Comparison between blood hemoglobin concentration determined by point-of-care device and complete blood count in adult patients with dengue

Background Hematocrit measurement has been an indispensable tool for monitoring plasma leakage and bleeding in dengue patients. However, hematocrit measurement by automated methods is hampered by frequent venipunctures. Utility of point-of-care hemoglobin (POC-Hb) test for monitoring dengue patients has not been established. We evaluated the relationship between hemoglobin measured by POC-Hb testing and hematocrit measured by the automated method in adult dengue patients. Methodology and principal findings Adult dengue patients were recruited at two university hospitals in Thailand from October 2019 to December 2020. POC-Hb test was performed using capillary blood simultaneously with venipuncture to obtain whole blood for an automated complete blood count (CBC) analysis. The correlation of hemoglobin and hematocrit measurement was evaluated. A total of 44 dengue patients were enrolled. Twenty-nine patients (65.9%) were female, with a median age of 31 years (interquartile range 22–41). Of the enrolled patients, 30 (68.2%), 11 (25.0%), and 3 (6.8%) were classified as dengue without warning signs, with warning signs, and severe dengue, respectively. Seven patients (15.9%) had hemoconcentration, and five patients (11.3%) had bleeding. A total of 216 pairs of POC-Hb and CBC were evaluated. A significant positive correlation was observed between hemoglobin measured by POC-Hb testing and hematocrit measured by an automated CBC (r = 0.869, p <0.001). Bland-Altman analysis between hemoglobin measured by POC-Hb testing and an automated CBC showed a bias of -0.43 (95% limit of agreement of -1.81 and 0.95). Using the cutoff of POC-Hb ≥20% as a criteria for hemoconcentration, the sensitivity and specificity of hemoconcentration detected by POC-Hb device were 71.4% and 100.0%, respectively. Conclusions Hemoglobin measurement by POC-Hb testing has a strong correlation with hematocrit in adult patients with dengue fever. However, the sensitivity in detecting hemoconcentration is fair. The adjunct use of capillary POC-Hb testing can decrease the frequency of venipuncture. Further study in children is encouraged.

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332: Can a point-of-care hemoglobin device replace complete blood count for fetal blood sampling during intrauterine transfusion?

American Journal of Obstetrics and Gynecology ◽

10.1016/j.ajog.2017.10.268 ◽

2018 ◽

Vol 218 (1) ◽

pp. S207-S208

Author(s):

Cathy Monteith ◽

Jahan Jadauji ◽

Hala Abu ◽

Ann M. McHugh ◽

Jennifer C. Donnelly ◽

...

Keyword(s):

Blood Count ◽

Complete Blood Count ◽

Point Of Care ◽

Blood Sampling ◽

Fetal Blood ◽

Fetal Blood Sampling ◽

Intrauterine Transfusion

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A clinical corelation study of dengue fever with hepatic dysfunction in children and their outcome

International Journal of Contemporary Pediatrics ◽

10.18203/2349-3291.ijcp20211081 ◽

2021 ◽

Vol 8 (4) ◽

pp. 706

Author(s):

Srividya G. M. ◽

Poornima Lakshmi

Keyword(s):

