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Immunology Letters Oct 2022About 40% to 50% of children with Henoch-Schonlein purpura often suffer from nephritis, which can cause irreversible renal damage. Significantly increased peripheral T...
BACKGROUND
About 40% to 50% of children with Henoch-Schonlein purpura often suffer from nephritis, which can cause irreversible renal damage. Significantly increased peripheral T lymphocytes and reduced B lymphocytes have been widely reported as hallmarks of Henoch-Schonlein purpura nephritis (HSPN) differing from Henoch-Schonlein purpura without nephritis (HSP). While the role of peripheral immune cells, especially CD8+ T cells, in the development of nephritis of Henoch-Schonlein purpura is not clear.
OBJECTIVES
To explore the changes of peripheral CD8+ T cells and the association of CD8+ T cell markers with indicators of renal function in HSP and HSPN patients.
PATIENTS AND METHODS
A total of 27 HSP and 16 HSPN patients were included in this study. The serum urea, serum creatinine, 24-hour urinary protein and peripheral white blood cell counts were collected from hospital registry systems. The T cell surface markers (CD28, CD107a and CD69) and cytokine (TNFα and IFNγ) secretion capacity were measured by flow cytometry.
RESULTS
Compared with HSP patients, The number of CD8+ T cells in HSPN patients increased significantly (p=0.0003) and demonstrated with decreased CD69 expression (p<0.0001) and decreased cytokine secretion. The expression level of CD69 in CD3+, CD4+ and CD8+ T cells all significantly correlated negatively with serum creatinine and 24-hour urinary protein in HSP and HSPN children.
CONCLUSIONS
The inhibition of CD8+ T cell activity was significantly related to the decline of renal function in HSP and HSPN patients. It is possible to monitor renal function by detecting the expression of CD69 on CD8+ T cells in HSP and HSPN patients.
Topics: CD28 Antigens; CD8-Positive T-Lymphocytes; Child; Creatinine; Humans; IgA Vasculitis; Nephritis; T-Lymphocytes; Tumor Necrosis Factor-alpha; Urea
PubMed: 36174770
DOI: 10.1016/j.imlet.2022.09.003 -
American Family Physician Feb 2016Bleeding and bruising are common symptoms in the primary care setting. The patient history can help determine whether the bruising or bleeding is abnormal. The... (Review)
Review
Bleeding and bruising are common symptoms in the primary care setting. The patient history can help determine whether the bruising or bleeding is abnormal. The International Society on Thrombosis and Hemostasis has developed a bleeding assessment tool that can be used to indicate possible pathology. A family history of bleeding problems may suggest a hereditary coagulation defect. Such a history is especially important in children who may not have experienced a major bleeding episode. Medication review can identify pharmacologic causes of the bleeding or bruising. Physical examination findings such as mucocutaneous bleeding suggest that the underlying condition is caused by platelet dysfunction, whereas hemarthroses or hematomas are more common in coagulopathy. If the history and physical examination findings suggest a bleeding diathesis, initial laboratory testing includes a complete blood count, peripheral blood smear, prothrombin time (PT), and partial thromboplastin time (PTT). A normal PT and PTT indicate a platelet disorder, the most common of which is von Willebrand disease. A normal PT and prolonged PTT signal a deficit in the intrinsic pathway, and a mixing study should be performed. A vitamin K challenge is indicated in patients with an abnormal PT and normal PTT. A workup for liver failure is warranted in patients with prolonged PT and PTT. If initial testing does not reveal an etiology in a patient with a high suspicion for a bleeding disorder, the patient should be referred to a hematologist for additional evaluation.
Topics: Blood Coagulation Disorders; Blood Coagulation Tests; Child; Hemorrhage; Humans; Primary Health Care
PubMed: 26926815
DOI: No ID Found -
Arteriosclerosis, Thrombosis, and... Apr 2018
Review
Topics: Anticoagulants; Blood Coagulation; Blood Platelets; Clinical Decision-Making; Coronary Artery Disease; Hemorrhage; Humans; Patient Selection; Peripheral Arterial Disease; Platelet Activation; Platelet Aggregation Inhibitors; Risk Factors; Time Factors; Treatment Outcome
PubMed: 29449336
DOI: 10.1161/ATVBAHA.117.310048 -
Ceska a Slovenska Oftalmologie :... 2019Peripheral exudative hemorrhagic chorioretinopathy (PEHCR) is relatively rare and especially less known and therefore less often diagnosed condition of the retina...
