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Concept: Complete blood count


Red cell distribution width (RDW) is a parameter of the standard full blood count tests, measuring the size variability of erythrocytes. Recently, its elevation has been proven to reliably reflect the extent systematic inflammation, mainly in cardiometabolic diseases. Up to date, its association with solid malignancies has been scarcely investigated.

Concepts: Cancer, Breast cancer, Metastasis, Anemia, Complete blood count, Mean corpuscular volume, Red blood cell distribution width


Recent studies suggest that leukocytes and erythrocytes play a role in coagulation. However, whether leukocytes, erythrocytes and other hematological variables are associated with risk of venous thrombosis is not well known. To study this, we used data from 2473 venous thrombosis patients and 2935 controls. The variables assessed were: total leukocytes, granulocytes, lymphocytes, monocytes, hematocrit, hemoglobin, erythrocytes and red cell indices (mean corpuscular volume, mean hemoglobin volume, mean corpuscular hemoglobin volume and red cell distribution width). We found a strong dose-response relation for higher red cell distribution width and monocytes with risk of venous thrombosis, with odds ratios of 3.1 (95% confidence interval, 2.0-4.8) and 2.8 (95% confidence interval, 1.3-5.8), respectively, after adjustment for age, sex, C-reactive protein, malignancy and co-morbidities. Monocyte count and red cell distribution width were associated with venous thrombosis even within reference ranges. A low monocyte count (< 0.12x109/L) was associated with a lower venous thrombosis risk after full adjustment (odds ratios 0.6; 95% confidence interval, 0.4-0.8). In summary, high red cell distribution width and blood monocytes, two unexpensive and easily obtainable tests were clearly associated with an increased risk of venous thrombosis. Future studies should evaluate the underlying mechanism and the use of these variables in prediction models for first and recurrent thrombosis.

Concepts: Immune system, White blood cell, Monocyte, Blood, Red blood cell, Hematology, Complete blood count, Mean corpuscular volume


In the current study, core-crosslinked polymeric micelles (DEX-PMs) loaded with three different DEX derivatives designed to display different drug release kinetics, were evaluated for cancer therapy and compared to another effective nanomedicine formulation (long-circulating liposomes encapsulating dexamethasone, LCL-DEX). Pharmacokinetic studies with both radiolabeled dexamethasone and polymer showed that these polymeric systems have long circulating half-lives and may accumulate at the tumor site to a higher extent than liposomes. The in vitro drug release profiles and circulating drug levels in the blood stream show that DEX-PMs with dexamethasone covalently entrapped via a sulfone ester-containing linker (DMSL2) have prolonged circulation time and intermediate drug release kinetics compared to the other polymeric DEX-releasing systems. Furthermore, as the free dexamethasone circulating levels were similar when administered as DMSL2-PM or LCL-DEX, these systems were evaluated simultaneously for antitumor efficacy in B16F10 melanoma bearing mice. The corticosteroid-targeted systems inhibited tumor growth to a similar extent and both increased survival compared to free drug. Recently antitumor efficacy of targeted formulations has been correlated with a systemic effect: a decrease of white blood cell count. In this study all three polymeric systems, liposomes as well as free drug had similar effects on the number of circulating white blood cells, although white blood cell counts recovered faster in the group receiving free drug. In conclusion, corticosteroid-targeting with a polymeric system or a liposomal system translates in similar therapeutic effects. The proven high versatility of the PM with possible optimization and adjustment of the drug release to that required by the therapeutic application, clearly demonstrates the potential of these systems for the treatment of chronic inflammatory diseases including cancer.

Concepts: Immune system, White blood cell, Monocyte, Lymphocyte, Blood, Bone marrow, Leukemia, Complete blood count


BACKGROUND: HIV-1 group M viruses diverge 25%-35% in envelope, important for viral attachment during infection, and 10-15% in the pol region, under selection pressure from common antiretrovirals. In Asia, subtypes B and CRF01_AE are common genotypes. Our objectives were to determine whether clinical, immunologic or virologic treatment responses differed by genotype in treatment-naïve patients initiating first-line therapy. METHODS: Prospectively collected, longitudinal data from patients in Thailand, Hong Kong, Malaysia, Japan, Taiwan and South Korea were provided for analysis. Covariates included demographics, hepatitis B and C coinfections, baseline CD4 T lymphocyte count and plasma HIV-1 RNA levels. Clinical deterioration (a new diagnosis of CDC category B/AIDS-defining illness or death) was assessed by proportional hazards models. Surrogate endpoints were 12-month change in CD4 cell count and virologic suppression post-therapy, evaluated by linear and logistic regression, respectively. RESULTS: Of 1105 patients, 1036 (93.8%) infected with CRF01_AE or subtype B were eligible for inclusion in clinical deterioration analyses and contributed 1546.7 person-years of follow-up (median:413 days, IQR:169-672 days). Patients >40 years demonstrated smaller immunological increases (p=0.002) and higher risk of clinical deterioration (HR=2.17; p=0.008). Patients with baseline CD4 cell counts >200 cells/μL had lower risk of clinical deterioration (HR=0.373; p=0.003). A total of 532 patients (48.1% of eligible) had CD4 counts available at baseline and 12 months post-therapy for inclusion in immunolgic analyses. Patients infected with subtype B had larger increases in CD4 counts at 12 months (p=0.024). A total of 530 patients (48.0% of eligible) were included in virologic analyses with no differences in response found between genotypes. CONCLUSIONS: Results suggest that patients infected with CRF01_AE have reduced immunologic response to therapy at 12 months, compared to subtype-B-infected counterparts. Clinical deterioration was associated with low baseline CD4 counts and older age. The lack of differences in virologic outcomes suggests that all patients have opportunities for virologic suppression.

