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Bakr S, Yousief E, Ezzat EM, Elsary AY, Elamir AM, Gamal M. Screening of subclinical functional hemoglobin and red blood cell abnormalities among blood donors of Fayoum University Hospital in Egypt: Are RET-He, and IRF useful screening tools? Transfus Apher Sci 2023; 62:103781. [PMID: 37524581 DOI: 10.1016/j.transci.2023.103781] [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: 04/27/2023] [Revised: 07/20/2023] [Accepted: 07/26/2023] [Indexed: 08/02/2023]
Abstract
BACKGROUND The effectiveness of red cell transfusion in a given blood unit that relied on both quantity and quality of donated cells undoubtedly affects prognostic outcomes. OBJECTIVE We aimed to determine the frequency of subclinical functional hemoglobin and red cell abnormalities in donated blood of Fayoum University Hospital in Egypt. Additionally, to assess the usefulness of reticulocyte mean hemoglobin content (RET-He) and immature reticulocyte fraction (IRF) as screening measures for such abnormalities. MATERIAL AND METHODS This cross-sectional study enrolled 200 volunteer blood donors who met the national standard criterion of blood donation. Complete blood count with reticulocyte parameters, serum ferritin, sickling test, G6PD assay, Mentzer index, and naked-eye single tube red cell osmotic fragility test were carried out. RESULTS Functional red cell abnormalities represented 44 % of this cohort. Out of them, 4.5 % had iron deficiency, 11 % had a positive sickling test, 19 % had G6PD deficiency, and 9.5 % had suspicious thalassemia. The sensitivity and specificity test for RET-He in selective identification of functional hemoglobin abnormalities in donated blood were 83.3 % and 61.2 %, respectively at a cutoff value of 26.9. Though there was no statistically significant effect of RET-He on the selective detection of G6PD deficiency, IRF had a statistically significant high level with a p-value of 0.04. CONCLUSION Subclinical functional red cell abnormalities seem to be prevalent among blood donors. Reticulocyte/ erythrocyte indices could be useful screening tools for red cell abnormalities. Further studies are required for assessing the impact of transfusing such abnormalities to neonates and other critical recipients.
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Affiliation(s)
- Salwa Bakr
- Department of Clinical Pathology/Hematology, Faculty of Medicine, Fayoum University, Fayoum, Egypt.
| | - Eman Yousief
- Department of Clinical Pathology/Hematology, Faculty of Medicine, Fayoum University, Fayoum, Egypt
| | - Eman Mahmoud Ezzat
- Department of Internal Medicine, Faculty of Medicine, Fayoum University, Fayoum, Egypt
| | - Asmaa Younis Elsary
- Department of Public Health and Community Medicine, Faculty of Medicine, Fayoum University, Fayoum, Egypt
| | - Azza M Elamir
- Department of Medical Biochemistry and Molecular Biology, Faculty of Medicine, Fayoum University, Fayoum, Egypt
| | - Mona Gamal
- Department of Clinical Pathology/Hematology, Faculty of Medicine, Fayoum University, Fayoum, Egypt
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Combaluzier S, Loosveld M, Nivaggioni V. Detection of unstable haemoglobin variants with Sysmex XN-10. Int J Lab Hematol 2023; 45:e21-e23. [PMID: 36113870 DOI: 10.1111/ijlh.13967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Accepted: 08/29/2022] [Indexed: 11/30/2022]
Affiliation(s)
- Sophie Combaluzier
- Laboratoire d'Hématologie, Hôpital de la Timone, Assistance Publique-Hôpitaux de Marseille, Marseille, France
| | - Marie Loosveld
- Laboratoire d'Hématologie, Hôpital de la Timone, Assistance Publique-Hôpitaux de Marseille, Marseille, France.,CNRS, INSERM, CIML, Aix Marseille University, Marseille, France
| | - Vanessa Nivaggioni
- Laboratoire d'Hématologie, Hôpital de la Timone, Assistance Publique-Hôpitaux de Marseille, Marseille, France
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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: 5] [Impact Index Per Article: 2.5] [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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Nivaggioni V, Van Mirre E, Brousseau J, Loosveld M. Detection of Southern Asian Ovalocytosis with Sysmex XN-10: A complement to the decision tree previously described. Int J Lab Hematol 2021; 44:e84-e86. [PMID: 34664395 DOI: 10.1111/ijlh.13733] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Revised: 09/20/2021] [Accepted: 09/29/2021] [Indexed: 11/27/2022]
Affiliation(s)
- Vanessa Nivaggioni
- Laboratoire d'Hématologie, Hôpital de la Timone, Assistance Publique - Hôpitaux de Marseille, Marseille, France
| | - Edwin Van Mirre
- CERTE Medical Diagnostics and Advise, Division Clinical Chemistry, Groningen, The Netherlands
| | - Julie Brousseau
- AP-HP, service d'Hématologie Biologique, Hôpital R. Debré, Paris, France
| | - Marie Loosveld
- Laboratoire d'Hématologie, Hôpital de la Timone, Assistance Publique - Hôpitaux de Marseille, Marseille, France.,CNRS, INSERM, CIML, Aix Marseille University, Marseille, France
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Fermo E, Vercellati C, Bianchi P. Screening tools for hereditary hemolytic anemia: new concepts and strategies. Expert Rev Hematol 2021; 14:281-292. [PMID: 33543663 DOI: 10.1080/17474086.2021.1886919] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
INTRODUCTION Hereditary hemolytic anemias are a group of rare and heterogeneous disorders due to abnormalities in structure, metabolism, and transport functions of erythrocytes; they may overlap in clinical and hematological features making differential diagnosis difficult, particularly in mild and atypical forms. AREAS COVERED In the present review, the main tools currently adopted in routine hematologic investigation for the diagnosis of hereditary hemolytic anemias are described, together with the new diagnostic approaches that are being to be developed in the next future. Available recommendations in this field together with a systematic review through MEDLINE, EMBASE, and PubMED for publications in English from 2000 to 2020 in regards to diagnostic aspects of hereditary hemolytic anemias have been considered. EXPERT OPINION The recent development of specific molecules and treatments for hereditary hemolytic anemias and the increased interest in translational research raised the attention on differential diagnosis and the demand for novel diagnostic assays and devices. Automatic blood cell analyzers, omic-approaches including NGS technologies, and development of new automated tools based on artificial neural networks definitely represent the future strategies in this field.