Peripheral exudative hemorrhagic chorioretinopathy (PEHCR) is relatively rare and especially less known and therefore less often diagnosed condition of the retina periphery predominantly in patients of higher age. Usually temporal periphery is affected. The finding is bilateral in approximately 30 %. Clinically it manifests by multibulbar prominences in periphery, which can sometimes resemble choroidal melanoma. It concerns exudations and hemorrhages under retina (sub-retinal) or under retinal pigment epithelium (sub-RPE). Within weeks or months hemorrhagy is resorbed and flattened and chorioretinal atrophy of various grade remains in affected area, sometimes combined with retinal fibrosis. If the affected area remains limited to the periphery, the central visual acuity does not have to be reduced. Affection is considered to be peripheral form of wet age-related macular degeneration or peripheral form of idiopathic polypoidal choroidal vasculopathy. By differential diagnosis is necessary to exclude especially malignant choroidal melanoma and choroidal detachment. Case report: Own case of 83 years old patient with bilateral PEHCR is described and photo documented. Creation of new prominence - fresh bleeding under retina and RPE in superior periphery - had been captured. Photo documentation of lesion in early stage and in stage of resorbtion after several weeks. Affected areas remained limited to periphery and did not have influence on central vision. That was influenced by degeneration of macula and vitreomacular traction syndrome with distinct epiretinal membrane. Conclusion: PEHCR is less frequent or less diagnosed condition of the retina periphery in old patients. Ongoing exudation and sub-retinal or sub-RPE bleeding. Within weeks heals with chorioretinal scars and subretinal fibrosis. Central vision does not have to be damaged, if lesions do not spread to macula.
Topics: Aged, 80 and over; Choroid Diseases; Fluorescein Angiography; Humans; Macula Lutea; Retinal Hemorrhage; Retinal Pigment Epithelium
PubMed: 31537076
DOI: 10.31348/2019/2/4 -
BMC Pediatrics Jun 2023The Haematological Reference Intervals (RIs) are prone to vary on the basis of various factors such as altitude, age, sex, socioeconomic status, etc. These values play a...
BACKGROUND
The Haematological Reference Intervals (RIs) are prone to vary on the basis of various factors such as altitude, age, sex, socioeconomic status, etc. These values play a major role in laboratory data interpretation and determine the necessary clinical treatment. Currently, India has no well-established RI for cord blood haematological parameters of newborns. This study aims to establish these intervals from Mumbai, India.
METHOD
A cross sectional study was conducted in a tertiary care hospital of India from October 2022 to December 2022 on healthy and term neonates having normal birth weight and born to healthy pregnant mothers. About 2 - 3 mL of cord blood was collected from the clamped cord into EDTA tubes from 127 term neonates. The samples were analysed in the haematology laboratory of the institute and the data was analysed. The upper and lower limits were determined using non-parametric method. The Mann-Whitney U test was used to compare the distribution of the parameters between sex of infant, modes of deliveries, maternal age and obstetric history. P value less than 0.05 was considered to declare statistical significance.
RESULT
The median values and 95% RI for umbilical cord blood haematological parameters of newborns were as follows: WBC = 12.35 [2.56-21.19] × 10/L, RBC = 4.34 [2.45-6.27] × 10/L, HGB = 14.7 [8.08-21.44] g/dL, HCT = 48 [29-67]%, MCV = 109.6 [59.04-159.1] fL, MCH = 34.5 [30.54-37.79] pg, MCHC = 31.3 [29.87-32.75] %, PLT = 249 [16.97-479.46] × 10/L,LYM = 38 [17-62] %, NEU = 50 [26-74] %, EOS = 2.3 [0.1-4.8] %, MON = 7.3 [3.1-11.4], BAS = 0 [0-1]. This study found no statistically significant difference between sex of infants, except MCHC, and obstetric history. A significant difference was observed in WBC, EOS% and absolute NEU, LYM, MON and BAS by delivery type. A higher platelet count and absolute LYM was observed in the cord blood compared to venous blood.
CONCLUSIONS
For the first time, haematological reference intervals in cord blood were established for newborns in Mumbai, India. The values are applicable for newborns from this area. Larger study throughout the country is required.
Topics: Infant; Female; Pregnancy; Humans; Infant, Newborn; Fetal Blood; Cross-Sectional Studies; Reference Values; Blood Cell Count; Hematology
PubMed: 37291518
DOI: 10.1186/s12887-023-04090-2 -
Archives of Pathology & Laboratory... Jul 2022Clinical laboratories and the training of pathology residents are tightly regulated environments. Compliance with regulatory requirements must be addressed when...
CONTEXT.—
Clinical laboratories and the training of pathology residents are tightly regulated environments. Compliance with regulatory requirements must be addressed when developing entrustable professional activities (EPAs) for pathology residents.
OBJECTIVE.—
To describe the development of EPAs for peripheral blood and body fluid review in compliance with Clinical Laboratory Improvement Amendments and College of American Pathologists personnel and testing requirements. To examine the impact of EPA implementation on the workflow in a busy hematology laboratory.
