Congreso Nacional Laboratorio Clínico 2018...Materiales y métodos: Se realizó la revisión de...
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Actualización en la interpretación de las anemias carenciales ¿Qué hay de nuevo en el siglo XXI? Eloísa Urrechaga, PhD Consultor Senior en Análisis Clínicos Congreso Nacional Laboratorio Clínico 2018
Transcript of Congreso Nacional Laboratorio Clínico 2018...Materiales y métodos: Se realizó la revisión de...
Actualizacioacuten en la interpretacioacuten de las anemias carenciales iquestQueacute hay de nuevo en el siglo XXI
Eloiacutesa Urrechaga PhDConsultor Senior en Anaacutelisis Cliacutenicos Congreso Nacio
nal Laboratorio Cliacutenico 2018
Poblacioacuten sana caucaacutesica
Congreso Nacional Laboratorio Cliacutenico
2018
A Saacutenchez Salinas AM Garciacutea Hernaacutendez A Martiacutenez Mariacuten V Cabantildeas PerianesSindrome anemico Medicine 201612(20)1127-35
Congreso Nacional Laboratorio Cliacutenico
2018
Anemias carenciales
Anemia ferropeacutenicaTincioacuten de Perls en meacutedula osea(hemosiderina y sideroblastos negativos)Sideremia baja saturacioacuten de transferrina disminuiacuteda ferritina seacuterica baja receptor soluble de transferrina(aumentado) y protoporfirinaeritrocitaria libre (aumentada)Anemia megaloblaacutesticaVitamina B12 seacuterica disminuida folato seacuterico normal o aumentado y folato intraeritrocitario disminuido se observan en la deficiencia de vitamina B12Folato seacuterico e intraeritrocitariodisminuidos y vitamina B12 seacuterica normal se encuentran en la deficiencia de folato
Congreso Nacional Laboratorio Cliacutenico
2018
Actualizacioacuten en la interpretacioacuten de las anemias carenciales iquestQueacute hay de nuevo en el siglo XXI
La gran novedad consiste en que podemos evitar que un sujeto sano lleguea padecer una anemia carencial utilizando los paraacutemetros del hemogramaavanzadohelliphellip
helliphellip y no soacutelo contamos con la serie rojahelliphelliphellip
Congreso Nacional Laboratorio Cliacutenico
2018
AM Garcia Hernandez A Sanchez Salinas V Cabanas Perianes M Blanquer Blanquer Protocolo diagnostico diferencial del sindromeAnemico Medicine 201612(20)1170-4
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
Total YLD resulting from all causes of anemia by country
Kassebaum NJ et al Blood 2014123615-624 copy2014 by American Society of Hematology
Congreso Nacional Laboratorio Cliacutenico
2018
Clamaschella C Iron deficiency anemia N Engl J Med 20153721832-43
Congreso Nacional Laboratorio Cliacutenico
2018
Iron Cycle
Fleming RE Ponka P N Engl J Med 2012366348-359Congreso Nacional Laboratorio Cliacutenico
2018
Camaschella C N Engl J Med 20153721832-43Congreso Nacio
nal Laboratorio Cliacutenico 2018
G Lippi amp M Plebani Recent developments and innovations in red blood cells diagnostics Journal of Laboratory and Precision Medicine 2018DOI 1021037jlpm20180709 AOP
Innovative erythrocyte parametersThese innovative parameters most typically include automated reticulocyte andnucleated RBC counts hemoglobinization of reticulocytes and RBC reticulocytehemoglobin content reticulocyte maturation automatic analysis and calculationof microcytic and hypochromic RBC
The various combination of these different parameters not only may be useful tocomplement clinical history physical examination and results of moreconventional laboratory investigations (ie CBC ferritin transferrin ironhaptoglobin folic acid and vitamin B12 among others) for investigating theunderlying cause(s) of anemia
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
Biomarcadores de Eritroyesis
Urrechaga E Borque L Escanero JF Biomarkers of hypochromia the contemporary assessment of
Iron status and erythropoiesis Journal of Biomedicine and Biotechnology
httpdxdoiorg1011552013603786
Abreviatura
(unidades)
Compantildeiacutea
RBC Hipocromos Hypo () Siemens
Hb Reticulocitaria CHr (pg) Siemens
RBC Hipocromos HPO () Abbott
Hb Reticulocitaria media MCHr (pg) Abbott
RBC Hipocromos Hypo He () Sysmex
