficiency. Nutrients 2024; 16:1092. [PMID: 38613125 PMCID: PMC11013337 DOI: 10.3390/nu16071092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2024] [Revised: 03/28/2024] [Accepted: 04/04/2024] [Indexed: 04/14/2024] Open
Abstract
Iron deficiency in the fetal and neonatal period (perinatal iron deficiency) bodes poorly for neurodevelopment. Given its common occurrence and the negative impact on brain development, a screening and treatment strategy that is focused on optimizing brain development in perinatal iron deficiency is necessary. Pediatric societies currently recommend a universal iron supplementation strategy for full-term and preterm infants that does not consider individual variation in body iron status and thus could lead to undertreatment or overtreatment. Moreover, the focus is on hematological normalcy and not optimal brain development. Several serum iron indices and hematological parameters in the perinatal period are associated with a risk of abnormal neurodevelopment, suggesting their potential use as biomarkers for screening and monitoring treatment in infants at risk for perinatal iron deficiency. A biomarker-based screening and treatment strategy that is focused on optimizing brain development will likely improve outcomes in perinatal iron deficiency.
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Affiliation(s)
- Raghavendra B. Rao
- Division of Neonatology, Department of Pediatrics, University of Minnesota Medical School, Minneapolis, MN 55455, USA;
- Masonic Institute for the Developing Brain, Minneapolis, MN 55414, USA
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6
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Thorsted A, Zecchin C, Berges A, Karlsson MO, Friberg LE. Predicting the Long-Term Effects of Therapeutic Neutralization of Oncostatin M on Human Hematopoiesis. Clin Pharmacol Ther 2024. [PMID: 38501358 DOI: 10.1002/cpt.3246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Accepted: 03/02/2024] [Indexed: 03/20/2024]
Abstract
Therapeutic neutralization of Oncostatin M (OSM) causes mechanism-driven anemia and thrombocytopenia, which narrows the therapeutic window complicating the selection of doses (and dosing intervals) that optimize efficacy and safety. We utilized clinical data from studies of an anti-OSM monoclonal antibody (GSK2330811) in healthy volunteers (n = 49) and systemic sclerosis patients (n = 35), to quantitatively determine the link between OSM and alterations in red blood cell (RBC) and platelet production. Longitudinal changes in hematopoietic variables (including RBCs, reticulocytes, platelets, erythropoietin, and thrombopoietin) were linked in a physiology-based model, to capture the long-term effects and variability of therapeutic OSM neutralization on human hematopoiesis. Free serum OSM stimulated precursor cell production through sigmoidal relations, with higher maximum suppression (Imax ) and OSM concentration for 50% suppression (IC50 ) for platelets (89.1% [95% confidence interval: 83.4-93.0], 6.03 pg/mL [4.41-8.26]) than RBCs (57.0% [49.7-64.0], 2.93 pg/mL [2.55-3.36]). Reduction in hemoglobin and platelets increased erythro- and thrombopoietin, respectively, prompting reticulocytosis and (partially) alleviating OSM-restricted hematopoiesis. The physiology-based model was substantiated by preclinical data and utilized in exploration of once-weekly or every other week dosing regimens. Predictions revealed an (for the indication) unacceptable occurrence of grade 2 (67% [58-76], 29% [20-38]) and grade 3 (17% [10-25], 3% [0-7]) anemias, with limited thrombocytopenia. Individual extent of RBC precursor modulation was moderately correlated to skin mRNA gene expression changes. The physiological basis and consideration of interplay among hematopoietic variables makes the model generalizable to other drug and nondrug scenarios, with adaptations for patient populations, diseases, and therapeutics that modulate hematopoiesis or exhibit risk of anemia and/or thrombocytopenia.
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Affiliation(s)
- Anders Thorsted
- Department of Pharmacy, Uppsala University, Uppsala, Sweden
- Clinical Pharmacology Modelling & Simulation, GSK, Stevenage, UK
| | - Chiara Zecchin
- Clinical Pharmacology Modelling & Simulation, GSK, Stevenage, UK
| | - Alienor Berges
- Clinical Pharmacology Modelling & Simulation, GSK, Stevenage, UK
| | | | - Lena E Friberg
- Department of Pharmacy, Uppsala University, Uppsala, Sweden
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Sandri BJ, Kim J, Lubach GR, Lock EF, Ennis-Czerniak K, Kling PJ, Georgieff MK, Coe CL, Rao RB. Prognostic Performance of Hematological and Serum Iron and Metabolite Indices for Detection of Early Iron Deficiency Induced Metabolic Brain Dysfunction in Infant Rhesus Monkeys. J Nutr 2024; 154:875-885. [PMID: 38072152 PMCID: PMC10942850 DOI: 10.1016/j.tjnut.2023.10.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Revised: 10/18/2023] [Accepted: 10/25/2023] [Indexed: 12/27/2023] Open
Abstract
BACKGROUND The current pediatric practice of monitoring for infantile iron deficiency (ID) via hemoglobin (Hgb) screening at one y of age does not identify preanemic ID nor protect against later neurocognitive deficits. OBJECTIVES To identify biomarkers of iron-related metabolic alterations in the serum and brain and determine the sensitivity of conventional iron and heme indices for predicting risk of brain metabolic dysfunction using a nonhuman primate model of infantile ID. METHODS Simultaneous serum iron and RBC indices, and serum and cerebrospinal fluid (CSF) metabolomic profiles were determined in 20 rhesus infants, comparing iron sufficient (IS; N = 10) and ID (N = 10) infants at 2 and 4 mo of age. RESULTS Reticulocyte hemoglobin (RET-He) was lower at 2 wk in the ID group. Significant IS compared with ID differences in serum iron indices were present at 2 mo, but Hgb and RBC indices differed only at 4 mo (P < 0.05). Serum and CSF metabolomic profiles of the ID and IS groups differed at 2 and 4 mo (P < 0.05). Key metabolites, including homostachydrine and stachydrine (4-5-fold lower at 4 mo in ID group, P < 0.05), were altered in both serum and CSF. Iron indices and RET-He at 2 mo, but not Hgb or other RBC indices, were correlated with altered CSF metabolic profile at 4 mo and had comparable predictive accuracy (area under the receiver operating characteristic curve scores, 0.75-0.80). CONCLUSIONS Preanemic ID at 2 mo was associated with metabolic alterations in serum and CSF in infant monkeys. Among the RBC indices, only RET-He predicted the future risk of abnormal CSF metabolic profile with a predictive accuracy comparable to serum iron indices. The concordance of homostachydrine and stachydrine changes in serum and CSF indicates their potential use as early biomarkers of brain metabolic dysfunction in infantile ID.
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Affiliation(s)
- Brian J Sandri
- Division of Neonatology, Department of Pediatrics, University of Minnesota, Minneapolis, MN, United States; Masonic Institute for the Developing Brain, University of Minnesota, Minneapolis, MN, United States
| | - Jonathan Kim
- Division of Biostatistics, School of Public Health, University of Minnesota, Minneapolis, MN, United States
| | - Gabriele R Lubach
- Harlow Center for Biological Psychology, University of Wisconsin, Madison, WI, United States
| | - Eric F Lock
- Division of Biostatistics, School of Public Health, University of Minnesota, Minneapolis, MN, United States
| | - Kathleen Ennis-Czerniak
- Division of Neonatology, Department of Pediatrics, University of Minnesota, Minneapolis, MN, United States
| | - Pamela J Kling
- Division of Neonatology, Department of Pediatrics, University of Wisconsin, Madison, WI, United States
| | - Michael K Georgieff
- Division of Neonatology, Department of Pediatrics, University of Minnesota, Minneapolis, MN, United States; Masonic Institute for the Developing Brain, University of Minnesota, Minneapolis, MN, United States
| | - Christopher L Coe
- Harlow Center for Biological Psychology, University of Wisconsin, Madison, WI, United States
| | - Raghavendra B Rao
- Division of Neonatology, Department of Pediatrics, University of Minnesota, Minneapolis, MN, United States; Masonic Institute for the Developing Brain, University of Minnesota, Minneapolis, MN, United States.
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Hevessy Z, Toth G, Antal-Szalmas P, Tokes-Fuzesi M, Kappelmayer J, Karai B, Ajzner E. Algorithm of differential diagnosis of anemia involving laboratory medicine specialists to advance diagnostic excellence. Clin Chem Lab Med 2024; 62:410-420. [PMID: 37823455 DOI: 10.1515/cclm-2023-0807] [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: 07/28/2023] [Accepted: 10/03/2023] [Indexed: 10/13/2023]
Abstract
OBJECTIVES Anemia is a severe global public health issue. Testing practices for anemia suggest overuse of screening laboratory tests and misinterpretation of studies even in "easy-to-diagnose" underlying causes, leading to late diagnoses and missed treatment opportunities. We aimed to develop a complete and efficient algorithm for clinical pathologists and laboratory medicine physicians for the differential diagnosis of anemia. METHODS Comprehensive literature search encompassing original articles, studies, reviews, gold standard books, and other evidence. RESULTS We created a complex algorithm, primarily for clinical pathology/laboratory use, that explores all major and several rare causes of anemia in an efficient and evidence-based manner. The algorithm includes gold-standard diagnostic laboratory tests available in most clinical laboratories and indices that can be easily calculated to provide an evidence-based differential diagnosis of anemia. CONCLUSIONS The diagnostic strategy combines previously available diagnostic tests and protocols in an efficient order. Clinical pathologists following the algorithm can independently provide valuable diagnostic support for healthcare providers. Clinical pathologists providing complete differential diagnostic services with the proposed algorithm may create an opportunity for an advanced diagnostic service that supports diagnostic excellence and helps patients receive a timely diagnosis and early treatment opportunities.
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Affiliation(s)
- Zsuzsanna Hevessy
- Department of Laboratory Medicine, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Gabor Toth
- Department of Laboratory Medicine, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Peter Antal-Szalmas
- Department of Laboratory Medicine, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Margit Tokes-Fuzesi
- Department of Laboratory Medicine, University of Pecs, Medical School, Pecs, Hungary
| | - Janos Kappelmayer
- Department of Laboratory Medicine, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Bettina Karai
- Department of Laboratory Medicine, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Eva Ajzner
- Central Laboratory of Szabolcs-Szatmar-Bereg County Teaching Hospital, Nyiregyhaza, Hungary
- Hematology Unit of South-Pest Central Hospital and National Institute of Hematology and Infectology, Budapest, Hungary
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9
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Paabo T, Mihkelson P, Beljantseva J, Rähni A, Täkker S, Porosk R, Kilk K, Reimand K. Diagnostic performance of automated red cell parameters in predicting bone marrow iron stores. Clin Chem Lab Med 2024; 62:442-452. [PMID: 37776061 DOI: 10.1515/cclm-2023-0772] [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: 07/20/2023] [Accepted: 09/20/2023] [Indexed: 10/01/2023]
Abstract
OBJECTIVES The aim of the study was to determine the diagnostic performance of novel automated red cell parameters for estimating bone marrow iron stores. METHODS The study was a retrospective single-centre study based on data from an automated haematology analyser and results of bone marrow iron staining. Red cell parameters were measured on a Sysmex XN-series haematology analyser. Bone marrow iron stores were assessed semiquantitatively by cytochemical reaction according to Perls. RESULTS The analysis included 429 bone marrow aspirate smears from 393 patients. Median age of patients was 67 years, 52 % of them were female. The most common indication for bone marrow examination was a plasma cell dyscrasia (n=104; 24 %). Median values of percentage of hypochromic and hyperchromic red blood cells (%HYPO-He, %HYPER-He), reticulocyte haemoglobin equivalent (RET-He) and microcytic red blood cells (MicroR) were statistically significantly different between cases with iron deplete and iron replete bone marrow. In a logistic regression model, ferritin was the best predictor of bone marrow iron stores (AUC=0.891), outperforming RET-He and %HYPER-He (AUC=0.736 and AUC=0.722, respectively). In a combined model, ferritin/MicroR index achieved the highest diagnostic accuracy (AUC=0.915), outperforming sTfR/log ferritin index (AUC=0.855). CONCLUSIONS While single automated red cell parameters did not show improved diagnostic accuracy when compared to traditional iron biomarkers, a novel index ferritin/MicroR has the potential to outperform ferritin and sTfR/log ferritin index for predicting bone marrow iron stores. Further research is needed for interpretation and implementation of novel parameters and indices, especially in the context of unexplained anaemia and myelodysplastic syndromes.
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Affiliation(s)
- Triin Paabo
- Department of Biochemistry, University of Tartu, Tartu, Estonia
- Department of Haematology and Bone Marrow Transplant, Tartu University Hospital, Tartu, Estonia
| | - Piret Mihkelson
- United Laboratories, Tartu University Hospital, Tartu, Estonia
| | | | - Ain Rähni
- United Laboratories, Tartu University Hospital, Tartu, Estonia
| | - Signe Täkker
- United Laboratories, Tartu University Hospital, Tartu, Estonia
| | - Rando Porosk
- Department of Biochemistry, University of Tartu, Tartu, Estonia
| | - Kalle Kilk
- Department of Biochemistry, University of Tartu, Tartu, Estonia
| | - Katrin Reimand
- United Laboratories, Tartu University Hospital, Tartu, Estonia
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10
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Ding N, Ma YH, Guo P, Wang TK, Liu L, Wang JB, Jin PP. Reticulocyte hemoglobin content associated with the risk of iron deficiency anemia. Heliyon 2024; 10:e25409. [PMID: 38327465 PMCID: PMC10847927 DOI: 10.1016/j.heliyon.2024.e25409] [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] [Received: 08/31/2023] [Revised: 01/24/2024] [Accepted: 01/25/2024] [Indexed: 02/09/2024] Open
Abstract
Background/Objective Reticulocyte hemoglobin content (MCHr) was recognized as a rapid and reliable marker for investigating iron deficiency (ID). We hypothesized that MCHr was associated with the risk of iron deficiency anemia in adults. Methods This is a dual-center case-control study. A total of 806 patients and healthy individuals were recruited from Ruijin Hospital and Xinhua Hospital affiliated to Shanghai Jiaotong University School of Medicine between January 2021 and December 2021. The participants were categorized into iron deficiency anemia (IDA) group (n = 302), non-IDA group (n = 366), and healthy control group (n = 138). According to the MCHr level, the participants were divided into two groups, i.e. normal MCHr (≥25 pg) and decreased MCHr (<25 pg) group. Multivariate logistic regression analysis and adjusted subgroup analysis were conducted to estimate the relative risk between MCHr and IDA, with confounding factors including age, sex, hemoglobin (Hb), mean corpuscular volume (MCV), mean corpuscular hemoglobin (MCH), mean corpuscular hemoglobin concentration (MCHC), Hematocrit (HCT), serum iron (Fe), ferritin (Ferrit), and total iron binding capacity (TIBC). Results Compared with the non-IDA, the MCHr level with IDA decreased significantly. ROC curve analysis showed that MCHr had the largest area under the AUC curve. After comprehensive adjustment for confounding factors, individuals with normal level of MCHr exhibited a decreased risk of IDA (OR = 0.68 [0.60, 0.77], P < 0.01), while the risk of IDA was up to 5 times higher for those with decreased MCHr. Conclusion Our findings supported the hypothesis that MCHr was associated with the risk of IDA in adults and could serve as an indicator of IDA severity. MCHr holds clinical value as an auxiliary diagnostic indicator, providing valuable insights into whether invasive examinations are warranted in the assessment of IDA.
