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Reviews in Medical Virology Mar 2022The red blood cell distribution width (RDW), an indicator of anisocytosis has emerged as a potential tool for risk stratification of critically ill patients with sepsis.... (Meta-Analysis)
Meta-Analysis
The red blood cell distribution width (RDW), an indicator of anisocytosis has emerged as a potential tool for risk stratification of critically ill patients with sepsis. Prognostic predictors are of paramount interest for prompt intervention and optimal utilization of the healthcare system in this ongoing context of the Coronavirus Disease 2019 (COVID-19) pandemic. The current systematic review and meta-analysis aims to explore the utility of RDW in the prognosis of COVID-19 patients. A comprehensive screening of electronic databases was performed up to 30th April 2021 after enrolling in PROSPERO (CRD42020206685). Observational studies or interventional studies, evaluating the impact of RDW in COVID-19 outcomes (mortality and severity) are included in this meta-analysis.Our search retrieved 25 studies, with a total of 18,392 and 3,446 COVID-19 patients for mortality and disease severity outcomes. Deceased and critically ill patients had higher RDW levels on admission in comparison to survivors and non-severe patients (SMD = 0.46; 95%CI 0.31-0.71; I = 88% and SMD = 0.46; 95%CI 0.26-0.67; I = 60%, respectively). In a sub-group analysis of 2,980 patients, RDW > 14.5 has been associated with increased risk of mortality (OR = 2.73; 95%CI 1.96-3.82; I = 56%). However, the evidences is of low quality. A higher level of RDW on admission in COVID-19 patients is associated with increased morbidity and mortality. However, further studies regarding the cut-off value of RDW are the need of the hour.
Topics: COVID-19; Erythrocyte Indices; Erythrocytes; Humans; Observational Studies as Topic; Prognosis; SARS-CoV-2
PubMed: 34091982
DOI: 10.1002/rmv.2264 -
Veterinary Medicine International 2021Hepatocellular carcinoma (HCC) is one of the most common neoplasms that has been described in many domestic animal species. Hence, the disease has significant economic...
Hepatocellular carcinoma (HCC) is one of the most common neoplasms that has been described in many domestic animal species. Hence, the disease has significant economic importance; thus, this study aimed to describe the cytopathological characteristics of hepatocellular carcinomas in cattle slaughtered at Bishoftu Elfora Abattoir, Central Ethiopia. A cross-sectional study design with a purposive sampling technique was performed from October 2017 to May 2018 using macroscopic, histopathologic, and cytological methods. For that matter, a total of sixty cattle were assessed for the presence of a hepatic tumor; however, only 1/60 (0.6%) case was found to be affected by hepatocellular carcinomas. On gross examination, hepatocellular carcinomas exhibited soft, white, multifocal nodules (10-40 mm in diameter) on different lobes of the liver. On the cut surface, the tumor revealed a sharply circumscribed border and was divided into lobules by thin connective tissue. The central zone of the tumors exhibited depression with a whitish fibrous area. Moreover, on histopathology, the tumors divulged unencapsulated carcinomatous lesions consisting of a thick, compact, somewhat ambiguous trabecular pattern of arrangement that was unglued by thin collagenous stroma. Cytological studies suggest that the tumor cells showed anisocytosis, anisokaryosis, prominent nucleoli, multinuclearity, palisading arrangements of neoplastic cells, increased N : C ratios, light eosinophilic cytoplasm, high mitotic index, and cytoplasmic and intranuclear vacuoles. In conclusion, cytopathological findings support a diagnosis of HCC in the liver; thus, further studies with a large sample size and use of immunohistochemistry are important for further characterization of hepatocellular carcinomas in cattle.
PubMed: 34035888
DOI: 10.1155/2021/6649172 -
Animals : An Open Access Journal From... Mar 2021Red cell distribution width (RDW) is a quantitative measurement of anisocytosis. This hematological parameter is an important prognostic biomarker for different...
