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Mengistu Sissay, Teklay, Melatwork Tibebu, Tagesachew Wasihun, and Aster Tsegaye. "Hematological reference intervals for adult population of Dire Dawa town, East Ethiopia." PLOS ONE 16, no. 2 (February 16, 2021): e0244314. http://dx.doi.org/10.1371/journal.pone.0244314.
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Background Reference interval (RI) for hematological parameters is used to interpret laboratory test results in the diagnosis, management and monitoring of hematologic disorders. Several factors including sex, age, dietary patterns, pregnancy status, ethnicity and geographic location affect hematological RIs. However, manufacturers derived reference value is currently in use in most developing countries including Ethiopia. This study aimed to establish hematological RIs for adult population living in Dire Dawa town, East Ethiopia. Methods In this cross-sectional study, 513 apparently healthy adults of Dire Dawa town were enrolled from January to March 2019. From these, 342 (171 males and 171 non-pregnant females) were aged 18–65 years while 171 were pregnant women aged 15–49 years. After obtaining written informed consent, 5ml fresh whole blood was collected of which 2ml was used for hematologic analysis using Mindray BC-3000plus hematology analyzer and 3ml for serological tests. The 2.5th and 97.5th RI was computed by non-parametric test employing SPSS version 24. P-value <0.05 was considered statistically significant. Result Males had significantly higher reference value for most of red cell parameters (Hgb, RBC, HCT, MCH and MCHC) than females (p <0.05), while most of the WBC parameters were significantly higher in females than males. Moreover, non-pregnant women had higher values for most of red cell parameters than pregnant women. Pregnant women had higher WBC parameters than their non-pregnant counterparts. Conclusion The hematologic RIs obtained in this study shows variation between genders, between pregnant and non-pregnant women, from the clinical practice currently utilised in Dire Dawa town and from studies conducted in Ethiopia, African countries as well as the Western population. It underscores the need for utilising gender and pregnancy specific, locally derived hematologic RI for better management, diagnosis and monitoring of hematologic disorders for adults of both genders and pregnant women.
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Hicks, Lisa K., Harriet Bering, Kenneth R. Carson, Adam E. Haynes, Judith Kleinerman, Vishal Kukreti, Alice Ma, et al. "Five hematologic tests and treatments to question." Blood 124, no. 24 (December 4, 2014): 3524–28. http://dx.doi.org/10.1182/blood-2014-09-599399.
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Abstract Choosing Wisely® is a medical stewardship initiative led by the American Board of Internal Medicine Foundation in collaboration with professional medical societies in the United States. The American Society of Hematology (ASH) released its first Choosing Wisely® list in 2013. Using the same evidence-based methodology as in 2013, ASH has identified 5 additional tests and treatments that should be questioned by clinicians and patients under specific, indicated circumstances. The ASH 2014 Choosing Wisely® recommendations include: (1) do not anticoagulate for more than 3 months in patients experiencing a first venous thromboembolic event in the setting of major, transient risk factors for venous thromboembolism; (2) do not routinely transfuse for chronic anemia or uncomplicated pain crises in patients with sickle cell disease; (3) do not perform baseline or surveillance computed tomography scans in patients with asymptomatic, early-stage chronic lymphocytic leukemia; (4) do not test or treat for heparin-induced thrombocytopenia if the clinical pretest probability of heparin-induced thrombocytopenia is low; and (5) do not treat patients with immune thrombocytopenia unless they are bleeding or have very low platelet counts.
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Hicks, Lisa K., Harriet Bering, Kenneth R. Carson, Adam E. Haynes, Judith Kleinerman, Vishal Kukreti, Alice Ma, et al. "Five hematologic tests and treatments to question." Hematology 2014, no. 1 (December 5, 2014): 599–603. http://dx.doi.org/10.1182/asheducation-2014.1.599.
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Abstract Choosing Wisely® is a medical stewardship initiative led by the American Board of Internal Medicine Foundation in collaboration with professional medical societies in the United States. The American Society of Hematology (ASH) released its first Choosing Wisely® list in 2013. Using the same evidence-based methodology as in 2013, ASH has identified 5 additional tests and treatments that should be questioned by clinicians and patients under specific, indicated circumstances. The ASH 2014 Choosing Wisely® recommendations include: (1) do not anticoagulate for more than 3 months in patients experiencing a first venous thromboembolic event in the setting of major, transient risk factors for venous thromboembolism; (2) do not routinely transfuse for chronic anemia or uncomplicated pain crises in patients with sickle cell disease; (3) do not perform baseline or surveillance computed tomography scans in patients with asymptomatic, early-stage chronic lymphocytic leukemia; (4) do not test or treat for heparin-induced thrombocytopenia if the clinical pretest probability of heparin-induced thrombocytopenia is low; and (5) do not treat patients with immune thrombocytopenia unless they are bleeding or have very low platelet counts.
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Zheng, J., Z. R. Dong, Y. P. Tang, Y. Q. Huang, Q. B. Zhang, F. Dai, and Y. F. Qing. "AB0449 CLINICAL CHARACTERISTICS AND RISK FACTORS OF SYSTEMIC SCLEROSIS WITH HEMATOLOGIC SYSTEM DAMAGES." Annals of the Rheumatic Diseases 80, Suppl 1 (May 19, 2021): 1252.1–1252. http://dx.doi.org/10.1136/annrheumdis-2021-eular.3465.
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Background:SSc characterized by varying degrees of fibrosis of the skin and internal organs, clinicians pay more attention to skin and viscera conditions, tend to ignore hematologic system damage. Studies have shown that rheumatic disease such as SLE, RA, pSS often accompanied with hematologic system damages, and hematologic system damages is multiple organ involvement and risk factor of poor prognosis[1-2].Objectives:To investigate the the clinical features, laboratory characteristics and risk factors of Systemic Sclerosis (SSc) patient with hematologic system damages.Methods:The clinical data of 180 patients were collected from January 2010 to April 2020, at the Affiliated Hospital of North Sichuan Medical College. The demographic information, laboratory tests, and clinical symptoms were analyzed retrospectively.Results:Among 180 SSc patients, 70(38.9%) cases were complicated with hematologic system damages. 51(72.9%) cases had anemia, 24 cases (34.3%) had leukopenia, 24 cases (34.3%) had thrombocytopenia, and 22 cases had hematologic system damages associated with more than two cell line involvement. Clinical symptoms: arthritis was significantly higher in the hematologic system damages group than patient without (P<0.05), however, there was no significantly difference in gender, age, disease course, respiratory symptoms, gastrointestinal symptoms, Raynaud’s phenomenon, interstitial lung disease and pulmonary hypertension (all P>0.05). Laboratory tests: ESR and hsCRP were increased in the hematologic system damages group, while the albumin decreased (all P<0.05). The positive rates of resistance to anti-dsDNA antibody and anti-ribosomal P protein antibody was higher in the hematologic system damages group (all P<0.05). Prognosis: During follow-up, leukopenia was more likely to recover, while the thrombocytopenia was more difficult to recover. Logistics regression analysis showed that positive of anti-ribosomal P protein antibody maght be a risk factor for SSc complicated with hematologic system damages [OR = 3.930(P<0.05)] (Table 1).Conclusion:SSc complicated with hematologic system damages is common, and patients with hematologic system damages have more serious clinical symptoms, some of whom have difficulty in recovey. Anti-ribosomal P protein antibody may be a risk factor of SSc hematologic system damages.Table 1.Bivariate logistics regression analysis on risk factors associated with hematologic damages in SSc.FactorBSEWaldOR(95%CI)P valuearthritis0.6540.3473.5431.922(0.973-3.797)0.060ESR-0.0810.4870.0280.922(0.355-2.393)0.868hsCRP-0.0070.4920.0000.993(0.379-2.607)0.989anti-dsDNA0.8680.6731.6642.393(0.637-8.916)0.197anti-Rib-P1.3690.6364.6333.930(1.130-13.666)0.031References:[1]González-Naranjo L A, Betancur O M, Alarcón G S, et al. Features associated with hematologic abnormalities and their impact in patients with systemic lupus erythematosus: Data from a multiethnic Latin American cohort[J]. Seminars in Arthritis and Rheumatism, 2016,45(6):675-683.DOI:10.1016/j.semarthrit.2015.11.003.[2]Skare T, Damin R, Hofius R. Prevalence of the American College of Rheumatology hematological classification criteria and associations with serological and clinical variables in 460 systemic lupus erythematosus patients[J]. Revista Brasileira de Hematologia e Hemoterapia, 2015,37(2):115-119.DOI:10.1016/j.bjhh.2015.01.006Disclosure of Interests:None declared.
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Bi, Hongchen, Xiaoli Luo, Haozhi Zhang, Mingyang Wang, Aiming Pang, Sizhou Feng, Erlie Jiang, and Yujie Cui. "Evaluation of Platelet and Clotting Parameters in Hematologic Malignancies and Hematopoietic Stem Cell Transplantation Patients with Candidemia." Blood 142, Supplement 1 (November 28, 2023): 5441. http://dx.doi.org/10.1182/blood-2023-188010.
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1.Backgroud In recent years, the number and proportion of deaths from fungal infections have increased year by year. The fatality rate of fungemia is about 0.4 per 100 000 [Pfaller MA, et al. Clin Microbiol Rev. 2007]. Chemotherapy can effectively treat hematological malignancies. Data from multi-center studies in China show that the overall mortality rate of patients receiving chemotherapy for hematological malignancies is only 1.5%, and the mortality rate of patients with clinically diagnosed invasive fungi is as high as 11.7% [ Sun Y, et al. Tumor Biol, 2015]. The surveillance data of China Hospital Invasive Fungal Disease Surveillance Network from 2015 to 2017 showed that Candida albicans was the most common pathogen among 4 010 Candida strains isolated from patients with candidemia from 77 hospitals in China [Xiao M, et al. J Infect Dis, 2020]. 2.Methods We conducted a retrospective study that collected relevant clinical information from 34 hematologic malignancies and hematopoietic stem cell transplantation (HSCT) patients with candidemia between 2017 to 2022 in Hematology Hospital, Chinese Academy of Medical Sciences. The blood specimens of patients suspected to have candidemia were collected and cultured. After diagnosis, they were regarded as the candidemia group, and 107 healthy people were selected as the control group. Candidemia is classified as invasive or non-invasive according to whether it involves tissues or organs damage. Blood routine and clotting related tests were performed at the Clinical Laboratory Center of Hematology Hospital, Chinese Academy of Medical Sciences. 3.Results 3.1 General Characteristics of the Study Subjects A total of 34 hematologic malignancies and HSCT patients with candidemia were recruited. Of these 34 patients, 28 were male and 6 were female. Meanwhile, 107 healthy people were recruited as control group. The characteristics of two groups are presented in Table 1. 3.2 Hematologic malignancies and HSCT patients with abnormal blood routine are at increased risk of candidemia Hematologic malignancies and HSCT patients with candidemia present as lower white blood cell count, lower red blood cell count, higher lymphocyte ratio, lower lymphocyte count, lower monocyte count, lower neutrophil count and ratio, and lower NEU/PLT compared with control group. 3.3 Candidemia cause platelet activation in hematologic malignancies and HSCT patients The PLT and PCT of hematologic malignancies and HSCT patients with candidemia were significantly lower than control group. Meanwhile, MPV and P-LCR were higher than control group. It revealed that hematologic malignancies and HSCT patients with candidemia may present with platelet activation, while PLT and PCT level were low in this group. 3.4 Invasive candidemia can cause a decrease in platelets and an increase in MPV/PLT Furthermore, we found that PLT level was lower and MPV/PLT level was higher in hematologic malignancies and HSCT patients with invasive candidemia than hematologic malignancies and HSCT patients with non-invasive candidemia. 3.5 Candidemia can cause coagulation dysfunction in hematologic malignancies and HSCT patients Hematologic malignancies and HSCT patients with candidemia had coagulation dysfunction symptoms such as prolonged PT and APTT, reduced antithrombin III activity, and high INR. 3.6 Candidemia can cause hyperfibrinolysis in hematologic malignancies and HSCT patients Meanwhile, hematologic malignancies and HSCT patients with candidemia showed reduced TT, increasing fibrinogen, fibrinogen degradation products, and D-Dimer. 4.Conclusion In conclusion, we demonstrated for the first time that decreasing platelet count and activated platelet function in hematologic malignancies and HSCT patients with candidemia. Invasive candidemia may cause lower platelet count and more activated platelet function in hematologic malignancies and HSCT patients. At the same time, we found that candidemia can cause coagulation dysfunction and hyperfibrinolysis in hematologic malignancies and HSCT patients. We hope that our study can provide a new perspective on the cognition and diagnosis of hematologic malignancies and HSCT patients with candidemia.
