Application of Innovative Hemocytometric Parameters and Algorithms for Improvement of Microcytic Anemia Discrimination.

Hemocytometric parameters like red blood cell (RBC) count, mean red blood cell volume (MCV), reticulocyte count, red blood cell distribution width (RDW-SD) and zinc protoporphyrin (ZPP) are frequently established for discrimination between iron-deficiency anemia and thalassemia in subjects with microcytic erythropoiesis. However, no single marker or combination of tests is optimal for discrimination between iron-deficiency anemia and thalassemia. This is the reason why many algorithms have been introduced.

Aspects of platelet disturbances in haemodialysis patients.

Patients with mild-to-chronic kidney disease (CKD) exhibit a variety of haemostatic disorders, ranging from an increased clotting tendency and reductions in the levels of natural inhibitors of coagulation to defective fibrinolysis. In addition, platelet (PLT) abnormalities are common. In this minireview, we report on aspects of haemodialysis (HD)-induced PLT activation.

Coagulation activation, depletion of platelet granules and endothelial integrity in case of uraemia and haemodialysis treatment.

Background: During haemodialysis (HD) treatment, increase of platelet (PLT) activation and induction of procoagulant activity is demonstrated. Although the role of the endothelium and its direct interaction with coagulation and homeostasis is known, it is not elucidated how PLT activation markers and activation of coagulation coincide with markers of endothelial integrity during HD treatment. In the present study uraemia and HD induced changes, with particular emphasis on PLT granules depletion, activation of coagulation and endothelial integrity were investigated.

Effects of iron supplementation on red blood cell hemoglobin content in pregnancy.

Although a mild degree of anemia is common in the third trimester of pregnancy, it remains a challenge to establish whether a decrease in hemoglobin (Hb) concentration is physiological or pathological. The World Health Organization suggested a Hb concentration of 110 g/L to discriminate anemia. Several European investigators recommended Hb cut-off values of between 101-110 g/L.

Transient impairment of reticulocyte hemoglobin content and hepcidin-25 induction in patients with community-acquired pneumonia.

Introduction: Patients with community-acquired pneumonia (CAP) often exhibit a declining hemoglobin (Hb) concentration. During inflammation pro-inflammatory cytokines and cells of the reticuloendothelial system induce disturbances in iron homeostasis. In this study inflammation markers and hepcidin-25 concentrations were monitored together with short-term alterations in reticulocyte hemoglobinization (RET-He).

Efficacy of advanced discriminating algorithms for screening on iron-deficiency anemia and β-thalassemia trait: a multicenter evaluation.

For many years, application of RBC indices has been recommended for discriminating between subjects with iron deficiency from those with thalassemia. However, application of the algorithms resulted in only 30% to 40% of subjects being appropriately classified. The aim of the study was to establish the efficacy of algorithms for anemia screening including new hematologic parameters such as percentage of hypochromic and microcytic RBCs and hemoglobin content of reticulocytes.

D-dimer levels in assessing severity and clinical outcome in patients with community-acquired pneumonia. A secondary analysis of a randomised clinical trial.

Background: D-dimer levels are in several studies elevated in patients with CAP. In this study we assess the use of D-dimer levels and its association with severity assessment and clinical outcome in patients hospitalised with community-acquired pneumonia.

Methods: In a subset of randomised trial patients with community-acquired pneumonia serial D-dimer levels was analysed.

Electron microscopic observation in case of platelet activation in a chronic haemodialysis subject.

During haemodialysis (HD), platelets (PLTs) are activated and release granule contents. As HD treatment occurs three times a week, it has been demonstrated that PLTs are exhausted due to the repetitive character of the treatment. To identify PLT depletion morphologically, PLT evaluation was performed by light microscopy and electron microscopy (EM) in a chronic HD subject and a healthy reference subject.

Platelet depletion, platelet activation and coagulation during treatment with hemodialysis.