Red cell distribution width (RDW) is a quantitative measurement of anisocytosis. This hematological parameter is an important prognostic biomarker for different cardiovascular disorders in humans but its influence on survival has been poorly investigated in dogs with cardiovascular disease. The RDW and various clinical, complete blood count, serum biochemical and echocardiographic variables were retrospectively investigated in 146 client-owned dogs with myxomatous mitral valve disease (MMVD) at various disease stages, with or without concurrent diseases and treatment. Laboratory variables, including RDW, urea, and white blood cell (WBC), in addition to the echocardiographic variable left atrium to aorta ratio were found to be independent predictors of all-cause mortality at six months in a multivariable Cox proportional hazards regression model. In particular, the hazard ratio of RDW was 1.203 (95% confidence interval = 1.045-1.384; = 0.010). The negative effect of increased RDW on outcome was confirmed using Kaplan-Meier curve analysis. The results of this study indicate that RDW acted as an independent predictor of negative outcome in dogs with MMVD.
PubMed: 33799710
DOI: 10.3390/ani11030778 -
BMJ Case Reports Mar 2021Haemophagocytic lymphohistiocytosis (HLH) is a rare diagnosis that carries a high degree of mortality. We present this case of a previously healthy 22-year-old woman,...
Haemophagocytic lymphohistiocytosis (HLH) is a rare diagnosis that carries a high degree of mortality. We present this case of a previously healthy 22-year-old woman, who was admitted acutely ill to the hospital. One week prior, she had been seen by her primary care physician for fatigue and malaise. At that time, she was noted to have anterior and posterior cervical lymphadenopathy. She was referred to the emergency room and was diagnosed with acute Epstein-Barr virus (EBV) mononucleosis based on her clinical symptoms and positive heterophile antibody test. She was discharged after an uneventful 48-hour stay on the wards. She represented 7 days after discharge with cough, fatigue, nausea, vomiting, epigastric abdominal pain, diarrhoea, weight loss and subjective fevers. She had also reported haematemesis, epistaxis and melaena. Vital signs included temperature 36.9°C, blood pressure 90/50 mm Hg, heart rate 130 beats per minute and respiratory rate 32 breaths per minute. Physical examination was notable for an acutely ill appearing woman with scleral icterus, hepatosplenomegaly and palpable cervical and axillary lymphadenopathy. Complete blood count showed pancytopaenia with haemoglobin 59 g/L (normal 120-160 g/L), white blood cell count 2.7×10/L (normal 4-10.5×10/L) and platelet count 50×10/L (normal 150-450×10/L). The white blood cell count differential included 58% neutrophils (normal 38%-77%) with immature neutrophils in band form elevated at 45% (normal <14%), 16% lymphocytes (normal 20%-48%), 7% monocytes (normal <12%) and no eosinophils (normal <6%). Blood smear revealed anisocytosis, poikilocytosis and hypochromia. Coagulation panel showed elevated levels of d-dimer level at 1.39 µg/mL (normal <0.45 µg/mL), prolonged prothrombin time at 34.4 s (normal 11-15 s), prolonged activated partial thromboplastin time of 55.6 s (normal 25-34 s), prolonged international normalised ratio at 3.31 (normal <1.1) and low fibrinogen 60 mg/dL (normal >200 mg/dL). Lipid panel showed cholesterol at 114 mg/dL (normal 125-200 mg/dL), triglycerides 207 mg/dL (normal 30-150 mg/dL), high-density lipoprotein cholesterol 10 mg/dL (normal 40-60 mg/dL) and low-density lipoprotein cholesterol 63 mg/dL (normal <100 mg/dL). Other lab abnormalities included elevated ferritin of 6513 ng/mL (normal 10-150 ng/mL) and elevated lactate dehydrogenase of 1071 unit/L (normal 95-240 unit/L). Soluble interleukin-2 receptor alpha level was elevated at 60 727 units/mL (normal 223-710 units/mL). Fluorodeoxyglucose-positron emission tomography (FDG-PET) scan showed abnormal tracer localisation within the paratracheal, hilar, pelvic, abdominal and subcarinal lymph nodes, along with FDG-PET positive hepatosplenomegaly. A bone marrow biopsy showed hypercellular marrow (95% cellularity) with trilineage haematopoiesis, haemophagocytic cells, polytypic plasmacytosis and T-cell lymphocytosis, along with positive latent membrane protein-1 immunohistochemical staining for EBV. EBV quantitative DNA PCR showed >1 million copies. These findings were consistent with a diagnosis of HLH secondary to EBV infection. Despite intense therapy with the HLH-94 protocol, the patient expired from her illness after a prolonged hospital course.