Hepatic Dysfunction ◽

Total Bilirubin ◽

Complete Blood Count ◽

Dengue Infection ◽

Liver Function Tests ◽

Significant Rise ◽

Warning Signs ◽

Severe Dengue ◽

Serum Total Bilirubin ◽

Life Threatening

Background: The study was hepatic dysfunction in childhood dengue infection and to study clinical co-relation like severity, clinical features, and outcome.Methods: Dengue sero positive patients of 100 were admitted during the study period and examined for hepatomegaly and jaundice and subjected to complete blood count, liver function tests, ultrasound abdomen, PT, APTT, HBsAg, HCV, Widal and analysed.Results: All patients presented with fever, most commonly occurred in age group of 5 to 7 years, hepatomegaly was the commonest clinical sign seen, thrombocytopenia was seen in 88% of cases, serum total bilirubin was raised in 10% of subjects with severe dengue infection. Serum SGOT was raised in 74 % of patients with dengue. When compared between the groups, rise in SGOT occurred in 74% of patients with probable dengue, 98% with warning signs and 100% in severe dengue. SGPT was raised in 58% of patients with dengue infection. When compared between the groups, rise in SGPT occurred in 42% of patients with probable dengue, 66% with warning signs and 81% in severe dengue. SGPT was raised in 28% of patients with dengue infection. When compared between the groups, rise in SGOT occurred in 9.5% of patients with probable dengue, 32% with warning signs and 82% in severe dengue. Prothrombin time was raised in 11% of patients. When compared between the groups, rise in PT occurred in 6.4% with warning signs and 72% in severe dengue. When compared between the groups, rise in APTT occurred in 6.4% of patients with warning signs and 72% in severe dengue. When compared between the groups fall in serum protein occurred in 12.7% with warning signs and 54.5% in severe dengue. 2 cases of severe dengue expired, in which the enzyme levels were highly elevated.Conclusions: Significant rise of liver enzymes helps in recognition of severe forms of dengue infection. As hepatic dysfunction in dengue is transient and reversible, early identification of the same should help to reduce life threatening complications. This can help to reduce the morbidity and mortality due to dengue infection.al population.

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Coagulopathy in Cardiac Surgery: Etiology and Treatment Options

Cardiothoracic Critical Care ◽

10.1093/med/9780190082482.003.0033 ◽

2020 ◽

pp. 313-322

Author(s):

Dana Teodorescu ◽

Caroline Larkin

Keyword(s):

Cardiac Surgery ◽

Laboratory Testing ◽

Blood Count ◽

Complete Blood Count ◽

Point Of Care ◽

Treatment Options ◽

Coagulation Factors ◽

Bleeding Diathesis ◽

Standard Laboratory ◽

Post Cardiac Surgery

This chapter reviews the causes and outlines an approach to the management of coagulopathy following cardiac surgery. Bleeding after cardiac surgery is common and expected up to a rate of 2 mL/kg/h for the first 6 hours. A more significant hemorrhage needs to be investigated and treated. Causes are often multifactorial. It is imperative that surgical causes be excluded early concomitant to providing resuscitation, investigating other medical causes for bleeding, and treating coagulopathy empirically until laboratory testing becomes available. The most frequent causes for coagulopathy post–cardiac surgery are excess heparinization, prolonged cardiopulmonary bypass time, hypothermia, acidosis, and preexisting bleeding diathesis. The management of coagulopathy implies maintenance of the normal physiological conditions for coagulation, reversal of excess heparinization, treatment of hyperfibrinolysis, maintaining normal levels of coagulation factors, and transfusion of platelets if thrombocytopenia or platelet dysfunction occurs. The chapter reviews what is involved in standard laboratory testing (complete blood count, prothrombin time, activated partial thromboplastin time, fibrinogen level, etc.) for coagulopathy. Also discussed is point-of-care testing and how the results from these tests should be interpreted. The chapter details the various blood products that are required in this scenario and suggests doses and transfusion thresholds.

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Narrowed reference intervals for complete blood count in a multiethnic population

Clinical Chemistry and Laboratory Medicine (CCLM) ◽

10.1515/cclm-2018-1263 ◽

2019 ◽

Vol 57 (9) ◽

pp. 1382-1387

Author(s):

Seungok Lee ◽

Chui Mei Ong ◽

Yu Zhang ◽

Alan H.B. Wu

Keyword(s):