Hb Reticulocitaria equivalente Ret He (pg) Sysmex
Low Hb density
Contenido de Hb Reticulocitaria
Expresioacuten Hb reticulocitaria
LHD ()
RHCc (pg)
RHE (pg)
Beckman Coulter
Horiba ABX
Mindray
Congreso Nacional Laboratorio Cliacutenico
2018
Informacioacuten avanzada valor antildeadido
Reticulocitos Eritrocitos
bull Permanecen en la sangre 1-2 diacuteas hasta que se convierten en eritrocitos maduros
bull El contenido de hemoglobinapuede reflejar la cantidad de hierro disponible de maneraefectiva
bull Refleja la calidad de la eritropoyesis en el periodoinmediato
bull Permanecen en la sangre 90-120 diacuteas
bull Las diversas subpoblacionespueden reflejar el status feacuterrico en las pasadas semanas
bull MCV MCH son las medias del
conjunto de RBC las de fracciones indican la contribucioacuten de los diversos tipos de RBC a las medias
Congreso Nacional Laboratorio Cliacutenico
2018
Angulo alto
Dispersioacuten lateral Hb
Angulo bajo
Dispersioacuten frontal VOLUMEN
LASER Absorbancia Fluorescencia
RNA contenido
Citometriacutea
Congreso Nacional Laboratorio Cliacutenico
2018
RETICULOCITOS
Compantildeiacutea Instrumento Meacutetodo Colorante Paraacutemetros
Abbott CELLDYN Ruby
CELLDYN
Sapphire
Absorbancia
Fluorescencia
Nuevo azul
metileno
Sybr II
IRF
IRF MCHr MCVr
Beckman
Coulter
UniCell DxH
LH series
Impedancia
citometriacutea de flujo
VCS
Nuevo azul
metileno
Nuevo azul
metileno
IRF MRVHLRRSf
IRF MRV
MSCVHLR
Horiba ABX Pentra
DX120
Impedancia
citometriacutea de flujo
fluorescencia
Naranja de tiazol IRF MRV RETH
RHbC
Siemens ADVIA 120 Absorbancia
Scatter
Oxazine 750 IRF MCVr CHr
Sysmex XE5000 XN Fluorescencia Polimetina IRF RetHe ΔHeCongreso Nacional Laboratorio Cliacutenico
2018
Los reticulocitos precursores de los eritrocitos madurangeneralmente a lo largo de unos dos diacuteas El recuento dereticulocitos es por lo tanto una medida de la cantidad dela eritropoyesis en la meacutedulaParaacutemetros derivados de los reticulocitos los describenmorfoloacutegicamente tamantildeo contenido en Hemoglobinacantidad de material geneacuteticoDe esta forma al referirse a caracteriacutesticas de losreticulocitos es la calidad de la eritropoyesis la que puedeser evaluada
La Hb reticulocitaria se relaciona con la cantidad de hierro disponible efectivamente para laeritropoyesis un valor bajo indica que el aporte es deficitario respecto a la demanda en el momentoactual 28-30 pg
Congreso Nacional Laboratorio Cliacutenico
2018
MCV MCH son los valores medios de volumen y Hb en toda la poblacioacuten RBC
No informan acerca de las ceacutelulas individuales
Ni de la variedad de eacutestas anisocitosis policromasia
Congreso Nacional Laboratorio Cliacutenico
2018
Se cuentan el nuacutemero de pulsos de 36-360fL y el nuacutemero de partiacuteculas que tienen el mismo tamantildeo y se trasladan los resultados a una graacutefica de Volumen Nuacutemero de ceacutelulasSe obtiene el histograma de RBC que proporciona
bull Nuacutemero de RBC el nuacutemero de pulsos dentro de este rango de tamantildeos
bull MCV se corresponde con la media del histograma de RBC
bull RDW o ADE Ancho de Distribucioacuten del histograma de RBC se corresponde con el coeficiente de variacioacuten de la curva
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
Abbott Sapphire lo calcula en el 50 de la altura del pico del histogramaSysmex y Mindray al 20 desde la base del histogramaSiemens calcula la anchura del pico comprendido entre 60 y 120 fL
Aunque RDW ADE generalmente se entiendecomo coeficiente de variacioacuten de ladistribucioacuten de los voluacutemenes de loseritrocitos algunos analizadoreshematoloacutegicos lo calculan desde la medicioacutendirecta de la anchura de la distribucioacuten
Congreso Nacional Laboratorio Cliacutenico
2018
G Lippi amp M Plebani
Recent developments and innovations in red blood cells diagnostics
Journal of Laboratory and Precision Medicine 2018
DOI 1021037jlpm20180709 AOPCongreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
copy 2012 Mindray Confidential 26
HDWHYPERHYPO
HDW HGB Distribution Width
