Beyond the Bloody Mess: Hematologic Assessment

Hematologic assessment is part of the routine assessment of acute and critically ill patients. Nurses must be aware of the reference ranges for complete blood cell counts and common coagulation profiles. A case study is presented of an elderly patient, taking warfarin for atrial fibrillation, who falls and sustains a head laceration. The subsequent assessment, hospital course, and treatments required are outlined.

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A New Study of Intraosseous Blood for Laboratory Analysis

Archives of Pathology & Laboratory Medicine ◽

10.5858/2009-0381-oa.1 ◽

2010 ◽

Vol 134 (9) ◽

pp. 1253-1260 ◽

Cited By ~ 2

Author(s):

Larry J. Miller ◽

Thomas E. Philbeck ◽

Diana Montez ◽

Cathy J. Spadaccini

Keyword(s):

Blood Cell ◽

Critically Ill ◽

White Blood Cell ◽

Critically Ill Patients ◽

Blood Chemistry ◽

Laboratory Analysis ◽

Blood Samples ◽

Cell Counts ◽

Blood Cell Counts ◽

White Blood Cell Counts

Abstract Context.—Intraosseous (IO) blood is frequently used to establish a blood chemistry profile in critically ill patients. Questions remain regarding the reliability of IO blood for laboratory analysis and established criteria regarding the amount of marrow/blood to waste before taking an IO sample are not available. Objectives.—To evaluate IO-derived blood for routine laboratory blood tests needed in the care of critically ill patients and to determine the amount of marrow/blood to waste before drawing blood from the IO space for laboratory analysis. Design.—Blood samples were drawn from peripheral veins of 10 volunteers. Within 5 minutes, 2 IO blood samples were obtained; one following 2 mL of waste and another following 6 mL of waste. Samples were analyzed for complete blood count and chemistry profile. Values were analyzed using Pearson correlation coefficients. Levels of significance were determined using the t distribution. Mean values for the draws were calculated and compared, with the intravenous blood sample serving as a control for the IO samples. Results.—There was a significant correlation between intravenous and IO samples for red blood cell counts and hemoglobin and hematocrit levels but not for white blood cell counts and platelet counts. There was a significant correlation between intravenous and IO samples for glucose, blood urea nitrogen, creatinine, chloride, total protein, and albumin concentrations but not for sodium, potassium, CO2, and calcium levels. Conclusions.—When venous blood cannot be accessed, IO blood aspirate may serve as a reliable alternate, especially for hemoglobin and hematocrit levels and most analytes in a basic blood chemistry profile. Exceptions are CO2 levels and platelet counts, which may be lower, and white blood cell counts, which may appear elevated.

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White blood cell counts, CRP, GGT and LDH in the elderly German population

Journal of Laboratory Medicine ◽

10.1515/labmed-2018-0133 ◽

2019 ◽

Vol 43 (2) ◽

pp. 57-65

Author(s):

Gabriele Röhrig ◽

Ingrid Becker ◽

Anna Hagemeier ◽

Kai Gutensohn ◽

Thomas Nebe

Keyword(s):

Blood Cell ◽

White Blood Cell ◽

Reference Values ◽

German Population ◽

Reference Ranges ◽

Inclusion Criteria ◽

Cell Counts ◽

Blood Cell Counts ◽

White Blood Cell Counts ◽

Glutamyl Transferase

Abstract Background Hematological abnormalities are frequently found in geriatric patients. However, little data is available on reference values for total blood cell counts in older patients. This study is focused on the analysis of reference values for white blood cell counts in aged persons ≥60 years. Methods This was a cross-sectional study of outpatient laboratory data of 2015 from a German countrywide working laboratory company; inclusion criteria: age ≥60 years, parameters evaluated by the laboratory company between 1.1.2015 and 31.12.2015; exclusion criteria: glomerular filtration rate (GFR) <60 mL/min, lack of inclusion criteria; primary objective: mean leukocyte count; secondary objective: mean counts of lymphocytes, eosinophil, neutrophil and basophil leukocytes as well as platelets, C-reactive protein (CRP), γ-glutamyl transferase (GGT) and lactate dehydrogenase (LDH) in hematologically healthy persons aged ≥60 years. Results Data of 30,611 persons aged ≥60 years were evaluated by age groups. Results for leukocytes, basophils, eosinophils, neutrophils and lymphocytes remained within the reference ranges recommended by the German Society of Hematology and Oncology (DGHO) and the German Association of Specialists in Internal Medicine (BDI); the lower reference limit for normal platelet values in males was below the DGHO reference value with 136,000/μL (confidence interval [CI] 129,000;142,000); similarly, our results for normal monocyte values were above the DGHO reference values with 6.0% (5.7;6.2) to 14.3% (13.9;14.8) in males and 5.4% (5.2;5.6) to 12.9% (12.6;13.4) in females; CRP, GGT and LDH values were above the BDI reference values, comparable with the previous data of a senior patient cohort analysis. Conclusions Adaptation of reference values for selected laboratory parameters in older German patients should be well considered.