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Zhiguleva, L. Yu. "Current structure, organization and evaluation of effectiveness of the specialized outpatient medical care for patients with blood diseases in a metropolis." Kazan medical journal 95, no. 2 (April 15, 2014): 261–67. http://dx.doi.org/10.17816/kmj2077.
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Aim. To analyze the structure, organization and effectiveness of outpatient medical care for patients with blood diseases in St. Petersburg, Russia. Methods. 83 reports submitted by the heads of hematological offices at 2000-2012 were analyzed. The effectiveness was evaluated using routine statistical tests. The prevalence of the diseases was assessed by registration forms №7, 35, the data provided by information and analytical center of the Healthcare Committee and the City cancer registry. Medical aid provided to patients at 2010-2012 was studied, for this purpose 250 outpatient files (025/y form) were randomly picked out, the data were collected using specially designed registration cards (254 parameters). Results. Municipal, federal and departmental institutions provide hematologic outpatient medical care in St. Petersburg. The major burden of providing medical care to hematologic patients lays on interdistrict hematological offices, which actively follow-up and treat patients with hematologic cancers. Every sixth patient has complications, and 75% - comorbidities. During the period of study, the attendance rate increased by 33.4% (from 64 766 in 2000 to 86 405 in 2012), the number of the newly-diagnosed patients with hematologic cancers increased by 13.9% (p 0.05), the share of patients with hematologic cancers increased from 28.0 to 50.4%. Cumulative incidence of lymphomas increased from 69.9 to 96.0 per 100 thousand of population; leukemia - from 49.7 to 79.3. Mortality due to lymphomas decreased from 8.1% in 2001 to 5.3% in 2012, and due to leukemia - from 9.2% to 3.6%. Five-year survival rate of patients with leukemia increased from 56.6% to 63.2 % over the period of 2010-2012. Conclusion. The study shows the effectiveness of outpatient hematologic care in St. Petersburg. To further improve the efficiency of outpatient hematologic care in metropolis, it is important to improve the knowledge of hematologic diseases by doctors and pediatricians of general healthcare network, to review the workload of hematological office staff, to focus on preventive component of hematologic care (quality of occupational medical examinations), to develop and implement the new organizational techniques providing costs reduction and improving quality of life.
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Soloe, C., K. Bandel, M. Jarblum, E. Willacy, S. Squire, D. Driscoll, J. Kepner, and T. Gansler. "Information needs of hematologic cancer survivors." Journal of Clinical Oncology 24, no. 18_suppl (June 20, 2006): 18547. http://dx.doi.org/10.1200/jco.2006.24.18_suppl.18547.
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18547 Background: Little is known about how information needs of cancer survivors/patients (S/P), caregivers (CG), and non-caregiver relatives (NCG) evolve during the cancer experience. Methods: We conducted structured interviews of 21 leukemia, lymphoma, and multiple myeloma S/P, 13 CG, and 19 NCG, and asked them to prioritize information needs during the 4 cancer experience phases from a list of 13 topics. This research was supported by the Division of Cancer Prevention and Control of the Centers for Disease Control and Prevention. Results: Information preferences varied (Friedman’s test, P < 0.0001) by phase of the cancer experience. Topics ranked highest (median rank in parentheses) before treatment, during treatment, after treatment, and at relapse, respectively, were diagnostic tests (2), cancer/ cancer types (2.5), treatment options (3.4), hospitals/cancer centers (3.5), and insurance/financial issues (4); coping with treatment side effects (3), insurance/financial issues (4.5), treatment options (5), hospitals/cancer centers (5), and long term side effects (5); long term side effects (2), tests to detect recurrence (2), risk factors (3), diagnostic tests (4), and support groups (5); and tests to detect recurrence (3), insurance/financial issues (3), cancer/cancer types (4), diagnostic tests (5), and treatment options (5). Across the cancer experience, the highest priority topics for S/P, CG, and NCG, were cancer/ cancer types (4), treatment options (4), long term side effects (5), and risk factors (5); diagnostic tests (4.5), coping with side effects of treatment (5), and treatment options (5); and treatment options (3), diagnostic tests (4), and 5 other topics tied for 3rd place (6). In-depth, semi-structured interviews conducted with the surveys provided additional detail regarding responses collected in the prioritization exercise. Conclusions: Clinicians can help S/P, CG, and NCG by offering role- and cancer continuum-targeted information. No significant financial relationships to disclose.
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Rosen, Peter J., Richard C. Wender, Haleh Kadkhoda, and Scott L. Kober. "Measuring the Ability of Primary-Care Physicians To Diagnose and Manage Patients with Hematologic Malignancies." Blood 110, no. 11 (November 16, 2007): 3312. http://dx.doi.org/10.1182/blood.v110.11.3312.3312.
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Abstract In 2004, the Centers for Disease Control and Prevention awarded funding (Coop. Agreement No. U58/CCU324301-01) for the Hematologic Oncology Primary Intervention Networking Group (HOPING), a national educational initiative of the Institute for Continuing Healthcare Education (the Institute). HOPING was developed to increase survivorship of patients with hematologic malignancies beyond 5 years. Its intent was to educate PCPs on the signs and symptoms of hematologic malignances to encourage more appropriate and timely referrals to a specialist, as well as to identify and bridge gaps in knowledge regarding the long-term follow-up and care of survivors of hematologic malignancies. Methods: Educational strategies included live presentations at primary care conferences, distribution of resource materials at an educational booth, and a resource Web site (www.hopingdocs.org). As part of the HOPING initiative, immediate participant feedback was gathered during live programs through an audience response system as well as through registrant surveys distributed at the booth and on the Web. The questions within those two settings were intended to gauge the practitioner’s ability to properly recognize the signs and symptoms of hematologic malignancies and provide appropriate follow-up care for patients with hematologic malignancies. Results: Data were collected from a total of 357 individuals (277 from live activities, 80 from online/booth surveys). Approximately 64% of the live program survey respondents were physicians; the majority identified themselves as family practice/family medicine or internal medicine specialists. When asked how they would monitor a 54-year-old male patient free from Hodgkin’s lymphoma for five years, only 44% of respondents correctly indicated that they would conduct an annual physical exam, clinical lab tests, thyroid function tests, and a chest x-ray. Respondents also showed lack of knowledge regarding appropriate studies to order for a patient presenting with specific symptoms and laboratory test results consistent with leukemia. The online/booth surveys were completed by 80 respondents; specific demographic data were not collected. Only 22% of respondents said that they are confident educating patients (and/or their caregivers) about hematologic malignancies. Respondents’ experience with available blood tests for MGUS and MDS was particularly poor -- only 10% said that they "have ordered" such tests while 46% were "unaware" of available tests. The overall ability of respondents to detect possible signs and symptoms of hematologic malignancies (specifically, leukemia, lymphoma, and multiple myeloma) was also low. Conclusion: In the eyes of the primary care community, hematologic malignancies are low-volume, high-risk conditions, and the complexity of diagnosing and providing long-term care to patients with hematologic malignancies is a growing challenge. Post-treatment chronic conditions such as late-onset cardiomyopathy, hypertension, and secondary malignancies often develop after therapy for hematologic malignancies and must be properly managed. Gaps in knowledge regarding the signs, symptoms, and diagnosis of hematologic malignancies may negatively impact timely referral to specialists. Because of their increasingly vital role in the cancer care continuum, PCPs need additional education to improve the short- and long-term outcomes of patients with hematologic malignancies.
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Ooi, Shirley Beng Suat, Bee-Choo Koh-Tai, Tar Choon Aw, Tang Chino Lau, and Steven Tuck Foo Chan. "Assessment of Dehydration in Adults Using Hematologic and Biochemical Tests." Academic Emergency Medicine 4, no. 8 (August 1997): 840–46. http://dx.doi.org/10.1111/j.1553-2712.1997.tb03804.x.
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Ahn, Jung Ja. "Study on the Hematologic and Blood Chemical Tests in Preelcampsia." Ewha Medical Journal 9, no. 3 (1986): 175. http://dx.doi.org/10.12771/emj.1986.9.3.175.
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Kumura, Takeo, Masayuki Hino, Takahisa Yamane, and Noriyuki Tatsumi. "Argatroban as an anticoagulant for both hematologic and chemical tests." Journal of Clinical Laboratory Analysis 14, no. 4 (2000): 136–40. http://dx.doi.org/10.1002/1098-2825(2000)14:4<136::aid-jcla2>3.0.co;2-1.
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Bowhay-Carnes, Elizabeth Ann, Shuko Lee, and Paromita Datta. "Evaluation of leukocytosis: Benign or malignant." Journal of Clinical Oncology 34, no. 7_suppl (March 1, 2016): 245. http://dx.doi.org/10.1200/jco.2016.34.7_suppl.245.
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245 Background: Hematologists frequently evaluate patients with leukocytosis to differentiate between benign and malignant causes. The objective of this quality improvement project was to identify risk factors for malignant leukocytosis. Methods: A retrospective analysis of 1,330 consults in ALM VA Outpatient Hematology Clinic between 1/1/2011 and 2/22/2015 was performed. 147 patients referred for evaluation of leukocytosis were included in this study. The following data was collected: sex, age, race, ethnicity, BMI, tobacco use, total WBC, tempo of leukocytosis (constant vs intermittent), Hg level, plt count, ANC, ALC, AMC, AEC, ABC, laboratory tests performed during work-up, final diagnosis (primary hematologic malignancy vs secondary causes). 35 patients (24%) with a diagnosis of primary hematologic malignancy were compared with 112 patients (76%) with secondary causes and the relative risk of a primary hematology malignancy related to various risk factors was calculated. Results: See Table. Conclusions: Statistically significant independent risk factors for the presence of a primary hematologic malignancy as the cause of leukocytosis were identified. There was no increased risk based on race, ethnicity, BMI, AMC, or AEC. By identifying risk factors for malignant leukocytosis, we have created and implemented an algorithm outlining clinically appropriate and cost-effective laboratory evaluation for patients with leukocytosis.[Table: see text]
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O’Brien, Sarah H., Sherif M. Badawy, Seth J. Rotz, Mona D. Shah, Julie Makarski, Rachel S. Bercovitz, Mary-Jane S. Hogan, et al. "The ASH-ASPHO Choosing Wisely Campaign: 5 hematologic tests and treatments to question." Blood Advances 6, no. 2 (January 24, 2022): 679–85. http://dx.doi.org/10.1182/bloodadvances.2020003635.