HDW is the distribution width of Hgb histogram
Congreso Nacional Laboratorio Cliacutenico
2018
copy 2012 Mindray Confidential 27
MCHrHDWHYPERHYPOMCHr Mean RET HGB Concentration
Congreso Nacional Laboratorio Cliacutenico
2018
Histograma RBC el mapa de Mie
28 41
Congreso Nacional Laboratorio Cliacutenico
2018
Abbott Mindray Siemens
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
Severe Iron Deficiency Anemia Female 34 years
19 th March 18 th April
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
SysmexRBCHe erythrocyte Hb equivalentRetHe reticulocyte Hb equivalent(content)
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
MIC
MAC
HPO HPR
Congreso Nacional Laboratorio Cliacutenico
2018
copy 2012 Mindray Confidential 36
MINDRAY MCHrHDWHYPERHYPO
MCHr Mean RET HGB Concentration
HDW HGB Distribution Width
HYPER The percentage of hyperchromicred blood cells
HYPO The percentage of hypochromic red blood cells
Thalassemia screeningIDA treatment monitoringIDA screening
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
Hipocromo
Hipercroacutemico onormocroacutemico
iquestConcentracioacuten o contenido de Hemoglobina
Hipocroacutemiconormocroacutemico
Abbott Mindray Siemens Hypo CONCENTRACIOacuteN Hblt280gL
Sysmex Hypo CONTENIDO Hblt 17 pg
Congreso Nacional Laboratorio Cliacutenico
2018
Low Hb Density
Microcytic Factor Maf = (HbMCV)100
Nuevo moacutedulo transductor muacuteltiple con laacuteser de diodo y dos sensores oacutepticos
Anaacutelisis de hasta 50000 ceacutelulas con 7 paraacutemetros tecnoloacutegicos (leucocitos reticulocitos eritroblastos)
1 Volumen digital
2 Conductividad digital
3 5 aacutengulos de dispersioacuten de luz laacuteser digital
bull MALS (Median Angle Light Scatter)
bull UMALS (Upper Median Angle Light Scatter) 20deg a 43deg
bull LMALS (Lower Median Angle Light Scatter) 09deg a 19deg
bull LALS (Low Angle Light Scatter) asymp 51deg
bull AL2 (Axial Light Loss) 0deg a 05deg
Congreso Nacional Laboratorio Cliacutenico
2018
Hierro es un elemento criacutetico para elfuncionamiento oacuteptimo y supervivenciade las ceacutelulas
Disfuncioacuten mitocondrialActividad enzimaacutetica afectadaProteiacutenas de transporte y estructuralesproteins
Capacidad fiacutesica mermadaCapacidad de trabajo reducidaCapacidades cognitivas afectadasMorbilidad y mortalidad
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
It is generally assumed that worldwide ldquoat least half the anemia is due tonutritional iron deficiencyrdquo and that ldquoup to a prevalence of iron deficiency anemiaof 40 the prevalence of iron deficiency will be about 25 times that of anemiardquoHowever it is evident from the foregoing discussion that there are considerablevariations in both of these ratios depending on the age and sex of the peoplebeing studied the region of the world in which they live and the prevalence ratesof other causes of anemia
WHO Department of Nutrition for Health and DevelopmentAssessing the iron status of populations including literature reviews report of a Joint World Health OrganizationCenters for DiseaseControl and Prevention Technical Consultation on the Assessment of Iron Status at the Population Level Geneva Switzerland 6ndash8 April2004 ndash 2nd ed
Congreso Nacional Laboratorio Cliacutenico
2018
Estaacute bien establecido que la anemia produce una miriacuteada de secuelas tanto fiacutesicas comopsicoloacutegicas
Pero los efecto deleteacutereos se deben al deficit de hierro que es un evento previo a que seestablezca la anemia
El deacuteficit de hierrro auacuten sin anemia tiene efectos negativos en el desarrollo cognitivo y fiacutesico
Rattehalli D et al Iron deficiency without anemia do not wait for the Hemoglobin to drop
Health Policy and Technology 2013 2 45-48Congreso Nacio
nal Laboratorio Cliacutenico 2018
SuominenP et al Serum transferrin receptor and transferrin receptor-ferritin index identify healthy subjects with subclinical iron deficits Blood 1998 92 2934ndash9Halwachs-Baumann G Diagnosis of anaemia old things rearranged Wien Med Wochenschr 2012 162478ndash88
