Influence of red blood cell indices on HbA1c performance in detecting dysglycaemia in a Singapore preconception cohort study

Abnormalities of red blood cell (RBC) indices may affect glycated haemoglobin (HbA1c) levels. We assessed the influence of haemoglobin (Hb) and mean corpuscular volume (MCV) on the performance of HbA1c in detecting dysglycaemia among reproductive aged women planning to conceive. Women aged 18–45 years (n = 985) were classified as normal (12 ≤ Hb ≤ 16 g/dL and 80 ≤ MCV ≤ 100 fL) and abnormal (Hb < 12 g/dL and/or MCV < 80 fL). The Area Under the Receiver Operating Characteristic (AUROC) curve was used to determine the performance of HbA1c in detecting dysglycaemic status (prediabetes and diabetes). There were 771 (78.3%) women with normal RBC indices. The AUROCs for the normal and abnormal groups were 0.75 (95% confidence interval 0.69, 0.81) and 0.80 (0.70, 0.90), respectively, and were not statistically different from one another [difference 0.04 (− 0.16, 0.08)]. Further stratification by ethnicity showed no difference between the two groups among Chinese and Indian women. However, Malay women with normal RBC indices displayed lower AUROC compared to those with abnormal RBC indices (0.71 (0.55, 0.87) vs. 0.98 (0.93, 1.00), p = 0.002). The results suggest that the performance of HbA1c in detecting dysglycaemia was not influenced by abnormal RBC indices based on low Hb and/or low MCV. However, there may be ethnic variations among them.

Assessment of significance of erythrocyte indices as metabolic and microvascular complications markers in patients with type 1 and type 2 diabetes mellitus

Erythrocyte morphology is a reflection of both physiological and pathological reactions occurring in the body of patients with diabetes mellitus (hyperglycemia, adipose tissue dysfunction, dyslipidemia, lipid peroxidation, angiopathy, diabetic nephropathy, etc.). There are no available data in the literature that would characterize gradual and progressive changes in the morphology of the erythron system in patients with diabetes mellitus, the more so any analysis of the relationships with pathogenetic factors affecting them.Aim. The aim of the study was to evaluate the nature of erythrocyte index relationships with vascular and metabolic complications of type 1 and type 2 diabetes mellitus. The main objective of the study was to determine the changes in red blood cell indices at different stages of diabetic microangiopathies and in the presence of different indicators of metabolic control.Material and Methods. A total of 122 patients were enrolled in a single-stage, single-center, comparative, controlled study. Patients were assigned to three groups: group 1 comprised patients with type 1 diabetes mellitus (n = 41); group 2 comprised patients with type 2 diabetes mellitus (n = 67); and group 3 comprised control patients (n = 14). Statistical processing of the results was performed using the SPSS Statistics 20 software.Results. Patients with diabetes mellitus are characterized by qualitative changes in the erythron system manifesting as changes in red blood cell indices.The study identified the significant associations between the changes in erythron system (erythrocyte indices) and various phenotypic features of patients with type 1 and type 2 diabetes mellitus, namely: the duration of diabetes of over 10 years, type 2 diabetes mellitus in combination with obesity, and the presence of dyslipidemia, diabetic retinopathy, and poorly controlled diabetes mellitus if glycated hemoglobin exceeded 8% with a subsequent corresponding increase per each 1%.Conclusion. Additional studies are required to implement these markers, in particular, a red cell distribution width, as risk factors for unfavorable prognosis i.e. the risk of developing various diabetes mellitus complications.

