Complete blood count using VCS (volume, conductivity, light scatter) technology is affected by hyperlipidemia in a child with acute leukemia
Dilek Gürlek GökçebayFatih AzıkPamir Işıkİkbal Ok BozkayaAteş KaraE. B. TAVILNeşe YaralıBahattin Tunç
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Asparaginase, an effective drug in the treatment of childhood acute lymphoblastic leukemia (ALL), has become an important component of most childhood ALL regimens during the remission induction or intensification phases of treatment. The incidence range of asparaginase-associated lipid abnormalities that are seen in children is 67–72%. Lipemia causes erroneous results, which uses photometric methods to analyze blood samples. We describe a case of l-asparaginase-associated severe hyperlipidemia with complete blood count abnormalities. Complete blood count analysis was performed with Beckman COULTER® GEN·S™ system, which uses the Coulter Volume, Conductivity, Scatter technology to probe hydrodynamically focused cells. Although an expected significant inaccuracy in hemoglobin determination occurred starting from a lipid value of 3450 mg/dl, we observed that triglyceride level was 1466 mg/dl. Complete blood count analysis revealed that exceptionally high hemoglobin, mean corpuscular hemoglobin, and mean corpuscular hemoglobin concentration levels vs. discordant with red blood cell count, mean corpuscular volume, and hematocrit levels. Total leukocyte count altered spontaneously in a wide range, and was checked with blood smear. Platelet count was in expected range (Table 1). Thus, we thought it was a laboratory error, and the patient’s follow-up especially for red cell parameters was made by red blood cell and hematocrit values. Table 1. Patient’s complete blood count analysis according to the days of induction Day of induction Hb (g/dl) Hct (%) MCV (fl) MCH (pg) MCHC (g/dl) RDW (%) RBC (× 106/μl) WBC (× 10³/μl) Plt (× 10³/μl) 26 11.2 30.8 92 34 36.5 18 3.3 1.2 124 30 14.1 31 93 42 45 17.6 3.4 10.1 156 33 16.8 27 92 57 62 17 2.9 2.3 113 36 18.9 29 97 63 65 18.9 3.01 13.5 182 37 13.6 28.5 98 47 47 20 2.8 6.7 151 38 8.9 26.3 98 33 33 22 2.6 2.7 117 Hb, hemoglobin; MCV, mean corpuscular volume; MCH, mean corpuscular hemoglobin; MCHC, mean corpuscular hemoglobin; Hct, hematocrit; RBC, red blood cell count; RDW, red cell distribution width; WBC, white blood cell count; Plt, platelet count.Keywords:
Mean corpuscular hemoglobin
Complete blood count
Coulter counter
Hyperlipidemia
Background: Febrile seizures (FS) are the most common type of convulsion in young children. The predisposing factors are still under investigation; however, iron insufficiency might play a role in this regard. Objectives: Our objective was to determine the association between iron status and febrile seizure. Patients and Methods: This prospective case-control study was conducted among 109 children aged 6 months to 6 years and hospitalized for the first episode of FS. The case group was compared to a group of 70 age- and sex-matched controls admitted to the same ward with the same diagnosis of infection. The control and case groups were matched based on family history of FS, age, sex, temperature, cause of illness, erythrocyte sedimentation rate (ESR), white blood cells (WBC), and platelets. Venous blood samples were examined for complete blood count (CBC), serum iron, serum ferritin, and total iron-binding capacity. The CBC included measurements of red blood cell (RBC), hemoglobin (Hb), hematocrit (HCT), mean corpuscular volume (MCV), mean corpuscular hemoglobin (MCH), mean corpuscular hemoglobin concentration (MCHC), WBC, and platelets. Results: There were no significant differences between the study groups in terms of temperature, ESR, WBC, and platelets. The mean Hb, HCT, ferritin, iron, and MCH were significantly lower in the case group than in the control group. The mean level of MCV in the FS group was lower than the mean level of MCV in the control group, but the difference was not significant. Conclusions: Low levels of serum ferritin and iron might play a role in the pathogenesis of simple febrile seizure. Further longitudinal studies are clearly needed to confirm our findings.
