Laboratory hematology : official publication of the International Society for Laboratory Hematology
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The objective of this descriptive study was to relate hematological parameters of patients visiting the emergency department (ED) to mortality. The study included 1698 adult patients visiting the ED for any reason who underwent blood gas analysis. The results of hemoglobin concentration, leukocyte count, and platelet count were related to mortality within 7 days after admittance to the hospital. ⋯ This showed higher mortality in the groups of patients with leukocyte counts outside the reference range (4.0-10.0 x 10 (9)/L, p < .01) and in the group of patients with platelet counts below the reference range (150-450 x 10 (9)/L, p < .0001). High mortality is also seen in the group of women with hemoglobin concentrations outside the reference range (12.1-15.7 g/dL, p < .01), for men no difference was observed. In conclusion, our study shows clinically relevant differences in mortality in hematological parameters in an unselected population at the ED, irrespective of underlying pathology.
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Comparative Study
Comparison of neutrophil CD64 expression, manual myeloid immaturity counts, and automated hematology analyzer flags as indicators of infection or sepsis.
There is a clear need for improved indicators of infection or sepsis to increase the sensitivity and specificity of both diagnosis and therapeutic monitoring. One of the effects of inflammatory cytokines on the innate immune response is the rapid up-regulation of CD64 expression on the neutrophil membrane. We and others have hypothesized that the measurement of neutrophil CD64 expression might represent an improved diagnostic indicator of infection and sepsis. ⋯ Neutrophil CD64 expression demonstrated a superior sensitivity (94.1%), specificity (84.9%), and positive predictive likelihood ratio (6.24), compared with neutrophil counts (sensitivity, 79.4%; specificity, 46.8%; positive predictive likelihood ratio, 1.49), band counts (sensitivity, 87.5%; specificity, 43.5%; positive predictive likelihood ratio, 1.55), myeloid immaturity fraction (sensitivity, 94.6%; specificity, 84.5%; positive predictive likelihood ratio, 2.12), and flagging on an automated hematology analyzer (sensitivity, 94.1%; specificity, 40.5%; positive predictive likelihood ratio, 1.58). Relative to the other laboratory parameters, the neutrophil CD64 parameter also provided the best separation of the 4 clinical groups. The findings indicate that neutrophil CD64 expression as determined by quantitative flow cytometry is an improved diagnostic indicator of infection/sepsis relative to current laboratory indicators of relative or absolute myeloid cell counts or hematology analyzer flagging algorithms.
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This study compared the white blood cell (WBC) and red blood cell (RBC) counts obtained with the Cell-Dyn 3200 (CD 3200) with results obtained by hemocytometer, the reference method for counting cerebrospinal fluid (CSF) and other body fluid specimens. Ninety-six CSF and 65 body fluid specimens were evaluated. Background counts were maintained on the CD 3200 at 0.001 x 10(9)/L and 0.00 x 10(12)/L for WBC and RBC counts, respectively. ⋯ In contrast to the only other instrument with comparable reportable ranges, the CD 3200 requires a smaller sample volume without any special sample preparation, reagents, or software. By using the CD 3200 with our laboratory-specific rules for agreement between duplicate counts, we would be able to reduce our manual CSF specimen counts from 192 TNC and 192 RBC counts to 2 TNC and 178 RBC counts. For body fluid specimens, our manual counts would be reduced from 130 TNC and 130 RBC counts to 10 TNC and 4 RBC counts.
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The clinical diagnosis of venous thromboembolism (VTE), which includes both deep vein thrombosis (DVT) and pulmonary embolism (PE), is often difficult and requires a number of imaging tests plus clinical assessment. It is now accepted that pretest clinical probability of disease plus a sensitive, quantitative D-Dimer assay can be used to reliably exclude VTE. In design of diagnostic strategies for VTE it is recommended that the D-Dimer assay be evaluated for sensitivity and specificity in well-designed, blinded studies using a cohort of patients for whom the assay will ultimately be used. ⋯ The findings demonstrate that a diagnostic strategy using the IL Test D-Dimer assay as a first-line test in combination with pretest probability is safe and can be used in patients with suspected VTE. In conclusion, patient analysis results indicating low or moderate pretest probability for VTE and a negative IL Test D-Dimer (cutoff value of 237 ng/mL) assay result on the ACL 9000 reliably exclude VTE (both PE and DVT). We expect that inclusion of the rapid IL Test D-Dimer assay for assessment of suspected VTE in the emergency department at Providence will result in improved patient diagnosis and therapy, reduction in unnecessary radiological investigations, and lowering of overall costs associated with investigation of patients suspected of having VTE disease.
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Comparative Study
External quality assessment of automated hematology analyzer performance using fresh human blood samples in Shanghai.
We set out to assess the performance and degree of agreement for the different automated hematology analyzers (AHAs) currently used within the Shanghai region. Analyzers from 5 different manufacturers were represented within the 114 hospitals that participated in this project: Abbott, ABX, Beckman Coulter, Nihon Kohden, and Sysmex. We determined the results obtained on 115 hematology analyzers in the 114 different hospitals for hemoglobin (HGB), red blood cell count (RBC), white blood cell count (WBC), hematocrit (HCT), and platelet count (PLT) from fresh anticoagulated blood samples from healthy donors. ⋯ An important result was that the CBC parameter CVs were also well within established US Clinical Laboratory Improvement Amendments of 1988 guidelines for AHA performance. Combined with a comprehensive education program, the Shanghai external fresh blood quality assessment program has resulted in closer agreement among the various AHA manufacturers, with only very small differences for RBC, HGB, HCT, WBC, and PLT counts. The success of this program has given us increased confidence in the comparability of results and subsequent patient management using the various types of AHAs currently in use in the hospitals within the Shanghai region.