Screening for hemoglobinopathy with capillary electrophoresis in adult patients

Hemoglobinopathy screening is frequently needed in adult patients, including prenatal carrier screen, workup of unexplained anemia, and bone marrow donor and recipient screening. However, the preferred test method for screening of hemoglobinopathy is not well established due to limited guidance from professional societies. American College of Obstetricians and Gynecologists’ Committee on Genetics recommended hemoglobin electrophoresis as the screening method of hemoglobinopathy in pregnancy; nevertheless, electrophoresis employs various methodologies, including acid gel electrophoresis, alkaline gel electrophoresis, and capillary electrophoresis (CE) with alkaline buffer. For other adult patient populations who need hemoglobinopathy screening, no clear guidelines dictate the method of choice. A previous study has shown that CE captures major hemoglobinopathies with comparable performance to high-performance liquid chromatography (HPLC) in pediatric patients but no study has investigated using CE alone in adult patient screening. In this retrospective study, we evaluated the utility of CE as a screening method to rule out clinically significant hemoglobin variants. During eight months, 312 adult patients without previously identified hemoglobin variants had hemoglobinopathy screening performed using a comprehensive testing algorithm. This cascade algorithm screens for hemoglobinopathy using both CE (Capillarys, Sebia, Paris, France) and HPLC (laboratory-developed test) with reflex to more advanced variant identification such as mass spectrometry and genetic analyses. Categories of abnormal findings were reviewed to determine if hemoglobinopathy can be identified by using CE only. The patient population mainly consists of pregnant women and anemic patients with hematologic malignancies with an average age of 42. Out of the 312 screened patients, 47 had abnormal results. The most frequent condition was elevated hemoglobin F (N=25) ranging 2-5% seen in leukemia patients on chemotherapy attributed to bone marrow stress. Eight cases of beta plus thalassemia (featuring hemoglobin A2 &gt;4%) and 3 cases of hemoglobin C trait were identified in patients with little to mild clinical manifestations (red blood cell indices suggesting anemia). Decreased hemoglobin A2 fraction was observed in 7 patients, and potential causes were alpha thalassemia or iron deficiency. Other less common hemoglobinopathies included heterozygote A2 prime (N=3, a benign delta chain variant that migrates separately from hemoglobin A2 on CE) and hemoglobin G-Philadelphia (N=1). All of the abnormal results are identifiable by CE alone, although HPLC and more advanced methods help confirm the diagnosis. Our study shows that CE as the first line of screening method would rule out major hemoglobinopathies in adults. There have been reports that rare but clinically significant hemoglobin variants like hemoglobin Malmo may not be detected by CE, and therefore, certain pre-test probability factors need to be considered when testing for hemoglobinopathies, such as race/ethnicity background, family history, red blood cell indices, and iron deficiency status.

Diagnostic Utility of Red Blood Cell Indices-Derived Formulas in Discriminating Beta-Thalassemia Trait from Iron Deficiency Anemia

Background The two most frequently encountered microcytic hypochromic anemias are iron deficiency anemia (IDA) and β-thalassemia trait (β-TT) which need relatively expensive laboratory tests to be differentiated. Objectives This study aims at evaluating the diagnostic utility of different discrimination formulas derived from red blood cell indices from complete blood count in the differentiation of β-TT from IDA. Subjects and Methods This study was conducted on 140 subjects; 40 healthy individuals and 100 patients (60 IDA and 40 β-TT) recruited from outpatient clinics of Ain Shams University Hospitals. They were 45 males and 95 females (M: F 1:2.1), their ages ranged from 19 to 63 years. Patients were subjected to measurement of CBC, iron profile, Hb electrophoresis and HPLC and calculation of RBC indices- derived formulas. Results Comparative studies of different formulas among the studied group shows that England and Fraser (E & F), MDHL, MCHD, MCI and Zaghloul 2 can significantly differentiate between β-TT patients and IDA patients (P was 0.009, 0.008, 0, 0.001 and 0.050 respectively). Evaluation of diagnostic performance (efficacy) of the studied RBCs formulas showed that Zaghloul 2 is the best index in discriminating β-TT from IDA at cut off 66.61 with specificity (97.5%), sensitivity (76.7%) and diagnostic efficacy (85%). This was followed by MCI at cut off 22.73 with specificity (57.5%), sensitivity (85.0%) and diagnostic efficacy (74. %). Then they are followed by MDHL at cut off 1.487 with specificity (50.0%), sensitivity (86.7%) and diagnostic efficacy (72.0), then England and Fraser with cut off 8.9 with specificity (50.0%), sensitivity (80.0%) and diagnostic efficacy (68.0%), and lastly MCHD with cut off 0.296 with specificity (72.5%), sensitivity (61.7%) and diagnostic efficacy (66.0%). Values above these cut off levels indicate β-TT whereas values below these levels indicate IDA except for E&F formula where &lt;8.9 cut off indicate β-TT and &gt;8.9 indicate IDA. Conclusion Zaghloul 2 formula showed the highest efficacy in the differentiation of β-TT from IDA (85%) followed by MCI (74%) and MDHL (72%) then England and Fraser (68%) and lastly MCHD (66%). They can be used for screening in big population, being simple and inexpensive, and then followed by the usual confirmatory tests. Their real use comes in rural areas and primary care facilities where only red blood cell indices are handy. They can be calculated and the cases can be referred to secondary health care to take the confirmatory tests for diagnosis.

Valorization of Erythrocyte Indices in the Neonatal Period - A Pilot Study

Abnormal red blood cell indices are frequently missed among newborns that perform blood tests for any clinical reason.