Topics: Adult; Epstein-Barr Virus Infections; Female; Herpesvirus 4, Human; Humans; Infectious Mononucleosis; Lymphohistiocytosis, Hemophagocytic; Pancytopenia; Young Adult
PubMed: 33789863
DOI: 10.1136/bcr-2020-241222 -
Hematology, Transfusion and Cell Therapy 2022The myelodysplastic syndrome (MDS) represents a group of hematopoietic neoplasms that is characterized by clonal hematopoiesis, cytopenia and abnormal cellular...
INTRODUCTION
The myelodysplastic syndrome (MDS) represents a group of hematopoietic neoplasms that is characterized by clonal hematopoiesis, cytopenia and abnormal cellular maturation. Red cell distribution width (RDW) refers to the variation degree of erythrocyte size and it is a reflection of anisocytosis. Higher values have been linked to adverse outcomes, such as increased mortality, vascular events, kidney and liver disease and demonstrated to harbor poor prognosis in solid and hematological malignancies. The RDW value can be used as a contributing parameter for MDS diagnosis, as well as its prognosis. In this study, we essentially aimed to demonstrate the correlation between the RDW and MDS prognostic indexes.
MATERIALS AND METHODS
Ninety-four MDS patients at the Aydın Adnan Menderes University Hematology Division were included in the study. The correlations between the RDW and laboratory values (either lactate dehydrogenase, albumin, globulin or ferritin) and the RDW prognostic scoring indexes (IPSS, WPSS, IPSS-R and LR-PSS) were investigated. The PASW for Windows, version 21.0 (SPSS Inc., Chicago, IL, USA), was used for statistical assessment. A p-value below 0.05 was the cut-off for the statistical significance.
RESULTS
The mean age of all the patients was 73 ± 10 years. Patients were observed for 41.88 ± 25 months. The mean RDW value for all cases was 15.5 ± 2.39. We found a statistically significant difference of survival between RDW values below and above 15.5% (p = 0.016). A significant difference was also observed according to the prognostic scoring indexes (see below).
CONCLUSION
An increase in RDW is probably related to dysplasia in the MDS and this constitutes a possible explanation for the poor outcome. Prognostic indexes might incorporate the RDW as a parameter in the future.
PubMed: 33583768
DOI: 10.1016/j.htct.2020.11.007 -
International Journal of Molecular... Feb 2021Liposomal technologies are used in order to improve the effectiveness of current therapies or to reduce their negative side effects. However, the liposome-erythrocyte...
Liposomal technologies are used in order to improve the effectiveness of current therapies or to reduce their negative side effects. However, the liposome-erythrocyte interaction during the intravenous administration of liposomal drug formulations may result in changes within the red blood cells (RBCs). In this study, it was shown that phosphatidylcholine-composed liposomal formulations of Photolon, used as a drug model, significantly influences the transmembrane potential, stiffness, as well as the shape of RBCs. These changes caused decreasing the number of stomatocytes and irregular shapes proportion within the cells exposed to liposomes. Thus, the reduction of anisocytosis was observed. Therefore, some nanodrugs in phosphatidylcholine liposomal formulation may have a beneficial effect on the survival time of erythrocytes.
Topics: Animals; Cell Shape; Chlorophyllides; Drug Compounding; Erythrocytes; Female; Hemolysis; Liposomes; Membrane Potentials; Phosphatidylcholines; Porphyrins; Radiation-Sensitizing Agents; Swine
PubMed: 33567766
DOI: 10.3390/ijms22041710 -
PloS One 2020Detailed temporal analyses of complete (full) blood count (CBC) parameters, their evolution and relationship to patient age, gender, co-morbidities and management...
COVID-19 disease-Temporal analyses of complete blood count parameters over course of illness, and relationship to patient demographics and management outcomes in survivors and non-survivors: A longitudinal descriptive cohort study.
BACKGROUND
Detailed temporal analyses of complete (full) blood count (CBC) parameters, their evolution and relationship to patient age, gender, co-morbidities and management outcomes in survivors and non-survivors with COVID-19 disease, could identify prognostic clinical biomarkers.
METHODS
From 29 January 2020 until 28 March 2020, we performed a longitudinal cohort study of COVID-19 inpatients at the Italian National Institute for Infectious Diseases, Rome, Italy. 9 CBC parameters were studied as continuous variables [neutrophils, lymphocytes, monocytes, platelets, mean platelet volume, red blood cell count, haemoglobin concentration, mean red blood cell volume and red blood cell distribution width (RDW %)]. Model-based punctual estimates, as average of all patients' values, and differences between survivors and non-survivors, overall, and by co-morbidities, at specific times after symptoms, with relative 95% CI and P-values, were obtained by marginal prediction and ANOVA- style joint tests. All analyses were carried out by STATA 15 statistical package.