Mean corpuscular hemoglobin
Complete blood count
White blood cell
Venous blood
Erythrocyte sedimentation rate
Mean platelet volume
Febrile seizure
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Asparaginase, an effective drug in the treatment of childhood acute lymphoblastic leukemia (ALL), has become an important component of most childhood ALL regimens during the remission induction or intensification phases of treatment. The incidence range of asparaginase-associated lipid abnormalities that are seen in children is 67–72%. Lipemia causes erroneous results, which uses photometric methods to analyze blood samples. We describe a case of l-asparaginase-associated severe hyperlipidemia with complete blood count abnormalities. Complete blood count analysis was performed with Beckman COULTER® GEN·S™ system, which uses the Coulter Volume, Conductivity, Scatter technology to probe hydrodynamically focused cells. Although an expected significant inaccuracy in hemoglobin determination occurred starting from a lipid value of 3450 mg/dl, we observed that triglyceride level was 1466 mg/dl. Complete blood count analysis revealed that exceptionally high hemoglobin, mean corpuscular hemoglobin, and mean corpuscular hemoglobin concentration levels vs. discordant with red blood cell count, mean corpuscular volume, and hematocrit levels. Total leukocyte count altered spontaneously in a wide range, and was checked with blood smear. Platelet count was in expected range (Table 1). Thus, we thought it was a laboratory error, and the patient’s follow-up especially for red cell parameters was made by red blood cell and hematocrit values. Table 1. Patient’s complete blood count analysis according to the days of induction Day of induction Hb (g/dl) Hct (%) MCV (fl) MCH (pg) MCHC (g/dl) RDW (%) RBC (× 106/μl) WBC (× 10³/μl) Plt (× 10³/μl) 26 11.2 30.8 92 34 36.5 18 3.3 1.2 124 30 14.1 31 93 42 45 17.6 3.4 10.1 156 33 16.8 27 92 57 62 17 2.9 2.3 113 36 18.9 29 97 63 65 18.9 3.01 13.5 182 37 13.6 28.5 98 47 47 20 2.8 6.7 151 38 8.9 26.3 98 33 33 22 2.6 2.7 117 Hb, hemoglobin; MCV, mean corpuscular volume; MCH, mean corpuscular hemoglobin; MCHC, mean corpuscular hemoglobin; Hct, hematocrit; RBC, red blood cell count; RDW, red cell distribution width; WBC, white blood cell count; Plt, platelet count.
Mean corpuscular hemoglobin
Complete blood count
Coulter counter
Hyperlipidemia
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Objectives: Hemoglobin & red blood cell indices (mean corpuscular volume, mean corpuscular hemoglobin, mean corpuscular hemoglobin concentration, red cell distribution width) among adolescent. Study Design: Cross-Sectional study (Descriptive). Setting: Department of Physiology, Baqai Medical University (BMU) Karachi. Period: 6 months from February to August 2017. Material & Methods: A total of 500 students of MBBS, BDS, DPT with having age ranges from 18-25 years were enrolled in this study. The anthropometric measurement [height (m2) and weight (kg)] was recorded for calculation of the Body Mass Index and Complete blood count i-e Hemoglobin (Hb%), Mean Corpuscular Volume (MCV), Mean corpuscular hemoglobin (MCH), Mean corpuscular hemoglobin concentration (MCHC), Red cell distribution width (RDW) was done and calculated. Data analysis was done on Microsoft excel & SPSS version 22.0 was used. Results: It was seen that the comparison of Hb%, MCV & RDW had no significant (p>0.001) association of study participants to different categories of Body Mass Index. Mean corpuscular hemoglobin (MCH) (X²=28.278, p<0.001) and Mean corpuscular hemoglobin concentration (MCHC) (X²=15.659, p=0.016) were statistically significantly association with different categories of Body Mass Index. Conclusion: Mean corpuscular hemoglobin and Mean corpuscular hemoglobin concentration had statistically significant (p<0.001) association with body mass index (BMI).