DESIGN.—
A training program was designed to prepare pathology residents to function as independent testing personnel in compliance with Clinical Laboratory Improvement Amendments. After a series of lectures, hands-on microscopy sessions, self-assessment quizzes, and achievement of a passing score on a training assessment exam, residents were deemed competent to release certain results independently. The volume and the turnaround time of hematology tests were compared before and after residents were integrated into the laboratory workflow. Faculty and residents were surveyed to assess satisfaction with the training.
RESULTS.—
Empowering residents to independently release noncritical results from peripheral blood and body fluid reviews had no adverse impact on test turnaround time. The resident contribution to workflow resulted in a corresponding decrease in the number of cases that required attending pathologist review. Faculty and residents viewed the EPAs as beneficial to service and education.
CONCLUSIONS.—
The implementation of the EPAs had a beneficial effect on the laboratory, the trainees, and faculty. Our experience may be helpful to other training programs as EPAs become more widely implemented in residency training.
Topics: Clinical Competence; Hematology; Humans; Internship and Residency; Surveys and Questionnaires
PubMed: 34619751
DOI: 10.5858/arpa.2020-0630-OA -
Malaria Journal Sep 2022Simple and accurate diagnosis is a key component of malaria control programmes. Microscopy is the current gold standard, however it requires extensive training and the...
BACKGROUND
Simple and accurate diagnosis is a key component of malaria control programmes. Microscopy is the current gold standard, however it requires extensive training and the results largely rely on the skill of the microscopists. Malaria rapid diagnostic tests (RDT) can be performed with minimal training and offer timely diagnosis, but results are not quantitative. Moreover, some Plasmodium falciparum parasites have evolved and can no longer be detected by existing RDT. Developed by the Sysmex Corporation, the XN-31 prototype (XN-31p) is an automated haematology analyser capable of detecting Plasmodium-infected erythrocytes and providing species differentiation and stage specific parasite counts in venous blood samples without any preparation in approximately one minute. However, factors such as stable electricity supply in a temperature-controlled room, cost of the instrument and its initial set-up, and need for proprietary reagents limit the utility of the XN-31p across rural settings. To overcome some of these limitations, a hub and spoke diagnosis model was designed, in which peripheral health facilities were linked to a central hospital where detection of Plasmodium infections by the XN-31p would take place. To explore the feasibility of this concept, the applicability of capillary blood samples with the XN-31p was evaluated with respect to the effect of sample storage time and temperature on the stability of results.
METHODS
Paired capillary and venous blood samples were collected from 169 malaria-suspected outpatients in Homa Bay County Referral Hospital, Kenya. Malaria infections were diagnosed with the XN-31p, microscopy, RDT, and PCR. Capillary blood samples were remeasured on the XN-31p after 24 h of storage at either room (15-25 °C) or chilled temperatures (2-8 °C).
RESULTS
Identical results in malaria diagnosis were observed between venous and capillary blood samples processed immediately after collection with the XN-31p. Relative to PCR, the sensitivity and specificity of the XN-31p with capillary blood samples were 0.857 and 1.000, respectively. Short-term storage of capillary blood samples at chilled temperatures had no adverse impact on parasitaemia and complete blood counts (CBC) measured by the XN-31p.
CONCLUSION
These results demonstrate the potential of the XN-31p to improve routine malaria diagnosis across remote settings using a hub and spoke model.
Topics: Diagnostic Tests, Routine; Hematology; Humans; Kenya; Malaria; Malaria, Falciparum; Plasmodium falciparum; Sensitivity and Specificity
PubMed: 36050757
DOI: 10.1186/s12936-022-04259-7 -
Journal of Clinical Laboratory Analysis Oct 2022Chronic subdural hematoma (CSDH) is a common neurosurgical disease with an increasing incidence. The absorption route of CSDH is not clear. Whether inflammatory factors...
BACKGROUND
Chronic subdural hematoma (CSDH) is a common neurosurgical disease with an increasing incidence. The absorption route of CSDH is not clear. Whether inflammatory factors enter the peripheral blood and cause systemic reactions is unknown.
METHODS
We screened 105 CSDH patients and 105 control individuals. Their clinical characteristics and blood routine results were collected and compared. The blood routine changes of CSDH patients before and after treatment were compared. Age-stratified analysis was performed due to age may affect the inflammatory markers.
RESULTS
The white blood cell count, absolute neutrophil count, neutrophil percentage, neutrophil-lymphocyte count ratio (NLR), and platelet to lymphocyte count ratio (PLR) of CSDH patients before treatment were within the normal range, while were significantly higher than the control individuals (p < 0.001). The absolute lymphocyte count and lymphocyte percentage of control individuals were higher than those of patients (p < 0.001). The inflammatory cells in patients of different age groups were similar. After the patient was cured, the white blood cell count, the absolute value and percentage of neutrophils decreased (p < 0.05), while the number of monocytes increased.