MAIN FINDINGS
379 COVID-19 patients [273 (72% were male; mean age was 61.67 (SD 15.60)] were enrolled and 1,805 measures per parameter were analysed. Neutrophils' counts were on average significantly higher in non-survivors than in survivors (P<0.001) and lymphocytes were on average higher in survivors (P<0.001). These differences were time dependent. Average platelets' counts (P<0.001) and median platelets' volume (P<0.001) were significantly different in survivors and non-survivors. The differences were time dependent and consistent with acute inflammation followed either by recovery or by death. Anaemia with anisocytosis was observed in the later phase of COVID-19 disease in non-survivors only. Mortality was significantly higher in patients with diabetes (OR = 3.28; 95%CI 1.51-7.13; p = 0.005), obesity (OR = 3.89; 95%CI 1.51-10.04; p = 0.010), chronic renal failure (OR = 9.23; 95%CI 3.49-24.36; p = 0.001), COPD (OR = 2.47; 95% IC 1.13-5.43; p = 0.033), cardiovascular diseases (OR = 4.46; 95%CI 2.25-8.86; p = 0.001), and those >60 years (OR = 4.21; 95%CI 1.82-9.77; p = 0.001). Age (OR = 2.59; 95%CI 1.04-6.45; p = 0.042), obesity (OR = 5.13; 95%CI 1.81-14.50; p = 0.002), renal chronic failure (OR = 5.20; 95%CI 1.80-14.97; p = 0.002) and cardiovascular diseases (OR 2.79; 95%CI 1.29-6.03; p = 0.009) were independently associated with poor clinical outcome at 30 days after symptoms' onset.
INTERPRETATION
Increased neutrophil counts, reduced lymphocyte counts, increased median platelet volume and anaemia with anisocytosis, are poor prognostic indicators for COVID19, after adjusting for the confounding effect of obesity, chronic renal failure, COPD, cardiovascular diseases and age >60 years.
Topics: Biomarkers; Blood Cell Count; COVID-19; Cohort Studies; Demography; Erythrocyte Indices; Female; Humans; Inflammation; Leukocyte Count; Longitudinal Studies; Lymphocytes; Male; Mean Platelet Volume; Middle Aged; Neutrophils; Prognosis; Rome; Survivors
PubMed: 33370366
DOI: 10.1371/journal.pone.0244129 -
Scientific Reports Nov 2020Tilapia lake virus (TiLV) causes high mortality and high economic losses in tilapines. We describe an experimental challenge study focusing on early post challenge...
Tilapia lake virus (TiLV) causes high mortality and high economic losses in tilapines. We describe an experimental challenge study focusing on early post challenge innate immune responses. Nile tilapia (Oreochromis niloticus) were infected with 10 TCID/mL TiLV intraperitoneally, followed by virus quantification, histopathology and gene expression analysis in target (brain/liver) and lymphoid (spleen/headkidney) organs at 3, 7, 12, 17, and 34 days post challenge (dpc). Onset of mortality was from 21 dpc, and cumulative mortality was 38.5% by 34 dpc. Liver and kidney histopathology developed over the period 3-17 dpc, characterized by anisocytosis, anisokaryocytosis, and formation of multinucleated hepatocytes. Viral loads were highest at early time (3 dpc) in liver, spleen and kidney, declining towards 34 dpc. In brain, viral titer peaked 17 dpc. Innate sensors, TLRs 3/7 were inversely correlated with virus titer in brain and headkidney, and IFN-ß and Mx showed a similar pattern. All organs showed increased mRNA IgM expression over the course of infection. Overall, high virus titers downplay innate responses, and an increase is seen when viral titers decline. In silico modeling found that TiLV segments 4, 5 and 10 carry nucleolar localization signals. Anti-viral effects of TiLV facilitate production of virus at early stage of infection.