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A complete blood cell count (CBC) is one of most common test requested by a doctor that gives information about the cells in a patient`s blood. These days, counting the cells in a patient`s blood is generally automated by use of an automated analyzer. Because an automated cell counter samples and counts so many cells, the results are very precise. In addition to counting, automated analyzers also measure the amount of hemoglobin in the blood and red blood cell indices including mean corpuscular volume (MCV), mean corpuscular hemoglobin (MCH), mean corpuscular hemoglobin concentration (MCHC), and red blood cell distribution width (RDW). These informations are very helpful to a physician who is trying to identify the cause of a patient`s disease. If the red cells are smaller or larger than normal, or if there`s a lot of variation in the size of the red cells, these data can help guide the direction of further testing and expedite the diagnostic process so patients can get the treatment they need quickly. Therefore, we need to pay more attention to the interpretation of CBC results. (Korean J Med 78:531-539, 2010)
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In this study, hematology was evaluated in jundiá fish males and females fed with three protein levels: 24, 27 and 30% CP. A total of 270 fishes (135 males and 135 females – initial weight of 216.38 ± 26.73 g) were fed during 100 days, in a water re-use system containing 18 tanks (six treatments and three replicates). After this period, six fishes by treatment were captured for blood collection, by which the following values were obtained: hematocrit, hemoglobin, red blood cells, mean corpuscular volume, mean corpuscular hemoglobin, mean corpuscular hemoglobin concentration and platelets. The males showed higher values (P<0.01) of red blood cells, hematocit and hemoglobin comparing to the females. The females showed higher platelet values. Platelets and mean corpuscular hemoglobin concentration were affected by dietetic protein level. Corpuscular volume and mean corpuscular hemoglobin were not affected by the diet protein level nor the fish sex (P>0.05). It can be concluded that jundiá fish males showed higher hematological parameters compared to females. The dietary protein influences in platelets and mean corpuscular hemoglobin concentration of jundiá fish.
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The patient, with a 1-year history of idiopathic thrombocytopenic purpura, was admitted to the hospital because of a severely decreased platelet count (9000/μL) found during follow-up complete blood count testing. She did not have any significant complaints. There was no history of bleeding from any source. However, on questioning, she mentioned a few spontaneous ecchymoses on the arms. No other significant findings were obtained on physical examination. Her complete blood count was remarkable for moderate anemia (hemoglobin, 8.5–9.6 g/ dL), microcytosis (mean corpuscular volume of 60.8 fl, mean corpuscular hemoglobin of 19.7 pg, and mean corpuscular hemoglobin concentration of 32.4 g/dL), and elevated red cell distribution width (19.1%). Her red blood cell count was within the normal range. The platelet count was 11 000/μL. Mild neutrophilia with a mild left shift was also present. The patient was admitted with a diagnosis of a relapse of idiopathic thrombocytopenic purpura, and treatment with steroids and intravenous immunoglobulin was initiated. Because of the microcytic anemia, further workup was performed, and hemoglobin studies were ordered. Hemoglobin electrophoresis was performed at alkaline (8.6) and acidic (6.2) pH. The corresponding gels are presented in Figure 1, A and B, respectively. Arrows indicate the index case in lane 3 of both gels. Lanes 1 and 5 are markers (hemoglobin A, S, C and hemoglobin A, F). Figure 2 represents the scan of the alkaline gel, and Figure 3 the high-performance liquid chromatography results.What is your diagnosis?S/E hemoglobinopathy occurs in a double-heterozygous individual with 2 different mutations in the beta-chain genes located on the p arm of chromosome 11. It is quite a rare entity.12 The prevalence of S/E carriers among all individuals with major hemoglobinopathies is not defined, because only a few cases have been reported so far. As is well known, the S mutation causes substitution of valine for glutamic acid in the 6 position, and the E mutation causes substitution of lysine for glutamic acid in the 26 position in the hemoglobin beta chain. As a result of mutations in both beta chains, the patient does not have any hemoglobin A. Approximately 30% to 35% of the total hemoglobin is hemoglobin E, and about 60% to 65% is hemoglobin S. The hemoglobin F level is usually normal or might be slightly elevated. The hemoglobin A2 level cannot be assessed from the high-performance liquid chromatography data, because hemoglobin E has the same retention time as hemoglobin A2 and overlaps the A2 pick (Figure 3, the shaded area). Isoelectric focusing and its modification could be used for separation of these hemoglobins.3–5S/E hemoglobinopathy is usually associated with mild anemia, microcytosis, and the presence of few target cells. As a rule, it does not cause sickle cell formation, and there are no complications associated with sickling. In general, these are healthy individuals with no significant pathologic changes related to the hemoglobinopathy. However, there are some reports that describe manifestations of a sickling disorder in affected individuals.6 To the best of our knowledge, there is no information suggesting higher incidence of idiopathic thrombocytopenic purpura in individuals with S/E or any other hemoglobinopathy. Most likely, in our case, these conditions occurred coincidentally.The S mutation is the most common hemoglobin mutation in the African American population as well as in black populations worldwide. The E mutation is most common in Southeast Asia. This implies a higher probability of appearance of such double-heterozygous individuals from interracial relationships between individuals belonging to these ethnic groups. Nevertheless, S/E individuals have been reported in families where both biologic parents belong to the same ethnic group. These are cases of Saudi Arabian, Indian, Pakistani, Turkish, and African American origin. Our patient is of African American background.