Congreso Nacional Laboratorio Cliacutenico
2018
Hemoglobina de reticulocito y su importancia en el diagnoacutestico temprano de anemiaferropeacutenica
Y Maacuterquez-Beniacutetez et al Universidad de BocayaAugust
2018 DOI 1022267rus182003133 aop
El contenido de hemoglobina de reticulocitos (CHr) es un paraacutemetro en la biometriacuteahematoloacutegica automatizada utilizado como un marcador de la biodisponibilidad delhierro en la eritropoyesis
Objetivo Exponer la aplicabilidad de la CHr como un paraacutemetro en el diagnoacutesticoprecoz de la anemia por deficiencia de hierro asiacute como su medicioacuten e interpretacioacuten
Materiales y meacutetodos Se realizoacute la revisioacuten de artiacuteculos cientiacuteficos en ingleacutes y espantildeolen las bases de datos PubMed ScienceDirect LILACS y Medline usando descriptoresvalidados en Medical Subject Headings (MeSH) considerando periodo depublicabilidad del 80 inferior a 5 antildeos
Conclusiones La CHr es un paraacutemetro de gran utilidad en el diagnoacutestico temprano deanemia ferropeacutenica y otras patologiacuteas como deficiencia funcional de hierro estadosde inflamacioacuten croacutenica y enfermedad renal croacutenica
Biomarcador temprano en el diagnoacutestico de deficiencia de hierro antes de presentarsecambios morfoloacutegicos eritrociacuteticosCongreso Nacio
nal Laboratorio Cliacutenico 2018
bull A total of 1105 NES participants (639 men 466 women)bull CHr becomes affected in a relatively early stage in the development of iron deficiency before iron
deficiency anemia and clinical symptoms become apparentbull Therefore this parameter might be useful to identify persons healthy and diseased at risk of
developing iron deficiency anemia and subsequently to apply interventions in order to prevent further development of iron deficiency anemiaCongreso Nacio
nal Laboratorio Cliacutenico 2018
Hb reticulocitaria sensible para detectar la fase inicial del deacuteficit de hierro cuando laeritropoyesis requiere maacutes cantidad que la que recibe ANTES de que la anemia seestablezca
Congreso Nacional Laboratorio Cliacutenico
2018
No ID LID P
RBC 1012L 48 (08) 437 (05) lt00001
Hb gL 135 (6) 131 (12) 0006
MCV fL 922 (21) 902 (38) 0006
MCH pg 324 (07) 306 (22) lt00001
MCHC gL 339 (6) 319 (23) 0001
RDW
Ret He pg
Hypo He
LHD
Ferritin microgL
131 (06)
338 (21)
03 (015)
28 (20)
86 (3)
145 (21)
278 (24)
69 (55)
56 (25)
16 (76)
lt00001
lt00001
lt00001
lt00001
lt00001
AUC 95 CI Cutoff Sensitivity Specificity
LHD 0898 0819-0978 50 859 841
Ret He 0914 0824-1000 299pg 868 857
Hypo He 0934 0856-1000 16 857 921
Clinical value of markers of hypochromia in the detection of latent iron deficiency in non-anemic premenopausal women
No ID Hb gt 120 gL s-ferritin was within reference intervalLatent Iron Defiency Hb gt 120 gL s-ferritin lt 30 μgL
Urrechaga E et al Journal Clin Lab Analysis 2016 30 (5) 623-627
97 women (388) in 250 apparently healthy women had latent IDCongreso Nacional Laboratorio Cliacutenico
2018
Schorer G et al Abstract Jahreskongress der Deutschen Gesellschaft fuumlr Transfusionsmedizin und Immunhaumlmatologie Rostock 15 - 18 September 2009
Congreso Nacional Laboratorio Cliacutenico
2018
Caring for Those Who Share Mitigating Iron Deficiency in Regular Blood DonorsMast Alan E
bull Iron deficiency caused by regular blood donation is a problem facing blood centers Each blood donation removes 200 to 250 mg of iron from the donor Consequently many donors become iron deficient with repeated donation
bull This presents a challenge to blood centers that has become more acute in recent years with the realization that iron deficiency even in the absence of anemia is associated with adverse effects including fatigue and decreased exercise tolerance as well as neurological symptoms such as decreased cognitive function pica and restless leg syndrome
bull REDS-II investigators performed a longitudinal study investigating the iron status of blood donors over a two year period called the REDS-II Donor Iron Status Evaluation (RISE)