Bioincompatibility is the total of side effects during hemodialysis (HD) including, amongst others, changes in platelet (PLT) level. Deviations in PLT count, immature PLT count, PLT morphology, CD62p expression, Platelet Factor 4 (PF4), β-Thromboglobulin (β-TG), serotonin, Thrombin-Antithrombin III (TAT) and Prothrombin Fragment 1+2 (F1+2) are monitored before and during treatment with HD in order to elucidate the interaction between modifications in PLT morphology, PLT activation and markers concerning activation of coagulation. Different patterns with time indicate that there is no correlation between an increased amount of depleted PLTs and increased amounts of PLT activation markers such as CD62p, PF4, β-TG and serotonin.

The role of the extracorporeal circuit in the trapping and degranulation of platelets.

Background: Although platelet (PLT) activation and degranulation are well-known phenomena during hemodialysis (HD), controversies still exist about their nature and origin.

Methods: PLT characteristics [PLT numbers, mean PLT volume (MPV), PLT distribution width (PDW), PLT large cell ratio (p-LCR), immature PLT fraction] and activation status [CD62p expression, platelet factor 4 (PF4) and beta-thromboglobulin (BTG) plasma levels] were estimated in 19 patients before and during HD. Blood was sampled from both the afferent and efferent lines.

Post-dilution haemodiafiltration and low-flux haemodialysis have dissimilar effects on platelets: a side study of CONTRAST.

Background: Cardiovascular disease (CVD) is the leading cause of death in patients with end-stage renal disease (ESRD). Platelet (PLT) dysfunction, which is a well-known phenomenon in advanced chronic renal failure, corresponds positively with CVD in these patients. The accumulation of retained uraemic toxins might play an important role in this respect.

Platelet activation in clinical haemodialysis: LMWH as a major contributor to bio-incompatibility?

Background: The sum of undesirable side effects, occurring during haemodialysis (HD), is called bio-incompatibility. Concerning platelets, both an increase in the expression of the cell surface marker P-selectin (CD62p) and release of the intracellular granule product platelet factor 4 (PF4) have been described. However, as PF4 is also abundantly present on endothelium-bound proteoglycans, it is questionable whether the HD-induced increase is exclusively attributable to release from platelets.

Reduction in platelet activation by citrate anticoagulation does not prevent intradialytic hemodynamic instability.

Background: The etiology of intradialytic hemodynamic instability is multifactorial. Of the various factors involved, a rise in core temperature seems to be crucial. In this respect, the bioincompatibility of hemodialysis (HD) treatment might play an important role.

Erythropoiesis activity, iron availability and reticulocyte hemoglobinization during treatment with hemodialysis and in subjects with uremia.

In hemodialysis subjects correction of anemia is facilitated by combined supplementation of intravenous iron and recombinant human erythropoietin. Reticulocyte hemoglobin content (RET-He) is considered to be an actual indicator reflecting functional iron availability for erythropoiesis. In the present study, interdependence between biochemical analytes reflecting iron status and hemocytometric parameters indicating the degree of hemoglobinization of reticulocytes and red blood cells, respectively, is established.

Hemoglobinization and functional availability of iron for erythropoiesis in case of thalassemia and iron deficiency anemia.

Microcytic erythropoiesis in case of anemia is frequently due to iron deficiency or may be due to alpha- and beta- thalassemia trait as a result of increased activity of erythropoiesis. The aim of the present study was to evaluate alterations with regard to the degree of hemoglobinization in reticulocytes in comparison with mature erythrocytes. Iron availability in subjects with anemia resulting from iron deficiency and alpha- or beta- thalassemia was studied by application of conventional as well hemocytometric parameters that have recently become available.

Citrate anticoagulation abolishes degranulation of polymorphonuclear cells and platelets and reduces oxidative stress during haemodialysis.

Background: During haemodialysis (HD), polymorphonuclear cells (PMNs) and platelets are activated and release various granule products, including myeloperoxidase (MPO) and platelet factor 4 (PF4). MPO triggers the generation of reactive oxygen species, leading to irreversible protein, carbohydrate and lipid modification. PF4 probably also contributes to oxidative stress.