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Hemoglobin electrophoresis
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Background: Febrile seizures (FS) are the most common type of convulsion in young children. The predisposing factors are still under investigation; however, iron insufficiency might play a role in this regard. Objectives: Our objective was to determine the association between iron status and febrile seizure. Patients and Methods: This prospective case-control study was conducted among 109 children aged 6 months to 6 years and hospitalized for the first episode of FS. The case group was compared to a group of 70 age- and sex-matched controls admitted to the same ward with the same diagnosis of infection. The control and case groups were matched based on family history of FS, age, sex, temperature, cause of illness, erythrocyte sedimentation rate (ESR), white blood cells (WBC), and platelets. Venous blood samples were examined for complete blood count (CBC), serum iron, serum ferritin, and total iron-binding capacity. The CBC included measurements of red blood cell (RBC), hemoglobin (Hb), hematocrit (HCT), mean corpuscular volume (MCV), mean corpuscular hemoglobin (MCH), mean corpuscular hemoglobin concentration (MCHC), WBC, and platelets. Results: There were no significant differences between the study groups in terms of temperature, ESR, WBC, and platelets. The mean Hb, HCT, ferritin, iron, and MCH were significantly lower in the case group than in the control group. The mean level of MCV in the FS group was lower than the mean level of MCV in the control group, but the difference was not significant. Conclusions: Low levels of serum ferritin and iron might play a role in the pathogenesis of simple febrile seizure. Further longitudinal studies are clearly needed to confirm our findings.
Mean corpuscular hemoglobin
Complete blood count
White blood cell
Erythrocyte sedimentation rate
Venous blood
Mean platelet volume
Febrile seizure
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Venous blood samples were collected monthly from 60 male and 60 female Sinclair(S-1) miniature swine from 1 through 36 months of age. Hematologic parameters evaluated included: erythrocyte count, packed cell volume, hemoglobin concentration, mean corpuscular volume, mean corpuscular hemoglobin, mean corpuscular hemoglobin concentration, leukocyte count and differential leukocyte counts. Mean erythrocyte count increased from 3 through 9 months of age and declined thereafter. Mean packed cell volume and hemoglobin concentration decreased from 1 to 3 months of age, increased from 3 through 10 months of age and remained stable thereafter. From 7 through 36 months of age, females had greater mean packed cell volume and hemoglobin concentration than did males. Mean corpuscular volume and mean corpuscular hemoglobin increased linearly from 3 through 24 months of age and remained stable thereafter with females having greater mean corpuscular volumes and mean corpuscular hemoglobins than did males. Mean corpuscular hemoglobin concentration increased linearly from 1 through 30 months of age. Mean leukocyte count decreased from 1 through 9 months of age and remained stable thereafter. From 10 through 36 months of age, mean leukocyte count was greater for males than for females. From 6 through 24 months of age, mean per cent lymphocytes was greater for females than for males; whereas, mean per cent neutrophils was greater for males than for females.
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