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Affiliation(s)
- Ning Ding
- Department of Laboratory Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 201801, China
| | - Yan-Hui Ma
- Department of Laboratory Medicine, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200092, China
| | - Ping Guo
- Department of Laboratory Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China
| | - Tian-Kai Wang
- Department of Laboratory Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 201801, China
| | - Lin Liu
- Department of Laboratory Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 201801, China
| | - Jian-Biao Wang
- Department of Laboratory Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China
| | - Pei-Pei Jin
- Department of Laboratory Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 201801, China
- Department of Laboratory Medicine, Ruijin-Hainan Hospital, Shanghai Jiao Tong University School of Medicine (Hainan Boao Research Hospital), Hainan, 571473, China
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11
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Visser M, Hof WFJ, Broek AM, van Hoek A, de Jong JJ, Touw DJ, Dekkers BGJ. Unexpected Amanita phalloides-Induced Hematotoxicity-Results from a Retrospective Study. Toxins (Basel) 2024; 16:67. [PMID: 38393145 PMCID: PMC10891511 DOI: 10.3390/toxins16020067] [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: 12/19/2023] [Revised: 01/17/2024] [Accepted: 01/23/2024] [Indexed: 02/25/2024] Open
Abstract
INTRODUCTION Amanita phalloides poisoning is a serious health problem with a mortality rate of 10-40%. Poisonings are characterized by severe liver and kidney toxicity. The effect of Amanita phalloides poisonings on hematological parameters has not been systematically evaluated thus far. METHODS Patients with suspected Amanita phalloides poisonings were retrospectively selected from the hospital database of the University Medical Center Groningen (UMCG). Medical data-including demographics; liver, kidney, and blood parameters; treatment; and outcomes-were collected. The severity of the poisoning was scored using the poison severity score. RESULTS Twenty-eight patients were identified who were admitted to the UMCG with suspected Amanita phalloides poisoning between 1994 and 2022. A time-dependent decrease was observed for hemoglobin and hematocrit concentrations, leukocytes, and platelets. Six out of twenty-eight patients developed acute liver failure (ALF). Patients with ALF showed a higher increase in liver enzymes, international normalized ratios, and PSS compared to patients without ALF. Conversely, hemoglobin and platelet numbers were decreased even further in these patients. Three out of six patients with ALF died and one patient received a liver transplant. CONCLUSION Our study shows that Amanita phalloides poisonings may be associated with hematotoxicity in patients. The quantification of hematological parameters is of relevance in intoxicated patients, especially in those with ALF.
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Affiliation(s)
- Miranda Visser
- Department of Clinical Pharmacy and Pharmacology, University Medical Center Groningen (UMCG), 9713 GZ Groningen, The Netherlands; (M.V.); (W.F.J.H.); (A.M.B.); (A.v.H.); (J.J.d.J.); (D.J.T.)
| | - Willemien F. J. Hof
- Department of Clinical Pharmacy and Pharmacology, University Medical Center Groningen (UMCG), 9713 GZ Groningen, The Netherlands; (M.V.); (W.F.J.H.); (A.M.B.); (A.v.H.); (J.J.d.J.); (D.J.T.)
| | - Astrid M. Broek
- Department of Clinical Pharmacy and Pharmacology, University Medical Center Groningen (UMCG), 9713 GZ Groningen, The Netherlands; (M.V.); (W.F.J.H.); (A.M.B.); (A.v.H.); (J.J.d.J.); (D.J.T.)
| | - Amanda van Hoek
- Department of Clinical Pharmacy and Pharmacology, University Medical Center Groningen (UMCG), 9713 GZ Groningen, The Netherlands; (M.V.); (W.F.J.H.); (A.M.B.); (A.v.H.); (J.J.d.J.); (D.J.T.)
| | - Joyce J. de Jong
- Department of Clinical Pharmacy and Pharmacology, University Medical Center Groningen (UMCG), 9713 GZ Groningen, The Netherlands; (M.V.); (W.F.J.H.); (A.M.B.); (A.v.H.); (J.J.d.J.); (D.J.T.)
| | - Daan J. Touw
- Department of Clinical Pharmacy and Pharmacology, University Medical Center Groningen (UMCG), 9713 GZ Groningen, The Netherlands; (M.V.); (W.F.J.H.); (A.M.B.); (A.v.H.); (J.J.d.J.); (D.J.T.)
- Department of Pharmaceutical Analysis, Groningen Research Institute of Pharmacy, University of Groningen, 9713 AV Groningen, The Netherlands
| | - Bart G. J. Dekkers
- Department of Clinical Pharmacy and Pharmacology, University Medical Center Groningen (UMCG), 9713 GZ Groningen, The Netherlands; (M.V.); (W.F.J.H.); (A.M.B.); (A.v.H.); (J.J.d.J.); (D.J.T.)
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12
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Perez-Ecija A, Martinez C, Fernandez-Castañer J, Mendoza FJ. The Immature Reticulocyte Fraction (IRF) in the Sysmex XN-1000V Analyzer Can Differentiate between Causes of Regenerative and Non-Regenerative Anemia in Dogs and Cats. Animals (Basel) 2024; 14:349. [PMID: 38275808 PMCID: PMC10812539 DOI: 10.3390/ani14020349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Revised: 01/09/2024] [Accepted: 01/19/2024] [Indexed: 01/27/2024] Open
Abstract
The Sysmex XN-1000V analyzer can identify those reticulocytes with high RNA content and fluorescence, providing the immature reticulocyte fraction (IRF). While this parameter has been used in human medicine to identify the cause of anemia, few studies have focused on its use in veterinary medicine. In this study, we determined the IRF and related reticulocyte parameters in a large population of non-anemic and anemic dogs and cats (subclassified depending on the origin of their anemia). The IRF was significantly higher in hemolytic anemias compared to hemorrhagic ones in both species. Moreover, the IRF was significantly lower in dogs and cats with bone marrow failure than in other non-regenerative anemias and in both groups compared to pre-regenerative anemias. The accurate cut-off values for the differential in regenerative anemias and reference ranges for both species using the Sysmex XN-1000V are also reported. The measurement of the IRF in this analyzer can help clinicians to further classify the type of anemia in both species.
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Affiliation(s)
- Alejandro Perez-Ecija
- Department of Animal Medicine and Surgery, University of Cordoba, Campus Rabanales, Road Madrid-Cadiz km 396, 14104 Cordoba, Spain; (C.M.); (F.J.M.)
- Veterinary Teaching Hospital, University of Cordoba, Campus Rabanales, Road Madrid-Cadiz km 396, 14104 Cordoba, Spain;
| | - Carmen Martinez
- Department of Animal Medicine and Surgery, University of Cordoba, Campus Rabanales, Road Madrid-Cadiz km 396, 14104 Cordoba, Spain; (C.M.); (F.J.M.)
- Veterinary Teaching Hospital, University of Cordoba, Campus Rabanales, Road Madrid-Cadiz km 396, 14104 Cordoba, Spain;
| | - Julio Fernandez-Castañer
- Veterinary Teaching Hospital, University of Cordoba, Campus Rabanales, Road Madrid-Cadiz km 396, 14104 Cordoba, Spain;
| | - Francisco J. Mendoza
- Department of Animal Medicine and Surgery, University of Cordoba, Campus Rabanales, Road Madrid-Cadiz km 396, 14104 Cordoba, Spain; (C.M.); (F.J.M.)
- Veterinary Teaching Hospital, University of Cordoba, Campus Rabanales, Road Madrid-Cadiz km 396, 14104 Cordoba, Spain;
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13
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Zhang X, Ren H, Tian J, Yang C, Luo H. Usefulness of baseline immature reticulocyte fraction to mature reticulocyte fraction ratio (IMR) as A prognostic predictor for patients with small cell lung cancer. Heliyon 2024; 10:e23830. [PMID: 38192754 PMCID: PMC10772623 DOI: 10.1016/j.heliyon.2023.e23830] [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] [Received: 04/29/2023] [Revised: 12/05/2023] [Accepted: 12/13/2023] [Indexed: 01/10/2024] Open
Abstract
Background Small cell lung cancer (SCLC) has a strong invasive ability and a high degree of malignancy, so accurate prognosis prediction is crucial for making the most favorable treatment decision.Unfortunately, there is a scarcity of prognostic indicators specific to SCLC. Reticulocyte levels in blood parameters have been linked to the prognosis of various malignancies. Given SCLC's aggressive characteristics, identifying reliable prognostic markers, such as reticulocyte counts, becomes pivotal in enhancing prognostic accuracy and guiding effective therapeutic strategies. Objective This study aimed to evaluate the predictive power of the immature reticulocyte fraction (IRF) to mature reticulocyte fraction (MRF) ratio (IMR) for survival outcomes in patients with SCLC. Materials and methods A retrospective analysis was conducted on 192 patients with small cell lung cancer (SCLC). The median values of various prognostic indicators, such as IMR, IRF, MRF, reticulocyte count (RET), SII (systemic immune-inflammatory index), were utilized as cutoff points, categorizing patients into high and low groups. The Kaplan-Meier method, univariate, multivariate analyses Cox regression, and C-index were used to analyze the prognostic factors for overall survival (OS). Results In our cohort, 138 (71.9 %) were male, 119 (62 %) were smokers, and 82 (57.3 %) were older than 60 years old. The median survival time was 18.15 months.Higher mortality was observed in the high IMR and high IRF groups, while the high MRF group exhibited lower mortality. At the same time, mortality was lower in the high MRF group. Univariate analysis showed that smoking history (P = 0.006), tumor stage (P = 0.002), chemotherapy cycle (P = 0.014), IMR (P = 0.01), and many other factors significantly affected the prognosis of SCLC. Multivariate analysis demonstrated that elevated IMR was an independent adverse predictor of OS (P = 0.039, HR = 0.330). Spearman test confirmed that the prognostic indicators IRF, IMR, and SII were positively correlated with the overall survival rate of patients with SCLC. Kaplan-Meier analysis showed that the OS rate of patients with high IMR was significantly worse (P = 0.0096). In addition, we found that IMR was superior to IRF in distinguishing patients with different outcomes in the low and high groups (P < 0.05). Our novel integration index, combining IMR with the TNM stage system and SII index, exhibited superior prognostic value compared to the original index. Additionally, the combination of prognostic indicators IMR and SII significantly stratified stage I-II SCLC patients (P <0.05). Conclusions The prognostic index based on peripheral blood IMR stands out as an independent predictor for SCLC patients pre-treatment. Its accessibility through routine blood analysis facilitates immediate clinical application without requiring prolonged scientific research validation. The integration of IMR with the TNM score enhances survival prediction and risk stratification. Notably, when combined with the SII score, the new IMR index demonstrates significant improvements in prognostication for stage I-II small cell lung cancer.
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Affiliation(s)
- Xingmei Zhang
- College of Medical Technology, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, 610042, China
- Department of Clinical Laboratory, Sichuan Clinical Research Center for Cancer, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, Affiliated Cancer Hospital of University of Electronic Science and Technology of China, Chengdu, 610041 China
| | - Hanxiao Ren
- College of Medical Technology, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, 610042, China
| | - Jiangchuan Tian
- Key Laboratory of Clinical Laboratory Diagnostics (Chinese Ministry of Education), College of Laboratory Medicine, Chongqing Medical Laboratory Microfluidics and SPRi Engineering Research Center, Chongqing Medical University, Chongqing 400016, China
- Department of Laboratory Medicine, Guang'an People's Hospital, Guang'an, Sichuan, 638000, China
| | - Chaoguo Yang
- College of Medical Technology, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, 610042, China
| | - Huaichao Luo
- Department of Clinical Laboratory, Sichuan Clinical Research Center for Cancer, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, Affiliated Cancer Hospital of University of Electronic Science and Technology of China, Chengdu, 610041 China
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14
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Liu Y, Dai S, Xu Y, Xiang Y, Zhang Y, Xu Z, Sun L, Zhang GCX, Shu Q. Integration of Network Pharmacology and Experimental Validation to Explore Jixueteng - Yinyanghuo Herb Pair Alleviate Cisplatin-Induced Myelosuppression. Integr Cancer Ther 2024; 23:15347354241237969. [PMID: 38462913 DOI: 10.1177/15347354241237969] [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] [Indexed: 03/12/2024] Open
Abstract
Jixueteng, the vine of the bush Spatholobus suberectus Dunn., is widely used to treat irregular menstruation and arthralgia. Yinyanghuo, the aboveground part of the plant Epimedium brevicornum Maxim., has the function of warming the kidney to invigorate yang. This research aimed to investigate the effects and mechanisms of the Jixueteng and Yinyanghuo herbal pair (JYHP) on cisplatin-induced myelosuppression in a mice model. Firstly, ultra-high performance liquid chromatography quadrupole time-of-flight mass spectrometry (UPLC-Q-TOF/MS) screened 15 effective compounds of JYHP decoction. Network pharmacology enriched 10 genes which may play a role by inhibiting the apoptosis of bone marrow (BM) cells. Then, a myelosuppression C57BL/6 mice model was induced by intraperitoneal (i.p.) injection of cis-Diaminodichloroplatinum (cisplatin, CDDP) and followed by the intragastric (i.g.) administration of JYHP decoction. The efficacy was evaluated by blood cell count, reticulocyte count, and histopathological analysis of bone marrow and spleen. Through the vivo experiments, we found the timing of JYHP administration affected the effect of drug administration, JYHP had a better therapeutical effect rather than a preventive effect. JYHP obviously recovered the hematopoietic function of bone marrow from the peripheral blood cell test and pathological staining. Flow cytometry data showed JYHP decreased the apoptosis rate of BM cells and the western blotting showed JYHP downregulated the cleaved Caspase-3/Caspase-3 ratios through RAS/MEK/ERK pathway. In conclusion, JYHP alleviated CDDP-induced myelosuppression by inhibiting the apoptosis of BM cells through RAS/MEK/ERK pathway and the optimal timing of JYHP administration was after CDDP administration.
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Affiliation(s)
- Yi Liu
- The First School of Clinical Medicine of Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
| | - Shuying Dai
- The First School of Clinical Medicine of Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
| | - Yixiao Xu
- School of Pharmaceutical Sciences of Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
| | - Yuying Xiang
- The First School of Clinical Medicine of Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
| | - Yao Zhang
- The First School of Clinical Medicine of Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
| | - Zeting Xu
- The First School of Clinical Medicine of Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
| | - Lin Sun
- Zhejiang Provincial Hospital of Chinese Medicine, Hangzhou, China
| | | | - Qijin Shu
- Zhejiang Provincial Hospital of Chinese Medicine, Hangzhou, China
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15
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Abstract
The developing brain is particularly vulnerable to extrinsic environmental events such as anemia and iron deficiency during periods of rapid development. Studies of infants with postnatal iron deficiency and iron deficiency anemia clearly demonstrated negative effects on short-term and long-term brain development and function. Randomized interventional trials studied erythropoiesis-stimulating agents and hemoglobin-based red blood cell transfusion thresholds to determine how they affect preterm infant neurodevelopment. Studies of red blood cell transfusion components are limited in preterm neonates. A biomarker strategy measuring brain iron status and health in the preanemic period is desirable to evaluate treatment options and brain response.