Concepts: HIV, Immune system, Lymphocyte, B cell, Subtypes of HIV, CD4, Thymus, Complete blood count


INTRODUCTION: Usually, oral manifestations of chronic lymphocytic leukemia CLL are related to an advanced stage of a diagnosed disease, and rarely may lead to diagnosis. CLL can also present as bleeding, rarely isolated. We report a rare case of CLL the first symptoms of which were recurrent epistaxis and asymptomatic intraoral swelling. CASE PRESENTATION: A 74-year-old woman consulted for recurrent epistaxis. She presented with a small asymptomatic swelling in the left superior vestibule. Computed tomography revealed a tissular-like mass without invasion of surrounding tissues. The hemogram revealed thrombocytopenia and leukocytosis with 51% of lymphocytes. The immuno-histochemical analysis of the lesion and of the bone marrow allowed diagnosing stage IV CLL. DISCUSSION: CLL may present as unusual symptoms. It should be suspected in elderly patients presenting with atypical clinical signs such as oral swelling or signs of bone marrow involvement.

Concepts: White blood cell, Lymphocyte, Blood, Medical terms, Bone marrow, Leukemia, Medical signs, Complete blood count


Approximately 5.4 million cubic yards of coal fly ash and water spilled into the Emory River embayment of Watts Bar Reservoir in east Tennessee on Dec 22, 2008. Raccoons were collected in 2009 and 2010 from the spill site (10/y) and unexposed areas (5/y) to determine whether metals and metalloids were accumulating in raccoons and if any negative health effects resulted from exposure to the spilled coal fly ash. Tissues were analyzed from each animal to determine the concentrations of 26 metals/metalloids. Complete blood cell counts (CBC), plasma biochemistry panels, and histopathology of select tissues also were performed. Results were analyzed by year and exposure status. Although significant differences were present in some tissues for some metals/metalloids, only arsenic in hair, iron in muscle, nickel in hair, selenium in hair and muscle, strontium in hair, and vanadium in hair and liver were increased in spill site animals (one or both years) compared with unexposed animals. No clinically important differences were observed between groups regarding CBC or plasma biochemistry analyses. Lesions were observed on histopathology in some tissues, but there was no difference in the prevalence of lesions between spill site and unexposed animals. There does not seem to be any important accumulation of metals/metalloids or negative health effects in raccoons associated with exposure to coal fly ash compared with unexposed animals.

Concepts: Metal, Coal, Complete blood count, Fly ash, Pozzolana, Bottom ash, Raccoon, Kingston Fossil Plant coal fly ash slurry spill


INTRODUCTION: The CELL-DYN Emerald is a compact bench-top hematology analyzer that can be used for a three-part white cell differential analysis. To determine its utility for analysis of human and mouse samples, we evaluated this machine against the larger CELL-DYN Sapphire and Sysmex XT2000iV hematology analyzers. METHODS: 120 human (normal and abnormal) and 30 mouse (normal and abnormal) samples were analyzed on both the CELL-DYN Emerald and CELL-DYN Sapphire or Sysmex XT2000iV analyzers. For mouse samples, the CELL-DYN Emerald analyzer required manual recalibration based on the histogram populations. RESULTS: Analysis of the CELL-DYN Emerald showed excellent precision, within accepted ranges (white cell count CV% = 2.09%; hemoglobin CV% = 1.68%; platelets CV% = 4.13%). Linearity was excellent (R(2)  ≥ 0.99), carryover was minimal (<1%), and overall interinstrument agreement was acceptable for both human and mouse samples. Comparison between the CELL-DYN Emerald and Sapphire analyzers for human samples or Sysmex XT2000iV analyzer for mouse samples showed excellent correlation for all parameters. CONCLUSION: The CELL-DYN Emerald was generally comparable to the larger reference analyzer for both human and mouse samples. It would be suitable for use in satellite research laboratories or as a backup system in larger laboratories.