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Affiliation(s)
- Elisa Fermo
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico Milano, UOC Ematologia, UOS Fisiopatologia Delle Anemie, Milan, Italy
| | - Cristina Vercellati
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico Milano, UOC Ematologia, UOS Fisiopatologia Delle Anemie, Milan, Italy
| | - Paola Bianchi
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico Milano, UOC Ematologia, UOS Fisiopatologia Delle Anemie, Milan, Italy
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Pei LX, Leepile TT, Cochrane KM, Samson KLI, Fischer JAJ, Williams BA, Kroeun H, Bonifacio L, Karakochuk CD. Can Automated Hematology Analyzers Predict the Presence of a Genetic Hemoglobinopathy? An Analysis of Hematological Biomarkers in Cambodian Women. Diagnostics (Basel) 2021; 11:diagnostics11020228. [PMID: 33546311 PMCID: PMC7913495 DOI: 10.3390/diagnostics11020228] [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: 12/02/2020] [Revised: 01/26/2021] [Accepted: 01/29/2021] [Indexed: 12/03/2022] Open
Abstract
Genetic hemoglobinopathies are the most common single-gene disorder worldwide. Some automated hematology analyzers have the capability of flagging individuals who may have hematological disorders based on complete blood count (CBC) biomarkers. We aimed to evaluate the accuracy of a hematology analyzer in identifying genetic hemoglobinopathies in Cambodian women and to determine which hematological biomarkers are the best predictors. A CBC was completed using a Sysmex XN-1000 analyzer and hemoglobinopathies were determined with capillary hemoglobin electrophoresis for 808 nonpregnant Cambodian women. Sysmex XN-1000 Interpretive Program (IP) messages, which flag potential hematological disorders, were produced from CBC results. Then, 2 × 2 tables were used to determine sensitivity and specificity of the IP message “Hemoglobin defect” to detect a genetic hemoglobinopathy. Receiver operating characteristic (ROC) analyses assessed the diagnostic ability of six CBC biomarkers to predict a genetic hemoglobinopathy. In total, 74% of women had a hemoglobinopathy (predominantly Hb E and α-thalassemia). “Hb defect” IP message sensitivity and specificity for genetic hemoglobinopathy detection were 10.4% and 98.6%, respectively. Variable selection strategies yielded a two-variable model including mean corpuscular volume (MCV) and red blood cell (RBC) count (AIC = 99.83, AUCROC = 0.98 (95% CI: 0.97, 0.99)) for the prediction of a homozygous EE disorder. Sensitivity and specificity values do not justify the use of Sysmex XN-1000 IP flag messages for identification of genetic hemoglobinopathies in Cambodian women. Development of an algorithm based on MCV and RBC biomarkers may optimize the screening ability of automated hematology analyzers.
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Affiliation(s)
- Lulu X. Pei
- Food, Nutrition and Health, The University of British Columbia, Vancouver, BC V6T 1Z4, Canada; (L.X.P.); (K.M.C.); (K.L.I.S.); (J.A.J.F.); (B.A.W.); (L.B.)
- Department of Statistics, The University of British Columbia, Vancouver, BC V6T 1Z4, Canada
| | - Tebogo T. Leepile
- Integrated Studies in Land and Food Systems, The University of British Columbia, Vancouver, BC V6T 1Z4, Canada;
| | - Kelsey M. Cochrane
- Food, Nutrition and Health, The University of British Columbia, Vancouver, BC V6T 1Z4, Canada; (L.X.P.); (K.M.C.); (K.L.I.S.); (J.A.J.F.); (B.A.W.); (L.B.)
- BC Children’s Hospital Research Institute, Vancouver, BC V5Z 4H4, Canada
| | - Kaitlyn L. I. Samson
- Food, Nutrition and Health, The University of British Columbia, Vancouver, BC V6T 1Z4, Canada; (L.X.P.); (K.M.C.); (K.L.I.S.); (J.A.J.F.); (B.A.W.); (L.B.)