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Abstract Choosing Wisely is a medical stewardship and quality-improvement initiative led by the American Board of Internal Medicine Foundation in collaboration with leading medical societies in the United States. The American Society of Hematology (ASH) has been an active participant in the Choosing Wisely project. In 2019, ASH and the American Society of Pediatric Hematology/Oncology (ASPHO) formed a joint task force to solicit, evaluate, and select items for a pediatric-focused Choosing Wisely list. By using an iterative process and an evidence-based method, the ASH-ASPHO Task Force identified 5 hematologic tests and treatments that health care providers and patients should question because they are not supported by evidence, and/or they involve risks of medical and financial costs with low likelihood of benefit. The ASH-ASPHO Choosing Wisely recommendations are as follows: (1) avoid routine preoperative hemostatic testing in an otherwise healthy child with no previous personal or family history of bleeding, (2) avoid platelet transfusion in asymptomatic children with a platelet count >10 × 103/μL unless an invasive procedure is planned, (3) avoid thrombophilia testing in children with venous access-associated thrombosis and no positive family history, (4) avoid packed red blood cells transfusion for asymptomatic children with iron deficiency anemia and no active bleeding, and (5) avoid routine administration of granulocyte colony-stimulating factor for prophylaxis of children with asymptomatic autoimmune neutropenia and no history of recurrent or severe infections. We recommend that health care providers carefully consider the anticipated risks and benefits of these identified tests and treatments before performing them.
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Murakami, Jun, and Yukihiro Shimizu. "Hepatic Manifestations in Hematological Disorders." International Journal of Hepatology 2013 (2013): 1–13. http://dx.doi.org/10.1155/2013/484903.
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Liver involvement is often observed in several hematological disorders, resulting in abnormal liver function tests, abnormalities in liver imaging studies, or clinical symptoms presenting with hepatic manifestations. In hemolytic anemia, jaundice and hepatosplenomegaly are often seen mimicking liver diseases. In hematologic malignancies, malignant cells often infiltrate the liver and may demonstrate abnormal liver function test results accompanied by hepatosplenomegaly or formation of multiple nodules in the liver and/or spleen. These cases may further evolve into fulminant hepatic failure.
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Scarisbrick, Julia J., Sean Whittaker, Alun V. Evans, Elisabeth A. Fraser-Andrews, Fiona J. Child, Alan Dean, and Robin Russell-Jones. "Prognostic significance of tumor burden in the blood of patients with erythrodermic primary cutaneous T-cell lymphoma." Blood 97, no. 3 (February 1, 2001): 624–30. http://dx.doi.org/10.1182/blood.v97.3.624.
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Abstract Erythrodermic cutaneous T-cell lymphoma (CTCL) includes patients with erythrodermic mycosis fungoides who may or may not exhibit blood involvement and Sézary syndrome and in whom hematological involvement is, by definition, present at diagnosis. These patients were stratified into 5 hematologic stages (H0-H4) by measuring blood tumor burden, and these data were correlated with survival. The study identified 57 patients: 3 had no evidence of hematologic involvement (H0), 8 had a peripheral blood T-cell clone detected by polymerase chain reaction (PCR) analysis of the T-cell receptor gene and less than 5% Sézary cells on peripheral blood smear (H1), and 14 had either a T-cell clone detected by Southern blot analysis or PCR positivity with more than 5% circulating Sézary cells (H2). Twenty-four patients had absolute Sézary counts of more than 1 × 109 cells per liter (H3), and 8 patients had counts in excess of 10 × 109 cells per liter (H4). The disease-specific death rate was higher with increasing hematologic stage, after correcting for age at diagnosis. A univariate analysis of 30 patients with defined lymph node stage found hematologic stage (P = .045) and lymph node stage (P = .013) but not age (P = .136) to be poor prognostic indicators of survival. Multivariate analysis identified only lymph node stage to be prognostically important, although likelihood ratio tests indicated that hematologic stage provides additional information (P = .035). Increasing tumor burden in blood and lymph nodes of patients with erythrodermic CTCL was associated with a worse prognosis.The data imply that a hematologic staging system could complement existing tumor-node-metastasis staging criteria in erythrodermic CTCL.
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Hong, Sang-Wook, Hye Ryoun Kim, and Suk-Won Ahn. "Inflammatory Polyneuropathy Associated with Myelodysplastic Syndrome." Journal of the Korean Neurological Association 40, no. 4 (November 1, 2022): 338–42. http://dx.doi.org/10.17340/jkna.2022.4.11.
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Inflammatory polyneuropathy may be associated with various tumorous diseases, including hematological malignancy. A 50-year-old man visited neurologic department complaining of bilateral lower extremities weakness, tingling sensation and weight loss. Initially he was diagnosed as demyelinating sensorimotor polyneuropathy after performing the nerve conduction study, furthermore myelodysplastic syndrome was revealed by the hematologic tests and bone marrow examination. Conclusively, high-dose steroid therapy, intravenous immunoglobulin and chemotherapy improved neurological symptoms. This case suggests myelodysplastic syndrome could be uncommon cause of the inflammatory polyneuropathy.
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Brenneman, Susan K., Angela V. Belland, Erin M. Hulbert, and Stephanie Korrer. "Hematologic Malignancies: Impact of an Integrated Pathology Process and Decision Support Tool on Diagnosis and Follow-up Health Care Costs." Blood 124, no. 21 (December 6, 2014): 6014. http://dx.doi.org/10.1182/blood.v124.21.6014.6014.
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Abstract Background: The process of integrating and interpreting information from multiple diagnostic tests, which may have been provided by multiple laboratories, can result in inaccurate diagnoses and treatment delays for patients with hematologic malignancies. A diagnostic process and decision support tool that integrates laboratory results and guides clinical diagnosis may improve diagnostic accuracy and targeted treatment. This study compares the completeness and actionability of bone marrow biopsy work-up results as well as follow-up health care costs for patients with suspected hematologic cancers whose diagnostic tests were managed by specialty hematology and other types of laboratories. Methods: Adult patients who had undergone a bone marrow biopsy (BMB) and had been diagnosed with a hematologic condition between January 2007 and March 2012 were identified from a large US commercial health insurance database affiliated with Optum. Patient cohorts were identified based upon laboratories performing marrow morphologic assessment/directing testing sequence: Genoptix (GX, a specialty hematology-testing laboratory) and large commercial laboratories and other laboratories such as community hospital laboratories (OL); academic labs were not included. Cohorts identified for medical chart review were matched for age, sex, geographic region, primary diagnosis on the bone marrow biopsy index date, comorbidity score, and all-cause health care costs. Medical charts were obtained from the BMB-referring physician. Independent oncologists and hematologists reviewed patients’ medical charts to determine the impact of BMB pathology reports on diagnosis and disease management. GX and OL reports were compared for completeness (diagnostic work-up in accordance with guidelines and no additional tests recommended) and actionability (enough information provided to make or rule out a diagnosis and to generate treatment recommendations). Administrative claims health care costs per patient per month (PPPM) for the period 30 days post-biopsy through 12 months were examined. Logistic regression assessed differences between cohorts for completeness, actionability and definitive diagnosis adjusted for age, gender, comorbidity and initial diagnosis on the index date. Generalized linear models assessed costs, adjusting for demographics, baseline clinical characteristics, initial diagnosis on the BMB date, definitive diagnosis, completeness and actionability on the BMB work-up report. Results: This analysis included 499 subjects with BMB results from GX (n=249) or OL (n=250). Overall, average age of patients was 52 (SD 12) with baseline Quan-Charlson score of 1.2 (SD 1.5). The majority of patients had a non-cancer hematological condition diagnosis on the index date (GX 64% and OL 56%) rather than a specific hematological cancer diagnosis. The GX BMB work-up reports were more likely to be complete (OR 2.2; p=0.001) and provide a definitive diagnosis (OR 2.1; p< 0.001) than the OL BMB work-up reports. The odds for GX reports to be actionable compared to OL reports for actionability were greater (OR 1.3) although not statistically significant. Follow-up PPPM overall health care costs for GX patients were 32% (p=0.04) lower than for the OL patients. Conclusions: Comprehensive integrated reports of complete bone marrow biopsy work-up results provide advantages over traditional lab reports by highlighting critical information and ensuring testing is completed according to both guidelines and clinical need. Disclosures Brenneman: Optum: Employment. Belland:Optum: Employment. Hulbert:Optum: Employment. Korrer:Optum: Employment, Equity Ownership.
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Sajjad, Sahir, Abdul Ghaffar, and Muhammad Imran Qadir. "Demographic and hematologic pattern of acute myeloid leukemia patients from lower Punjab area." Pakistan Journal of Pharmaceutical Research 2, no. 2 (July 15, 2016): 127. http://dx.doi.org/10.22200/pjpr.20162127-135.
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Purpose of this study was to evaluate the demographic and hematologic pattern of acute myeloid leukemia patients from lower Punjab area. The treatment of the acute myeloid leukemia patients is related with the unsatisfactory rates of complete responses that usually as short lived. At the relapse of leukemia patients the evaluation of investigational treatment strategies, therapeutic decision making by clinically useful prognostic index. All the hematological techniques were applied to increase the life expectancy of the leukemia patients. The study concluded that acute myeloid leukemia was prevalent in local population especially in males as compared to females. All the patients had varied CBCs profiles. The hematological tests are used to characterize the disease for its management and treatment to increase the life expectancy of the patients.
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Engel-Nitz, Nicole M., Benjamin Eckert, Rui Song, Erin M. Hulbert, Jeffrey McPheeters, and April Teitelbaum. "Changes in Diagnoses and Outcomes for Patients of Hematopathology Specialty and Other Laboratories." Blood 120, no. 21 (November 16, 2012): 4700. http://dx.doi.org/10.1182/blood.v120.21.4700.4700.