San Francisco ◽

Blood Count ◽

Complete Blood Count ◽

Hemoglobin Concentration ◽

Reference Intervals ◽

Mean Corpuscular Hemoglobin ◽

Corpuscular Hemoglobin ◽

Multiethnic Population ◽

Race Ethnicity ◽

Eosinophil Counts

Abstract Background Biological variation studies have shown that the complete blood count (CBC) has narrow within-individual variation and wide group variation, indicating that the use of reference intervals (RIs) is challenging. The aim of this study was to examine differences in CBC RIs according to race/ethnicity in a multiethnic population at a hospital in San Francisco in hopes of improving the medical utility of CBC testing. Methods Subject data were obtained by screening CBC results from the medical records of outpatients meeting certain criteria who visited Zuckerberg San Francisco General Hospital from April 2017 to January 2018. From these records, sex- and race/ethnicity-specific CBC RIs were calculated as the 2.5th to 97.5th percentiles. Results From a total of 552 subjects, 47.9% were male (65 White, 50 Black, 71 Hispanic and 54 Asian) and 52.1% were female (51 White, 39 Black, 122 Hispanic and 72 Asian). The RIs of neutrophil, lymphocyte and eosinophil counts; and hemoglobin, mean corpuscular volume (MCV), mean corpuscular hemoglobin (MCH) and mean corpuscular hemoglobin concentration (MCHC) showed significant differences (p<0.05) among the four racial/ethnic groups: neutrophil, lymphocyte and eosinophil counts; and MCHC in males, and hemoglobin, MCV, MCH and MCHC in females. Conclusions Race/ethnicity-specific CBC RIs should be taken into consideration in a multiethnic population to better interpret patient status and make progress toward precision medicine.

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Determination of Hemoglobin Level Among 9-Month-Old Infants Visiting Well Child Clinic

Global Pediatric Health ◽

10.1177/2333794x211036629 ◽

2021 ◽

Vol 8 ◽

pp. 2333794X2110366

Author(s):

Pongtong Puranitee ◽

Sajee Fuangfu ◽

Oraporn Dumrongwongsiri

Keyword(s):

Infant Formula ◽

Associated Factors ◽

Blood Count ◽

Complete Blood Count ◽

Point Of Care ◽

Hemoglobin Level ◽

Breastfed Infants ◽

Confident Interval ◽

Prevalence Of Anemia

Screening for anemia is recommended among infants aged 9 to 12 months. This study was conducted to determine the prevalence of anemia among 9-month-old infants at Well Child Clinic, and associated factors with anemia. Well Child record of all visits during January to December 2018 were reviewed. Hemoglobin (Hb) was determined by complete blood count (CBC) or point-of-care Hb (POC-Hb). Anemia was found in 99 from 145 infants (68.3%). The prevalence of anemia was 33.3% and 72.8% when tested by CBC and POC-Hb, respectively. Breastfed Infants had significantly lower mean Hb than formula-fed infants. The odd ratio [95% confident interval] of having anemia among infants who were fed with infant formula were 0.37 [0.14-0.94]; P = .038 when compared to breastfed infants. There was a high proportion of anemia among 9-month-old infants in Rama-WCC and breastfeeding was associated with anemia in infants. The use of POC-Hb may overestimate the prevalence of anemia.

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Volume, Conductivity and Scatter Properties of Leukocytes (VCS Technology) in Detecting Sepsis in Critically Ill Adult Patients

Blood ◽

10.1182/blood.v118.21.4729.4729 ◽

2011 ◽

Vol 118 (21) ◽

pp. 4729-4729 ◽

Cited By ~ 3

Author(s):

Aikaterini Dilmoula ◽

Zaina Kassengera ◽

Hulyan Turkan ◽

Dyanne Dalcomune ◽

Dmitry Sukhachev ◽

...

Keyword(s):