Concepts: Hemoglobin, Red blood cell, Anemia, Hematocrit, Thrombocytopenia, Complete blood count, Algebraic geometry, Abbott Laboratories


The aim of the study was to evaluate the relationship between age-dependent changes in total leukocyte count (TLC) and certain selected differential counts expressed as frequencies (granulocytes, band cells, eosinophils, lymphocytes, and monocytes) and longevity in physically healthy men and women aged 45+. Longitudinal data on cell counts from 142 subjects (68 men and 74 women; all aged 45-70 and examined for 25 years) were compared with cross-sectional data from 225 subjects (113 men and 112 women; this group was divided into four categories of average lifespan; i.e.: 53, 63, 68, and 76+ years of age). ANOVA, t test, and regression analysis were employed. Secular changes in leukocyte count were controlled. Men had continuously higher TLC compared with women. Moreover, sex differences in patterns of changes with age were found. The longitudinal assessment revealed a U-shaped pattern of changes in TLC in men (y=0.0026×(2)-0.2866x+14.4374; R(2)=0.852) and women (y=0.0048×(2)-0.5386x+20.922; R(2)=0.938), whereas the cross-sectional comparison showed an inverted U-shaped pattern in men (y=-0.0021×(2)+0.2421x; R(2)=0.417) and women (y=-0.0017×(2)+0.2061x; R(2)=0.888). In general, the comparison of longitudinal and cross-sectional data on changes with age in TLC indicates that longevity favors individuals with lower yet normal TLC and this correlation is more pronounced in men. In conclusion, our findings are in line with previous longitudinal studies of aging and suggest that lower TLC within the normal range (4.0-10.0×10(3)/μL) can be a useful predictor of longevity in physically healthy individuals.

Concepts: Immune system, White blood cell, Cross-sectional study, Gerontology, Aging, Granulocyte, Complete blood count, Eosinophil granulocyte


In April 2012 we carried out a 1-year hematological study on a population of wild Japanese monkeys inhabiting the forest area of Fukushima City. This area is located 70 km from the Fukushima Daiichi Nuclear Power Plant (NPP), which released a large amount of radioactive material into the environment following the Great East Japan Earthquake of 2011. For comparison, we examined monkeys inhabiting the Shimokita Peninsula in Aomori Prefecture, located approximately 400 km from the NPP. Total muscle cesium concentration in Fukushima monkeys was in the range of 78-1778 Bq/kg, whereas the level of cesium was below the detection limit in all Shimokita monkeys. Compared with Shimokita monkeys, Fukushima monkeys had significantly low white and red blood cell counts, hemoglobin, and hematocrit, and the white blood cell count in immature monkeys showed a significant negative correlation with muscle cesium concentration. These results suggest that the exposure to some form of radioactive material contributed to hematological changes in Fukushima monkeys.

Concepts: Hemoglobin, Blood, Red blood cell, Hematology, Japan, Hematocrit, Complete blood count, Honshū


The mean platelet volume (MPV), red cell distribution width (RDW) and neutrophil-to-lymphocyte ratio (NLR) comprise laboratory markers in ankylosing spondylitis (AS). There is a controversy in the literature regarding which type of ear involvement is characteristic of AS. The aim of this study was to simultaneously investigate the MPV, RDW, platelet to lymphocyte (PLR) and NLR in patients with AS and their relationships with high-frequency hearing thresholds. Thirty patients with AS and 35 age-matched healthy subjects were included. Each subject was tested with low- (250, 500, 1000 and 2000 Hz) and high- (4000, 8000, 10,000, 12,000, 14,000 and 16,000 Hz) frequency audiometry. Additionally, the case and control groups were evaluated regarding the average hearing thresholds in bone conduction. The erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) levels were measured. The RDW, MPV, neutrophils, lymphocytes and platelet counts were evaluated with the complete blood count. Furthermore, the NLR and PLR were calculated. The complete blood count, platelet numbers, ESR, CRP and NLR levels were significantly increased in the AS patients compared with the healthy controls (p < 0.001, p = 0.007, p < 0.001, p < 0.001 and p = 0.047, respectively). There was no statistically significant difference in the RDW, PLR or MPV levels (p > 0.05) in the AS patients compared with the healthy controls. The BASDAI score and disease duration were not correlated with the ESR, CRP levels, MPV, PLR, RDW or NLR in patients with AS (all; p > 0.05). The AS patients had increased average measurement values for the hearing threshold in both ears at frequencies of 250, 500, 1000 and 2000 Hz; however, there was no statistically significant difference (p > 0.05). The average values of the hearing threshold in both ears at the high frequencies of 4000, 6000, 8000, 10,000, 12,000 and 14,000 Hz were significantly increased in the case group; however, it was not significantly increased at 16,000 Hz. The current study is the first to investigate the PLR, NLR, MPV and RDW levels in acute AS. We identified a significantly increased NLR, leukocyte count, ESR and CRP in AS patients. Sensorineural hearing loss, especially at extended high frequencies, is common in patients with AS and may represent an extra-articular feature of the disease. The combined use of NLR with the leukocyte count and other clinical assessments may facilitate the diagnostic process of ankylosing spondylitis.

Concepts: White blood cell, Lymphocyte, Blood, Ear, Thrombocytopenia, C-reactive protein, Erythrocyte sedimentation rate, Complete blood count