Chronic Kidney Disease of Unknown Etiology (CKDu) in Sri Lanka: Hematological Changes and Pro-Inflammation Suggest Likely Predictors of Advance Disease, as Renal Outcomes Show Prevalent Normoalbuminuria

CKDu needs to be characterized in fundamental areas to improve etiological understanding and disease management. In a cross-sectional study, blood cell profile and plasma inflammatory cytokines were followed by automated analysis and sandwich ELISA, respectively. Disease development stages and proteinuria were ascertained by eGFR and UACR. Comparison among control and stages (ANOVA/Dunnett’s MRT) revealed time-specific changes (p < 0.05), including decreased erythrocytes (G5) and hematocrit (G5), and increased MCHC (G3b, G4), MCV (G5), and MCH (G5). CKDu decreased (p < 0.05) lymphocytes (G3b, G4, G5), monocytes (G3b), MPV (G3b, G4, G5), and plateletcrit (G3b, G4), and increased basophils (G3a, G3b, G4), N/L (G4) and PLR (G4–G5). MCHC and aforesaid leukocyte variables were in correlation (rho > ±0.03, p < 0.05, Pearson’s test) with disease development. MCP-1 and IL-6 spiked (p > 0.05) at G3b. Multivariate analyses confirmed that MCP-1, lymphocytes, and BMI were related to renal dysfunction, pointing to inflammation, compromised immunity, and muscle wasting as CKDu effects. Nonproteinuric CKDu was prevalent (23.2–35.6% of total CKDu) with (p < 0.05) elevated basophils (G3a), N/L (G4), and depleted lymphocytes (G4). In both forms, G1–G2 were unaffected, and the earliest change was G3a basophils. Results suggest that MCP-1, lymphocyte count, N/L, and PLR may verify the stage and predict impending ESRD in advance proteinuric CKDu.

Subacute combined degeneration of spinal cord – the only manifestation in an otherwise “normal” vitamin B12 deficient patient.

Sub acute combined degeneration (SACD) is a myelopathy associated with vitamin B12 deficiency. Vitamin B12 deficiency may present with neurological and/or hematological features - neurological features commonly presenting at a later stage than hematological changes. Our case is an unusual presentation of SACD without anemia

A Descriptive Study on Hematological Changes in Brucellosis Infected Individuals

Background: Brucellosis is a zoonotic organism that causes diseases in both animals and humans. Human contact with infected domestic animals is often a transmission route of Brucellosis infection. This infection affects hematological parameters of the patients. We carried this study to determine the changes in various hematological parameters in our study subjects. Patients and Methodology: This study was carried out in Nangarhar regional hospital and safi medical complex on 45 Afghani people from December 2018 up to December 2020. The study design was prospective. A total of 45 patients (Cases) with confirmed diagnosis of Brucellosis on the basis of serology enrolled in the study. Complete blood count and Erythrocyte sedimentation rate studies are also performed. Considered hematological parameters includes Hemoglobin (Hb), White Blood Cell count (WBC), Platelet count (PLT) and ESR. As well interview was done with each patient and a questionnaire was used. The collected data was analyzed with Microsoft excel program Autosum statistics. Results. A total of 45 patients were enrolled. The mean age±SD of the patients under the study were (28.74±15.22) years. The most common hematological changes observed were; anemia (57.7%), thrombocytopenia (24%), leucocytosis (13.3%), pancytopenia (24.4%), lymphocytopenia (31.1%), lymphocytosis (55.5%) & leucopenia (40%). Erythrocyte sedimentation rate were elevated in about 66% of patients. Fever and headache were the most common presenting symptoms (73%) and (82%) respectively. Night sweats in (40%), joint pain (53%), muscle pain (53%) and lymphadenopathy in 46% of patients. Conclusion: This result of this study shows that Brucellosis commonly affects people of low socioeconomical states, female sex, uneducated, those consuming contaminated dairy products, peoples living in rural areas and those having consuming or contact with animal. Salmonella typhi causes changes in the hematological parameters due to involvement of bone marrow.

Heterogeneity of Hematological Response to Hypoxia and Short-Term or Medium-Term Bed Rest

Hematological changes are commonly observed following prolonged exposure to hypoxia and bed rest. Typically, such responses have been reported as means and standard deviations, however, investigation into the responses of individuals is insufficient. Therefore, the present study retrospectively assessed individual variation in the hematological responses to severe inactivity (bed rest) and hypoxia. The data were derived from three-bed rest projects: two 10-d (LunHab project: 8 males; FemHab project: 12 females), and one 21-d (PlanHab project: 11 males). Each project comprised a normoxic bed rest (NBR; PIO2=133mmHg) and hypoxic bed rest (HBR; PIO2=91mmHg) intervention, where the subjects were confined in the Planica facility (Rateče, Slovenia). During the HBR intervention, subjects were exposed to normobaric hypoxia equivalent to an altitude of 4,000m. NBR and HBR interventions were conducted in a random order and separated by a washout period. Blood was drawn prior to (Pre), during, and post bed rest (R1, R2, R4) to analyze the individual variation in the responses of red blood cells (RBC), erythropoietin (EPO), and reticulocytes (Rct) to bed rest and hypoxia. No significant differences were found in the mean ∆(Pre-Post) values of EPO across projects (LunHab, FemHab, and PlanHab; p&gt;0.05), however, female EPO responses to NBR (Range - 17.39, IQR – 12.97 mIU.ml−1) and HBR (Range – 49.00, IQR – 10.91 mIU.ml−1) were larger than males (LunHab NBR Range – 4.60, IQR – 2.03; HBR Range – 7.10, IQR – 2.78; PlanHab NBR Range – 7.23, IQR – 1.37; HBR Range – 9.72, IQR – 4.91 mIU.ml−1). Bed rest duration had no impact on the heterogeneity of EPO, Rct, and RBC responses (10-d v 21-d). The resultant hematological changes that occur during NBR and HBR are not proportional to the acute EPO response. The following cascade of hematological responses to NBR and HBR suggests that the source of variability in the present data is due to mechanisms related to hypoxia as opposed to inactivity alone. Studies investigating hematological changes should structure their study design to explore these mechanistic responses and elucidate the discord between the EPO response and hematological cascade to fully assess heterogeneity.