Topics: Animals; Antibodies, Viral; Brain; Cichlids; Fish Diseases; Gene Expression Regulation; Hepatocytes; Host-Pathogen Interactions; Immunity, Innate; Immunoglobulin M; Interferon-beta; Kidney; Liver; Negative-Sense RNA Viruses; Spleen; Survival Analysis; Time Factors; Toll-Like Receptor 3; Toll-Like Receptor 7
PubMed: 33230226
DOI: 10.1038/s41598-020-73781-y -
Diagnostic Pathology Oct 2020Histologic features of idiopathic non-cirrhotic portal hypertension (INCPH) may overlap with those without INCPH. Recently, these features have been recognized as part...
BACKGROUND
Histologic features of idiopathic non-cirrhotic portal hypertension (INCPH) may overlap with those without INCPH. Recently, these features have been recognized as part of the larger spectrum of porto-sinusoidal vascular disease (PSVD). We assessed interobserver agreement on histologic features that are commonly associated with INCPH and studied whether a provision of relevant clinical history improves interobserver agreement.
METHODS
The examined histologic features include lobular (such as anisocytosis, nodular regeneration, sinusoidal dilatation, increased parenchymal draining veins, and incomplete fibrous septa) and portal tract changes (such as paraportal shunting vessel(s), portal tract remnant, increased number of portal vessels, and obliterative portal venopathy). Thirty-four archived liver samples from patients with (group A) and without (group B) INCPH were retrieved. A total of 90 representative images of lobules (L) and portal tracts (P) were distributed among 9 liver pathologists blinded to true clinical history. Each pathologist answered multiple choice questions based on the absence (Q1) or presence (Q2) of clinical history of portal hypertension. Fleiss' kappa coefficient analysis (unweighted) was performed to assess interobserver agreement on normal versus abnormal diagnosis, in L and P, based on Q1 and Q2.
RESULTS
The kappa values regarding normal versus abnormal diagnosis were 0.24, 0.24, 0.18 and 0.18 for L-Q1, L-Q2, P-Q1, and P-Q2, respectively. With true clinical history provided, the kappa values were L- 0.32, P-0.17 for group A and L-0.12, P-0.14 for group B. Four pathologists changed their assessments based on the provided history. Interobserver agreement on the interpretation of L and P as normal versus abnormal was slight to fair regardless of provision of clinical history.
CONCLUSIONS
Our findings indicate that the histologic features of INCPH/PSVD are not limited to patients with portal hypertension and are subject to significant interobserver variation.
Topics: Adolescent; Adult; Aged; Female; Humans; Hypertension, Portal; Liver Cirrhosis; Male; Middle Aged; Observer Variation; Pathologists; Young Adult
PubMed: 33097074
DOI: 10.1186/s13000-020-01049-0 -
Pathogens & Immunity 2020Red cell distribution width (RDW), a measure of anisocytosis, is observed in chronic inflammation and is a prognostic marker in critically ill patients without COVID-19,...
BACKGROUND
Red cell distribution width (RDW), a measure of anisocytosis, is observed in chronic inflammation and is a prognostic marker in critically ill patients without COVID-19, but data in COVID-19 are limited.
METHODS
Between March 12 and April 19, 2020, 282 individuals with confirmed COVID-19 and RDW available within 7 days prior to COVID-19 confirmation were evaluated. Individuals were grouped by quartiles of RDW. Association between quartiles of RDW and mortality was assessed using the Kaplan-Meier method and statistical significance was assessed using the log-rank test. The association between RDW and all-cause mortality was further assessed using a Cox proportional hazards model. Plasma cytokine levels in uninfected ambulatory adults without cardiovascular disease (n=38) were measured and bivariate Spearman correlations and principle components analysis were used to identify relationships between cytokine concentrations with RDW.
RESULTS
After adjusting for age, sex, race, cardiovascular disease, and hemoglobin, there was an association between RDW and mortality (Quartile 4 vs Quartile 1: HR 4.04 [1.08-15.07]), with each 1% increment in RDW associated with a 39% increased rate of mortality (HR 1.39 [1.21-1.59]). Remote RDW was also associated with mortality after COVID-19 infection. Among uninfected ambulatory adults without cardiovascular disease, RDW was associated with elevated pro-inflammatory cytokines (TNF-α, IL8, IL6, IL1b), but not regulatory cytokines (TGFb).
CONCLUSIONS
Anisocytosis predicts short-term mortality in COVID-19 patients, often predates viral exposure, and may be related to a pro-inflammatory phenotype. Additional study of whether the RDW can assist in the early identification of pending cytokine storm is warranted.
PubMed: 33089037
DOI: 10.20411/pai.v5i1.391