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Affiliation(s)
- Tate Gisslen
- Division of Neonatology, Department of Pediatrics, University of Minnesota Medical School, Academic Office Building, 2450 Riverside Avenue, SAO-401, Minneapolis, MN 55454, USA.
| | - Raghavendra Rao
- Division of Neonatology, Department of Pediatrics, University of Minnesota Medical School, Academic Office Building, 2450 Riverside Avenue, SAO-401, Minneapolis, MN 55454, USA
| | - Michael K Georgieff
- Division of Neonatology, Department of Pediatrics, University of Minnesota Medical School, Academic Office Building, 2450 Riverside Avenue, SAO-401, Minneapolis, MN 55454, USA
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16
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Bahr TM, Tan S, Smith E, Beauman SS, Schibler KR, Grisby CA, Lowe JR, Bell EF, Laptook AR, Shankaran S, Carlton DP, Rau C, Baserga MC, Flibotte J, Zaterka-Baxter K, Walsh MC, Das A, Christensen RD, Ohls RK. Serum ferritin values in neonates <29 weeks' gestation are highly variable and do not correlate with reticulocyte hemoglobin content. J Perinatol 2023; 43:1368-1373. [PMID: 37596391 PMCID: PMC10825191 DOI: 10.1038/s41372-023-01751-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Revised: 05/23/2023] [Accepted: 08/07/2023] [Indexed: 08/20/2023]
Abstract
OBJECTIVES To compare serum ferritin and RET-He values among extremely low gestational age neonates ELGANs with other markers of iron-deficient erythropoiesis. STUDY DESIGN This is a secondary analysis of the NICHD Darbepoetin Trial. Study data from placebo recipients who had a serum ferritin, a RET-He, and a mean corpuscular volume (MCV) measurement within a 24-hour period were analyzed for correlation. RESULTS Mixed linear regression models showed no association between ferritin and RET-He at both early (β = 0.0016, p = 0.40) and late (β = -0.0001, p = 0.96) time points. Positive associations were observed between RET-He and MCV at baseline, early, and late time points (p < 0.01, =0.01, <0.001, respectively), while ferritin was not associated with MCV at any time point. CONCLUSIONS Our study shows that RET-He is better correlated with MCV as a marker of iron-limited erythropoiesis than ferritin. The results suggest that ferritin is limited as a marker of iron sufficiency in premature infants. STUDY IDENTIFICATION FDA IND Number 100138; ClinicalTrials.gov number NCT03169881; NRN ID number NICHD-NRN-0058 (Darbe).
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Affiliation(s)
- Timothy M Bahr
- Division of Neonatology, Department of Pediatrics, University of Utah Health, Salt Lake City, UT, USA.
- Department of Neonatology, Intermountain Healthcare, Murray, UT, USA.
| | - Sylvia Tan
- Social, Statistical and Environmental Sciences Unit, RTI International, Washington, DC, USA
| | - Emily Smith
- Social, Statistical and Environmental Sciences Unit, RTI International, Washington, DC, USA
| | - Sandra S Beauman
- Department of Pediatrics, University of New Mexico, Albuquerque, NM, USA
| | - Kurt R Schibler
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Cathy A Grisby
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Jean R Lowe
- Department of Pediatrics, University of New Mexico, Albuquerque, NM, USA
| | - Edward F Bell
- Department of Pediatrics, University of Iowa, Iowa City, IA, USA
| | - Abbot R Laptook
- Department of Pediatrics, Brown University, Providence, RI, USA
| | - Seetha Shankaran
- Department of Pediatrics, Wayne State University, Detroit, MI, USA
| | - David P Carlton
- Department of Pediatrics, Emory University, Atlanta, GA, USA
| | - Carrie Rau
- Division of Neonatology, Department of Pediatrics, University of Utah Health, Salt Lake City, UT, USA
| | - Mariana C Baserga
- Division of Neonatology, Department of Pediatrics, University of Utah Health, Salt Lake City, UT, USA
| | - John Flibotte
- Department of Pediatrics, University of Pennsylvania, Philadelphia, PA, USA
| | - Kristin Zaterka-Baxter
- Social, Statistical and Environmental Sciences Unit, RTI International, Washington, DC, USA
| | - Michele C Walsh
- Division of Extramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD, USA
| | - Abhik Das
- Social, Statistical and Environmental Sciences Unit, RTI International, Washington, DC, USA
| | - Robert D Christensen
- Division of Neonatology, Department of Pediatrics, University of Utah Health, Salt Lake City, UT, USA
- Department of Neonatology, Intermountain Healthcare, Murray, UT, USA
| | - Robin K Ohls
- Division of Neonatology, Department of Pediatrics, University of Utah Health, Salt Lake City, UT, USA
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17
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Overmars LM, van Solinge WW, Ruijter HMD, van der Worp HB, Van Es B, Hulsbergen-Veelken CAR, Biessels GJ, Exalto LG, Haitjema S. Sexual dimorphism in peripheral blood cell characteristics linked to recanalization success of endovascular thrombectomy in acute ischemic stroke. J Thromb Thrombolysis 2023; 56:614-625. [PMID: 37596427 PMCID: PMC10550865 DOI: 10.1007/s11239-023-02881-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/02/2023] [Indexed: 08/20/2023]
Abstract
Endovascular thrombectomy (EVT) success to treat acute ischemic stroke varies with factors like stroke etiology and clot composition, which can differ between sexes. We studied if sex-specific blood cell characteristics (BCCs) are related to recanalization success. We analyzed electronic health records of 333 EVT patients from a single intervention center, and extracted 71 BCCs from the Sapphire flow cytometry analyzer. Through Sparse Partial Least Squares Discriminant Analysis, incorporating cross-validation and stability selection, we identified BCCs associated with successful recanalization (TICI 3) in both sexes. Stroke etiology was considered, while controlling for cardiovascular risk factors. Of the patients, successful recanalization was achieved in 51% of women and 49% of men. 21 of the 71 BCCs showed significant differences between sexes (pFDR-corrected < 0.05). The female-focused recanalization model had lower error rates than both combined [t(192.4) = 5.9, p < 0.001] and male-only models [t(182.6) = - 15.6, p < 0.001]. In women, successful recanalization and cardioembolism were associated with a higher number of reticulocytes, while unsuccessful recanalization and large artery atherosclerosis (LAA) as cause of stroke were associated with a higher mean corpuscular hemoglobin concentration. In men, unsuccessful recanalization and LAA as cause of stroke were associated with a higher coefficient of variance of lymphocyte complexity of the intracellular structure. Sex-specific BCCs related to recanalization success varied and were linked to stroke etiology. This enhanced understanding may facilitate personalized treatment for acute ischemic stroke.
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Affiliation(s)
- L Malin Overmars
- Central Diagnostic Laboratory, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands.
- Department of Neurology and Neurosurgery, UMC Utrecht Brain Center, University Medical Center, Utrecht University, Utrecht, The Netherlands.
| | - Wouter W van Solinge
- Central Diagnostic Laboratory, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Hester M den Ruijter
- Laboratory of Experimental Cardiology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - H Bart van der Worp
- Department of Neurology and Neurosurgery, UMC Utrecht Brain Center, University Medical Center, Utrecht University, Utrecht, The Netherlands
| | - Bram Van Es
- Central Diagnostic Laboratory, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | | | - Geert Jan Biessels
- Department of Neurology and Neurosurgery, UMC Utrecht Brain Center, University Medical Center, Utrecht University, Utrecht, The Netherlands
| | - Lieza G Exalto
- Department of Neurology and Neurosurgery, UMC Utrecht Brain Center, University Medical Center, Utrecht University, Utrecht, The Netherlands
| | - Saskia Haitjema
- Central Diagnostic Laboratory, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
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18
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Marchesani S, Di Mauro M, Ceglie G, Grassia G, Carletti M, Cristofaro RC, Cossutta M, Curcio C, Palumbo G. The blood count as a compass to navigate in the ever-changing landscape of the carrier state of hemoglobinopathies: a single-center Italian experience. Front Pediatr 2023; 11:1228443. [PMID: 37868262 PMCID: PMC10587575 DOI: 10.3389/fped.2023.1228443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Accepted: 09/20/2023] [Indexed: 10/24/2023] Open
Abstract
Introduction Approximately 7% of the worldwide population exhibits variations in the globin genes. The recent migration of populations from countries where hemoglobin disorders are endemic has resulted in important epidemiological changes with the diffusion of newly discovered or poorly characterized genetic variants and new combinations and very heterogeneous clinical phenotypes. The aim of our study is to assess the parameters that are more significant in predicting a positive genetic testing outcome for hemoglobinopathies in a pediatric population of patients presenting with anemia or microcythemia, without a definite diagnosis. Methods and materials This study included patients evaluated in our hematological outpatient clinic for anemia and/or microcythemia despite normal ferritin levels. A screening of pathological hemoglobins using high-performance liquid chromatography (HPLC) was performed for the entire population of the study. Subsequently, patients with hemoglobin (Hb) S trait and patients with an HPLC profile compatible with beta thalassemia trait were excluded from the study. Genetic screening tests for hemoglobinopathies were performed on the remaining patients, which involved measuring the red blood cell (RBC) counts, red blood cells distribution width (RDW), reticulocyte count, and mean corpuscular volume of reticulocytes (MCVr). Results This study evaluated a total of 65 patients, consisting of nine patients with negative genetic analysis results and 56 patients with positive genetic analysis results. The Hb and RDW values in these two groups did not demonstrate statistical significance. On the other hand, there were statistically significant differences observed in the mean corpuscular volume (MCV), RBC count, reticulocyte count, and MCVr between the two groups. Furthermore, in the group of patients with positive genetic test results, specific genetic findings associated with different HPLC results were observed. In particular, 13 patients with positive genetic test results had normal HPLC findings. Discussion This study has demonstrated that HPLC, while serving as a valuable first-level test, has some limitations. Specifically, it has been observed that some patients may exhibit a negative HPLC result despite a positive genetic analysis. In addition to the presence of low levels of Hb and HPLC alterations, other parameters could potentially indicate the underlying mutations in the globin genes. Therefore, we propose that the complete blood cell count be utilized as a widely available parameter for conducting targeted genetic analyses to avoid the risk of overlooking rare hemoglobinopathies.
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Affiliation(s)
- Silvio Marchesani
- University Department of Pediatrics, Bambino Gesù Children’s Hospital, University of Rome Tor Vergata, Rome, Italy
| | - Margherita Di Mauro
- University Department of Pediatrics, Bambino Gesù Children’s Hospital, University of Rome Tor Vergata, Rome, Italy
| | - Giulia Ceglie
- Department of Pediatric Hematology and Oncology, Cell and Gene Therapy, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
- Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Ginevra Grassia
- University Department of Pediatrics, Bambino Gesù Children’s Hospital, University of Rome Tor Vergata, Rome, Italy
| | - Michaela Carletti
- Clinical Laboratory Unit, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
| | | | - Matilde Cossutta
- University Department of Pediatrics, Bambino Gesù Children’s Hospital, University of Rome Tor Vergata, Rome, Italy
| | - Cristina Curcio
- Medical Genetics Laboratory, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Giuseppe Palumbo
- University Department of Pediatrics, Bambino Gesù Children’s Hospital, University of Rome Tor Vergata, Rome, Italy
- Department of Pediatric Hematology and Oncology, Cell and Gene Therapy, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
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19
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Loo E, Rodrigues Simoes NJ, Browne LJ, Mindiola Romero AE, Kaur P. Hematology lab waste reduction through implementation of peripheral smear review criteria. Int J Lab Hematol 2023; 45:813-815. [PMID: 37211976 DOI: 10.1111/ijlh.14103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Accepted: 05/03/2023] [Indexed: 05/23/2023]
Affiliation(s)
- Eric Loo
- Department of Pathology and Laboratory Medicine, Dartmouth-Hitchcock Medical Center, Dartmouth Health, Lebanon, New Hampshire, USA
| | - Nathalie J Rodrigues Simoes
- Department of Pathology and Laboratory Medicine, Dartmouth-Hitchcock Medical Center, Dartmouth Health, Lebanon, New Hampshire, USA
| | - Leslie J Browne
- Department of Pathology and Laboratory Medicine, Dartmouth-Hitchcock Medical Center, Dartmouth Health, Lebanon, New Hampshire, USA
| | - Andres E Mindiola Romero
- Department of Pathology and Laboratory Medicine, Dartmouth-Hitchcock Medical Center, Dartmouth Health, Lebanon, New Hampshire, USA
| | - Prabhjot Kaur
- Department of Pathology and Laboratory Medicine, Dartmouth-Hitchcock Medical Center, Dartmouth Health, Lebanon, New Hampshire, USA
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20
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Kitaoka H, Shitara Y, Kashima K, Ochiai S, Chikai H, Watanabe K, Ida H, Kumagai T, Takahashi N. Risk factors for anemia of prematurity among 30-35-week preterm infants. Fukushima J Med Sci 2023; 69:115-123. [PMID: 37164765 PMCID: PMC10480510 DOI: 10.5387/fms.2022-21] [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: 05/23/2022] [Accepted: 03/22/2023] [Indexed: 05/12/2023] Open
Abstract
BACKGROUND The risk factors for anemia of prematurity (AOP) among late preterm infants are unelucidated. We identified risk factors for declining hemoglobin (Hb) concentration and triggering factors for AOP treatment in infants born at 30-35 gestational weeks. METHODS From 2012 to 2020, we conducted a single-center retrospective study of infants born at 30-35 weeks of gestation without congenital anomalies or severe hemorrhage. The primary outcome was AOP development, defined by initiation of treatments including red blood cell transfusion, subcutaneous injections of erythropoietin, and iron supplementation. A multivariable logistic regression model was used to investigate potential risk factors for AOP. RESULTS A total of 358 infants were included. Lower gestational age (odds ratio, 0.19; 95% confidence interval 0.11-0.32), small for gestational age (SGA; 7.17, 2.15-23.9), low maternal Hb level before birth (0.66, 0.49-0.87), low Hb at birth (0.71, 0.57-0.89), and multiple large blood samplings (1.79; 1.40-2.29) showed significantly higher odds for AOP development. CONCLUSIONS Gestational age, SGA, low maternal Hb before birth, Hb at birth, and high number of large blood samplings were positively associated with AOP development in infants born at 30-35 gestational weeks.
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Affiliation(s)
- Hiroki Kitaoka
- Department of Pediatrics, Yaizu City Hospital
- Department of Pediatrics, The University of Tokyo Hospital
| | | | - Kohei Kashima
- Department of Pediatrics, The University of Tokyo Hospital
| | | | - Hayato Chikai
- Department of Pediatrics, Yaizu City Hospital
- Department of Neonatology, Tokyo Metropolitan Bokutoh Hospital
| | | | - Hiroto Ida
- Department of Pediatrics, Yaizu City Hospital
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21
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Chen H, Yu J, Wei Q, Zhang Y, Ouyang X, Wang S. Intravenous iron and erythropoietin therapy for postoperative anemia among orthopedic surgery patients. J Orthop Surg Res 2023; 18:510. [PMID: 37464433 DOI: 10.1186/s13018-023-03926-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Accepted: 06/12/2023] [Indexed: 07/20/2023] Open
Abstract
BACKGROUND Postoperative anemia is a risk factor for adverse surgical outcomes. Our study aimed to assess the role of intravenous iron and erythropoietin therapy for the rapid correction of anemia following orthopedic surgery. METHODS Patients undergoing elective orthopedic surgery were prospectively enrolled and randomly divided into three groups: Control (placebo), Group 1 (IV iron monotherapy), and Group 2 [combined IV iron and recombinant human erythropoietin (rHuEPO) therapy]. Blood tests were performed preoperative (baseline) and on postoperative days (PODs) 1, 3, and 7. RESULTS All groups demonstrated significantly lower hemoglobin (Hb) concentrations compared to baseline, with no significant inter-group differences in postoperative Hb concentrations (p > 0.05). Serum erythropoietin, ferritin, and vitamin B12 levels, and reticulocyte count increased beyond normal ranges in all groups. Significantly lower serum iron levels were observed postoperatively in all groups (p < 0.05). No significant inter-group differences in hepcidin level were observed (p > 0.05). CONCLUSION Postoperative treatment with combined intravenous iron and rHuEPO was ineffective in correcting postoperative anemia among orthopedic surgery patients, besides achieving higher reticulocyte counts in the first week of surgery. No improvement in mobilization of storage iron was achieved with rHuEPO. We further suggest against vitamin B12 administration during the early postoperative period.