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Abstract Abstract 4700 Introduction: Advances in diagnostic testing, including molecular profiling, have improved diagnostic accuracy for hematologic cancers, but with increased need for integration and interpretation of data from multiple tests. Accurate and earlier diagnosis may be achieved with use of hematopathology specialty laboratories, supporting appropriate patient management. This study compares diagnostic changes, patterns of additional testing, treatment decisions, and health care costs for patients with suspected hematologic cancers whose diagnostic tests were managed by specialty hematology and other types of laboratories. Methods: Patients with bone marrow procedure (biopsy/aspirate) and suspected hematologic cancer/disease were identified from claims data (2005 – 2011) from a large US health plan. Included patients had ≥6 pre- & ≥3-months post-biopsy health plan coverage. Lab tests in the 30 days post-biopsy were identified. Patient cohorts were based upon laboratories performing marrow morphology assessment/directing testing sequence: Genoptix (GX, a specialty hematology-testing laboratory); large commercial laboratories (LL), and other laboratories (OL) such as community hospital laboratories; academic labs were not included. Following the bone marrow testing, initial diagnoses were identified. As a proxy for diagnostic uncertainty, we determined whether patients' initial diagnoses remained stable and whether diagnostic changes were recorded in the 1 year following initial biopsy; codes indicative of disease progression or hematologic signs/symptoms were explicitly not counted as instability or change. Health care costs (per patient per month) for the 1 year period post-biopsy were examined. Chi-square and F-tests assessed unadjusted differences between cohorts. Logistic regression assessed differences between cohorts in stability, change in diagnosis and repeat biopsies. Generalized linear models assessed costs, adjusting for demographics, baseline clinical characteristics and initial and final diagnoses. Results: The study population included a total of 1,387 GX, 4,162 LL, and 19,115 OL patients with suspected hematologic malignancy/disease and bone marrow morphology assessment. OL patients were slightly younger (average age 58.19 OL vs. 59.88 GX, 59.39 LL, P<0.001), and slightly more likely to be enrolled in MedicareAdvantage plans (25.24% OL, vs. 23.00% GX and 21.19% LL, p<0.001). Stability of initial diagnosis varied across the cohorts; 6.16% GX, 8.04% LL, and 9.73% OL patients had unstable initial diagnoses (p<0.001); compared to OL, adjusted odds ratios were 0.864 for GX [95% CI: 0.678,1.1] and 1.07 for LL [95% CI: 0.93, 1.23]. Changes to hematologic diagnoses occurred for 7.88% of GX, 11.19% of LL, and 14.08% OL patients (p<0.001), with adjusted odds ratios of change vs. OL of 0.82 for GX [95% CI: 0.72, 0.93] and 0.93 for LL [95% CI: 0.86, 1.01]. Fewer GX patients underwent repeat marrow biopsies (9.59% GX, vs. 17.11% LL and 28.16% OL, p<0.001), with differences remaining after adjusting for types of cancer diagnoses and other characteristics (odds ratios vs. OL: GX 0.31 [0.25, 0.37]; LL 0.54 [0.49, 0.60]). Among patients who began chemotherapy, 4.58% GX, 6.68% LL, and 7.37% OL (p=0.91) changed treatment within 30 days of treatment initiation; an additional 1.78% GX, 3.68% LL, and 5.12% OL (p=0.001) patients changed treatment within 60 days. 1-year PPPM costs adjusted for differences in patient characteristics were $8,202 GX, $7,711 LL, and $10,302 OL p<0.05); unadjusted costs were $5,362 GX, $6,409 LL, and $10,061 OL (P<0.001). Adjusted costs PPPM excluding the testing period were $6,019 GX, $6,649 LL, and $7,801 OL (p<0.05); unadjusted costs for this period were $3,853 GX, $5,171 LL, and $7,653 OL (P<0.0001). Conclusions: Stability and changes in hematologic diagnoses varied by the type of lab performing the initial testing on the bone marrow sample, with a trend for fewer changes observed for the hematology specialty lab. Repeat bone marrow biopsies, changes in chemotherapy, and costs in the period following initial diagnostic workup were lower for patients whose samples were assessed by the specialty laboratory versus other types of laboratories after adjusting for differences in patient populations. Further exploration of the impact of management by specialized (hematopathologist) compared to general pathology services on outcomes is warranted. Disclosures: Engel-Nitz: Novartis Molecular Diagnostics: Research Funding to OptumInsight Other. Eckert:Novartis Molecular Diagnostics: Employment. Song:Novartis Molecular Diagnostics: Research funding to OptumInsight. Other. Hulbert:Novartis Molecular Diagnostics: Research Funding to OptumInsight. Other. McPheeters:Novartis Molecular Diagnostics: Research funding to OptumInsight Other. Teitelbaum:Novartis Molecular Diagnostics: Research funding to OptumInsight. Other.
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Galvão, Gilmar Rodrigues, Elane Guerreiro Giese, Gilvando Rodrigues Galvão, Luiz Fernando Moraes Moreira, Maridelzira Betânia Moraes David, Erica Flávia Silva Azevedo, Mateus Augusto de Carvalho Santana, and Bruno Kleidson da Silva Maia. "Hematological values in bradypus variegatus (Schinz, 1825) from creatories of the Belém metropolitan region." Revista Ibero-Americana de Ciências Ambientais 10, no. 5 (October 12, 2019): 82–88. http://dx.doi.org/10.6008/cbpc2179-6858.2019.005.0008.
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The blood tissue is made up of three main cell types: erythrocytes (red blood cells), leukocytes (white blood cells) and platelets (thrombocytes), suspended in a liquid phase named plasma. In addition to the cells, blood is composed of proteins, inorganic and organic substances, hormones and various components. The captive condition can also predispose the animal to a number of conditions, making it necessary to carry out laboratory tests for the biomonitoring of the animals. Among these tests, the complete hemogram stands out. This is done to assess the general health, guiding and deepening the nature of pathophysiological situations besides its utility as an aid to diagnosis and prognosis of certain diseases. The objective of this study is to describe the hematological values of brown-throated sloth (Bradypus variegatus). Hence, eleven adult animals of both sexes (seven males and four females) at appropriate health conditions were used in the experiment. Blood was collected from the cephalic vein and analyzed through veterinary hematology counter. The evaluate hematological parameters included total count of erythrocytes and leukocytes, hematocrit, hemoglobin concentration, average corpuscular volume, average corpuscular hemoglobin, average corpuscular hemoglobin concentration differential leukocyte count and platelet count. In general, the values did not differ from few studies in the literature. However, the score of platelets was greater in males than in females. The results achieved in the study can serve as a basis in determination and interpretation as hematologic references to brown-throated sloths in Para Amazon.
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Shapira, Shiran, Dina Kazanov, Fatin Mdah, Hadas Yaakobi, Yair Herishanu, Chava Perry, Irit Avivi, et al. "Feasibly of CD24/CD11b as a Screening Test for Hematological Malignancies." Journal of Personalized Medicine 11, no. 8 (July 27, 2021): 724. http://dx.doi.org/10.3390/jpm11080724.
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An estimated 1.24 million blood cancer cases occur annually worldwide, accounting for approximately 6% of all cancer cases. Currently, there are no standardized hematology cancer screening tests that are recommended for the general population. CD24 is a mucin-like cell surface molecule and P-selectin ligand, which plays a significant role in the maturation of B-lymphocytes and was found to be overexpressed in a number of hematological malignancies. Our primary aim was to assess the sensitivity and specificity of the CD24/CD11b-based blood test for the detection of hematological malignancies. Our cohort included 488 subjects with positive hematological cancer diagnosis (n = 122) and healthy subjects (n = 366). CD24/CD11b expression in peripheral blood leukocytes (PBLs) obtained from blood samples of participants was analyzed by flow cytometry. Our results demonstrated that the average levels of CD24/CD11b in healthy patients (21.7 ± 9.0) were statistically significantly lower compared to levels of CD24/CD11b in cancer patients (29.5 ± 18.7, p < 0.001). The highest levels of CD24/CD11b were found in multiple myeloma (39.1 ± 23.6), followed by chronic myeloid leukemia (33.0 ± 13.7) and non-Hodgkin lymphoma (32.3 ± 13.3). The test had an overall sensitivity for hematologic cancers of 78.5% (95% CI, 70.7–86.3%) and specificity of 80.2% (95% CI, 76.1–84.3%). In conclusion, our findings indicate the feasibility of a CD24/CD11b-based blood test as a screening test of hematological malignancies.
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Banaszak, Lauren G., Matthew James Brunner, Chad Guenther, and Eliot C. Williams. "A Comprehensive Microscopy and Peripheral Blood Smear Curriculum for Hematology Fellows." Blood 142, Supplement 1 (November 28, 2023): 7202. http://dx.doi.org/10.1182/blood-2023-185126.
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Background: Peripheral blood smear (PBS) analysis is an essential skill for the practicing hematologist and allows for the timely diagnosis of a variety of hematologic disorders. In most cases, PBS analysis can be performed faster than advanced laboratory tests, allowing for the prompt treatment of life-threatening diseases, such as acute promyelocytic leukemia and thrombotic microangiopathies. For these reasons, the Accreditation Council for Graduate Medical Education requires that hematology fellows achieve competency in PBS interpretation in order to graduate. However, most hematology training programs lack a structured PBS curriculum and formalized method of skills assessment. Consensus recommendations were recently developed by a multi-institutional focus group as to the ideal structure and components of PBS curricula within hematology training programs (Chase et al., Blood Advances, 2023). Herein, we report our initial experience implementing a longitudinal PBS curriculum for hematology fellows based on these consensus guidelines and demonstrate the effectiveness of this curriculum using a novel assessment tool. Methods: We developed a longitudinal PBS curriculum for hematology fellows at the University of Wisconsin-Madison. The curriculum included an introductory course for first-year fellows on the use of a microscope, slide handling, and PBS review using a hands-on and collaborative approach (Figure 1A). The introductory course included five two-hour sessions spanning the first two months of fellowship. The first three sessions were led by a faculty member and senior fellow and included training on how to use the microscope as well as identification of normal blood cell morphology and blood cell morphologies and hematologic diagnoses deemed high-priority by consensus recommendations using a slide library. For the final two sessions, the fellows were provided with a set of unknowns and asked to work as a group to identify the pathologic findings and underlying diagnosis. The introductory course was supplemented with ongoing experience and education on PBS interpretation through hematology consult, ward, and clinic rotations throughout fellowship under the direction of hematology faculty skilled in PBS analysis. A novel assessment tool was distributed to participants before and after the introductory course in order to assess the effectiveness of the curriculum. The assessment tool was a ten-question image-based questionnaire in which fellows were prompted to identify high-priority morphologies or hematologic diagnoses after being provided with a clinical vignette and associated PBS for review. Results: To date, four hematology fellows have participated in the PBS curriculum. Prior to the introductory course, no participants expressed feeling very or extremely confident in analyzing and interpreting PBS. After the introductory course, 25% of participants expressed feeling very confident in analyzing and interpreting PBS, whereas the remaining 75% felt somewhat confident. 75% of participants strongly agreed that the course improved their ability to use a microscope, and 100% of participants strongly agreed that the course improved their ability to analyze and interpret PBS. Participation in the course led to improved ability of participants to identify high-priority blood cell morphologies and diagnoses as determined by the assessment tool (Figure 1B, 8.25/10 pre-course compared to 9/10 post-course). Conclusions: Our longitudinal PBS curriculum was perceived positively by hematology fellows and led to improved confidence and independence in using a microscope and PBS interpretation. Additionally, participation in the introductory course improved identification of high-priority PBS morphologic abnormalities and hematologic diagnoses. Our curriculum and assessment tool serve as proof of concept that can now be improved upon and potentially adopted on a larger scale to promote competency in PBS interpretation among hematology trainees.
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Ebert, Benjamin L., and Todd R. Golub. "Genomic approaches to hematologic malignancies." Blood 104, no. 4 (August 15, 2004): 923–32. http://dx.doi.org/10.1182/blood-2004-01-0274.
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AbstractIn the past several years, experiments using DNA microarrays have contributed to an increasingly refined molecular taxonomy of hematologic malignancies. In addition to the characterization of molecular profiles for known diagnostic classifications, studies have defined patterns of gene expression corresponding to specific molecular abnormalities, oncologic phenotypes, and clinical outcomes. Furthermore, novel subclasses with distinct molecular profiles and clinical behaviors have been identified. In some cases, specific cellular pathways have been highlighted that can be therapeutically targeted. The findings of microarray studies are beginning to enter clinical practice as novel diagnostic tests, and clinical trials are ongoing in which therapeutic agents are being used to target pathways that were identified by gene expression profiling. While the technology of DNA microarrays is becoming well established, genome-wide surveys of gene expression generate large data sets that can easily lead to spurious conclusions. Many challenges remain in the statistical interpretation of gene expression data and the biologic validation of findings. As data accumulate and analyses become more sophisticated, genomic technologies offer the potential to generate increasingly sophisticated insights into the complex molecular circuitry of hematologic malignancies. This review summarizes the current state of discovery and addresses key areas for future research.
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Silva, Bianca Ressetti da, Morgana de Fátima Kuteques Ferreira, Gabriela Maffezzolli, Marília de Oliveira Koch, Olair Carlos Beltrame, Isis Indaiara Gonçalves Granjeiro Taques, Amanda Noéli da Silva Campos, Daniel Moura de Aguiar, and Rosangela Locatelli Dittrich. "Detection molecular of Rangelia vitalii in dogs from Parana State, Southern Brazil." Revista Brasileira de Parasitologia Veterinária 28, no. 2 (April 2019): 310–13. http://dx.doi.org/10.1590/s1984-296120180080.
