Application of bone marrow samples for discrimination of acute promyelocytic leukemia from other types of acute leukemia using the routine automated hematology analyzer

Is large unstained cell percentage (%LUC) a novel diagnostic marker for periprosthetic joint infections?

BACKROUND

Periprosthetic joint infection (PJI) is a very important complication that occurs after total joint replacement. Diagnosing PJI is at least as difficult as this disease. There is no biomarker that alone can diagnose PJI.

OBJECTIVE

This study aimed to evaluate the effectiveness of large unstained cell percentage (%LUC) in diagnosing PJI and deciding on re-implantation in two stage septic exchange arthroplasty.

METHODS

Patients who underwent revision arthroplasty between 2019 and 2023 were screened retrospectively. These patients were grouped as those who underwent two-stage septic exchange and those who underwent aseptic exchange. Prosthesis removal from the patients who underwent two-stage septic exchange, before spacer application, and on the 3rd post-operative day after spacer application, Blood parameters were collected at the 1st month and before the second stage after the spacer application, and before the revision surgery from the patients who underwent aseptic exchange. White blood cell, neutrophil percentage, %LUC, albumin, sedim and CRP values were checked and recorded one by one from all patients.

RESULTS

The data of a total of 233 patients, including 133 patients in the two stage septic exchange group and 100 patients in the aseptic exchange group, were included in the study. When the predictive value of %LUC in PJI was accepted as cut-off 1.75, the sensitivity was 69.2% and the specificity was 73%. The change in %LUC over time in patients who underwent two-stage septic exchange was statistically significant (p= 0.0001). A positive correlation was found between the value of .%LUC after spacer application and the value of CRP before prosthesis protrusion/spacer application surgery, and the Spearman correlation coefficient was found to be 0.005.

CONCLUSION

%LUC value can be a promising biomarker for the diagnosis of PJI by considering both sensitivity and specificity rates. Apart from this, it is an easily accessible and effective biomarker for re-implantation decision making and evaluation of response to treatment, especially in two-stage septic exchange surgeries.

Role of large unstained cells in predicting successful stem cell collection in autologous stem cell transplantation

INTRODUCTION

Sufficient stem cell collection is mandatory for Autologous stem cell transplantation (ASCT). Peripheral CD34+ stem CD34 + stem cell counting by flow cytometry is the gold standard method in both the predicting and timing of successful stem cell collection. Large unstained cells (LUC) are large peroxidase-negative cells that are displayed on certain automatic cell counters and present large lymphocytes, virocytes, blasts, abnormal cells and hematopoietic stem cells. In this study, we evaluated the role of LUC parameters in the timing and prediction of successful stem cell collection.

METHODS

Patients with a diagnosis of multiple myeloma, lymphoma and testis tumor who proceed to ASCT were included in this study. Preapheresis LUC parameters were analyzed with Siemens ADVIA® 2120i system., Kruskal Wallis, Mann-Whitney U, Spearman Rho and receiver-operator curve (ROC) tests were used for analyses.

RESULTS

Ninety patients were evaluated. Peripheral CD34 + cell count was positively correlated with both LUC count (p = 0014) and LUC percentage (p = 0,01). LUC percentage in peripheral blood was positively correlated with mobilized stem cell count in the yield (p = 0.003). We found a LUC count of > 0.485 × 10⁹/L as a cut-off value for detecting > 20 × 10⁶/L CD34 +cells in the peripheral blood with a sensitivity of 64.6% and specificity of 75%. We defined > 2.15% as a cut-off value for LUC percentage to collect > 5 × 10⁶/kg of stem cells with a sensitivity of 64% and specificity of 63%. Additionally, total nucleated cell (TNC) count was negatively correlated with LUC percentage (p = 0.014) and positively correlated with LUC count (p = 0.001).

CONCLUSION

LUC parameters are readily available, simple and cheap tools that can be useful in both timing of CD34 count by flow cytometry in peripheral blood and in the prediction of successful mobilization. LUCs can also be an indicator of graft composition.