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Affiliation(s)
- Huixin Chen
- Department of Blood Transfusion, Wuhan Hospital of Traditional Chinese and Western Medicine, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jing Yu
- Department of Blood Transfusion, Wuhan Hospital of Traditional Chinese and Western Medicine, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Qing Wei
- Department of Transfusion, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yu Zhang
- Department of Blood Transfusion, Wuhan Hospital of Traditional Chinese and Western Medicine, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xilin Ouyang
- Department of Blood Transfusion, Chinese PLA General Hospital Fourth Medical Center, Beijing, 100048, China.
| | - Shun Wang
- Department of Clinical Laboratory, Wuhan Hospital of Traditional Chinese and Western Medicine, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China.
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22
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Champigneulle B, Stauffer E, Robach P, Doutreleau S, Howe CA, Pina A, Salazar-Granara AA, Hancco I, Guergour D, Brugniaux JV, Connes P, Pichon A, Verges S. Early effects of acetazolamide on hemoglobin mass and plasma volume in chronic mountain sickness at 5100 m. Pulmonology 2023:S2531-0437(23)00095-8. [PMID: 37263861 DOI: 10.1016/j.pulmoe.2023.05.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2022] [Revised: 04/19/2023] [Accepted: 05/10/2023] [Indexed: 06/03/2023] Open
Abstract
INTRODUCTION AND OBJECTIVES Chronic Mountain Sickness (CMS) syndrome, combining excessive erythrocytosis and clinical symptoms in highlanders, remains a public health concern in high-altitude areas, especially in the Andes, with limited therapeutic approaches. The objectives of this study were to assess in CMS-highlanders permanently living in La Rinconada (5100-5300 m, Peru, the highest city in the world), the early efficacy of acetazolamide (ACZ) and atorvastatin to reduce hematocrit (Hct), as well as the underlying mechanisms focusing on intravascular volumes. MATERIALS AND METHODS Forty-one males (46±8 years of age) permanently living in La Rinconada for 15 [10-20] years and suffering from CMS were randomized between ACZ (250 mg once-daily; N = 13), atorvastatin (20 mg once-daily; N = 14) or placebo (N = 14) uptake in a double-blinded parallel study. Hematocrit (primary endpoint) as well as arterial blood gasses, total hemoglobin mass (Hbmass) and intravascular volumes were assessed at baseline and after a mean (±SD) treatment duration of 19±2 days. RESULTS ACZ increased PaO2 by +13.4% (95% CI: 4.3 to 22.5%) and decreased Hct by -5.2% (95% CI: -8.3 to -2.2%), whereas Hct remained unchanged with placebo or atorvastatin. ACZ tended to decrease Hbmass (-2.6%, 95% CI: -5.7 to 0.5%), decreased total red blood cell volume (RBCV, -5.3%, 95% CI: -10.3 to -0.3%) and increased plasma volume (PV, +17.6%, 95% CI: 4.9 to 30.3%). Atorvastatin had no effect on intravascular volumes, while Hbmass and RBCV increased in the placebo group (+6.1%, 95% CI: 4.2 to 7.9% and +7.0%, 95%CI: 2.7 to 11.4%, respectively). CONCLUSIONS Short-term ACZ uptake was effective to reduce Hct in CMS-highlanders living at extreme altitude >5,000 m and was associated with both an increase in PV and a reduction in RBCV.
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Affiliation(s)
- B Champigneulle
- Univ. Grenoble Alpes, Inserm, CHU Grenoble Alpes, HP2, 38000 Grenoble, France.
| | - E Stauffer
- Laboratoire Interuniversitaire de Biologie de la Motricité (LIBM) EA7424, Team "Vascular Biology and Red Blood Cell", Université Claude Bernard Lyon 1, Université de Lyon, France; Laboratoire d'Excellence du Globule Rouge (Labex GR-Ex), PRES Sorbonne, Paris, France; Exploration Fonctionnelle Respiratoire, Médecine du Sport et de l'Activité Physique, Hospices Civils de Lyon, Hôpital Croix Rousse, Lyon, France
| | - P Robach
- Univ. Grenoble Alpes, Inserm, CHU Grenoble Alpes, HP2, 38000 Grenoble, France; National School for Mountain Sports, Site of the National School for Skiing and Mountaineering (ENSA), Chamonix, France
| | - S Doutreleau
- Univ. Grenoble Alpes, Inserm, CHU Grenoble Alpes, HP2, 38000 Grenoble, France
| | - C A Howe
- Centre for Heart, Lung and Vascular Health, School of Health and Exercise Sciences, University of British Columbia - Okanagan, Kelowna, Canada
| | - A Pina
- Department of Cardiovascular, Neural and Metabolic Sciences, Istituto Auxologico Italiano, IRCCS, S. Luca Hospital, Milan, Italy
| | - A A Salazar-Granara
- Universidad de San Martin de Porres, School of Medicine, Research Centre in Altitude Medicine, Lima, Peru
| | - I Hancco
- Univ. Grenoble Alpes, Inserm, CHU Grenoble Alpes, HP2, 38000 Grenoble, France
| | - D Guergour
- Unité Biochimie Immunoanalyse, Service de Biochimie Biologie Moléculaire et Toxicologie Environnementale, Institut de Biologie et Pathologie, CHU Grenoble Alpes, France
| | - J V Brugniaux
- Univ. Grenoble Alpes, Inserm, CHU Grenoble Alpes, HP2, 38000 Grenoble, France
| | - P Connes
- Laboratoire Interuniversitaire de Biologie de la Motricité (LIBM) EA7424, Team "Vascular Biology and Red Blood Cell", Université Claude Bernard Lyon 1, Université de Lyon, France; Laboratoire d'Excellence du Globule Rouge (Labex GR-Ex), PRES Sorbonne, Paris, France
| | - A Pichon
- Laboratoire Move EA 6314, Faculté des Sciences du Sport, Universit. De Poitiers, Poitiers, France
| | - S Verges
- Univ. Grenoble Alpes, Inserm, CHU Grenoble Alpes, HP2, 38000 Grenoble, France
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23
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Jung JH, Yang Y, Seo D, Cho S, Choi G, Kim Y. Clinical utility of immature reticulocyte fraction for identifying early red blood cell regeneration in anemic dogs. J Vet Intern Med 2023; 37:484-489. [PMID: 36762697 DOI: 10.1111/jvim.16641] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Accepted: 01/26/2023] [Indexed: 02/11/2023] Open
Abstract
BACKGROUND Evaluating regeneration is essential for the classification and differential diagnosis of anemia in dogs. Early detection of regeneration is challenging in anemic dogs. OBJECTIVES This study assessed the value of immature reticulocyte fraction (IRF) in differentiating preregenerative anemia (PRA) from nonregenerative anemia (NRA) in dogs. ANIMALS Ninety-four dogs: 49 controls and 45 with anemia. METHODS Case-control study. Fractions of low-, medium- (MFR), and high-fluorescence reticulocytes (HFR), were measured using the ADVIA 2120i hematology analyzer. The IRF was calculated as the sum of percentages of MFR and HFR. Data from dogs with regenerative anemia (RA, n = 19), PRA (n = 11), and NRA (n = 15) were retrospectively analyzed. The value of IRF was compared with reticulocyte production index (RPI) using the receiver operating characteristic (ROC) curve. RESULTS The median of IRF was significantly higher in dogs with RA (46.5%; range, 40.9-53.6%; P < .001) and PRA (40.6%; range, 27.7-47.1%; P = .01) than in controls (22.1%; range, 16.9-29.3%). The IRF in dogs with PRA showed no difference compared to dogs with RA (P > .99) but was higher than dogs with NRA (18.7%; range, 8.8-24%; P = .00). The area under the ROC curve of IRF was superior to that of RPI (0.897 vs 0.818, P = .00) in differentiating dogs with PRA from NRA. CONCLUSIONS AND CLINICAL IMPORTANCE The IRF is a reliable variable for detecting early regeneration in anemic dogs without reticulocytosis. The study suggests that the measurement of IRF could be useful in classifying anemic dogs.
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Affiliation(s)
- Jae-Ha Jung
- Laboratory of Clinical Pathology, College of Veterinary Medicine, Seoul National University, Seoul, Republic of Korea.,BK 21 FOUR Program for Future Veterinary Medicine Leading Education and Research Center, College of Veterinary Medicine, Seoul National University, Seoul, Republic of Korea
| | - Yeseul Yang
- Laboratory of Clinical Pathology, College of Veterinary Medicine, Seoul National University, Seoul, Republic of Korea
| | - Dansong Seo
- Laboratory of Clinical Pathology, College of Veterinary Medicine, Seoul National University, Seoul, Republic of Korea
| | - Soyeon Cho
- Laboratory of Clinical Pathology, College of Veterinary Medicine, Seoul National University, Seoul, Republic of Korea.,BK 21 FOUR Program for Future Veterinary Medicine Leading Education and Research Center, College of Veterinary Medicine, Seoul National University, Seoul, Republic of Korea
| | - Goeun Choi
- Laboratory of Clinical Pathology, College of Veterinary Medicine, Seoul National University, Seoul, Republic of Korea
| | - Yongbaek Kim
- Laboratory of Clinical Pathology, College of Veterinary Medicine, Seoul National University, Seoul, Republic of Korea.,Research Institute for Veterinary Science, College of Veterinary Medicine, Seoul National University, Seoul, Republic of Korea
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24
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Zhang L, Yang J, Lai C, Wan L, Xiong S, Kong W, Liu Z, Yu P, Chen M, Mai W, Khan SA, Deng M, Chen L, Lei Y, Zhou Q, Yu N, Li P, Chen Z, Ji T. Immunity against Delta and Omicron variants elicited by homologous inactivated vaccine booster in kidney transplant recipients. Front Immunol 2023; 13:1042784. [PMID: 36700230 PMCID: PMC9868555 DOI: 10.3389/fimmu.2022.1042784] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Accepted: 12/09/2022] [Indexed: 01/11/2023] Open
Abstract
Background A third mRNA vaccine booster is recommended to improve immunity against SARS-CoV-2 in kidney transplant recipients (KTRs). However, the immunity against SARS-CoV-2 Ancestral strain and Delta and Omicron variants elicited by the third dose of inactivated booster vaccine in KTRs remains unknown. Methods The blood parameters related to blood cells count, hepatic function, kidney function, heart injury and immunity were explored clinically from laboratory examinations. SARS-CoV-2 specific antibody IgG titer was detected using an enzyme-linked immunosorbent assay. Cellular immunity was analyzed using interferon-γ enzyme-linked immunospot assay. Results The results showed that there were no severe adverse effects and apparent changes of clinical laboratory biomarkers in KTRs and healthy volunteers (HVs) after homologous inactivated vaccine booster. A third dose of inactivated vaccine booster significantly increased anti-Ancestral-spike-trimer-IgG and anti-Ancestral-receptor binding domain (RBD)-IgG titers in KTRs and HVs compared with the second vaccination. However, the anti-Delta-RBD-IgG and anti-Omicron-RBD-IgG titers were significantly lower than anti-Ancestral-RBD-IgG titer in KTRs and HVs after the third dose. Notably, only 25.6% (10/39) and 10.3% (4/39) of KTRs had seropositivity for anti-Delta-RBD-IgG and anti-Omicron-RBD-IgG after booster, which were significantly lower than HVs (anti-Delta-RBD-IgG: 100%, anti-Omicron-RBD-IgG: 77.8%). Ancestral strain nucleocapsid protein and spike specific T cell frequency after booster was not significantly increased in KTRs compared with the second dose, significantly lower than that in HVs. Moreover, 33.3% (12/36), 14.3% (3/21) and 14.3% (3/21) of KTRs were positive for the Ancestral strain and Delta and Omicron spike-specific T cells, which were significantly lower than HVs (Ancestral: 80.8%, Delta: 53.8%, and Omicron: 57.7%). Conclusions A third dose of inactivated booster vaccine may significantly increase humoral immunity against the Ancestral strain in KTRs, while humoral and cellular immunity against the Delta and Omicron variants were still poor in KTRs.
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Affiliation(s)
- Lei Zhang
- Kidney Transplant Department, The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Jiaqing Yang
- State Key Laboratory of Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Changchun Lai
- Provincial Key Laboratory of Immune Regulation and Immunotherapy, Department of Medical Laboratory, School of Laboratory Medicine and Biotechnology, Southern Medical University, Guangzhou, Guangdong, China,Clinical Laboratory Medicine Department, Maoming People’s Hospital, Maoming, Guangdong, China
| | - Li Wan
- Clinical Laboratory Medicine Department, The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Shilong Xiong
- Clinical Laboratory Medicine Department, The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Weiya Kong
- Clinical Laboratory Medicine Department, The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Zijian Liu
- State Key Laboratories of Respiratory Diseases, Guangdong-Hong Kong-Macao Joint Laboratory of Infectious Respiratory Disease, Guangzhou Institutes of Biomedicine and Health, Chinese Academy of Sciences, Guangzhou, China
| | - Pei Yu
- Clinical Laboratory Medicine Department, The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Mingxiao Chen
- Clinical Laboratory Medicine Department, The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Weikang Mai
- Clinical Laboratory Medicine Department, The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Shahzad Akbar Khan
- Laboratory of Pathology, Department of Pathobiology, University of Poonch Rawalakot, Azad Kashmir, Pakistan
| | - Min Deng
- Clinical Laboratory Medicine Department, The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Lu Chen
- Clinical Laboratory Medicine Department, The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Yu Lei
- Clinical Laboratory Medicine Department, The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Qiang Zhou
- Clinical Laboratory Medicine Department, The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Nan Yu
- Provincial Key Laboratory of Immune Regulation and Immunotherapy, Department of Medical Laboratory, School of Laboratory Medicine and Biotechnology, Southern Medical University, Guangzhou, Guangdong, China,*Correspondence: Tianxing Ji, ; Zheng Chen, ; Pingchao Li, ; Nan Yu,
| | - Pingchao Li
- State Key Laboratories of Respiratory Diseases, Guangdong-Hong Kong-Macao Joint Laboratory of Infectious Respiratory Disease, Guangzhou Institutes of Biomedicine and Health, Chinese Academy of Sciences, Guangzhou, China,*Correspondence: Tianxing Ji, ; Zheng Chen, ; Pingchao Li, ; Nan Yu,
| | - Zheng Chen
- Kidney Transplant Department, The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, China,*Correspondence: Tianxing Ji, ; Zheng Chen, ; Pingchao Li, ; Nan Yu,
| | - Tianxing Ji
- Clinical Laboratory Medicine Department, The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, China,*Correspondence: Tianxing Ji, ; Zheng Chen, ; Pingchao Li, ; Nan Yu,
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25
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Argüello Marina M, López Rubio M, Castilla García L. [Autoimmune haemolytic anaemia]. Med Clin (Barc) 2023; 160:30-38. [PMID: 36334945 DOI: 10.1016/j.medcli.2022.07.021] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 07/28/2022] [Accepted: 07/29/2022] [Indexed: 12/29/2022]
Abstract
Autoimmune haemolytic anaemias (AIHA) are acquired haematological disorders caused by increased peripheral erythrocyte destruction mediated by autoantibodies against erythrocyte antigens. They classified according to aetiology into primary and secondary, and according to the type of antibody and reaction temperature into AIHA due to warm antibodies (w-AIHA) and AIHA due to cold antibodies (c-AIHA). The mainstay of management in w-AIHA remains glucocorticoid therapy, and the early addition of rituximab has shown good results in recent studies. Primary c-AIHA is mainly treated with rituximab, alone or in combination with chemotherapy. New drugs such as Syk inhibitors, anti-FcRn Ig and complement inhibitors are in advanced development and will expand the therapeutic arsenal, especially in refractory or relapsed cases.