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Abstract Rangelia vitalii infects erythrocytes, leukocytes and endothelial cells of dogs. The present study aimed to report the molecular detection confirmed by sequencing of R. vitalii in the state of Paraná, as well as describe the clinical, hematological and biochemical alterations of the infected dogs. Three sick dogs from the metropolitan area of Curitiba, PR, Brazil, underwent a physical exam, and laboratory tests included hematology, biochemistry, polymerase chain reaction (PCR), and gene sequencing. Clinical signs included apathy, anorexia, and hemorrhage. Intra-erythrocytic and extracellular piroplasms were found on peripheral blood smears from all three dogs. Blood samples from these animals were positive for Babesia sp. by PCR targeting 18S rRNA. PCR products from all three dogs were sequenced, and BLAST analysis showed that the PCR-generated sequences were highly homologous with those of R. vitalii previously reported. Hematologic findings included severe anemia, shift of neutrophils to the regenerative left, and thrombocytopenia. Serum urea levels were increased in all three dogs, and direct bilirubin levels were elevated in one dog.
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Dawson, Dominic R., Richard J. DeFrancisco, and Tracy Stokol. "Reference intervals for hematologic and coagulation tests in adult alpacas (Vicugna pacos)." Veterinary Clinical Pathology 40, no. 4 (October 24, 2011): 504–12. http://dx.doi.org/10.1111/j.1939-165x.2011.00359.x.
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Peters, Luanne L., Eleanor M. Cheever, Heather R. Ellis, Phyllis A. Magnani, Karen L. Svenson, Randy Von Smith, and Molly A. Bogue. "Large-scale, high-throughput screening for coagulation and hematologic phenotypes in mice*." Physiological Genomics 11, no. 3 (December 3, 2002): 185–93. http://dx.doi.org/10.1152/physiolgenomics.00077.2002.
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The Mouse Phenome Project is an international effort to systematically gather phenotypic data for a defined set of inbred mouse strains. For such large-scale projects the development of high-throughput screening protocols that allow multiple tests to be performed on a single mouse is essential. Here we report hematologic and coagulation data for more than 30 inbred strains. Complete blood counts were performed using an Advia 120 analyzer. For coagulation testing, we successfully adapted the Dade Behring BCS automated coagulation analyzer for use in mice by lowering sample and reagent volume requirements. Seven automated assay procedures were developed. Small sample volume requirements make it possible to perform multiple tests on a single animal without euthanasia, while reductions in reagent volume requirements reduce costs. The data show that considerable variation in many basic hematological and coagulation parameters exists among the inbred strains. These data, freely available on the World Wide Web, allow investigators to knowledgeably select the most appropriate strain(s) to meet their individual study designs and goals.
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Frinc, Ioana, Petru Ilies, Florin Zaharie, Delia Dima, Alina Tanase, Ljubomir Petrov, Alexandru Irimie, et al. "Transthoracic ultrasonography for the immunocompromised patient. A pilot project that introduces transthoracic ultrasonography for the follow-up of hematological patients in Romania." Romanian Journal of Internal Medicine 55, no. 2 (June 1, 2017): 103–16. http://dx.doi.org/10.1515/rjim-2017-0006.
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Abstract In the past decade, there has been significant progress in clinical hematology with the discovery of targeted molecules and thus the achievement of both hematologic and molecular responses. Nevertheless, chemotherapy remains the treatment of choice for many types of hematological malignancies. Aggressive chemotherapy leads to immunosuppression, accompanied by a high rate of infections and an increased rate of treatment-related mortality. Invasive fungal infections as well as more common bacterial and viral infections are frequent in immunocompromised patients as they are difficult to diagnose and treat. Pleuropulmonary infections in immunocompromised patients are diagnosed using clinical examination, imaging and laboratory tests. Many laboratory tests are run for several days before a final result is given and are expensive. Computer tomography is a reliable technique, but it is encumbered by high irradiation and high cost, and can assess lesions larger than 1 cm. Transthoracic ultrasound is a modern method, used in the diagnostic algorithm of pleuropulmonary pathology. It allows the diagnosis of small lesions, can be performed at the patients’ bedside, with acceptable costs and no irradiation. A fast, informed and accurate medical decision is essential for a favorable outcome in immunosuppressed patients with an adjacent infection. In the current case series we present the implementation of a new protocol for the follow-up of immunocompromised patients using transthoracic ultrasonography, of great potential use in the clinic.
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Liestiadi, Deddy Eka Febri, Emil Azlin, and Selvi Nafianti. "A hematologic scoring system and C-reactive protein compared to blood cultures for diagnosing bacterial neonatal sepsis." Paediatrica Indonesiana 57, no. 2 (April 28, 2017): 70. http://dx.doi.org/10.14238/pi57.2.2017.70-5.
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Background Neonatal sepsis is the leading cause of death after pneumonia. Definitive bacterial sepsis diagnoses are made by blood culture results, which require a lengthy time. C-reactive protein (CRP) levels and a hematologic scoring system by Rodwell et al. are rapid tests that may be useful for diagnosing neonatal sepsis. Objective To determine the diagnostic value of CRP measurement and a hematologic scoring system compared to blood culture as the gold standard for diagnosing neonatal sepsis. Methods A cross-sectional study was conducted from April to August 2015 in the Neonatology Ward of Haji Adam Malik Hospital, Medan. A total of 43 neonates who were clinically suspected to have sepsis underwent CRP, hematologic scoring, and blood cultures. The IT ratio and procalcitonin indices were also examined. Diagnostic values were analyzed by a 2x2 table.Results Fourteen percent from all sample had positive bacterial culture. The CRP measurements had a sensitivity of 92.8%, specificity of 62%, positive predictive value (PPV) of 54.1%, negative predictive value (NPV) of 94.7%, positive likelihood ratio (PLR) of 2.44, and negative likelihood ratio (NLR) of 0.11. The hematologic scoring system had a sensitivity of 100%, specificity of 82.7%, PPV of 73.6%, NPV of 100%, PLR of 5.78, and NLR of 0. Procalcitonin and IT ratio show a good value of sensitivity and NPV, respectively. Conclusion The hematologic scoring system has better specificity than CRP measurement as compared to blood culture. However, both tests have good sensitivity for diagnosing neonatal sepsis.
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Bakr, Salwa, Areej AlFattani, Randa Al-Nounou, Nasir Bakshi, Haitham Khogeer, Maha Alharbi, Nasser Almousa, et al. "Hematologic reference intervals for healthy adult Saudis in Riyadh." Annals of Saudi Medicine 42, no. 3 (May 2022): 191–203. http://dx.doi.org/10.5144/0256-4947.2022.191.
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BACKGROUND: Laboratory hematological tests are widely used in clinical practice to assess health and disease conditions. Reference ranges provided by laboratory reports are considered the most authoritative medical tools to assist in the decision-making phase. International standards institutes recommend that reference ranges be established for each region. OBJECTIVES: Provide reference values of routine hematological parameters in Saudi adults according to age and gender. DESIGN: Cross-sectional SETTING: Central province of Saudi Arabia. PATIENTS AND METHODS: Apparently healthy Saudi adults were subjected to laboratory testing of routine hematological parameters (full blood count, hemostatic profile, and serum hematinics), after completing a detailed health medical questionnaire. MAIN OUTCOME MEASURES: Hematological reference values based on the local population. SAMPLE SIZE AND CHARACTERISTICS: 637 after screening 827 potentially healthy Saudi adults with ages ranging from 15 to 65 years. RESULTS: The reference values of routine hematological parameters for the full population and by gender are presented with 90% CI as the lower and upper limits. Reference ranges mostly differed from universal established ranges shown in textbooks. CONCLUSION: The reference ranges of routine hematologic parameters for accurate assessment and appropriate management will help improve the routine clinical care of the adult Saudi population. LIMITATIONS: Difficulty in assessing health status of participants, who could have subclinical illnesses not reflected in the evaluated blood measurement. Lack of ability to eliminate individuals who might be carriers for haemoglobinopathies. Studies with larger sample sizes from different areas of the country are required to achieve a more accurate representation of the whole Saudi population. CONFLICT OF INTEREST: None.
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Uhrikova, Ivana, Milan Sepsi, Jana Hlozkova, Pavel Suchy, Marta Kasajova, Katerina Machackova, Delian P. Delev, Rachele Ciccocioppo, Peter Kruzliak, and Peter Scheer. "Changes in Hematologic and Coagulation Profiles in Rabbits with Right-ventricle Pacing." Folia Medica 58, no. 2 (June 1, 2016): 89–94. http://dx.doi.org/10.1515/folmed-2016-0013.
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Abstract Objectives: The aim of this study was to evaluate changes in hematology and coagulation in rabbits with right-ventricle pacing without medication. Animals and methods: Blood was collected from ten non-anesthetized male rabbits from the jugular vein before and one month after pacemaker placement. Total erythrocyte, leukocyte and platelet count, hemoglobin, hematocrit and differential leukocyte count were done on automatic veterinary flow cytometry hematologic analyzer. Prothrombin time, activated partial thromboplastin time, fibrinogen level, D-dimers and kaolin-activated thromboelastography was measured from citrated blood. Results: We found an increase in red blood cell mass and decrease in platelet count, while coagulation tests did not diff er between samplings. Conclusion: Right-ventricle pacing seems to have no influence on hemostasis in rabbits.
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Devkota, Khagendra Raj, S. Subedi, S. Bhandari, B. Kandel, J. Shrestha, and KS Sharma. "Myeloproliferative Disease: Dealing With a Diagnostic Dilemma." Nepalese Journal of Cancer 5, no. 1 (September 26, 2021): 67–69. http://dx.doi.org/10.3126/njc.v5i1.42283.
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Myeloproliferative neoplasms (MPNs) constitute a group of hematologic clonal diseases that affect one or more myeloid lineages with abnormal proliferation. It is rare disease entity and incidence is about 1.15 to 4.99/100 000 person-years among hematological neoplasms for all subtypes of MPNs combined. Patients who present with hepatosplenomegaly, hyperleukocytosis with monocytosis should have routine tests along with bone marrow morphology possibly biopsy, quantiferon TB Gold in tube test, Dengue fever IgM, IgG, NS-1 antigen, cytogenetics t(9;22), BCR cABL fusion gene, JAK-2 V617F, MPL mutations, CALR gene test done along with karyotyping and flowcytometry to evaluate and establish diagnosis towards management.
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Keruakous, Amany R., Teresa A. Scordino, James N. George, Leslie Renee Ellis, Myles Nickolich, and Adam S. Asch. "Hybrid Cross-Discipline, Interactive Curriculum to Nurture the Training Experience for Hematology-Oncology Trainees." Blood 138, Supplement 1 (November 5, 2021): 2981. http://dx.doi.org/10.1182/blood-2021-144988.