Critically Ill ◽

Blood Count ◽

Complete Blood Count ◽

Adult Patients ◽

Lower Quartile ◽

Post Test ◽

Reasonable Evidence ◽

Light Loss ◽

Post Test Probability ◽

Test Probability

Abstract Abstract 4729 Sepsis and its sequelae remain leading causes of death in critically ill patients. Early identification and subsequently prompt treatment of sepsis can have a major impact on the outcome of septic patients. White Blood Cell (WBC) count, neutrophils count or percentage and percentage of band and immature neutrophils have been included in the diagnostic criteria of sepsis d. Previous studies have shown that morphological changes of leukocytes during sepsis can be quantified using Volume, Conductivity and Scatter (VCS) technology by some hematology analyzers. DxH800 (Beckman Coulter, Fullerton, CA) has the potential to report, in addition to Volume and Conductivity, five extra-laser diffraction angles for each cellular event. The aim of the study was to evaluate the diagnostic accuracy of VCS parameters of leukocytes in detecting sepsis in critically ill adult patients. This prospective observational study involved all consecutive adult patients admitted to a 31-bed medico-surgical department of intensive care (ICU) for more than 4 hours in a 3.5-month period. Diagnosis of sepsis was based on standard definitions. Blood samples were run by DxH800. Complete blood count (CBC) and WBC differential, but not VCS parameters were reported to attending physicians. Of a total of 722 patients admitted during the observation period 422 had WBC differential (and thus VCS parameters) determined at admission, of whom 125 had sepsis Septic and non-septic patients had a median age (upper and lower quartile) of 60 (51-71) and 58 (45-72) years and APACHE II scores of 19 (14-25) and 11 (7-16). VCS parameters had higher Areas Under the Receiver Operating Characteristic Curve (AUC) than WBC or percentage of neutrophils for diagnosis of sepsis at admission (Table 1.).Table 1.DxH800 VCS parameters. Results as median values (upper and lower quartile)VCS parametersSepsis N=125No Sepsis N=317p valueAUC95%CI of AUCMean Volume of Neutrophils (MNVNE)153 (146–163)144 (140–148)<0.0010.780.72–0.83SD of Volume of Neutrophils (SDVNE)20 (18–23)17 (16–18)<0.0010.810.77–0.86Mean Axial Light loss of Neutrophils (MNAL2NE)155 (150–160)148 (144–151)<0.0010.780.73–0.84SD of Axial Light loss of Neutrophils (SDAL2NE)13 (12–16)11 (10–12)<0.0010.800.75–0.84Mean Volume of Monocytes (MNVMO)179 (169–189)163 (159–167)<0.0010.880.84–0.91SD of Volume of Monocytes (SDVMO)24 (21–28)18 (16–20)<0.0010.880.84–0.91SD of Axial Light loss of Monocytes (SDAL2MO)16 (15–20)13 (12–14)<0.0010.850.81–0.89WBC, 103/ml10.9 (7.3–15.3)10.5 (7.8–14.2)NS0.510.44–0.57Percent of Neutrophils, %85 (76–91)80 (68–88)<0.0010.610.55–0.67 On ICU admission, MNVMO had the highest discriminant values in detecting sepsis with sensitivity (Se) of 84%, specificity (Sp) 76%, positive predictive value (PPV)58%, negative predictive value (NPV) 92% and odds ratio (OR) 17 for a cutoff of 168. MNVMO<168 (59% of patients) gave reasonable evidence against sepsis (likelihood ratio (LR) of 0.21, pre- and post-test probability, 0.28 and 0.076,) and MNVMO≥175 (25% of patients) gave reasonable evidence for sepsis (LR of 6.85, pre- and post-test probability, 0.28 and 0.73, respectively). Only 16% of patients, in the intermediate range, had a rather uninformative test result (LR of 1.32). Combining monocyte or neutrophil VCS parameters with CRP slightly increases AUC to 0.91. During the ICU stay, VCS parameters were obtained in 316 initially non-septic patients, of whom 20 became septic. MNVMO < 174 excluded ICU-acquired infection with NPV of 99% and MNVMO > 174 predicted ICU-acquired infection 1.7 days earlier than clinical diagnosis (Se: 85%, Sp 68%, OR 12 and AUC=0.78, 95% CI: 66–90). CONCLUSIONS: This large prospective study in unselected critically ill adult patients demonstrates the diagnostic utility of VCS parameters, especially MNVMO, in detecting and, more importantly, excluding sepsis at admission and during ICU stay. VCS parameters are obtained automatically, routinely, within minutes, requiring neither additional sampling nor additional cost to that of complete blood count thus making their prospects very promising. Disclosures: Pradier: Beckman Coulter: Consultancy, Membership on an entity's Board of Directors or advisory committees.