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Affiliation(s)
- María Argüello Marina
- Servicio de Hematología y Hemoterapia, Hospital Universitario Príncipe de Asturias, Alcalá de Henares, Madrid, España.
| | - Montserrat López Rubio
- Servicio de Hematología y Hemoterapia, Hospital Universitario Príncipe de Asturias, Alcalá de Henares, Madrid, España
| | - Lucía Castilla García
- Servicio de Hematología y Hemoterapia, Hospital Universitario Príncipe de Asturias, Alcalá de Henares, Madrid, España
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26
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Perchard M, Barbaro P, Rane M, Norman A. Clinical utility of reticulocyte haemoglobin in the assessment of iron deficiency and iron deficiency anaemia in the paediatric population. J Paediatr Child Health 2023; 59:153-158. [PMID: 36334002 DOI: 10.1111/jpc.16265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Revised: 05/12/2022] [Accepted: 10/16/2022] [Indexed: 11/06/2022]
Abstract
AIM Reticulocyte haemoglobin (Ret-He) is a useful marker in the assessment of iron stores in adult and paediatric patients. It is currently not utilised in Pathology Queensland. The objective of this study is to verify Ret-He in our Pathology Queensland laboratory and assess the clinical utility in the assessment of iron deficiency (ID) and iron deficiency anaemia (IDA) in paediatric patients. METHODS Samples from patients aged <18 years sent to the Pathology Queensland laboratory that had paired full blood count and iron studies were included in this study. A minimum of 120 samples were required for verification of testing requirements and a minimum of 30 samples per age range were required for confirmation of published age-related reference intervals. RESULTS Published Ret-He reference intervals were confirmed for stated age ranges in normal (non-ID) patients. Ret-He below the reference range for age demonstrated a good correlation with ID and IDA. CONCLUSIONS Ret-He is a useful marker in the assessment of ID and IDA in a paediatric population. It is not affected by acute or chronic inflammation. Ret-He is sensitive and specific (86% and 92%) for the diagnosis of ID.
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Affiliation(s)
| | | | - Mark Rane
- Queensland Children's Hospital, Brisbane, Queensland, Australia
| | - Andrew Norman
- Queensland Children's Hospital, Brisbane, Queensland, Australia
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27
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Rao RB, Lubach GR, Ennis-Czerniak KM, Lock EF, Kling PJ, Georgieff MK, Coe CL. Reticulocyte Hemoglobin Equivalent has Comparable Predictive Accuracy as Conventional Serum Iron Indices for Predicting Iron Deficiency and Anemia in a Nonhuman Primate model of Infantile Iron Deficiency. J Nutr 2023; 153:148-157. [PMID: 36913448 PMCID: PMC10196609 DOI: 10.1016/j.tjnut.2022.11.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 10/05/2022] [Accepted: 11/09/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Infantile iron deficiency (ID) causes anemia and compromises neurodevelopment. Current screening relies on hemoglobin (Hgb) determination at 1 year of age, which lacks sensitivity and specificity for timely detection of infantile ID. Low reticulocyte Hgb equivalent (RET-He) indicates ID, but its predictive accuracy relative to conventional serum iron indices is unknown. OBJECTIVES The objective was to compare diagnostic accuracies of iron indices, red blood cell (RBC) indices, and RET-He for predicting the risk of ID and IDA in a nonhuman primate model of infantile ID. METHODS Serum iron, total iron binding capacity, unsaturated iron binding capacity, transferrin saturation (TSAT), Hgb, RET-He, and other RBC indices were determined at 2 wk and 2, 4, and 6 mo in breastfed male and female rhesus infants (N = 54). The diagnostic accuracies of RET-He, iron, and RBC indices for predicting the development of ID (TSAT < 20%) and IDA (Hgb < 10 g/dL + TSAT < 20%) were determined using t tests, area under the receiver operating characteristic curve (AUC) analysis, and multiple regression models. RESULTS Twenty-three (42.6%) infants developed ID and 16 (29.6%) progressed to IDA. All 4 iron indices and RET-He, but not Hgb or RBC indices, predicted future risk of ID and IDA (P < 0.001). The predictive accuracy of RET-He (AUC = 0.78, SE = 0.07; P = 0.003) for IDA was comparable to that of the iron indices (AUC = 0.77-0.83, SE = 0.07; P ≤ 0.002). A RET-He threshold of 25.5 pg strongly correlated with TSAT < 20% and correctly predicted IDA in 10 of 16 infants (sensitivity: 62.5%) and falsely predicted possibility of IDA in only 4 of 38 unaffected infants (specificity: 89.5%). CONCLUSIONS RET-He is a biomarker of impending ID/IDA in rhesus infants and can be used as a hematological parameter to screen for infantile ID.
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Affiliation(s)
- Raghavendra B Rao
- Division of Neonatology, Department of Pediatrics, University of Minnesota, Minneapolis, MN, USA; Masonic Institute for the Developing Brain, University of Minnesota, Minneapolis, MN, USA.
| | - Gabriele R Lubach
- Harlow Center for Biological Psychology, University of Wisconsin, Madison, WI, USA
| | | | - Eric F Lock
- Division of Biostatistics, School of Public Health, University of Minnesota, Minneapolis, MN, USA
| | - Pamela J Kling
- Division of Neonatology, Department of Pediatrics, University of Wisconsin, Madison, WI, USA
| | - Michael K Georgieff
- Division of Neonatology, Department of Pediatrics, University of Minnesota, Minneapolis, MN, USA; Masonic Institute for the Developing Brain, University of Minnesota, Minneapolis, MN, USA
| | - Christopher L Coe
- Harlow Center for Biological Psychology, University of Wisconsin, Madison, WI, USA
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Celik N, Laloğlu E, Aslan H. Novel markers in predicting Brucella sacroiliitis: The platelet large cell ratio and basal immature reticulocyte fraction. ASIAN PAC J TROP MED 2023. [DOI: 10.4103/1995-7645.368022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
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Prevalence and Implications of Low Reticulocyte-Hemoglobin Levels among Extreme Preterm Neonates: A Single-Center Retrospective Study. Nutrients 2022; 14:nu14245343. [PMID: 36558502 PMCID: PMC9788547 DOI: 10.3390/nu14245343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Revised: 11/29/2022] [Accepted: 12/07/2022] [Indexed: 12/23/2022] Open
Abstract
This retrospective cohort study aims to determine the epidemiology of iron deficiency among extreme preterm neonates and the association of iron-deficient status during the NICU stay with neurodevelopmental outcomes at 18−24 months. Neonates ≤29 weeks gestational age (GA) born between June 2016 and December 2019, who received routine iron supplementation were enrolled. Iron deficiency was defined as reticulocyte−hemoglobin (Ret-Hb) levels ≤ 29 pg at 36 weeks corrected age. A subcohort of neonates completed standardized developmental assessment at 18−24 months corrected age. Significant neurodevelopmental impairment (sNDI) was defined as either Bayley Scales of Infant Development score < 70 or cerebral palsy or blindness or hearing aided. Among a cohort of 215 neonates [GA 25.8 (1.7) weeks, birthweight 885 (232) g], prevalence of iron deficiency was 55%, 21%, 26%, and 13%, in neonates <24 weeks, 24−25 + 6 weeks, 26−27 + 6 weeks, and ≥ 28 weeks GA, respectively. Male sex and receipt of corticosteroid therapy were associated with iron-deficiency. In the subcohort analysis (n = 69), there was no statistically significant association between Ret-Hb levels at 36 weeks corrected age and the risk of sNDI [OR 0.99 (95% CI 0.85−1.2)]. Male infants and those who received postnatal corticosteroids are likely to have iron-limited erythropoiesis at corrected term despite routine iron-supplementation; however, low Ret-Hb levels during the neonatal period were not associated with significant neurological disability in early childhood.
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Liu LY, Gu Q, Hu X, Fan J, Liu XZ. Potential Mediators of Causal Associations of Circulating Triglycerides With Blood Pressure: Evidence From Genetic and Observational Data. Hypertension 2022; 79:2439-2447. [DOI: 10.1161/hypertensionaha.122.19510] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Background:
Existing evidence indicates that elevated triglycerides may affect blood pressure, but the underlying mechanisms are not fully understood. Herein, we aim to identify the intermediaries of associations of triglyceride with systolic blood pressure and diastolic blood pressure using the Mendelian randomization (MR) framework.
Methods:
Triglyceride-associated single nucleotide polymorphisms were extracted and used to match phenotypes in PhenoScanner. From the broad spectrum of possible triglyceride-associated traits, potential mediators linking triglyceride to blood pressure were screened out by MR and MR-based mediation analysis. Moreover, cross-sectional observational data of 206 341 adults were used to validate the mediators identified at the genetic level.
Results:
Among the nearly 100 raw phenotypes matched by 313 triglyceride-associated single nucleotide polymorphisms, 39 traits were filtered and integrated into subsequent analysis. By further filtering using MR analysis, only pulse rate and lymphocyte count (LC) were identified as independent mediators. MR-based mediation analysis showed that genetically predicted LC could mediate 9.2% of the association of triglyceride with systolic blood pressure; genetically predicted pulse rate and LC could mediate 18.3% and 17.6% of the association of triglyceride with DBP, respectively. Observational data also support the mediating role of pulse rate and LC.
Conclusions:
The current findings highlighted the mediating role of pulse rate and LC on the causal pathway from triglyceride to blood pressure and may contribute to a better understanding of the pathogenic mechanism by which high triglyceride affects other cardiometabolic factors.
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Affiliation(s)
- Lian Yong Liu
- Department of Endocriology, Punan Hospital of Pudong New District, Shanghai, China (L.Y.L.)
| | - Qing Gu
- Department of Endocrinology, Shidong Hospital, University of Shanghai for Science and Technology, China (Q.G., X.H.)
| | - Xue Hu
- Department of Endocrinology, Shidong Hospital, University of Shanghai for Science and Technology, China (Q.G., X.H.)
| | - Jie Fan
- Zhejiang Police College, Hangzhou, China (J.F.)
| | - Xing Zhen Liu
- Hangzhou Aeronautical Sanatorium for Special Service of China Air Force, China (X.Z.L.)
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Practical Approach to the Interpretation of Complete Blood Count Reports and Histograms. Indian Pediatr 2022. [DOI: 10.1007/s13312-022-2540-3] [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]
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Turudic D, Milosevic D, Bilic K, Prohászka Z, Bilic E. A Limited Course of Eculizumab in a Child with the Atypical Hemolytic Uremic Syndrome and Pre-B Acute Lymphoblastic Leukemia on Maintenance Therapy: Case Report and Literature Review. J Clin Med 2022; 11:jcm11102779. [PMID: 35628906 PMCID: PMC9142928 DOI: 10.3390/jcm11102779] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2022] [Revised: 04/25/2022] [Accepted: 05/10/2022] [Indexed: 02/06/2023] Open
Abstract
Acute lymphoblastic leukemia (ALL) is considered a possible risk for the occurrence of thrombotic microangiopathies. We present a girl with pre-B ALL successfully treated according to the BFM ALL IC-2009 protocol on maintenance therapy followed by aHUS occurrence. This is the seventh case of HUS/aHUS on ALL maintenance therapy and the first with clearly documented eculizumab use in the early stage of aHUS/secondary TMA. Standard and additional parameters were used in aHUS monitoring alongside the reticulocyte production index adjusted for age (RPI/A) and the aspartate aminotransferase-to-platelet ratio index (APRI) as markers of hemolysis and rapid response following treatment. RPI/A and APRI are markers of bone marrow response to anemia serving as red blood cell vs. platelet recovery markers. Together they mark the exact recovery point of thrombotic microangiopathy and serve as a prognostic marker of eculizumab treatment success. During the 8-month treatment and 6-month follow-up, no recurrence of hemolysis, ALL relapse, or renal damage were observed. A systematic review of the literature revealed 14/312 articles; five children had aHUS before the onset of ALL, and two children had both diseases concurrently. At least 3/7 patients are attributed to aHUS, of whom 2/7 have renal damage. Potential undiagnosed/unpublished cases may be assumed.
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Affiliation(s)
- Daniel Turudic
- Department of Pediatric Hematology and Oncology, University Hospital Centre Zagreb, Kispaticeva 12, 10000 Zagreb, Croatia; (D.T.); (E.B.)
| | - Danko Milosevic
- School of Medicine, University of Zagreb, Šalata 3, 10000 Zagreb, Croatia;
- Department of Pediatrics, General Hospital Zabok and Hospital of Croatian Veterans, Bracak 8, 49210 Bracak, Croatia
- Correspondence:
| | - Katarina Bilic
- School of Medicine, University of Zagreb, Šalata 3, 10000 Zagreb, Croatia;
| | - Zoltán Prohászka
- Department of Internal Medicine and Haematology, Semmelweis University, 1085 Budapest, Hungary;
- Research Group for Immunology and Haematology, Semmelweis University, 1085 Budapest, Hungary
| | - Ernest Bilic
- Department of Pediatric Hematology and Oncology, University Hospital Centre Zagreb, Kispaticeva 12, 10000 Zagreb, Croatia; (D.T.); (E.B.)
- School of Medicine, University of Zagreb, Šalata 3, 10000 Zagreb, Croatia;
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Yang H, Pawitan Y, Fang F, Czene K, Ye W. Biomarkers and Disease Trajectories Influencing Women's Health: Results from the UK Biobank Cohort. PHENOMICS (CHAM, SWITZERLAND) 2022; 2:184-193. [PMID: 35578620 PMCID: PMC9096057 DOI: 10.1007/s43657-022-00054-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Revised: 04/13/2022] [Accepted: 04/15/2022] [Indexed: 02/02/2023]
Abstract
Women's health is important for society. Despite the known biological and sex-related factors influencing the risk of diseases among women, the network of the full spectrum of diseases in women is underexplored. This study aimed to systematically examine the women-specific temporal pattern (trajectory) of the disease network, including the role of baseline physical examination indexes, and blood and urine biomarkers. In the UK Biobank study, 502,650 participants entered the cohort from 2006 to 2010, and were followed up until 2019 to identify disease incidence via linkage to the patient registers. For those diseases with increased risk among women, conditional logistic regression models were used to estimate odds ratios (ORs), and the binomial test of direction was further used to build disease trajectories. Among 301 diseases, 82 diseases in women had ORs > 1.2 and p < 0.00017 when compared to men, involving mainly diseases in the endocrine, skeletal and digestive systems. Diseases with the highest ORs included breast diseases, osteoporosis, hyperthyroidism, and deformity of the toes. The biomarker and disease trajectories suggested estradiol as a risk predictor for breast cancer, while a high percentage of reticulocyte, body mass index and waist circumference were associated with an increased risk of upper-limb neuropathy. In addition, the risk of cholelithiasis was increased in women diagnosed with dyspepsia and diaphragmatic hernia. In conclusion, women are at an increased risk of endocrine, skeletal and digestive diseases. The biomarker and disease trajectories in women suggested key pathways to a range of adverse outcomes downstream, which may shed light on promising targets for early detection and prevention of these diseases. Supplementary Information The online version contains supplementary material available at 10.1007/s43657-022-00054-1.