Clinical significance of large unstained cell count in estimating the current activity of antineutrophil cytoplasmic antibody-associated vasculitis

BACKGROUND

We investigated whether large unstained cell (LUC) count could estimate the current high activity according to Birmingham vasculitis activity score (BVAS) in patients with antineutrophil cytoplasmic antibody (ANCA) positive ANCA-associated vasculitis (AAV).

METHODS

We retrospectively reviewed the medical records of 176 immunosuppressive drug-naïve patients with ANCA positive AAV. Clinical and laboratory data at diagnosis, including LUC count, were collected. High BVAS was defined as the highest tertile of BVAS (BVAS ≥ 15) in this study.

RESULTS

The median age was 61.0 years, and 64.8% were female. The median LUC count was 60.0 mm³ , and LUC was detected in 106 patients. LUC count was significantly correlated with BVAS, age, white blood cell count, haemoglobin, platelet count, serum albumin, erythrocyte sedimentation rate and C-reactive protein. Overall, the median BVAS in AAV patients with LUC positivity was significantly higher than that in those without (14.0 vs 10.0). When the cut-off of LUC count for the current high BVAS was set as BVAS ≥ 15 mm³ , AAV patients with LUC count ≥ 15 mm³ had a significantly higher risk for the current high BVAS than those with LUC count < 15 mm³ (relative risk 2.596). However, in the multivariable linear and logistic regression analyses, LUC did not seem to estimate the current BVAS independently among clinical and laboratory variables.

CONCLUSION

LUC count was significantly correlated with the current BVAS and LUC count ≥ 15 mm³ could estimate the current high BVAS in patients with ANCA positive AAV.

The value of delta neutrophil index in neonatal sepsis diagnosis, follow-up and mortality prediction

BACKGROUND

The complete blood cell count (CBC) and peripheral blood smear were the most commonly ordered tests for the diagnosis of neonatal sepsis. Delta neutrophil index (DNI) shows leucocyte differentiation and calculated while CBC is performed.

AIMS

We aimed to evaluate the value of DNI in neonatal sepsis.

STUDY DESIGN

DNI was measured with Siemens Advia 2120 and 2120i devices. DNI was calculated as (neutrophil and eosinophil count in myeloperoxidase channel)-(polymorphonuclear leucocyte count in nuclear lobularity channel).

RESULTS

Study population included 141 and 87 neonates in sepsis (110 proven, 31 clinical) and control groups. Demographic characters were similar between groups. Proven sepsis group had lower birthweight and higher late-onset sepsis rate than clinical sepsis and control groups. Median DNI (16.3 vs 1,4) and CRP (6.8 vs 0,03 mg/dl) were significantly higher in sepsis group. Proven sepsis group had significantly higher DNI level than clinical sepsis group (20.8 vs 9.1). Cut-off level of DNI was 4.6 with 85% sensitivity and 80% specificity. Cut-off level of CRP was 0.58 mg/dl with 81% sensitivity and 82% specificity. Combination of DNI and CRP gave 98% sensitivity and 76% specificity. Mortality rate in sepsis group was 39%. Median DNI level in patients with mortality was significantly higher (30.1 vs 9.6). Cut-off level of DNI for mortality prediction was 16.1 with 75% sensitivity and 65% specificity. Follow-up levels of DNI was significantly decreased in 6-10 days to normal levels (16.3 to 4.2).

CONCLUSIONS

DNI was found to be useful in the diagnose, follow-up and mortality prediction of neonatal sepsis without extra blood to CBC.

Analysis of bone marrow aspiration fluid using automated blood cell counters

Cytomorphological examination of aspirate smears remains the basic method to diagnose hematologic disorders and to evaluate treatment-related changes. Last-generation hematological analyzers can count, besides cells normally circulating in peripheral blood, some types of immature and abnormal cells, such as erythroblasts and immature granulocytes. The complex nature of bone marrow fluid, however, has prevented until now the routine utilization of blood cell counters in this area. Recent studies have shown the possibility of using bone marrow fluid as a substitute for peripheral blood for clinical tests in particular situations and for repetitive cytologic examinations in specific clinical and research fields.