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RADIOTHERAPY EFFECT ON COMPLETE BLOOD COUNT PARAMETER IN PATIENTS WITH NASOPHARYNGEAL CARCINOMA

INTERNATIONAL JOURNAL OF NASOPHARYNGEAL CARCINOMA (IJNPC) ◽

10.32734/ijnpc.v2i01.3505 ◽

2020 ◽

Vol 2 (01) ◽

pp. 07-09

Author(s):

Achmad Chusnu Romdhoni ◽

Firas Farisi Alkaff ◽

Mega Kahdina ◽

Melinda Masturina ◽

Ristra Ramadhani

Keyword(s):

Nasopharyngeal Carcinoma ◽

Outpatient Clinic ◽

Medical Records ◽

Blood Count ◽

Complete Blood Count ◽

Hemoglobin Concentration ◽

Rank Test ◽

Mean Corpuscular Hemoglobin ◽

Lymphocyte Ratio ◽

Radiotherapy Treatment

Introduction: Nasopharyngeal carcinoma (NPC) is the most common malignant tumor of the nasopharynx. Radiotherapy is a therapy of choice for NPC that has been recognized for a long time and used in various centers of the world. However, radiotherapy is known to still have an adverse effect. It is common practice to evaluate Complete Blood Count (CBC) before, during, and after radiotherapy. However, there has been no study regarding the effect of radiotherapy on all CBC parameters. This study aims to analyze the effect of radiotherapy on CBC in NPC patients before and after radiotherapy treatment. Material and methods: This study was an observational study using secondary data from medical records at the radiotherapy outpatient clinic at Dr. Soetomo General Hospital Surabaya. The subject of this study was patients with NPC who underwent a full cycle of radiotherapy treatment on radiotherapy outpatient clinic in 2016. Patients with incomplete medical records and did not finish the radiotherapy treatment were excluded. A paired T-test and Wilcoxon signed-rank test were used for statistical analysis. Results: There were 105 patients included in this study. Mean Corpuscular Hemoglobin Concentration (MCHC), total leucocyte, lymphocyte, and thrombocyte was significantly decreased after a full cycle of radiotherapy (all p <0.05). Eosinophil, basophil, neutrophil, monocyte, Neutrophil to Lymphocyte ratio (NLR), and Platelet to Lymphocyte ratio (PLR) was significantly increased after a full cycle of radiotherapy (all p <0.05). Conclusion: Radiotherapy had a significant effect on the CBC parameter in NPC patients.

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Complete Blood Count Peculiarities in Pregnant SARS-CoV-2-Infected Patients at Term: A Cohort Study

Diagnostics ◽

10.3390/diagnostics12010080 ◽

2021 ◽

Vol 12 (1) ◽

pp. 80

Author(s):

Roxana Covali ◽

Demetra Socolov ◽

Razvan Socolov ◽

Ioana Pavaleanu ◽

Alexandru Carauleanu ◽

...

Keyword(s):

Blood Cell ◽

Red Blood Cell ◽

Blood Count ◽

Complete Blood Count ◽

Hemoglobin Concentration ◽

Mean Corpuscular Hemoglobin ◽

Mean Corpuscular Hemoglobin Concentration ◽

Blood Cell Count ◽

Corpuscular Hemoglobin ◽

Distribution Width

Background: During viral outbreaks, pregnancy poses an increased risk of infection for women. Methods: In a prospective study, all patients admitted for delivery at term to Elena Doamna Obstetrics and Gynecology University Hospital in Iasi, Romania, between 1 April 2020 and 31 December 2020 were included. There were 457 patients, divided into two groups: group 1, SARS-CoV-2-positive patients (n = 46) and group 2, SARS-CoV-2-negative patients (n = 411). Among other tests, complete blood count was determined upon admittance, and the following values were studied: white blood cell count, lymphocytes, neutrophils, red blood cell count, hemoglobin, mean corpuscular hemoglobin concentration, mean corpuscular hemoglobin, mean corpuscular volume, red blood cell distribution width, hematocrit, platelet count, mean platelet volume, platelet distribution width, plateletcrit, and platelet large cell ratio. Results: in pregnant SARS-CoV-2-infected patients at term, there was a significant decrease in white blood cell, neutrophil, and lymphocyte count, and an increase in mean corpuscular hemoglobin concentration, compared to healthy pregnant women at term, although all still within normal limits. None of the other components of the complete blood count or fetal outcomes studied was significantly influenced by SARS-CoV-2 infection in pregnant patients at term.