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Abstract Introduction: Hematologic malignancy is a complex science that requires the integration of numerous advanced pathology techniques, including flow cytometry, genomic analysis, and molecular diagnostics, for diagnosis and risk stratification to guide management plans and optimize patient care. Understanding the methodology and proper utilization of new laboratory test methodologies relevant to patient care are required competencies for graduating hematology/oncology trainees, put forth by the Accreditation Council for Graduate Medical Education (ACGME). Therefore, these competencies are heavily tested on specialty board certification exams. We aimed at familiarizing our trainees with distinct laboratory test methodologies, and classifications of hematologic neoplasms from a hematopathologist's perspective. Simplifying such a complex science is a potential way to help trainees conceptualize the proper uses of several diagnostic tests. A shared understanding of clinical and pathologic approaches to hematologic malignancies will lead to improved advanced knowledge in the field, test-taking capabilities and reflect on patient care. We hypothesized that delivering cross-discipline training will improve the level of knowledge for our trainees, and reflect on the hematology in-training-exam scores and subsequently improve the American board of hematology participation and pass rates. Method: Curriculum Description: We developed a cross-discipline curriculum, three-month experience that included rigorous training in advanced hematopathology focused on hematologic malignancies. The curriculum included two hours per week, hybrid style interactive sessions --online/in-person classes--. A self-directed component included pre-class readings and pre- and post-weekly quizzes. The in-person sessions included interactive, case-based seminars guided by cross-discipline faculty members. Instructors for the curriculum included a malignant hematologist and a hematopathologist. The enrollment to the described curriculum made available for all hematology-oncology fellows, internal medicine residents, and advanced practice providers (APPs). This project was accomplished as part of the ASH Medical Educator Institute. Evaluation plan: Trainees were given pre- and post-intervention case-based exams as well as pre- and post-quizzes every week, to assess their knowledge and level of progression. For hematology fellows, trainee's performance on in-training exams (ITEs) was also compared to a historical control group of trainees from the same program. Results: The training included twenty-six participants, eight hematology-oncology fellows, five medical residents, six APPs, and seven faculty. Faculty participants were excluded from the performance evaluation to avoid bias introduction. Pre-class surveys and quizzes were collected to measure baseline knowledge of different hematology subjects and to guide the focus of the training based on common weaknesses amongst a majority of participants. Eighty-six percent of participants elected to attend the training to improve their clinical practice experience and exam scores, the rest intended to network academically. Before each session, participants finished the pre-session quizzes that was compared to the post-session quizzes. We report the persistent positive impact of the sessions on the trainees' weekly performances. We measured the overall impact of the training, comparing the pre-intervention exam with midterm and final exam scores, which also significantly increased compared to pre-intervention scores. (Figures 1 & 2) For hematology Oncology trainees, we also measured the impact of this training on their in-training-exam scores, compared to historical controls from the same fellowship program. For the hematology in-training exam scores, we noticed a significant improvement after the intervention for the year 2021 compared to the year 2020. An increase in the program means score, which reflected on the program overall performance with an increase in our percentile rank by approximately 14 points. Conclusion: Developing a cross-discipline interactive training curriculum is an innovative method to enhance the hematology-oncology trainees' experience. It promoted their level of knowledge and improved exam skills, which is reflected in the annual in-training exam scores. Figure 1 Figure 1. Disclosures Ellis: Rafael Pharmaceuticals: Consultancy.
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Azegami, Tatsuhiko, Tomoyasu Nishimura, Ayano Murai-Takeda, Nobuko Yamada-Goto, Yasunori Sato, and Masaaki Mori. "The distributions of hematologic and biochemical values in healthy high-school adolescents in Japan." PLOS ONE 15, no. 11 (November 17, 2020): e0242272. http://dx.doi.org/10.1371/journal.pone.0242272.
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Laboratory tests of adolescents are often interpreted by using reference intervals derived from adults, even though these populations differ in their physical and physiologic characteristics and disease susceptibility. Therefore, to examine the distribution of laboratory values specific for adolescents, we analyzed hematologic and biochemical measurements obtained from 12,023 healthy Japanese adolescents (ages 15 through 18 years; male, 9165; female, 2858) during 2009 through 2018. Distributions were shown as medians with 95% (2.5th and 97.5th percentiles) of values and were compared with those from previous studies that examined similar Asian populations. There were some differences between hematologic parameters, serum creatinine and uric acid concentration, and lipid levels of Japanese adults and adolescents. In comparison with other Asian populations, the distributions of serum uric acid and high-density–lipoprotein cholesterol in the present study were slightly higher than those in the other studies. Although further research is need, the distributions of hematologic and biochemical tests in adolescents may have the potential to facilitate the early identification and management of disease in this population.
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Bou Zerdan, Maroun, Lewis Nasr, Ludovic Saba, Paul Meouchy, Nadine Safi, Sabine Allam, Jenish Bhandari, and Chakra P. Chaulagain. "A Synopsis Clonal Hematopoiesis of Indeterminate Potential in Hematology." Cancers 14, no. 15 (July 28, 2022): 3663. http://dx.doi.org/10.3390/cancers14153663.
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Clonal hematopoiesis of indeterminate potential can be defined as genetic mutations that correlate in hematologic neoplasia such as myelodysplastic syndrome. Patients with cytopenia increasingly undergo molecular genetic tests of peripheral blood or bone marrow for diagnostic purposes. Recently, a new entity has been demarcated to lessen the risk of incorrect diagnoses of hematologic malignancies. This new entity is a potential precursor of myeloid diseases, analogous to monoclonal gammopathy of undetermined significance as a potential precursor of multiple myeloma.
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Tang, Zhenya, Jun Gu, Guilin Tang, and L. Jeffrey Medeiros. "Quality Assurance/Quality Control of Fluorescence in Situ Hybridization Tests in Hematologic Malignancies." OBM Genetics 2, no. 4 (October 3, 2018): 1. http://dx.doi.org/10.21926/obm.genet.1804038.
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Turner, Samuel J., Terry R. Ketch, Sanjay K. Gandhi, and David C. Sane. "Routine hematologic clinical tests as prognostic markers in patients with acute coronary syndromes." American Heart Journal 155, no. 5 (May 2008): 806–16. http://dx.doi.org/10.1016/j.ahj.2007.11.037.
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Hicks, Lisa K., Harriet Bering, Kenneth R. Carson, Judith Kleinerman, Vishal Kukreti, Alice Ma, Brigitta U. Mueller, et al. "The ASH Choosing Wisely® campaign: five hematologic tests and treatments to question." Hematology 2013, no. 1 (December 6, 2013): 9–14. http://dx.doi.org/10.1182/asheducation-2013.1.9.
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Abstract Choosing Wisely® is a medical stewardship and quality improvement initiative led by the American Board of Internal Medicine Foundation in collaboration with leading medical societies in the United States. The ASH is an active participant in the Choosing Wisely® project. Using an iterative process and an evidence-based method, ASH has identified 5 tests and treatments that in some circumstances are not well supported by evidence and which in certain cases involve a risk of adverse events and financial costs with low likelihood of benefit. The ASH Choosing Wisely® recommendations focus on avoiding liberal RBC transfusion, avoiding thrombophilia testing in adults in the setting of transient major thrombosis risk factors, avoiding inferior vena cava filter usage except in specified circumstances, avoiding the use of plasma or prothrombin complex concentrate in the nonemergent reversal of vitamin K antagonists, and limiting routine computed tomography surveillance after curative-intent treatment of non-Hodgkin lymphoma. We recommend that clinicians carefully consider anticipated benefits of the identified tests and treatments before performing them.
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Hicks, Lisa K., Harriet Bering, Kenneth R. Carson, Judith Kleinerman, Vishal Kukreti, Alice Ma, Brigitta U. Mueller, et al. "The ASH Choosing Wisely® campaign: five hematologic tests and treatments to question." Blood 122, no. 24 (December 5, 2013): 3879–83. http://dx.doi.org/10.1182/blood-2013-07-518423.
Full textAbstract:
Abstract Choosing Wisely® is a medical stewardship and quality improvement initiative led by the American Board of Internal Medicine Foundation in collaboration with leading medical societies in the United States. The ASH is an active participant in the Choosing Wisely® project. Using an iterative process and an evidence-based method, ASH has identified 5 tests and treatments that in some circumstances are not well supported by evidence and which in certain cases involve a risk of adverse events and financial costs with low likelihood of benefit. The ASH Choosing Wisely® recommendations focus on avoiding liberal RBC transfusion, avoiding thrombophilia testing in adults in the setting of transient major thrombosis risk factors, avoiding inferior vena cava filter usage except in specified circumstances, avoiding the use of plasma or prothrombin complex concentrate in the nonemergent reversal of vitamin K antagonists, and limiting routine computed tomography surveillance after curative-intent treatment of non-Hodgkin lymphoma. We recommend that clinicians carefully consider anticipated benefits of the identified tests and treatments before performing them.
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Diverio, Daniela, Vincenzo Rossi, Giuseppe Avvisati, Silvia DeSantis, Alessandra Pistilli, Fabrizio Pane, Giuseppe Saglio, et al. "Early Detection of Relapse by Prospective Reverse Transcriptase-Polymerase Chain Reaction Analysis of the PML/RARα Fusion Gene in Patients With Acute Promyelocytic Leukemia Enrolled in the GIMEMA-AIEOP Multicenter “AIDA” Trial." Blood 92, no. 3 (August 1, 1998): 784–89. http://dx.doi.org/10.1182/blood.v92.3.784.
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Abstract Although the majority of patients with acute promyelocytic leukemia (APL) are potentially cured by treatments combining all-trans retinoic acid (ATRA) and chemotherapy (CHT), a sizable proportion (around 30%) will relapse during follow-up. Retrospective molecular monitoring studies using reverse transcriptase-polymerase chain reaction (RT-PCR) for the specific PML/RARα fusion gene, have shown that a positive test usually precedes the occurrence of hematologic relapse. Prospective RT-PCR analyses were performed since 1993 at diagnosis and at preestablished time intervals during follow-up in bone marrow (BM) samples of 163 patients with PML/RARα+ APL enrolled in the multicenter Gruppo Italiano Malattie Ematologiche Maligne dell' Adulto (GIMEMA) trial AIDA (All-trans retinoic acid plus Idarubicin). Treatment consisted of ATRA and idarubicin for induction followed by three polychemotherapy courses as consolidation. The sensitivity level of the RT-PCR assay for PML/RARα, as assessed by serial dilution experiments, was 10−4. All patients were in hematologic remission and tested PCR− at the end of consolidation. Of 21 who converted to PCR-positive thereafter, 20 underwent hematologic relapse at a median time of 3 months (range, 1 to 14) from the first PCR+ result. Seventeen of these 21 (81%) PCR+ conversions were recorded within the first 6 months postconsolidation. Of 142 who tested persistently PCR− in ≥2 tests after consolidation, 8 had hematologic relapse and 134 remained in complete remission (CR) after a median follow-up of 18 months (range, 6 to 38) postconsolidation. Using a time-dependent Cox model, the relative risk of hematologic relapse of patients who converted to PCR+ was 31.8 (confidence limits 95%, 12.9 to 78.3). Our results indicate that conversion to PCR positivity for PML/RARα during remission is highly predictive of subsequent hematologic relapse and highlight the prognostic value of stringent molecular monitoring during the early postconsolidation phase in APL. As a result of the present study, salvage treatment in patients enrolled in the GIMEMA trial AIDA is now anticipated at the time of molecular relapse, defined as the conversion to PCR positivity in two successive BM samplings during follow-up. © 1998 by The American Society of Hematology.
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Diverio, Daniela, Vincenzo Rossi, Giuseppe Avvisati, Silvia DeSantis, Alessandra Pistilli, Fabrizio Pane, Giuseppe Saglio, et al. "Early Detection of Relapse by Prospective Reverse Transcriptase-Polymerase Chain Reaction Analysis of the PML/RARα Fusion Gene in Patients With Acute Promyelocytic Leukemia Enrolled in the GIMEMA-AIEOP Multicenter “AIDA” Trial." Blood 92, no. 3 (August 1, 1998): 784–89. http://dx.doi.org/10.1182/blood.v92.3.784.415k06_784_789.