- BC Children’s Hospital Research Institute, Vancouver, BC V5Z 4H4, Canada
| | - Jordie A. J. Fischer
- Food, Nutrition and Health, The University of British Columbia, Vancouver, BC V6T 1Z4, Canada; (L.X.P.); (K.M.C.); (K.L.I.S.); (J.A.J.F.); (B.A.W.); (L.B.)
- BC Children’s Hospital Research Institute, Vancouver, BC V5Z 4H4, Canada
| | - Brock A. Williams
- Food, Nutrition and Health, The University of British Columbia, Vancouver, BC V6T 1Z4, Canada; (L.X.P.); (K.M.C.); (K.L.I.S.); (J.A.J.F.); (B.A.W.); (L.B.)
- BC Children’s Hospital Research Institute, Vancouver, BC V5Z 4H4, Canada
| | - Hou Kroeun
- Helen Keller International, Phnom Penh, Cambodia;
| | - Lizl Bonifacio
- Food, Nutrition and Health, The University of British Columbia, Vancouver, BC V6T 1Z4, Canada; (L.X.P.); (K.M.C.); (K.L.I.S.); (J.A.J.F.); (B.A.W.); (L.B.)
- BC Children’s Hospital Research Institute, Vancouver, BC V5Z 4H4, Canada
| | - Crystal D. Karakochuk
- Food, Nutrition and Health, The University of British Columbia, Vancouver, BC V6T 1Z4, Canada; (L.X.P.); (K.M.C.); (K.L.I.S.); (J.A.J.F.); (B.A.W.); (L.B.)
- BC Children’s Hospital Research Institute, Vancouver, BC V5Z 4H4, Canada
- Correspondence:
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Nivaggioni V, Bouriche L, Coito S, Le Floch AS, Ibrahim-Kosta M, Leonnet C, Arnoux I, Loosveld M. Use of Sysmex XN-10 red blood cell parameters for screening of hereditary red blood cell diseases and iron deficiency anaemia. Int J Lab Hematol 2020; 42:697-704. [PMID: 32639680 PMCID: PMC7754411 DOI: 10.1111/ijlh.13278] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Revised: 06/04/2020] [Accepted: 06/08/2020] [Indexed: 12/21/2022]
Abstract
Introduction In daily practice in haematology laboratories, red blood cell (RBC) abnormalities are frequent and their management is a real challenge. The aim of this study is to establish a “decision tree” using RBC and reticulocyte parameters from the SYSMEX XN‐10 analyser to distinguish between patients with a hereditary RBC disease from iron deficiency anaemia and other patients. Methods We analysed results of complete RBC counts in a cohort composed of 8217 adults divided into 5 different groups: iron deficiency anaemia (n = 120), heterozygous haemoglobinopathy (n = 92), sickle cell disease syndrome (n = 56), hereditary spherocytosis (n = 18) and other patients (n = 7931). A Classification And Regression Tree (CART) analysis was used to obtain a two‐step decision tree in order to predict these previous groups. Results Five parameters and the calculated RBC score were selected by the CART method: mean corpuscular haemoglobin concentration, percentage of microcytes, distribution width of the RBC histogram, percentage of nucleated red blood cells, immature reticulocytes fraction and finally RBC Score. When applying the tree and recommended flowchart, 158/166 of the RBC hereditary disease patients and 114/120 iron deficiency anaemia patients are detected. Overall, the correct classification rate reached 99.4%. Sensitivity and specificity for RBC disease detection were 95.2% and 99.9%, respectively. These results were confirmed in an independent validation cohort. Conclusion Based on the XN‐10 RBC and reticulocyte parameters, we propose a two‐step decision tree delivering a good prediction and classification of hereditary RBC diseases. These results can be used to optimize additional reticulocyte analysis and microscopy review.
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Affiliation(s)
- Vanessa Nivaggioni
- Laboratoire d'Hématologie, Hôpital de la Timone, Assistance Publique - Hôpitaux de Marseille, Marseille, France
| | | | | | - Anne-Sophie Le Floch
- Laboratoire d'Hématologie, Hôpital de la Timone, Assistance Publique - Hôpitaux de Marseille, Marseille, France
| | - Manal Ibrahim-Kosta
- Laboratoire d'Hématologie, Hôpital de la Timone, Assistance Publique - Hôpitaux de Marseille, Marseille, France
| | - Caroline Leonnet
- Laboratoire d'Hématologie, Hôpital de la Timone, Assistance Publique - Hôpitaux de Marseille, Marseille, France
| | - Isabelle Arnoux
- Laboratoire d'Hématologie, Hôpital de la Timone, Assistance Publique - Hôpitaux de Marseille, Marseille, France
| | - Marie Loosveld
- Laboratoire d'Hématologie, Hôpital de la Timone, Assistance Publique - Hôpitaux de Marseille, Marseille, France.,Aix Marseille Univ, CNRS, INSERM, CIML, Marseille, France
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