bull Results from the baseline analysis of regular donors (e 2 donations per year (females) or e 3 donations per year (males) revealed that over two-thirds of female donors and over one-half of male donors have iron deficiency
Congreso Nacional Laboratorio Cliacutenico
2018
Transfusion 2013 532766-2775
bull We evaluated the diagnostic sensitivity and specificity of red blood cell (RBC) hematology analyzer indices to assess iron status as a part of donor management iron deficient erythropoiesis (IDE) and absence of iron stores (AIS)
bull STUDY DESIGN AND METHODS A total of 1659 male and female donors from the Retrovirus Epidemiology Donor Study-II (REDS-II) Donor Iron Status Evaluation (RISE) study who were either first-timereactivated (FT RA no donations for 2 years) or frequent donors were recruited into a longitudinal study of regular donation of RBCs Of these 1002 donors returned 15 to 24 months later for a final assessment
Absent iron stores (AIS) was defined as plasma ferritin level of less than 12 mgL Logarithm of the ratio of soluble transferrin receptor to ferritin of at least 207 was used to define iron-deficient erythropoiesis (IDE)
bull RESULTS HYPOm and CHr detected IDE with comparable sensitivity 72 versus 69 but differed in specificity HYPOm 68 and CHr 53
For detecting AIS sensitivity was improved to 85 for HYPOm and 81 for CHr but specificity was reduced
Venous Hb had high specificity but poor sensitivity for IDE and AIS A plasma ferritin level of less than 267 mgL was a good surrogate for assessing IDE Congreso Nacio
nal Laboratorio Cliacutenico 2018
Microcytic RBC and reticulocyte mean cell hemoglobin content predicted iron depletion with
sensitivities 70 and 64
specificities of 72 and 78 respectively
When both combined
increased the sensitivity to 82
Congreso Nacional Laboratorio Cliacutenico
2018
Depending on the number of donations during the preceding12 months
Absent iron stores were detected in up to 214 of male and278 of female donors respectively
impaired hemoglobinisation IH was present in up to 64 maleand 167 female donors with 2 and 4 preceding donationsrespectively
The defined CHr cut-off value was 280 pg to detect IH infrequent whole blood donors with AIS leading to a testspecificity of 982 (positive predictive value PPV 577) inmale and of 978 (PPV 829) in female donors
It may help to prevent the development of anemia in frequentblood donors and also can help to decide whether donordeferral or even iron substitution need to be recommended
Congreso Nacional Laboratorio Cliacutenico
2018
Of the 501 blood donors sTfR and Ret-He detected Latent Iron Deficiency in 148 and 135 donors respectively
In comparison to sTfR Ret-He had sensitivity of 927 specificity of 9716 PPV of 931 and NPV of 963
Serum Ferritin TIBC and serum Iron had comparatively lower sensitivity of 8716 797 and 777 respectively
Conclusion Ret-He can be used as a routine screening test to detect LID in blood donors
This could provide an opportunity to make appropriate and timely interventions like dietary changes or drug supplementation
Congreso Nacional Laboratorio Cliacutenico
2018
Singh A Chaudhary R Pandey HC Sonker A Identification of iron status of blood donors by using low hemoglobin density and microcytic anemia factor Asian J Transfus Sci 20181246-50
The main objective of this study was to assess ifLHD and Maf could be used for assessment ofiron status in blood donors and also to establisha cut-off for these two parameters at which atentative iron deficiency could be reportedconclusively
Results LHD and Maf were able to differentiatebetween iron deficient and iron-depleteddonors from normal donorsA cutoff of 918 for LHD was able todifferentiate iron deficient and depleted statefrom normal iron statessensitivity 919 and specificity 71respectivelya cutoff of 1016 for Mafsensitivity 946 and specificity 968
MAf = (MVC Hb) 100
Congreso Nacional Laboratorio Cliacutenico
2018