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Affiliation(s)
- Haomin Yang
- Department of Epidemiology and Health Statistics, School of Public Health and Key Laboratory of Ministry of Education for Gastrointestinal Cancer, Fujian Medical University, Xue Yuan Road 1, University Town, Fuzhou, 350122 China ,Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, 17177 Stockholm, Sweden
| | - Yudi Pawitan
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, 17177 Stockholm, Sweden
| | - Fang Fang
- Institute of Environmental Medicine, Karolinska Institutet, 17177 Stockholm, Sweden
| | - Kamila Czene
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, 17177 Stockholm, Sweden
| | - Weimin Ye
- Department of Epidemiology and Health Statistics, School of Public Health and Key Laboratory of Ministry of Education for Gastrointestinal Cancer, Fujian Medical University, Xue Yuan Road 1, University Town, Fuzhou, 350122 China ,Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, 17177 Stockholm, Sweden
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Feugray G, Kasonga F, Grall M, Benhamou Y, Bobée-Schneider V, Buchonnet G, Daliphard S, Le Cam Duchez V, Lahary A, Billoir P. Assessment of Reticulocyte and Erythrocyte Parameters From Automated Blood Counts in Vaso-Occlusive Crisis on Sickle Cell Disease. Front Med (Lausanne) 2022; 9:858911. [PMID: 35492334 PMCID: PMC9044919 DOI: 10.3389/fmed.2022.858911] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Accepted: 03/21/2022] [Indexed: 12/18/2022] Open
Abstract
Sickle cell disease is a complex genetic disease involving cell adhesion between red blood cells, white blood cells, platelets and endothelial cells, inducing painful vaso-occlusive crisis (VOC). We assessed reticulocyte and erythrocyte parameters in a cohort of confirmed SCD patients, and investigated whether a combination of these routine laboratory biomarkers of haemolysis could be used to predict VOC development. Reticulocyte and erythrocyte parameters were evaluated using the Sysmex XN-9000 analyser. A total of 98 patients with SCD were included, 72 in steady state and 26 in VOC. Among the 72 patients in steady state, 22 developed a VOC in the following year (median: 3 months [2-6]). The following parameters were increased in SCD patients with VOC development compared to SCD patients without VOC development in the following year: reticulocyte count (94.6 109/L [67.8-128] vs. 48.4 109/L [24.9-87.5]), immature reticulocyte count (259 109/L [181-334] vs. 152 109/L [129-208]) reticulocyte/immature reticulocyte fraction (IRF) ratio (6.63 109/(L*%) [4.67-9.56] vs. 4.94 109/(L*%) [3.96-6.61]), and medium fluorescence reticulocytes (MFR) (19.9% [17.4-20.7] vs. 17.1% [15.95-19.75]). The association of a reticulocyte count of >189.4 109/L and an MFR of >19.75% showed a sensitivity of 81.8% and a specificity of 88% to predict VOC development in the following year. Based on our findings, a combination of routine laboratory biomarkers, as reticulocyte count, immature reticulocyte count and fluorescent reticulocyte fraction at steady state, could be used to predict VOC development in SCD.
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Affiliation(s)
- Guillaume Feugray
- General Biochemistry, Normandie Univ, Rouen University, INSERM U1096, CHU Rouen, Rouen, France
| | | | | | - Ygal Benhamou
- Department of Internal Medecine, Normandie Univ, Rouen University, INSERM U1096, CHU Rouen, Rouen, France
| | | | | | | | - Véronique Le Cam Duchez
- Normandie Univ, Rouen University, INSERM U1096, CHU Rouen, Vascular Hemostasis Unit, Rouen, France
| | | | - Paul Billoir
- Normandie Univ, Rouen University, INSERM U1096, CHU Rouen, Vascular Hemostasis Unit, Rouen, France
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Bouten J, Debusschere J, Lootens L, Declercq L, Van Eenoo P, Boone J, Bourgois JG. Six weeks of static apnea training does not affect Hbmass and exercise performance. J Appl Physiol (1985) 2022; 132:673-681. [PMID: 35050796 DOI: 10.1152/japplphysiol.00770.2021] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
PURPOSE Acute apnea is known to induce decreases in oxyhemoglobin desaturation (SpO2) and increases in erythropoietin concentration ([EPO]). This study examined the potential of an apnea training program to induce erythropoiesis and increase hematological parameters and exercise performance. METHODS Twenty-two male subjects were randomly divided into an apnea and control group. The apnea group performed a 6-week apnea training program consisting of a daily series of 5 maximal static apneas. Before and after training, subjects visited the lab on three test days to perform 1) a ramp incremental test measuring V̇O2peak, 2) CO-rebreathing for Hb mass determination and a 3-km time trial and 3) an apnea test protocol with continuous finger SpO2 registration. Venous blood samples were drawn before and 180 minutes after the apnea test for analysis of [EPO]. RESULTS Minimal SpO2 reached during the apnea test protocol was 91 ±7% pre and 82 ±7% post apnea training. The apnea test protocol did not elicit an acute increase in [EPO] (p=0.685) before nor after the training program. Consequently, resting [EPO] (p=0.170), Hbmass (p=0.134), V̇O2peak (p=0.796) and 3-km cycling time trial performance (p=0.509) were not affected either. CONCLUSION The apnea test and training protocol, consisting of 5 maximal static apneas, did not induce a sufficiently strong hypoxic stimulus to cause erythropoiesis and therefore did not result in an increase in resting [EPO], Hbmass, V̇O2peak or time trial performance. Longer and/or more intense training sessions inducing a stronger hypoxic stimulus are probably needed to obtain changes in hematological and exercise parameters.
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Affiliation(s)
- Janne Bouten
- Department of Movement and Sports Sciences, Ghent University, Ghent, Belgium
| | - Jonas Debusschere
- Department of Movement and Sports Sciences, Ghent University, Ghent, Belgium
| | - Leen Lootens
- Doping Control Laboratory, Department of Diagnostic Sciences, Ghent University, Ghent, Belgium
| | - Louise Declercq
- Department of Movement and Sports Sciences, Ghent University, Ghent, Belgium
| | - Peter Van Eenoo
- Doping Control Laboratory, Department of Diagnostic Sciences, Ghent University, Ghent, Belgium
| | - Jan Boone
- Department of Movement and Sports Sciences, Ghent University, Ghent, Belgium
| | - Jan Gustaaf Bourgois
- Department of Movement and Sports Sciences, Ghent University, Ghent, Belgium.,Centre of Sports Medicine, Ghent University, Ghent, Belgium
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Khonglah Y, Das J, Tiewsoh I, Chowdhury Z, Barman H. Utility of reticulocyte indices in the diagnosis of pancytopenia. J Family Med Prim Care 2022; 11:1335-1340. [PMID: 35516681 PMCID: PMC9067176 DOI: 10.4103/jfmpc.jfmpc_1121_21] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Revised: 10/08/2021] [Accepted: 10/21/2021] [Indexed: 12/05/2022] Open
Abstract
Introduction: Pancytopenia is a hematological condition in which there is a reduction in all three cell lines of blood. This study aims to evaluate the utility of reticulocyte indices such as reticulocyte % (retic %), immature reticulocyte fraction (IRF), and mean reticulocyte volume (MRV) in identifying the cause of pancytopenia. Materials and Methods: Reticulocyte indices were measured by an automated coulter. These values were then correlated with relevant biochemical and bone marrow results and cases were stratified into different etiological groups. Receiver operator curve (ROC) analysis was performed and various cut-off values were derived based on the reticulocyte indices. ROC was repeated to further classify cut-off values at every level to help formulate a diagnostic algorithm. Results: A total of 154 cases of pancytopenia were obtained. Ages ranged from 7 months to 87 years with a mean of 42, the male:female ratio was 1.08:1. The majority of the cases were megaloblastic anemias in which the cut-off values for retic % was <0.91 with a sensitivity of 78.1% and specificity of 70%, IRF was 0.45 with a sensitivity of 76.7% and specificity of 64%, and MRV was >121.8 fl with a sensitivity of 83.6% and specificity of 80%. The values on ROC could segregate nutritional from nonnutritional causes. The IRF and MRV also helped to differentiate megaloblastic anemia from dual deficiency anemia. Conclusion: Reticulocyte indices help identify the cause of pancytopenia. They can segregate nutritional anemia from other causes of pancytopenia allowing presumptive treatment to be initiated and may obviate invasive procedures such as bone marrow examination.
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Babacheva E, Rallis D, Christou H, Mitsiakos G, Mikos T, Dampala K, Tsakalidis C, Kioumi A, Goulis D, Soubasi V. Maternal diabetes and the role of neonatal reticulocyte hemoglobin content as a biomarker of iron status in the perinatal period. Front Endocrinol (Lausanne) 2022; 13:1011897. [PMID: 36425471 PMCID: PMC9679283 DOI: 10.3389/fendo.2022.1011897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Accepted: 10/24/2022] [Indexed: 11/11/2022] Open
Abstract
AIMS We aimed to evaluate the effects of maternal diabetes on neonatal iron status, measuring erythrocyte indices including hemoglobin, hematocrit, reticulocytes, mean corpuscular volume (MCV), percent (%) hypochromia, ferritin, and additionally mean reticulocyte hemoglobin content (MCHr) as an early marker of iron deficiency, and examine the association between neonatal MCHr, red cell indices, and ferritin. MATERIALS AND METHODS We conducted a hospital-based prospective cohort study in a tertiary neonatal unit of a University Hospital from 2018 to 2020. We enrolled 126 maternal-infant pairs of mothers whose pregnancy was associated with diabetes and 74 maternal-infant pairs from uncomplicated pregnancies. Erythrocyte indices were analyzed within the first twelve hours after birth. Erythrocyte parameters were compared between infants of the diabetes and the non-diabetic group. We examined the correlation of the neonatal MCHr with perinatal characteristics, including gestation, birth weight, maternal body mass index, the erythrocytic indices, maternal diabetes, maternal obesity, prematurity, small-for-gestational-age status, maternal preeclampsia, and maternal anemia. Finally, we evaluated the discordance between neonatal MCHr and neonatal ferritin. RESULTS Infants of the diabetes group had a significantly lower MCHr (32.6 pg vs. 34.2 pg, p=0.003) compared with infants of uncomplicated pregnancies. Neonatal MCHr was significantly correlated with maternal hypochromia (r=-0.237, p=0.004) and neonatal MCV (r=0.674, p<0.001). Neonatal MCHr was significantly associated with maternal diabetes [standardized coefficients 0.21, 95% confidence interval (CI) 0.05-0.58, p=0.003) and maternal preeclampsia (standardized coefficients 0.17, 95% CI 0.02-0.92, p=0.019), after adjusting for maternal anemia, maternal obesity, prematurity, and small-for-gestational-age status. Those results were consistent also when analyzing maternal-infant pairs with pre-existing diabetes, and maternal-infant pairs with gestational diabetes. There was significant discordance between neonatal MCHr and neonatal ferritin (p=0.001). CONCLUSIONS MCHr was significantly lower in infants of mothers whose pregnancy was associated with diabetes compared with infants of non-diabetic mothers and correlated with neonatal and maternal red cell indices of iron deficiency. Since there was significant discordance between neonatal MCHr and ferritin during the first postnatal day, it is possible that MCHr could be used as a screening test for iron deficiency, especially in infants.
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Affiliation(s)
- Evgeniya Babacheva
- Second Department of Neonatology, Aristotle University of Thessaloniki, School of Medicine, Thessaloniki, Greece
- *Correspondence: Evgeniya Babacheva,
| | - Dimitrios Rallis
- Second Department of Neonatology, Aristotle University of Thessaloniki, School of Medicine, Thessaloniki, Greece
| | - Helen Christou
- Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, United States
| | - George Mitsiakos
- Second Department of Neonatology, Aristotle University of Thessaloniki, School of Medicine, Thessaloniki, Greece
| | - Themistoklis Mikos
- Unit of Reproductive Endocrinology, First Department of Obstetrics and Gynecology, Aristotle University of Thessaloniki, School of Medicine, Thessaloniki, Greece
| | - Kalliopi Dampala
- Unit of Reproductive Endocrinology, First Department of Obstetrics and Gynecology, Aristotle University of Thessaloniki, School of Medicine, Thessaloniki, Greece
| | - Christos Tsakalidis
- Second Department of Neonatology, Aristotle University of Thessaloniki, School of Medicine, Thessaloniki, Greece
| | - Anna Kioumi
- Department of Hematology, Aristotle University of Thessaloniki, School of Medicine, Thessaloniki, Greece
| | - Dimitrios G. Goulis
- Unit of Reproductive Endocrinology, First Department of Obstetrics and Gynecology, Aristotle University of Thessaloniki, School of Medicine, Thessaloniki, Greece
| | - Vasiliki Soubasi
- Second Department of Neonatology, Aristotle University of Thessaloniki, School of Medicine, Thessaloniki, Greece
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Kumar U, Gupta AK, Singh N, Chandra H, Chowdhury N. Reference intervals for reticulocyte parameters (reticulocyte haemoglobin equivalent and immature reticulocyte fraction) in first-trimester pregnancy. J OBSTET GYNAECOL 2021; 42:1401-1403. [PMID: 34913799 DOI: 10.1080/01443615.2021.1983781] [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: 10/19/2022]
Abstract
Reticulocyte parameters including reticulocyte haemoglobin equivalent (Ret-He) and immature reticulocyte fraction (IRF) are newly recognised hematological parameters that are being used for diagnosis and follow-up of anaemic patients. Reference intervals of these parameters have been established in different populations, however, the data relating to pregnancy are still lacking. One hundred and fifty-five first-trimester pregnant females were screened and the reference interval was calculated after selecting the patient with fixed criteria. R statistical software was used for statistical calculations. We tried to establish a reference interval of Ret-He content and IRF in first-trimester pregnancy in our study.IMPACT STATEMENTWhat is already known on this subject? Ret-He and IRF have been established as the marker of iron deficiency and iron-deficiency anaemia in different age groups and as a marker of response to iron therapy. However, literature is scarce regarding the reference intervals of these parameters, especially in pregnancy.What do the results of this study add? This study establishes the reference interval of newer reticulocyte parameters in first-trimester pregnancy which is not yet established in the literature. Establishing a reference interval is required for any laboratory parameters to be used in the clinical context.What are the implications of these findings for clinical practice and further research? The results of this study may help in making a clinical decision regarding iron deficiency in early pregnancy which is one of the common clinical problems in pregnancy. This study also serves as a baseline study for further studies of reference intervals for newer reticulocyte parameters in pregnancy. A similar study with a larger study population and follow-up with iron therapy may establish these parameters as one of the important markers of iron deficiency in pregnancy and help institute iron therapy on case-to-case basis.
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Affiliation(s)
- Utpal Kumar
- Department of Pathology and Laboratory Medicine, All India Institute of Medical Sciences, Rishikesh, Rishikesh, India.,Department of Pathology and Laboratory Medicine, All India Institute of Medical Sciences, Gorakhpur, Gorakhpur, India
| | - Arvind Kumar Gupta
- Department of Pathology and Laboratory Medicine, All India Institute of Medical Sciences, Rishikesh, Rishikesh, India
| | - Neha Singh
- Department of Pathology and Laboratory Medicine, All India Institute of Medical Sciences, Rishikesh, Rishikesh, India
| | - Harish Chandra
- Department of Pathology and Laboratory Medicine, All India Institute of Medical Sciences, Rishikesh, Rishikesh, India
| | - Nilotpal Chowdhury
- Department of Pathology and Laboratory Medicine, All India Institute of Medical Sciences, Rishikesh, Rishikesh, India
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Bracho FJ. Reference intervals of automated reticulocyte count and immature reticulocyte fraction in a pediatric population. Int J Lab Hematol 2021; 44:461-467. [PMID: 34859588 DOI: 10.1111/ijlh.13776] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Revised: 11/10/2021] [Accepted: 11/12/2021] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Reticulocytes are erythroid precursors that develop into mature erythrocytes, and they are an important tool to assess erythropoietic activity, as their count indicates the balance between the cells released from the bone marrow, their stage of maturity, and their rate of development into mature erythrocytes. Considering the described biological variability of the absolute reticulocyte count (ARC) and the immature reticulocyte fraction (IRF) and the limited information available on these hematological parameters in children, this study determined the reference intervals (RIs) of these parameters in a healthy pediatric population. METHODS A retrospective, observational, and analytical study was designed to establish RIs for the ARC and the IRF according to age and sex. An indirect sampling method was applied to a mixed database of complete blood counts from children aged 2 months to 18 years, using the truncated maximum likelihood indirect method for reference interval estimation. Percentiles were calculated to obtain bimodal RIs. RESULTS From a total of 190,812 samples, 6,814 were selected. Gender stratification was not necessary for the ARC and the IRF but they required partitioning into six and two age groups, respectively. CONCLUSION This study determined, by an indirect sampling method, RIs for the ARC and the IRF in a pediatric population according to age and sex.