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Although the majority of patients with acute promyelocytic leukemia (APL) are potentially cured by treatments combining all-trans retinoic acid (ATRA) and chemotherapy (CHT), a sizable proportion (around 30%) will relapse during follow-up. Retrospective molecular monitoring studies using reverse transcriptase-polymerase chain reaction (RT-PCR) for the specific PML/RARα fusion gene, have shown that a positive test usually precedes the occurrence of hematologic relapse. Prospective RT-PCR analyses were performed since 1993 at diagnosis and at preestablished time intervals during follow-up in bone marrow (BM) samples of 163 patients with PML/RARα+ APL enrolled in the multicenter Gruppo Italiano Malattie Ematologiche Maligne dell' Adulto (GIMEMA) trial AIDA (All-trans retinoic acid plus Idarubicin). Treatment consisted of ATRA and idarubicin for induction followed by three polychemotherapy courses as consolidation. The sensitivity level of the RT-PCR assay for PML/RARα, as assessed by serial dilution experiments, was 10−4. All patients were in hematologic remission and tested PCR− at the end of consolidation. Of 21 who converted to PCR-positive thereafter, 20 underwent hematologic relapse at a median time of 3 months (range, 1 to 14) from the first PCR+ result. Seventeen of these 21 (81%) PCR+ conversions were recorded within the first 6 months postconsolidation. Of 142 who tested persistently PCR− in ≥2 tests after consolidation, 8 had hematologic relapse and 134 remained in complete remission (CR) after a median follow-up of 18 months (range, 6 to 38) postconsolidation. Using a time-dependent Cox model, the relative risk of hematologic relapse of patients who converted to PCR+ was 31.8 (confidence limits 95%, 12.9 to 78.3). Our results indicate that conversion to PCR positivity for PML/RARα during remission is highly predictive of subsequent hematologic relapse and highlight the prognostic value of stringent molecular monitoring during the early postconsolidation phase in APL. As a result of the present study, salvage treatment in patients enrolled in the GIMEMA trial AIDA is now anticipated at the time of molecular relapse, defined as the conversion to PCR positivity in two successive BM samplings during follow-up. © 1998 by The American Society of Hematology.
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Miller, Lyle D., Charles O. Thoen, Kenneth J. Throlson, Elmer M. Himes, and Ronald L. Morgan. "Serum Biochemical and Hematologic Values of Normal and Mycobacterium Bovis-Infected American Bison." Journal of Veterinary Diagnostic Investigation 1, no. 3 (July 1989): 219–22. http://dx.doi.org/10.1177/104063878900100304.
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Hematologic and serum biochemical tests were used to monitor the health of 3 groups of bison in an experimental study of tuberculosis. Bison were randomly assigned to Mycobacterium bovis-infected, M. bovis -sensitized, and uninfected control groups. Hematologic measurements included total and differential leukocyte counts, hemoglobin (Hb), packed cell volume (PCV), fibrinogen, and plasma proteins. Biochemical tests included serum urea nitrogen, creatinine, aspartate amino transferase, sorbitol dehydrogenase, serum calcium, and serum phosphorus. There were no significant differences (P = 0.05) in any test values between groups of bison. The bison data were combined and compared to similar data of cattle. The mean values for PCV and Hb were higher than values (PCV 24–46%, Hb 8–15 g/dl) for cattle. Mycobacterium bovis -infected bison had a slight increase in the number of blood monocytes and lymphocytes when compared to the uninfected bison but were within the normal ranges for bison and cattle. Other hematologic parameters were within normal ranges reported for cattle. Creatinine levels in all bison were above the normal range (1.0–1.5 mg/dl) for cattle. Phosphorus levels for M. bovis-infected and M. bovis -sensitized bison exceeded the normal range (5.6–8.0 mg/dl) reported for cattle. The level for uninfected bison was near the upper limit of normal for cattle. Mean values for other serum biochemical tests were within the normal ranges reported for cattle.
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Enrico, Alicia Inés, Beatriz Moiraghi, Graciela Klein, Maria del Rosario Cabrejo, Renee Crisp, Georgina Bendek, Mariana Gil, et al. "Argentine Registry of Hematologic Disease (RAEH) Chronics Myeloid Leukemia." Blood 118, no. 21 (November 18, 2011): 4455. http://dx.doi.org/10.1182/blood.v118.21.4455.4455.
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Abstract Abstract 4455 Introduction: The CML Registry was developed by the Argentine Society of Hematology as a part of the centralized RAEH. Results from epidemiologic and clinical data related to CML, will enable to determine the geographic distribution of the target population, to establish associated environmental causes, and mainly to rationalize resources supply. Objective: a) To analyze characteristics of CML patients registered in the RAEH; b) To evaluate the CML Registry performance through its first year. Materials and Methods: Patients with CML registered in the RAEH from January 1st, 2011 up to July 31st, 2011. The protocol allowed to enroll de novo patients as well as patients diagnosed from 2000 on. Result: Data reported by 15 hospitals were included: 224 patients were registered. Mean age was 50 (18–86 y) and gender distribution was female: 102, male: 122. Occupational data showed no a characteristic pattern. 96.5% of patients were diagnosed in chronic phase, while 3.5% were diagnosed in accelerated phase/blast crisis. In 6% of patients cytogenetic tests detected 8 abnormalities besides t(9,22): double Philadelphia chromosome and monosomy 12 were the most frequent findings. FISH tests were recorded for 18% of patients at the time of diagnosis. Bone marrow biopsy was reported as a diagnostic procedure in 51%. Qualitative BCR/ABL was recorded for 31% of patients at the time of diagnosis. Molecular RQ-PCR tests for follow-up of treatment response were reported for 51% of patients. Of the registered population, 21% received interferon as previous therapy to Imatinib (IM); 89% received IM 400mg daily; 6% required dose increase. Second line treatment with dasatinib or nilotinib was recorded in 34% and 14% of patients, respectively. At 60 months mean follow-up 8% of the registered population had developed blast crisis and 6% had died. Conclusions. The RAEH’s first year of performance in CML was assessed. This only reflects the experience with 15 sites. Data registered will allow us in the following years to learn about disease epidemiology and available resources to improve patient accessibility. Disclosures: No relevant conflicts of interest to declare.
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Paroskie, Allison, Shannon Carpenter, Deborah Lowen, James Anderst, Michael R. DeBaun, and Robert F. Sidonio. "Retrospective Review of Hematologic Evaluation in Children with Suspected Non-Accidental Injury, A First Step towards Evidence Based Guidelines." Blood 120, no. 21 (November 16, 2012): 2231. http://dx.doi.org/10.1182/blood.v120.21.2231.2231.
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Abstract Abstract 2231 Background Child maltreatment is a frequent cause of injury in the United States, occurring in approximately 695,000 children per year. Bleeding disorders can exacerbate and be confused with non-accidental injury (NAI); both of these diagnostic errors are life altering for the child and family. Despite the high incidence of child abuse and the independent relative high incidence of bleeding disorders, the optimal hemostatic evaluation is unclear for children who may be victims of NAI. Expert hematologic opinion recommends a multi-tiered approach, first investigating for common bleeding disorders, and subsequently investigating for rare defects in the coagulation and fibrinolytic pathways, if necessary. Further research is needed to develop evidence-based guidelines for the evaluation of bleeding disorders in children who may be victims of NAI. Objectives To review and analyze a five-year history of the hematologic investigation of children who presented with bleeding and/or bruising that was suspicious for NAI at Vanderbilt Children's Hospital (VCH). Our hypothesis is that there is a lack of a systematic approach for the hemostatic evaluation of children who present with bleeding symptoms and concern for NAI. Methods A retrospective cohort study design was employed. ICD-9 codes for NAI (995.5, 995.50, 995.54, 995.55, 995.59) were used. 354 medical records from 2007 – 2011 were reviewed and screened for inclusion and exclusion criteria, resulting in 198 fully evaluable patients. Medical records were then queried for details of clinical and laboratory evaluation that occurred at the initial presentation concerning for NAI. We defined a basic hematologic evaluation as a CBC, PT and PTT; and a comprehensive hematologic evaluation as a CBC, PT, PTT, factor VIII, IX and XI activity and von Willebrand evaluation. Data was analyzed using SPSS; statistical analysis was performed using frequencies and Chi-Square analysis. Outcomes The mean age for the studied population was 445 days (max 4687 days, minimum 6 days); 37% were male. Bleeding symptoms included intracranial hemorrhage (ICH) (40%) and bruising (58% without associated ICH, 73% with and without associated ICH), with approximately 60% demonstrating additional non-hematologic symptoms (i.e. fractures, burns). Hematologic laboratory tests performed included CBC in 66%, PT in 58%, and PTT in 55%; factor activity levels in 12% (primarily consisted of factors VIII and IX); and von Willebrand disease evaluation in 12% of subjects. Table 1 shows the percentage of laboratory tests obtained in the patients based on symptoms at presentation. Abnormal coagulation labs were seen in 33% of performed PT and 55% of PTT tests; 55% of abnormal PTs and 44% of abnormal PTTs repeated. Our defined basic evaluation was completed in 79% of patients with ICH and 36% of patients without ICH (p <0.00). Our defined comprehensive evaluation was completed in 9% of patients with ICH and 2% of patients without ICH (p 0.32). Only 1% (2 of 198) children in our cohort were diagnosed with hematologic disorders that explain their increased bleeding symptoms. Conclusion Complete hematologic evaluation of children who present with bleeding symptoms and concern for NAI is inconsistent. While some children with other findings diagnostic for NAI may not require a hematologic work-up from a medico-legal perspective, it is still prudent to consider common bleeding disorders as a potential contributing factor in the severity of symptoms. At VCH, laboratory evaluation was obtained with greater frequency in patients with hematologic symptoms only. Given the variability of tests obtained and the disparity between expert opinion and our historical evaluation, further investigation into the optimal evaluation of these patients is warranted at this time. A prospective cohort study would allow comprehensive evaluation of all children suspected of NAI resulting in a clear understanding of laboratory abnormalities and incidence of bleeding disorders. Disclosures: No relevant conflicts of interest to declare.
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Bottsford-Miller, J. N., A. Shafer, A. Deal, L. Filip, and W. Fowler. "Hematologic toxicities before and during bevacizumab chemotherapy in women with gynecologic malignancy." Journal of Clinical Oncology 27, no. 15_suppl (May 20, 2009): e16565-e16565. http://dx.doi.org/10.1200/jco.2009.27.15_suppl.e16565.