CONCLUSIONS
CSDH caused slight systemic inflammatory responses in the peripheral blood, implying that there is a non-hematologic route for the absorption of hematoma.
Topics: Hematoma, Subdural, Chronic; Humans; Leukocyte Count; Lymphocyte Count; Lymphocytes; Neutrophils; Retrospective Studies
PubMed: 36114782
DOI: 10.1002/jcla.24706 -
Journal of Special Operations Medicine... Sep 2022Transfusion of whole blood (WB) is a lifesaving treatment that prolongs life until definitive surgical intervention can be performed; however, collecting WB is a...
BACKGROUND
Transfusion of whole blood (WB) is a lifesaving treatment that prolongs life until definitive surgical intervention can be performed; however, collecting WB is a time-consuming and resource-intensive process. Furthermore, it may be difficult to collect sufficient WB at the point of injury to treat critically wounded patients or multiple hemorrhaging casualties. This study is a follow-up to the proof-of-concept study on the effect of airdrop on WB. In addition, this study confirms the statistical significance for the plausibility of using airdrop to deliver WB to combat medics treating casualties in the pre-hospital setting when Food and Drug Administration (FDA)-approved cold-stored blood products are not available.
METHODS
Forty-eight units of WB were collected and loaded into a blood cooler that was dropped from a fixed-wing aircraft under a Standard Airdrop Training Bundle (SATB) parachute or 68-in pilot chute. Twenty-four of these units were dropped from a C-145 aircraft, and 24 were dropped from a C-130 aircraft. A control group of 15 units of WB was storedin a blood cooler that was not dropped. Baseline and post-intervention laboratory tests were measured in both airdroppedand control units, including complete blood count; prothrombin time/partial thromboplastin time (PT/PTT); pH, lactate,potassium, bilirubin, glucose, fibrinogen, and lactate dehydrogenase (LDH) levels; and peripheral blood smears.
RESULTS
The blood cooler, cooling packs, and all 48 WB units did notsustain any major damage from the airdrop. There was noevidence of hemolysis. Except for the one slightly damagedbag that was not sampled, all airdropped blood met parameters for transfusion per the Joint Trauma System Whole BloodTransfusion Clinical Practice Guideline and the Associationfor the Advancement of Blood and Biotherapies (AABB) Circular of Information for the Use of Human Blood and BloodComponents.
CONCLUSIONS
Airdrop of fresh or stored WB in ablood cooler with a chute is a viable way of delivering bloodproducts to combat medics treating hemorrhaging patientsin the pre-hospital setting. This study also demonstrated theportability of this technique for multiple aircraft. The techniques evaluated in this study have the potential for utilizationin other austere settings such as wilderness medicine or humanitarian disasters where an acute need for WB delivery by airdrop is the only option.
Topics: Aircraft; Blood; Blood Transfusion; Hemorrhage; Humans; Military Medicine
PubMed: 35862850
DOI: 10.55460/A10N-KTMD -
Journal of Cerebral Blood Flow and... Jun 2019Growing evidences suggest that stroke is a systemic disease affecting many organ systems beyond the brain. Stroke-related systemic inflammatory response and immune... (Review)
Review
Growing evidences suggest that stroke is a systemic disease affecting many organ systems beyond the brain. Stroke-related systemic inflammatory response and immune dysregulations may play an important role in brain injury, recovery, and stroke outcome. The two main phenomena in stroke-related peripheral immune dysregulations are systemic inflammation and post-stroke immunosuppression. There is emerging evidence suggesting that the spleen contracts following ischemic stroke, activates peripheral immune response and this may further potentiate brain injury. Whether similar brain-immune crosstalk occurs in hemorrhagic strokes such as intracerebral hemorrhage (ICH) and subarachnoid hemorrhage (SAH) is not established. In this review, we systematically examined animal and human evidence to date on peripheral immune responses associated with hemorrhagic strokes. Specifically, we reviewed the impact of clinical systemic inflammatory response syndrome (SIRS), inflammation- and immune-associated biomarkers, the brain-spleen interaction, and cellular mediators of peripheral immune responses to ICH and SAH including regulatory T cells (Tregs). While there is growing data suggesting that peripheral immune dysregulation following hemorrhagic strokes may be important in brain injury pathogenesis and outcome, details of this brain-immune system cross-talk remain insufficiently understood. This is an important unmet scientific need that may lead to novel therapeutic strategies in this highly morbid condition.
Topics: Animals; Cerebral Hemorrhage; Immune System; Inflammation; Stroke; Subarachnoid Hemorrhage
PubMed: 30961425
DOI: 10.1177/0271678X19841443