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Cox HD, Miller GD, Manandhar A, Husk JD, Crouch AK, Eichner D. Tracking immature reticulocyte proteins for improved detection of recombinant human erythropoietin (rhEPO) abuse. Am J Hematol 2021; 96:1621-1629. [PMID: 34626008 DOI: 10.1002/ajh.26368] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Revised: 09/22/2021] [Accepted: 09/27/2021] [Indexed: 11/12/2022]
Abstract
Athletes abuse recombinant human erythropoietin (rhEPO) and erythropoiesis stimulating agents to increase hemoglobin mass and improve performance. To evade detection, athletes have developed sophisticated blood doping regimens, which often include rhEPO micro-dosing. Detection of these methods requires biomarkers with increased sensitivity and a sample matrix that is more amenable to frequent testing in the field. We have developed a method to measure two immature reticulocyte proteins, CD71 and ferrochelatase (FECH), and one total erythrocyte protein, Band 3, in dried blood spots (DBS). This method was tested in response to rhEPO administration after low doses, 40 IU/kg, micro-doses, 900 IU, or saline injection in 20 healthy subjects. During administration of low-dose rhEPO, the mean CD71/Band 3 and FECH/Band 3 ratio increased by 412 ± 197% and 250 ± 44%, respectively. The mean response for the current biomarker, RET%, increased by 195 ± 35%. During administration of rhEPO micro-doses, CD71/Band 3 increased to 127 ± 25% on day 35 and 139 ± 36% on day 39, while no increase was observed in RET%. After rhEPO administration, during the washout phase, mean values decreased to a minimum of 64 ± 4% and 64 ± 11% for CD71/Band 3 and RET%, respectively. However, CD71/Band 3 remained below 75% of baseline for at least 4 weeks after rhEPO injection, while RET% returned to baseline levels. The results demonstrate that immature reticulocyte proteins have a larger response to rhEPO administration than the current biomarker, RET%, and can be monitored in the DBS matrix.
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Affiliation(s)
- Holly D. Cox
- Sports Medicine Research and Testing Laboratory South Jordan Utah USA
| | | | | | - Jacob D. Husk
- Sports Medicine Research and Testing Laboratory South Jordan Utah USA
| | - Andre K. Crouch
- Sports Medicine Research and Testing Laboratory South Jordan Utah USA
| | - Daniel Eichner
- Sports Medicine Research and Testing Laboratory South Jordan Utah USA
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Biljak VR, Lapić I, Vidranski V, Herceg I, Tomić F, Šimac B, Horvat M, Čičak H, Vuljanić D, Dorotić A, Nikler A. Policies and practices in the field of laboratory hematology in Croatia - a current overview and call for improvement. Clin Chem Lab Med 2021; 60:271-282. [PMID: 34845883 DOI: 10.1515/cclm-2021-1027] [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: 09/20/2021] [Accepted: 11/18/2021] [Indexed: 11/15/2022]
Abstract
OBJECTIVES In 2019 The Croatian Working Group for Laboratory Hematology, on behalf of the Croatian Society of Medical Biochemistry and Laboratory Medicine, wanted to explore the background in field of laboratory hematology routine practice among Croatian laboratories in order to develop future strategies for producing national recommendations, if needed. METHODS During April and May 2019, a comprehensive survey covering all main parts of the total testing process within the field of laboratory hematology among Croatian medical laboratories was conducted. The survey comprised 49 inquiries. Data was collected using Survey Monkey (Palo Alto, CA, USA). All collected data was anonymized. RESULTS The response rate was 72%. There is still a substantial number of laboratories that have only three-part differential hematology analyzers (9%). Furthermore, a very high number of laboratories did not perform analyzer verification prior to implementation into routine work (31%). Out of those who have verified their analyzers, a diversity of guidelines and recommendations were used. Nearly 10% of the laboratories do not have a defined policy regarding specimen rejection. The majority of the participants perform internal quality control daily (83%), however, only 51% of respondents evaluate the agreement between different hematology analyzers on daily basis. Although more than 90% of Croatian laboratories have a defined policy regarding specimen rejection, only 61% of respondents continuously monitor quality indicators in routine practice. CONCLUSIONS The survey revealed substantial differences in all aspects of laboratory hematology practices among Croatian medical laboratories, indicating the need for universal recommendations at the national level.
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Affiliation(s)
- Vanja Radišić Biljak
- Working Group for Laboratory Hematology of the Croatian Society of Medical Biochemistry and Laboratory Medicine, Zagreb, Croatia.,Department of Medical Laboratory Diagnostics, University Hospital Sveti Duh, Zagreb, Croatia
| | - Ivana Lapić
- Working Group for Laboratory Hematology of the Croatian Society of Medical Biochemistry and Laboratory Medicine, Zagreb, Croatia.,Department of Laboratory Diagnostics, University Hospital Center Zagreb, Zagreb, Croatia
| | - Valentina Vidranski
- Working Group for Laboratory Hematology of the Croatian Society of Medical Biochemistry and Laboratory Medicine, Zagreb, Croatia.,Department of Oncology and Nuclear Medicine, Sestre Milosrdnice University Hospital Center, Zagreb, Croatia
| | - Ivona Herceg
- Working Group for Laboratory Hematology of the Croatian Society of Medical Biochemistry and Laboratory Medicine, Zagreb, Croatia.,Medical Biochemistry Laboratory, General Hospital "Dr. Tomislav Bardek", Koprivnica, Croatia
| | - Franciska Tomić
- Working Group for Laboratory Hematology of the Croatian Society of Medical Biochemistry and Laboratory Medicine, Zagreb, Croatia.,Department of Clinical Chemistry, Sestre Milosrdnice University Hospital Center, Zagreb, Croatia
| | - Brankica Šimac
- Working Group for Laboratory Hematology of the Croatian Society of Medical Biochemistry and Laboratory Medicine, Zagreb, Croatia.,Clinical Department of Laboratory Diagnostics, University Hospital Dubrava, Zagreb, Croatia
| | - Martina Horvat
- Working Group for Laboratory Hematology of the Croatian Society of Medical Biochemistry and Laboratory Medicine, Zagreb, Croatia.,Department of Medical Laboratory Diagnostics, University Hospital of Split, Split, Croatia
| | - Helena Čičak
- Working Group for Laboratory Hematology of the Croatian Society of Medical Biochemistry and Laboratory Medicine, Zagreb, Croatia.,Department of Medical Laboratory Diagnostics, University Hospital Sveti Duh, Zagreb, Croatia
| | - Dora Vuljanić
- Working Group for Laboratory Hematology of the Croatian Society of Medical Biochemistry and Laboratory Medicine, Zagreb, Croatia.,Department of Medical Laboratory Diagnostics, University Hospital Sveti Duh, Zagreb, Croatia
| | - Adrijana Dorotić
- Working Group for Laboratory Hematology of the Croatian Society of Medical Biochemistry and Laboratory Medicine, Zagreb, Croatia.,Department of Medical Laboratory Diagnostics, University Hospital Sveti Duh, Zagreb, Croatia
| | - Ana Nikler
- Working Group for Laboratory Hematology of the Croatian Society of Medical Biochemistry and Laboratory Medicine, Zagreb, Croatia.,Department of Medical Laboratory Diagnostics, University Hospital Sveti Duh, Zagreb, Croatia
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Suria N, Kaur R, Mittal K, Palta A, Sood T, Kaur P, Kaur G. Utility of reticulocyte haemoglobin content and immature reticulocyte fraction in early diagnosis of latent iron deficiency in whole blood donors. Vox Sang 2021; 117:495-503. [PMID: 34816444 DOI: 10.1111/vox.13216] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Revised: 10/05/2021] [Accepted: 10/12/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND AND OBJECTIVES The present study was planned to assess the clinical utility of reticulocyte haemoglobin content (CHr) and immature reticulocyte fraction (IRF) in the early detection of latent iron deficiency in blood donors. MATERIALS AND METHODS The prospective longitudinal observational study was conducted using the purposive sampling method. Written informed consent was obtained and donors were allocated into the first-time (FTD) and regular donor (RD) group. The enrolled blood donors (n = 205 in each group) were followed up for two subsequent whole blood donations. Haemoglobin (Hb), CHr, IRF and serum ferritin values were recorded at enrolment and two follow-ups. RESULTS The sensitivity of CHr in detecting iron-deficient erythropoiesis (serum ferritin values ≤ 26 μg/dl) was 45% and 56.7%, specificity 96.7%, positive predictive value (PPV) 85.6% and 90.8% and negative predictive value (NPV) 80.1% and 78.7%, respectively in FTD and RD cohorts. The sensitivity of IRF was 45.1% and 44.8%, specificity 93.4% and 97.1%, PPV 74.8% and 90.4% and NPV 79.6% and 74.5%, respectively in both the cohorts. The sensitivity of CHr in detecting absent iron stores (serum ferritin values ≤ 15 μg/dl) was 66.2% and 74.4%, specificity 92% and 90.6%, PPV 56.7% and 68.7% and NPV 94.5% and 92.8% among FTD and RD cohort, respectively. The sensitivity of IRF was 72.7% and 65.3%, specificity 90.3% and 94.3%, PPV 54.4% and 76% and NPV 95.4% and 90.8%, respectively in both the cohorts. CONCLUSION Reticulocyte hemoglobin content and IRF can be used along with complete blood count for early detection of iron deficiency in blood donors using the same blood sample at no extra cost.
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Affiliation(s)
- Nitika Suria
- Department of Transfusion Medicine, Government Medical College and Hospital, Chandigarh, Chandigarh, India
| | - Ravneet Kaur
- Department of Transfusion Medicine, Government Medical College and Hospital, Chandigarh, Chandigarh, India
| | - Kshitija Mittal
- Department of Transfusion Medicine, Government Medical College and Hospital, Chandigarh, Chandigarh, India
| | - Anshu Palta
- Department of Pathology, Government Medical College and Hospital, Chandigarh, Chandigarh, India
| | - Tanvi Sood
- Department of Transfusion Medicine, Government Medical College and Hospital, Chandigarh, Chandigarh, India
| | - Paramjit Kaur
- Department of Transfusion Medicine, Government Medical College and Hospital, Chandigarh, Chandigarh, India
| | - Gagandeep Kaur
- Department of Transfusion Medicine, Government Medical College and Hospital, Chandigarh, Chandigarh, India
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Savkovic S, Ly LP, Desai R, Howa J, Nair V, Eichner D, Handelsman DJ. Detection of testosterone microdosing in healthy females. Drug Test Anal 2021; 14:653-666. [PMID: 34811948 DOI: 10.1002/dta.3202] [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: 08/25/2021] [Revised: 11/08/2021] [Accepted: 11/09/2021] [Indexed: 11/10/2022]
Abstract
The ready detectability of synthetic androgens by mass spectrometry (MS)-based antidoping tests has reoriented androgen doping to using testosterone (T), which must be distinguished from its endogenous counterpart making detection of exogenous T harder. We investigated urine and serum steroid and hematological profiling individually and combined to determine the optimal detection model for T administration in women. Twelve healthy females provided six paired blood and urine samples over 2 weeks prior to treatment consisting of 12.5-mg T in a topical transdermal gel applied daily for 7 days. Paired blood and urine samples were then obtained at the end of treatment and Days 1, 2, 4, 7, and 14 days later. Compliance with treatment and sampling was high, and no adverse effects were reported. T treatment significantly increased serum and urine T, serum dihydrotestosterone (DHT), urine 5α-androstane-3α,17β-diol (5α-diol) epitestosterone (E), and urine T/E ratio with a brief window of detection (2-4 days) as well as total and immature (medium and high fluorescence) reticulocytes that remained elevated over the full 14 posttreatment days. Carbon isotope ratio MS and the OFF score and Abnormal Blood Profile score (ABPS) were not discriminatory. The optimal multivariate model to identify T exposure combined serum T, urine T/E ratio with three hematological variables (% high fluorescence reticulocytes, mean corpuscular hemoglobin, and volume) with the five variables providing 93% correct classification (4% false positive, 10% false negatives). Hence, combining select serum and urine steroid MS variables with reticulocyte measures can achieve a high but imperfect detection of T administration to healthy females.
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Affiliation(s)
- Sasha Savkovic
- Andrology Department, Concord Hospital & ANZAC Research Institute, University of Sydney, Sydney, New South Wales, Australia
| | - Lam P Ly
- Andrology Department, Concord Hospital & ANZAC Research Institute, University of Sydney, Sydney, New South Wales, Australia
| | - Reena Desai
- Andrology Department, Concord Hospital & ANZAC Research Institute, University of Sydney, Sydney, New South Wales, Australia
| | - John Howa
- Sports Medicine Research and Testing Laboratory, Salt Lake City, Utah, USA
| | - Vinod Nair
- Sports Medicine Research and Testing Laboratory, Salt Lake City, Utah, USA
| | - Daniel Eichner
- Sports Medicine Research and Testing Laboratory, Salt Lake City, Utah, USA
| | - David J Handelsman
- Andrology Department, Concord Hospital & ANZAC Research Institute, University of Sydney, Sydney, New South Wales, Australia
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Bracho FJ. Interindividual Biological Variability of Reticulocytes and Their Maturation Fractions in the Pediatric Population. Am J Clin Pathol 2021; 156:1019-1029. [PMID: 34061160 DOI: 10.1093/ajcp/aqab063] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES Because published data about the variability of reticulocyte counts in children are scarce, the interindividual biological variability of the automated reticulocyte count and its maturation fractions according to age and sex were analyzed. METHODS A retrospective, observational, analytical study was designed to establish and compare normal values of the automated reticulocyte count and its maturation fractions in different age and sex groups. The sample was drawn from results of CBC counts performed in children aged between 2 months and 18 years using an indirect sampling methodology. RESULTS A total of 9,362 CBC counts were analyzed. Automated reticulocyte count decreased between 2 months and 3 years of age and slowly increased thereafter, showing higher values in girls up to the age of 9 years, and equalized by sex thereafter. Immature reticulocyte fraction increased until 7 months of age; decreased progressively until 4 years of age; and then showed a discreet but constant rise, with significantly higher values in boys older than 1 year. The low-fluorescence fraction was relatively steady, with significantly higher values in girls aged 8 months and older. CONCLUSIONS The automated reticulocyte count and its maturation fractions show significant variations related to age and sex in pediatric patients.
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Affiliation(s)
- Fernando J Bracho
- Laboratory of Hematology, Luis Calvo Mackenna Hospital, Santiago, Chile
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Huang J, Xu K, Yu L, Pu Y, Wang T, Sun R, Liang G, Yin L, Zhang J, Pu Y. Immunosuppression characterized by increased Treg cell and IL-10 levels in benzene-induced hematopoietic toxicity mouse model. Toxicology 2021; 464:152990. [PMID: 34673135 DOI: 10.1016/j.tox.2021.152990] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Revised: 09/16/2021] [Accepted: 10/13/2021] [Indexed: 12/16/2022]
Abstract
Benzene is a typical hematopoietic toxic substance, that can cause serious blood and circulatory system diseases such as aplastic anemia, myelodysplastic syndrome and acute myeloid leukemia, but the immunological mechanism by which this occurs is not clear. T helper cells play a key role in regulating the immune balance in the body. In this study, benzene-induced hematopoietic toxicity BALB/c mice model was established, and changes in immune organs and T helper cell subsets (Th1, Th2, Th17 and Treg cells) were explored. At 28 days after subcutaneous injection of 150 mg/kg benzene, mice showed pancytopenia and obvious pathological damage to the bone marrow, spleen, and thymus. Flow cytometry revealed that the number of CD4+CD25+Foxp3+ Treg cells in the spleen increased significantly. The level of IL-10 in the spleen, serum, and bone marrow increased, while the levels of IL-17 in the spleen and serum decreased. Furthermore, the levels of CD4 and CD8 proteins in the spleen decreased. Immunofluorescence results showed that levels of Foxp3, a specific transcription factor that induced the differentiation of Treg cells, increased after exposure to benzene. Our results demonstrate that immunosuppression occurred in the benzene-induced hematopoietic toxicity model mice, and Treg cells and secreted IL-10 may play a key role in the process.