Enhanced long-term reduction of plasma leptin concentrations by super-flux polysulfone dialysers.

Background: Hyperleptinaemia in chronic haemodialysis (CHD) patients has been associated with malnutrition, which is an independent predictor of morbidity and mortality in this patient group.

Methods: To assess the influence of HD on plasma leptin, 10 CHD patients were crossover randomized to low-flux polysulfone (PS: F 6HPS), high-flux PS (F 60S), super-flux PS (F 500S) or super-flux cellulose-tri-acetate (CTA: Tricea 150G) for 12 weeks each. Blood samples were collected at the start of the study and each 12-week period.

Safety and efficacy of treatment with platelet GPIIb/IIIa receptor blockade in unstable angina patients awaiting PTCA at a referring clinic.

BACKGROUND: Although balloon angioplasty has assumed an important role in the management of refractory unstable angina (UA), that is, UA that does not respond to conventional therapy, it is limited by complications related to thrombosis and acute coronary occlusion. The complication rate is higher in patients with UA than in those whose condition is stable. Preprocedural use of abciximab, a monoclonal platelet glycoprotein IIb/IIIa receptor blocker, has been used effectively in patients with UA, but its acceptance may be limited by safety concerns and economic constraints.

Effect of nutrient supplementation on serum homocysteine, iron and proteins in psychogeriatric patients.

In a longitudinal follow-up study the effect of pharmaceutical supplementation of nutrients (folate, vitamin B12, B6, B1, C, iron and proteins) was established in 25 psychogeriatric patients (subject group). A reference group of 30 apparently healthy elderly subjects was used for comparison and statistical evaluation. At the time of hospitalization percentages concerning the incidence of decreased serum concentrations reflecting an inappropriate nutrient state in the subject group amounted to 28% for vitamin B12, 20% for folate, 36% for iron, 12% for transferrin and 56% for albumin concentrations.

Abnormally short activated partial thromboplastin times are related to elevated plasma levels of TAT, F1+2, D-dimer and FVIII:C.

Abnormally short activated partial thromboplastin times (APTTs) are associated with an increased risk of thrombotic disorders. We have examined the status of coagulation activity in subjects with short APTTs. In addition, the presence of the thrombotic risk factors G1691A-factor V, G20210A-prothrombin gene mutation and factor VIII coagulant activity (FVIII:C) was determined.

Intercurrent clinical events are predictive of plasma C-reactive protein levels in hemodialysis patients.

Background: In chronic hemodialysis (HD) patients, the repetitive induction of the acute phase response (APR) may induce a chronic micro-inflammatory state, leading to various long-term complications.

Methods: The present prospective study was designed to assess the alterations in the APR in 74 patients who were randomized to HD with a high-flux polysulfone (PS; F 60S), a super-flux PS (F 500S), or a super-flux cellulosic tri-acetate (CTA and CTA with filtered dialysate, CTA(f)) dialyzer. Blood samples collected at the start of the study and after twelve weeks were analyzed for interleukin-6 (IL-6) and C-reactive protein (CRP).

Persistent activation of coagulation and fibrinolysis after treatment of active ulcerative colitis.

Objective: Haemostatic changes may be involved in the pathogenesis and progression of ulcerative colitis. We studied longitudinally inflammatory and haemostatic parameters in patients treated for severe ulcerative colitis.

Design And Setting: We carried out a descriptive study of longitudinal blood measurements in patients with severe ulcerative colitis from one large regional hospital.

Clinical evaluation of changes in the morphology of eosinophils.

In order to diagnose and monitor patients with allergic diseases, we studied parameters which reflect not only the amount of eosinophils but also their state of activation. Morphologic features reveal additional information on the activity state of eosinophils. The number of nuclear lobes, cell size, amount of vacuoles and density of specific granules are considered characteristic features of eosinophils.