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Longitudinal multi-omics transition associated with fatality in critically ill COVID-19 patients

Intensive Care Medicine Experimental ◽

10.1186/s40635-021-00373-z ◽

2021 ◽

Vol 9 (1) ◽

Author(s):

Chaoyang Sun ◽

Yuzhe Sun ◽

Ping Wu ◽

Wencheng Ding ◽

Shiyou Wang ◽

...

Keyword(s):

Blood Cell ◽

Critically Ill ◽

Clinical Data ◽

Red Blood Cell ◽

Serum Samples ◽

Risk Of Death ◽

Cell Counts ◽

Blood Cell Counts ◽

Increased Risk ◽

Independent Cohort

Abstract Purpose Critically ill COVID-19 patients have significantly increased risk of death. Although several circulating biomarkers are thought to be related to COVID-19 severity, few studies have focused on the characteristics of critically ill patients with different outcomes. The objective of this study was to perform a longitudinal investigation of the potential mechanisms affecting the prognosis of critically ill COVID-19 patients. Methods In addition to clinical data, 113 whole blood samples and 85 serum samples were collected from 33 severe and critical COVID-19 patients without selected comorbidities. Multi-omics analysis was then performed using longitudinal samples. Results Obvious transcriptional transitions were more frequent in critical survivors than in critical non-survivors, indicating that phase transition may be related to survival. Based on analysis of differentially expressed genes during transition, the erythrocyte differentiation pathway was significantly enriched. Furthermore, clinical data indicated that red blood cell counts showed greater fluctuation in survivors than in non-survivors. Moreover, declining red blood cell counts and hemoglobin levels were validated as prognostic markers of poor outcome in an independent cohort of 114 critical COVID-19 patients. Protein–metabolite–lipid network analysis indicated that tryptophan metabolism and melatonin may contribute to molecular transitions in critical COVID-19 patients with different outcomes. Conclusions This study systematically and comprehensively depicted the longitudinal hallmarks of critical COVID-19 patients and indicated that multi-omics transition may impact the prognosis. Take home message Frequent transcriptional phase transitions may contribute to outcome in critically ill COVID-19 patients. Furthermore, fluctuation in red blood cell and hemoglobin levels may relate to poor prognosis. The biological function of melatonin was suppressed in COVID-19 non-survivors, which may provide a potential theoretical basis for clinical administration.

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An Alternative Elastase-mediated Degradation of Fibrinogen and Fibrin Observed in a Patient with Herpes Simplex Encephalitis and Pneumonia

Thrombosis and Haemostasis ◽

10.1055/s-0038-1650550 ◽

1996 ◽

Vol 76 (02) ◽

pp. 184-186 ◽

Cited By ~ 2

Author(s):

Kenji lijima ◽

Fumiyo Murakami ◽

Yasushi Horie ◽

Katsumi Nakamura ◽

Shiro Ikawa ◽

...

Keyword(s):

Herpes Simplex ◽

Blood Cell ◽

White Blood Cell ◽

Herpes Simplex Encephalitis ◽

Pmn Elastase ◽

Cell Counts ◽

Blood Cell Counts ◽

Sds Page ◽

White Blood Cell Counts ◽

Pmn Élastase

SummaryA 74-year-old female developed pneumonia following herpes simplex encephalitis. Her white blood cell counts reached 28,400/μl, about 90% of which consisted of granulocytes. The polymorphonuclear (PMN) elastase/α1-arantitrypsin complex levels increased and reached the maximum of 5,019 ng/ml, indicating the release of a large amount of elastase derived from the granulocytes. The mechanism of PMN elastase release was most likely to be granulocyte destruction associated with phagocytosis. The cleavage of fibrinogen and fibrin by PMN elastase, independent of plasmin, was indicated by the presence of the fragments in immunoprecipitated plasma from the patient corresponding to elastase-induced FDP D and DD fragments and the absence of fragments corresponding to plasmin-induced FDP D and DD fragments on SDS-PAGE. These findings suggested that the large amount of PMN elastase released from the excessive numbers of granulocytes in this patient with herpes simplex encephalitis and pneumonia, induced the cleavage of fibrinogen and fibrin without the participation of plasmin.

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