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Affiliation(s)
- Jiawei Huang
- Key Laboratory of Environmental Medicine Engineering, Ministry of Education, School of Public Health, Southeast University, Nanjing 210009, China
| | - Kai Xu
- Key Laboratory of Environmental Medicine Engineering, Ministry of Education, School of Public Health, Southeast University, Nanjing 210009, China
| | - Linling Yu
- Key Laboratory of Environmental Medicine Engineering, Ministry of Education, School of Public Health, Southeast University, Nanjing 210009, China
| | - Yunqiu Pu
- Key Laboratory of Environmental Medicine Engineering, Ministry of Education, School of Public Health, Southeast University, Nanjing 210009, China
| | - Tong Wang
- Key Laboratory of Environmental Medicine Engineering, Ministry of Education, School of Public Health, Southeast University, Nanjing 210009, China
| | - Rongli Sun
- Key Laboratory of Environmental Medicine Engineering, Ministry of Education, School of Public Health, Southeast University, Nanjing 210009, China
| | - Geyu Liang
- Key Laboratory of Environmental Medicine Engineering, Ministry of Education, School of Public Health, Southeast University, Nanjing 210009, China
| | - Lihong Yin
- Key Laboratory of Environmental Medicine Engineering, Ministry of Education, School of Public Health, Southeast University, Nanjing 210009, China
| | - Juan Zhang
- Key Laboratory of Environmental Medicine Engineering, Ministry of Education, School of Public Health, Southeast University, Nanjing 210009, China
| | - Yuepu Pu
- Key Laboratory of Environmental Medicine Engineering, Ministry of Education, School of Public Health, Southeast University, Nanjing 210009, China.
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Horiuchi Y, Hayashi F, Iwasaki Y, Matsuzaki A, Nishibe K, Kaniyu K, Marutani S, Saito K, Matsuoka S, Uchihashi K, Miida T, Ai T, Tabe Y. Peripheral granular lymphocytopenia and dysmorphic leukocytosis as simple prognostic markers in COVID-19. Int J Lab Hematol 2021; 43:1309-1318. [PMID: 34523805 PMCID: PMC8653062 DOI: 10.1111/ijlh.13696] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Revised: 08/11/2021] [Accepted: 08/19/2021] [Indexed: 12/11/2022]
Abstract
Introduction Developing prognostic markers can be useful for clinical decision‐making. Peripheral blood (PB) examination is simple and basic that can be performed in any facility. We aimed to investigate whether PB examination can predict prognosis in coronavirus disease (COVID‐19). Methods Complete blood count (CBC) and PB cell morphology were examined in 38 healthy controls (HCs) and 40 patients with COVID‐19. Patients with COVID‐19, including 26 mild and 14 severe cases, were hospitalized in Juntendo University Hospital (Tokyo, Japan) between April 1 and August 6, 2020. PB examinations were performed using Sysmex XN‐3000 automated hematology analyzer and Sysmex DI‐60 employing the convolutional neural network‐based automatic image‐recognition system. Results Compared with mild cases, severe cases showed a significantly higher incidence of anemia, lymphopenia, and leukocytosis (P < .001). Granular lymphocyte counts were normal or higher in mild cases and persistently decreased in fatal cases. Temporary increase in granular lymphocytes was associated with survival of patients with severe infection. Red cell distribution width was significantly higher in severe cases than in mild cases (P < .001). Neutrophil dysplasia was consistently observed in COVID‐19 cases, but not in HCs. Levels of giant neutrophils and toxic granulation/Döhle bodies were increased in severe cases. Conclusion Basic PB examination can be useful to predict the prognosis of COVID‐19, by detecting SARS‐CoV‐2 infection‐induced multi‐lineage changes in blood cell counts and morphological anomalies. These changes were dynamically correlated with disease severity and may be associated with disruption of hematopoiesis and the immunological system due to bone marrow stress in severe infection.
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Affiliation(s)
- Yuki Horiuchi
- Department of Clinical Laboratory Medicine, Juntendo University Graduate School of Medicine, Bunkyo-ku, Japan
| | | | | | - Akihiko Matsuzaki
- Department of Next Generation Haematology Laboratory Medicine, Juntendo University Graduate School of Medicine, Bunkyo-ku, Japan
| | - Kumiko Nishibe
- Department of Next Generation Haematology Laboratory Medicine, Juntendo University Graduate School of Medicine, Bunkyo-ku, Japan
| | - Kimiko Kaniyu
- Department of Next Generation Haematology Laboratory Medicine, Juntendo University Graduate School of Medicine, Bunkyo-ku, Japan
| | - Setsuko Marutani
- Department of Next Generation Haematology Laboratory Medicine, Juntendo University Graduate School of Medicine, Bunkyo-ku, Japan
| | - Kaori Saito
- Department of Next Generation Haematology Laboratory Medicine, Juntendo University Graduate School of Medicine, Bunkyo-ku, Japan
| | - Sachiko Matsuoka
- Department of Next Generation Haematology Laboratory Medicine, Juntendo University Graduate School of Medicine, Bunkyo-ku, Japan
| | | | - Takashi Miida
- Department of Clinical Laboratory Medicine, Juntendo University Graduate School of Medicine, Bunkyo-ku, Japan
| | - Tomohiko Ai
- Department of Clinical Laboratory Medicine, Juntendo University Graduate School of Medicine, Bunkyo-ku, Japan
| | - Yoko Tabe
- Department of Clinical Laboratory Medicine, Juntendo University Graduate School of Medicine, Bunkyo-ku, Japan.,Department of Next Generation Haematology Laboratory Medicine, Juntendo University Graduate School of Medicine, Bunkyo-ku, Japan
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Agarwal AM, Rets A. Laboratory approach to investigation of anemia in pregnancy. Int J Lab Hematol 2021; 43 Suppl 1:65-70. [PMID: 34288450 DOI: 10.1111/ijlh.13551] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 03/25/2021] [Accepted: 03/29/2021] [Indexed: 11/29/2022]
Abstract
Anemia is a global health problem in all age groups. According to World Health Organization (WHO), approximately 40% of pregnant women are anemic. Iron deficiency anemia (IDA) due to nutritional deficiency is the most common cause. The incidence of IDA varies worldwide depending on the socioeconomic status, but it remains the leading cause even in developed countries. Physiologic anemia of pregnancy due to relatively higher expansion of blood volume in comparison with elevated red blood cell mass also occurs frequently. Complete blood count (CBC) in the first trimester is recommended for all pregnant women to screen for anemia. The screening of pregnant women for IDA in absence of anemia is still debatable. If IDA is suspected, ferritin level of <30 ng/ml is diagnostic. Iron supplementation is recommended for all pregnant women to compensate the increased demand.
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Affiliation(s)
- Archana M Agarwal
- Department of Pathology, University of Utah Health and ARUP Laboratories, Salt Lake City, UT, USA
| | - Anton Rets
- Department of Pathology, University of Utah Health and ARUP Laboratories, Salt Lake City, UT, USA
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Klein M, Kaestner L, Bogdanova AY, Minetti G, Rudloff S, Lundby C, Makhro A, Seiler E, Cromvoirt A, Fenk S, Simionato G, Hertz L, Recktenwald S, Schäfer L, Haider T, Fried S, Borsch C, Marti HH, Sander A, Mairbäurl H. Absence of neocytolysis in humans returning from a 3-week high-altitude sojourn. Acta Physiol (Oxf) 2021; 232:e13647. [PMID: 33729672 DOI: 10.1111/apha.13647] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Revised: 03/05/2021] [Accepted: 03/05/2021] [Indexed: 12/26/2022]
Abstract
AIMS Total haemoglobin mass (tot-Hb) increases during high-altitude acclimatization. Normalization of tot-Hb upon descent is thought to occur via neocytolysis, the selective destruction of newly formed erythrocytes. Because convincing experimental proof of neocytolysis is lacking, we performed a prospective study on erythrocyte survival after a stay at the Jungfraujoch Research Station (JFJRS; 3450 m). METHODS Newly formed erythrocytes of 12 male subjects (mean age 23.3 years) were age cohort labelled in normoxia (110 m) and during a 19-day high-altitude sojourn by ingestion of 13 C2- and 15 N-labelled glycine respectively. Elimination dynamics for erythrocytes produced in normoxia and at high altitude were measured by isotope ratio mass spectrometry of haem, by determining tot-Hb, reticulocyte counts, erythrocyte membrane protein 4.1a/4.1b ratio and by mathematical modelling. RESULTS Tot-Hb increased by 4.7% ± 2.7% at high altitude and returned to pre-altitude values within 11 days after descent. Elimination of 13 C- (normoxia) and 15 N- (high altitude) labelled erythrocytes was not different. Erythropoietin levels and counts of CD71-positive reticulocytes decreased rapidly after descent. The band 4.1a/4.1b ratio decreased at altitude and remained low for 3-4 days after descent and normalized slowly. There was no indication of haemolysis. CONCLUSION We confirm a rapid normalization of tot-Hb upon descent. Based on the lack of accelerated removal of age cohorts of erythrocytes labelled at high altitude, on patterns of changes in reticulocyte counts and of the band 4.1a/4.1b ratio and on modelling, this decrease did not occur via neocytolysis, but by a reduced rate of erythropoiesis along with normal clearance of senescent erythrocytes.
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Affiliation(s)
- Marie Klein
- Medical Clinic VII Sports Medicine University Hospital Heidelberg Heidelberg Germany
- Translational Pneumology University Hospital Heidelberg Heidelberg Germany
| | - Lars Kaestner
- Experimental Physics Dynamics of Fluids Group Saarland University Saarbrücken Germany
- Theoretical Medicine and Biosciences Campus University HospitalSaarland University Homburg Germany
| | - Anna Y. Bogdanova
- Red Blood Cell Research Group Institute of Veterinary Physiology University of Zürich Zürich Switzerland
| | - Giampaolo Minetti
- Department of Biology and Biotechnology "L Spallanzani" Laboratories of Biochemistry University of Pavia Pavia Italy
| | - Silvia Rudloff
- Analytical Platform Stable Isotopes, and Cell Biology Institute of Nutritional Sciences Justus Liebig University Giessen Giessen Germany
| | - Carsten Lundby
- The Centre of Inflammation and Metabolism and the Centre for Physical Activity Research Rigshospitalet University of Copenhagen Hillerød Denmark
- Inland Norway University of Applied Sciences Lillehammer Norway
| | - Asya Makhro
- Red Blood Cell Research Group Institute of Veterinary Physiology University of Zürich Zürich Switzerland
| | - Elena Seiler
- Red Blood Cell Research Group Institute of Veterinary Physiology University of Zürich Zürich Switzerland
| | - Ankie Cromvoirt
- Red Blood Cell Research Group Institute of Veterinary Physiology University of Zürich Zürich Switzerland
| | - Simone Fenk
- Red Blood Cell Research Group Institute of Veterinary Physiology University of Zürich Zürich Switzerland
| | - Greta Simionato
- Experimental Physics Dynamics of Fluids Group Saarland University Saarbrücken Germany
- Theoretical Medicine and Biosciences Campus University HospitalSaarland University Homburg Germany
- Institute for Clinical and Experimental Surgery Saarland UniversityCampus University Hospital Homburg Germany
| | - Laura Hertz
- Experimental Physics Dynamics of Fluids Group Saarland University Saarbrücken Germany
| | - Steffen Recktenwald
- Experimental Physics Dynamics of Fluids Group Saarland University Saarbrücken Germany
| | - Larissa Schäfer
- Department of Anaesthesiology and Intensive Care Medicine University Hospital SalzburgParacelsus Medical University Salzburg Austria
| | - Thomas Haider
- Department of Cardiology University Hospital Zürich Zürich Switzerland
| | - Sebastian Fried
- Department of Anaesthesiology University Hospital Heidelberg Heidelberg Germany
| | - Christian Borsch
- Analytical Platform Stable Isotopes, and Cell Biology Institute of Nutritional Sciences Justus Liebig University Giessen Giessen Germany
| | - Hugo H. Marti
- Institute of Physiology and Pathophysiology University of Heidelberg Heidelberg Germany
| | - Anja Sander
- Institute of Medical Biometry and Informatics University Hospital Heidelberg Heidelberg Germany
| | - Heimo Mairbäurl
- Medical Clinic VII Sports Medicine University Hospital Heidelberg Heidelberg Germany
- Translational Pneumology University Hospital Heidelberg Heidelberg Germany
- Translational Lung Research Centre Heidelberg (TLRC) Part of the German Centre for Lung Research (DZL) Heidelberg Germany
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49
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Zheng B, Wille L, Peppel K, Hagen D, Matteson A, Ahlers J, Schaff J, Hua F, Yuraszeck T, Cobbina E, Apgar JF, Burke JM, Roberts J, Das R. A systems pharmacology model for gene therapy in sickle cell disease. CPT-PHARMACOMETRICS & SYSTEMS PHARMACOLOGY 2021; 10:696-708. [PMID: 34139105 PMCID: PMC8302248 DOI: 10.1002/psp4.12638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 03/11/2021] [Accepted: 03/27/2021] [Indexed: 11/17/2022]
Abstract
We developed a mathematical model for autologous stem cell therapy to cure sickle cell disease (SCD). Experimental therapies using this approach seek to engraft stem cells containing a curative gene. These stem cells are expected to produce a lifelong supply of red blood cells (RBCs) containing an anti‐sickling hemoglobin. This complex, multistep treatment is expensive, and there is limited patient data available from early clinical trials. Our objective was to quantify the impact of treatment parameters, such as initial stem cell dose, efficiency of lentiviral transduction, and degree of bone marrow preconditioning on engraftment efficiency, peripheral RBC numbers, and anti‐sickling hemoglobin levels over time. We used ordinary differential equations to model RBC production from progenitor cells in the bone marrow, and hemoglobin assembly from its constituent globin monomers. The model recapitulates observed RBC and hemoglobin levels in healthy and SCD phenotypes. Treatment simulations predict dynamics of stem cell engraftment and RBC containing the therapeutic gene product. Post‐treatment dynamics show an early phase of reconstitution due to short lived stem cells, followed by a sustained RBC production from stable engraftment of long‐term stem cells. This biphasic behavior was previously reported in the literature. Sensitivity analysis of the model quantified relationships between treatment parameters and efficacy. The initial dose of transduced stem cells, and the intensity of myeloablative bone marrow preconditioning are predicted to most positively impact long‐term outcomes. The quantitative systems pharmacology approach used here demonstrates the value of model‐assisted therapeutic design for gene therapies in SCD.
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Affiliation(s)
- Bo Zheng
- CSL Behring, King of Prussia, Pennsylvania, USA
| | - Lucia Wille
- Applied BioMath LLC, Concord, Massachusetts, USA
| | | | - David Hagen
- Applied BioMath LLC, Concord, Massachusetts, USA
| | | | | | - James Schaff
- Applied BioMath LLC, Concord, Massachusetts, USA
| | - Fei Hua
- Applied BioMath LLC, Concord, Massachusetts, USA
| | - Theresa Yuraszeck
- CSL Behring, King of Prussia, Pennsylvania, USA.,Applied BioMath LLC, Concord, Massachusetts, USA
| | | | | | - John M Burke
- Applied BioMath LLC, Concord, Massachusetts, USA
| | | | - Raibatak Das
- Applied BioMath LLC, Concord, Massachusetts, USA
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50
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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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