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e16565 Background: Many women undergoing chemotherapy for gynecologic malignancy experience hematologic toxicity that delays therapy or requires supportive intervention. In animal models anti-VEGF antibodies increase erythropoietin levels. We examined the hematologic toxicities experienced by patients prior to (PR) and during bevacizumab (BR) treatment. Methods: Retrospective, single-institution study of women with gynecologic malignancy treated at the University of North Carolina with bevacizumab as part of their therapy from January 2005 to June 2007. Data collected included prior therapies, blood product and growth factor use, and interruptions in therapy. Comparisons were made between individual patients’ hematologic parameters during the PR and BR. Median differences between hematologic nadirs were compared using Wilcoxon Signed Rank Tests. Differences in proportions were compared by Chi-Square or Fisher's Exact tests. Results: 43 patients ware identified, 40 with complete data. Most women were Caucasian (88%) and had ovarian or primary peritoneal carcinoma (77%); median (range) age was 53 (23–73). 32 (74%) received three or more different chemotherapy drugs before starting bevacizumab. The median difference in HCT nadir (31.2 vs. 33, p = 0.01) and ANC nadir (1.2 vs. 1.4, p = 0.04) during the PR and BR were significant in favor of the bevacizumab regimens. The median nadir differences for WBC (2.7 vs. 3.1, p = 0.1) and PLT (129 vs. 150, p = 0.07) were non-significant favoring BR. For HCT toxicity grades, 22 (55%) had the same grade during their PR and BR, 15 (38%) had a lower grade during BR, and 3 (7%) had a higher grade during BR (p = 0.001). Similar trends were seen for WBC (p = 0.27), ANC (p = 0.1), and PLT (p = 0.15). During BR there was a trend toward fewer patients receiving darbepoetin (66% vs. 44%, p = 0.07) and filgastrim (29% vs. 14%, p = 0.1). Conclusions: Patients receiving bevacizumab had no worse hematologic toxicity compared to their prior regimens and may have had less severe anemia. While not statistically significant, there were trends toward less growth factor use with bevacizumab. Patients who have had prior hematologic toxicity should be considered for bevacizumab. The effect of bevacizumab on hematologic toxicity should be evaluated with prospective data. No significant financial relationships to disclose.
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Seegmiller, Adam C., Annette S. Kim, Claudio A. Mosse, Mia A. Levy, Mary Ann Thompson, Megan K. Kressin, Madan H. Jagasia, et al. "Evidence-Based, Patient-Specific Guidelines Provide Efficient and Cost-Effective Molecular and Cytogenetic Testing in Hematologic Malignancy." Blood 118, no. 21 (November 18, 2011): 2073. http://dx.doi.org/10.1182/blood.v118.21.2073.2073.
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Abstract Abstract 2073 Introduction: Molecular and cytogenetic testing is critical in diagnosis and management of hematologic malignancies. These tests are expensive, complex, and frequently inappropriately ordered. There are no comprehensive guidelines to assist in the disease- and patient-specific selection of these tests. Traditionally, most tests are ordered before morphologic evaluation of the specimen, which could help guide test selection. We hypothesize that this leads to significant over-ordering of tests unnecessary for diagnosis or monitoring, as well as under-ordering of necessary tests. As part of the hematopathology diagnostic management team (DMT) effort, we evaluated this hypothesis by establishing evidence-based rules for molecular and cytogenetic test ordering that are applied by the pathologist after review of clinical history and bone marrow aspirate smears. Methods: Using published evidence and best clinical practices, a team of clinical hematologists and hematopathologists developed rules, termed standard operating procedures (SOPs), for selecting cytogenetic and molecular tests on bone marrow biopsies from adult patients performed for myelodysplastic syndrome/acute myeloid leukemia (MDS/AML), plasma cell myeloma, lymphoma, myeloproliferative neoplasms, lymphoblastic leukemia, and bone marrow failure. The rules specify testing in five clinical scenarios: diagnosis or follow-up with morphologically overt disease, bone marrow staging (for lymphoma), routine follow-up without overt disease, evaluation prior to stem cell transplant (pre-SCT), and follow-up after stem cell transplant (post-SCT). To determine the effect that application of these SOPs would have had on test ordering and results, bone marrow biopsies from adults (>18 years) were evaluated retrospectively over a six-month time period. Each test was ruled concordant or discordant with the corresponding SOP. Omitted tests, those recommended by the SOPs, but not performed, were also identified. Statistical analysis of concordant and discordant tests was performed using the Chi-square test. Results: A total of 3,007 tests (769 karyotypes, 1,790 FISH, and 448 molecular tests) were performed on 804 adult bone marrows. Of these, 1,080 (36%) were discordant with the SOPs. Discordant tests were most frequent in myeloma (471), MDS/AML (231), and lymphoma (215). The most common clinical settings for discordant tests were routine follow-up (403) and post-SCT (417). To determine if these tests were necessary, we determined the positive rate of both concordant and discordant tests. The positive rate was significantly higher in the concordant (490/1,929; 25%) than the discordant tests (38/1,078; 4%) (P<0.001). Of the 38 positive discordant tests, 15 were redundant, i.e., a more sensitive test for the abnormality was positive on the same sample. An additional 13 discordant tests were only weakly positive. Of these, most were negative at diagnosis or at subsequent bone marrow testing, suggesting that they may represent false positive results. Thus, only 10/1,080 (<1%) discordant tests had potential clinical significance. In 145 of the marrows (18%), there were 308 omitted tests. By eliminating the discordant tests and including the omitted tests, we estimate that institution of these SOPs would reduce the total number of cytogenetic and molecular tests by 26%, from 3,007 to 2,235. Conclusions: Retrospective analysis of cytogenetic and molecular test ordering demonstrates that more than one-third of cytogenetic or molecular tests ordered on bone marrow specimens at a large tertiary care institution were discordant with rules (SOPs) based on published literature and best clinical practices. Furthermore, the vast majority (>99%) of these discordant tests were negative for any abnormality, redundant, or potential false positives, suggesting that the exclusion of these tests would have little negative clinical impact. In addition, there were a large number of omitted tests, seen in 18% of all marrows. This analysis predicts that institution of rules-based morphology-influenced test ordering would decrease uninformative testing, while increasing appropriate informative tests, leading to more cost-effective, accurate, and complete diagnosis and monitoring of hematolymphoid malignancies. We have therefore instituted a rules-based, morphology-directed approach at our institution. Disclosures: No relevant conflicts of interest to declare.
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Gupta, Bhavna. "Atypical presentation of immune thrombocytopenia (ITP) with multiple somatic complaints without bleeding manifestations." MOJ Clinical & Medical Case Reports 11, no. 2 (2021): 43–44. http://dx.doi.org/10.15406/mojcr.2021.11.00379.
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Immune Thrombocytopenia (ITP) is a hematologic disorder characterized by immune mediated destruction of platelets leading to isolated thrombocytopenia. It presents as sudden onset of acute self-limiting episodes of bleeds which are usually minor but may present with intracranial hemorrhage. ITP is a clinical diagnosis of exclusion. No confirmatory diagnostic tests are available. Management depends on severity of bleeding rather than platelet counts. Here is a case report of a 16 years old female patient presenting with multiple somatic complaints and no history of bleeding manifestations with isolated thrombocytopenia and hematologic malignancy ruled out.
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Cantor, S. B., D. V. Hudson, B. Lichtiger, and E. B. Rubenstein. "Costs of blood transfusion: a process-flow analysis." Journal of Clinical Oncology 16, no. 7 (July 1998): 2364–70. http://dx.doi.org/10.1200/jco.1998.16.7.2364.
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PURPOSE To determine the cost of transfusing 2 units (U) of packed RBCs at a comprehensive cancer center. METHODS We performed a process-flow analysis to identify all costs of transfusing 2 U of allogeneic packed RBCs on an outpatient basis to patients with either (1) solid tumor who did not undergo bone marrow transplantation (BMT), (2) solid tumor who underwent BMT, (3) hematologic malignancy who did not undergo BMT, (4) hematologic malignancy who underwent allogeneic BMT, or (5) hematologic malignancy who underwent autologous BMT. We conducted structured interviews to determine the personnel time used and physical resources necessary at all steps of the transfusion process. RESULTS The mean cost of a 2-U transfusion of allogeneic packed RBCs was $548, $565, $569, $569, and $566 for patients with non-BMT solid tumor, BMT solid tumor, non-BMT hematologic malignancy, allogeneic BMT hematologic malignancy, and autologous BMT hematologic malignancy, respectively. Sensitivity analysis showed that total transfusion costs were sensitive to variations in the amount of clinician compensation and overhead costs, but were relatively insensitive to reasonable variations in the direct costs of blood tests and the blood itself, or the probability or extent of transfusion reaction. CONCLUSION The costs of the transfusion of packed RBCs are greater than previously analyzed, particularly in the cancer care setting.
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Kim, Sue Jung, Yoonjung Kim, Saeam Shin, Jaewoo Song, and Jong Rak Choi. "Comparison Study of the Rates of Manual Peripheral Blood Smear Review From 3 Automated Hematology Analyzers, Unicel DxH 800, ADVIA 2120i, and XE 2100, Using International Consensus Group Guidelines." Archives of Pathology & Laboratory Medicine 136, no. 11 (November 1, 2012): 1408–13. http://dx.doi.org/10.5858/arpa.2010-0757-oa.
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Context.—In the clinical laboratory, it is important both to reduce the number of peripheral blood slide reviews to save time and money and to avoid reporting false results. Objective.—To determine differences in the slide review rates of 3 widely used automated hematologic analyzers, the Unicel DxH 800 (Beckman Coulter Inc, Fullerton, California), ADVIA 2120i (Siemens Diagnostics, Tarrytown, New York), and XE 2100 (Sysmex, Kobe, Japan), using International Consensus Group for Hematology Review guidelines. Design.—A total of 1485 samples were tested, and 300 were manually reviewed. Slide review rates, sensitivity, specificity, and false-positive and false-negative rates were estimated using consensus group rules and compared using χ2 tests, Fisher exact tests, or generalized estimating equations. Results.—Unicel DxH 800, ADVIA 2120i, and XE 2100 showed 22.8%, 20.2%, and 28.6% slide review rates; 14.3%, 14.3%, and 9.7% false-negative rates; and 13.7, 11.3%, and 17.3% false-positive rates, respectively. All analyzers showed significantly higher false-negative rates than that of the consensus group (2.9%). Conclusions.—False-negative rates were higher than the recommended levels. Among 3 automated hematologic analyzers, XE 2100 showed the highest rate of slide review. Because the present study clearly shows that the slide review rates have distinct characteristics among the studied analyzers, each individual laboratory should consider selecting the most appropriate analyzer according to clinical characteristics. Analyzers with high sensitivity may be advantageous in outpatient settings for screening patients, whereas analyzers with high specificity may be beneficial in inpatient settings for efficient patient care.
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Lotfi, N., S. Mohamadi, and M. Mirzaei-Takmil. "Effects of stretching before intense exercise training on hematologic and cellular injury indices." Pedagogics, psychology, medical-biological problems of physical training and sports 22, no. 6 (December 20, 2018): 301–5. http://dx.doi.org/10.15561/18189172.2018.0604.
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Purpose: The aim of the study was to investigate the effect of stretching before intense exercise on hematologic parameters and cell injury. Subjects: The subjects of the present study were 12 adolescent members of the Kurdistan Province futsal team (age: 14.83 ± 0.38 years, height: 173.92 ± 5.90 cm, weight: 63.50 ± 7.94 kg, peak power: 459.42 ± 95.94 watts). The RAST test was used to estimate the anaerobic power and to create the training load. Indexes of blood including white and red blood cells, hemoglobin, hematocrit, platelet and the levels of CK and LDH enzyme activities were measured. Results: The results of the pre and the post tests showed that among hematological parameters and cell damage indexes, the red blood cell and hemoglobin in both groups and the level of LDH in the training group were not significantly changed (p>0.05). Other parameters in the pre-test and post-test measures were statistically changed (p<0.05). Conclusion: Based on the results of the present study, it seems that stretching before intense training decreases the cell damage and side effects of exercise training on the hematological factors.
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Yoon, Young Ahn, Mi-Ae Jang, Ji Sung Lee, Won-Ki Min, Kye Chul Kwon, Yong-Wha Lee, and You Kyoung Lee. "Effect of Accreditation on the Accuracy of Diagnostic Hematologic Tests: Standard Deviation Index Analysis." Annals of Laboratory Medicine 38, no. 1 (January 28, 2018): 67–70. http://dx.doi.org/10.3343/alm.2018.38.1.67.
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