Correlation of HbF, HbA2, and HbS in sickle cell disease and its prevalence in Nigerian patients: A case series of 2 patients

Sickle cell disease (SCD) is the most common inherited disorder of hemoglobin worldwide. In Nigeria, the prevalence of SCD is 20–30/1000 live births. The burden of the disease has reached a level where it contributes 9–16% of the under-five mortality in many West African countries. This case series evaluated the chromatographic patterns and red blood cell indices of sickle cell homozygous patients. Red cell indices, blood film, sickle solubility test, and chromatographic patterns using Bio-Rad HPLC D10 were evaluated for both patients. Both the patients were Nigerian and HPLC showed HbS window 81.7 and 81.6% and increased HbF, that is, 7.5 and 8.8%. HbA2 was normal in both the cases, that is, 2.2 and 2.6%. Our data suggest that homozygous sickle cell disease is very common among the Nigerian population with an increase in HbF along with HbS and HbA2 is normal.

EFFECT OF ENROFLOXACIN ON RED BLOOD CELL INDICES OF DUCKLINGS

In this study we present the results of our research into the effect of Enrofloxacin (a fluoroquinolone drug) on red blood cell indices of ducklings, breed Bashkir duck. The ducklings of the experiment group received Enrofloxacin at a concentration of 200 g/L via drinking water for 10 consecutive days. Blood samples from all the ducklings were collected by cardiac puncture on Day 1, Day 3, Day 5, Day 7, Day 9 and Day 11 after the withdrawal of the drug. After evaluating red blood cell indices, including RBC count, hematocrit, color index of blood, erythrocyte sedimentation rate, hemoglobin content and erythrocyte indices we observed short-term reliable changes in blood of ducklings in the experiment group. We registered the most dynamic changes in RBC count of Group II on Day 1, Day 9 and Day 11, when it increased by 16%, 14% and 16% respectively whereas on Day 3 we registered a single decrease by 8% as compared to the control group. We marked ambiguous variations in color index of blood, MCV and MHC. Throughout the experiment we noted the most pronounced changes in practically every value only on Day 5, when we registered increases in RBC count, hemoglobin content, color index of blood, hematocrit, mean corpuscular volume and mean hemoglobin content of duckling blood. In spite of the fact that these singular changes may reflect certain intensification of erythropoiesis, on the whole they do not reflect any negative effect of Enrofloxacin on physiological status of ducklings.

Determination of Red Cell Indices and Sero-prevalence of Transfusion Transmissible Infectious Diseases among Stable Paediatric Sickle Cell Patients

Red blood cell indices values were lower compared with control subjects, nature has it that SCD patients in the steady state have adapted their body system to this anaemic state and live healthy. Blood transfusion does not significantly increase the seroprevalence of transfusion transmissible infections in our clinically stable SCD participants.

Clinical characteristic, red blood cell indices, iron profile and prognosis of heart failure in females

Background: Heart failure is a leading killer worldwide, with concurrent anaemia and iron deficiency portending sepulchral prognosis. Anaemia is rampant, with 53% prevalence in Indian females, but iron deficiency can be present even without anaemia. Therefore, this study was planned to determine the clinical profile, red blood cell indices, and effects of iron deficiency, on the course and prognosis of heart failure in Indian females.Materials and methods: This was a hospital-based observational study, conducted at a tertiary care teaching institute in India. Data from 147 females enrolled in the study between September 2017 to March 2020 was collected out of all patients enrolled in ongoing heart failure registry at the institute. Clinical characteristics at presentation, iron profile, red blood cell indices, treatment and mortality data was collected.Results: Mean age of the subjects (n = 147) was 53.31 ± 17.1 years with 55% non-rheumatic and 45% with rheumatic heart disease. The patients with rheumatic heart disease were younger, with a higher prevalence of atrial fibrillation. Non-rheumatic patients had a higher prevalence of CV risk factors like diabetes, hypertension, renal failure, more patients in NYHA IV, and 83% patients had LVEF ≤40%. Anaemia was present in 49%, however iron deficiency was present in 89% (absolute iron deficiency in 80% and functional iron deficiency in 9%) with no significant difference between rheumatic and non-rheumatic group. Red blood cell indices showed no significant difference across the spectrum of iron deficiency and anaemia, except lower mean corpuscular volume in patients with both iron deficiency and anaemia. The mean survival time was 840 days, with no significant difference between groups. There was significantly higher mortality in patients with iron deficiency (log rank 0.045).Conclusion: Iron deficiency–with or without anaemia–is very high in Indian females, worsening survival in heart failure. Proper diagnosis with iron supplementation will improve the prognosis.