Characteristics of peripheral white blood cells in COVID-19 patients revealed by a retrospective cohort study

Background Peripheral hematological changes in severe COVID-19 patients may reflect the immune response during SARS-CoV-2 infection. Characteristics of peripheral white blood cells as early signals were needed to be investigated for clarifying its associations with the fatal outcomes in COVID-19 patients. Methods A retrospective cohort study was performed and the hospitalized COVID-19 patients were recruited in wards of Sino-French New City Branch of Tongji Hospital in Wuhan, Hubei province, China. Characteristics of peripheral white blood cells in survivors and non-survivors were analyzed. Comparison among patients with different level of eosinophils was performed. Results Of 198 patients included in this study, 185 were discharged and 13 died. Levels of eosinophils, lymphocytes and basophils in non-survivors were significantly lower than those in survivors. Death rate in low eosinophils group was higher and no patient died in normal eosinophils group (16.7% vs 0, P < 0.001). The proportion of patients in low eosinophils group who used glucocorticoids was higher than in normal eosinophils group, but glucocorticoids usage was not an indicator for death in subgroup analysis in low eosinophils patients. Moreover, positive correlation was found between the counts of lymphocytes and eosinophils in patients with glucocorticoids use but not in patients without the treatment. Conclusions Hematological changes differed between survivors and non-survivors with COVID-19. Lymphopenia and eosinopenia could be predictors for poor prognosis of COVID-19 patients. Initial counts of eosinophils may guide us in usage of glucocorticoids for COVID-19 treatment.

Hematological changes in patients with malaria in a tertiary care hospital, Multan, Punjab, Pakistan

Background: Malaria is one of the most common human infections and continues to cause significant morbidity and mortality all over the world. To assess and compare the hematological changes in common types of malaria in our patients.Methods: This observational study included 100 diagnosed malaria patients of Multan Medical and Dental college, Multan both from out patient department (OPD) and in-patient department, between March 2020 and March 2021. The diagnosis of malaria was confirmed by thick and thin film stained with Geimsa’s staining for malaria parasite and plasmodium species and the parasite index (MPI) in some cases. Complete blood counts (CBCs) were performed and WBC differential was done on all cases.Results: The most common type of malarial parasite was Plasmodium vivax followed by Plasmodium falciparum and 89% of the patient had thrombocytopenia, 70 % anemia, 23% had leukopenia and 10% had raised WBC count. The mean parasite load was 1.275±0.629%, 20 % of the cases showed neutropenia, 40 % had lymphopenia and 40 % showed monocytopenia. Of all the cases 15 % had neutrophilia, 8 % had lymphocytosis and 5 % had eosinophilia. Thrombocytopenia was slightly more in P. falciparum (58.69%) than P. vivax (30.18%) cases, p>0.05, whereas there was no significant difference in the incidence of anemia in two groups (34.68% vs 33.82%) with p>0.05.Conclusions: P. vivax is the common malarial parasite in our population. Both P. vivax and P. falciparum can cause marked hematological changes including thrombocytopenia, anemia, lymphopenia and monocytopenia.

Hematological changes in hypothyroidism and hyperthyroidism in adults

Thyroid function disorders are among the most common endocrine diseases. Thyroid disorders can cause certain forms of anemia, more commonly in hypothyroidism. Slightly decreased TLC, relative neutropenia, relative lymphocytosis or relative eosinophilia may be found in thyroid disorders. These observations confirmed the association between thyroid gland dysfunction and hemopoiesis.1) To study the pattern of hematological changes in thyroid dysfunction 2) To correlate thyroid function tests with complete blood count & red cell indices findings 3) To correlate complete blood count investigations and peripheral blood smear findings with serum TSH levels.It was an Observational study conducted during 18 months of period from March 2018 to October 2019 with 100 subjects of hypothyroidism, 80 subjects of hyperthyroidism and 100 euthyroid subjects as control group. CBC was done on automated cell counter. PBS was stained with Leishman stain and observed under microscope. TFTwas done by immunoassay method. It was done with SPSS Software.: Predominance of female was seen in hypothyroidism and hyperthyroidism. Significant decrease was seen in RBC, Hb, HCT, MCV and MCH in hypothyroid group, while in hyperthyroid group RBC, Hb and HCT were significantly decreased as compared with euthyroid control group. Both groups showed significant increase in RDW as compared with control group.It is important to carefully evaluate the thyroid hormones in cases of unexplained anemias. So, periodic evaluation for probable hematological changes should be done in all the patients with hypothyroidism and hyperthyroidism.

Hepatorenal syndrome: new insights about pathogenesis (part 1))

An analysis of literature reviews, clinical studies, experimental research, clinical recommendations from pubmed / Medline and ELIBRARY databases on keywords for“liver cirrhosis”and“hepatorenal syndrome”was carried out. In accordance with modern studies, the idea of the pathophysiology of hepatorenal syndrome was revised in recent years, departing from the assumption that the development of this pathology is associated only with renal hypoperphusion due to the development of peripheral systemic arterial vasodilation. Today, the effect of cardiovascular, immune, endocrine systems, coagulation systems, hematological changes, endothelial dysfunction, reception of drugs and other factors for the development of renal dysfunction is studied.