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725. Complete Blood Count Values Vary in Degree of Change with Day of Fever in Children with Dengue Fever

Open Forum Infectious Diseases ◽

10.1093/ofid/ofab466.922 ◽

2021 ◽

Vol 8 (Supplement_1) ◽

pp. S461-S462

Author(s):

Melissa E Day ◽

Miguel E Mejia Sang ◽

Yonairy Collado Puello ◽

Elvira J Diaz Brockmans ◽

Stephanie Rivera Defillo ◽

...

Keyword(s):

Dominican Republic ◽

Blood Cell ◽

Mean Corpuscular Volume ◽

Blood Count ◽

Complete Blood Count ◽

Hemoglobin Concentration ◽

Mean Corpuscular Hemoglobin ◽

Corpuscular Volume ◽

Mean Corpuscular Hemoglobin Concentration ◽

Corpuscular Hemoglobin

Abstract Background Dengue fever (DF) is an acute viral disease which can lead to severe illness, including dengue hemorrhagic fever, marked by thrombocytopenia and hemolytic anemia, as well as end-organ damage. Despite the well-known presentation and prevalence, changes in hematologic markers across the DF course have not been well-described in children. We sought to investigate the association of clinical laboratory values over time with dengue disease progression and outcome in a pediatric population in the Dominican Republic. Methods Pediatric participants were enrolled at Hospital Infantil Dr. Robert Reid Cabral in Santo Domingo, Dominican Republic, in a prospective, observational case-based study. Laboratory values, including complete blood count (CBC) indices and dengue titer results, were collected over the course of hospital stay. Using linear mixed models, we assessed whether 13 different CBC values and time trajectories differed by dengue status, including age and sex as covariates. To account for multiple testing, p≤0.0033 was considered significant. Results A total of 575 children ages 0 to 211 months met inclusion criteria; 51.8% (n=298) were male, and the median (IQR) age was 59 (14-93) months. Eighty-two percent (n=472) of participants had DF. CBC values across days 1 to 10 of fever in those with and without DF are depicted in Figure 1. Those with DF showed levels dropping more quickly across days of fever for hematocrit and hemoglobin (p≤ 0.002), with a more rapid decline in those with severe DF (p < 0.0001). Those with DF had levels increasing more quickly for mean corpuscular hemoglobin concentration (MCHC), monocyte number, and white blood cell counts (p ≤ 0.003), with those with severe DF having a more rapid increase (p < 0.001). The direction of the change across time differed by DF status for mean corpuscular volume and red blood cell distribution width (RDW) (p ≤ 0.0003), with those with severe DF showing an increase in RDW across day of fever (p= 0.0004). Figure 1. CBC values across day of fever in dengue (blue) and non-dengue (purple) patients. The graph above depicts the following CBC values across day of fever in dengue (blue) and non-dengue (purple) patients: a) white blood cell (WBC) count, b) platelet count, c) monocyte number, d) hemoglobin, e) mean corpuscular hemoglobin concentration (MCHC), and f) mean corpuscular volume (MCV). Values with an asterisk (*) represent significant values (p < 0.0033). Conclusion The trajectory of CBC measures differs between those with and without DF, despite similar clinical presentations. These laboratory differences may facilitate a better understanding of the clinical course of DF and may aid in earlier identification of DF in resource-limited settings. Disclosures Elizabeth P. Schlaudecker, MD, MPH, Pfizer (Grant/Research Support)Sanofi Pasteur (Advisor or Review Panel member)

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