Hb reticulocitaria sensible para detectar la fase inicial del deacuteficitde hierro cuando la eritropoyesis requiere maacutes cantidad que laque recibe ANTES de que la anemia se establezca
La deteccioacuten precoz del deacuteficit de hierro en la fase del balance negativo demanda aporte contribuye a reducir sus manifestaciones cliacutenicas en los pacientes afectados mejorando la salud puacuteblica
Un tratamiento menos prolongado con suplementos y menor consumo de los recursos sanitaros Contribuye a la eficiencia y sostenibilidad de los servicios sanitarios
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
Buttarello MLaboratory diagnosis of anemia are the old and new red cell parameters useful in classification and treatment howInt Jnl Lab Hem 2016 38 (Suppl 1) 123ndash132
Congreso Nacional Laboratorio Cliacutenico
2018
Buttarello MLaboratory diagnosis of anemia are the old and new red cell parameters useful in classification and treatment howInt Jnl Lab Hem 2016 38 (Suppl 1) 123ndash132
Congreso Nacional Laboratorio Cliacutenico
2018
Ralph Green amp Ananya Datta Mitra Megaloblastic Anemias Nutritional and Other CausesMed Clin N Am 2017 101 297ndash317
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
ANEMIA CARENCIAL CAUSAS
Factores alimentariosConsumir una dieta vegetariana mal planeadaAlimentacioacuten deficiente en los bebeacutesDesnutricioacuten durante el embarazo
Deacuteficit de absorcioacutenAlcoholismo croacutenicoEnfermedad de Crohn celiaquiacutea infeccioacuten otros problemas que le dificulten al cuerpo la digestioacuten de los alimentosAnemia perniciosa (factor intriacutenseco)Cirugiacuteas para extirpar ciertas partes del estoacutemago o el intestino delgado
MedicamentosB12 omeprazol metformina colchicina aminosalicilatos neomicinaFOLATO fenitoiacutena metotrexato sulfasalacina triamtereno pirimetamina trimetoprim con sulfametoxazol barbituacutericos
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
Reacciones metaboacutelicas en las que participan la vitamina B12 y el folato bull la conversioacuten de metilmalonil-CoA a succinil-CoA donde la adenosil-cobalamina actuacutea de
cofactor Por ello un deacuteficit de B12 conlleva un aumento de metilmalonil-CoA y de su producto de hidroacutelisis el aacutecido metilmaloacutenico
bull la siacutentesis de metionina a partir de homocisteina gracias a la metionina sintetasa y a la metil-cobalamina como cofactor En esta misma reaccioacuten el metiltetrahidrofolato es transformado a tetrahidrofolato que es necesario para la siacutentesis de DNA
Congreso Nacional Laboratorio Cliacutenico
2018
Anemia macrociacutetica secundaria a deficiencia de aacutecido foacutelico y de vitamina B12(cobalamina)
La deficiencia de B12 yo aacutecido foacutelico es la causa maacutes frecuente de megaloblastosis
Dentro de distintas funciones generales del metabolismo la vitamina B12 es uncofactor esencial en la siacutentesis de ADN y ARN compromete a todas las ceacutelulas delorganismo
Su deficiencia se manifiesta en oacuterganos con alto recambio celular como la meacutedulaosea y en el sistema nervioso central (SNC) a traveacutes de la siacutentesis de mielina y lareparacioacuten axonal
La deficiencia de cobalamina es responsable de alteraciones hematoloacutegicasneuroloacutegicas neurocognitivas y neuropsiquiaacutetricas
La siacutentesis defectuosa de ADN conduce a la apoptosis y a la hemoacutelisis (intra yextramedular) causantes de la hemopoyesis inefectiva
En meacutedula la siacutentesis ineficiente de DNA causa cambios megaloblaacutesticos comoconsecuencIa anemia y citopenias
Congreso Nacional Laboratorio Cliacutenico
2018
Limitaciones de los meacutetodos diagnoacutesticos claacutesicos
Volumen Corpuscular Medio (VCM) y morfologiacutea de sangre perifeacuterica En una serie de pacientes con deacuteficit de cobalamina soacutelo un 29 teniacutean anemia y soacutelo un 36 teniacutean un VCM gt 100 fL
Un VCM normal no puede ser empleado para rechazar una determinacioacuten de nivel de cobalamina ya que hasta un 25 de casos con manifestaciones neuroloacutegicas cursan con un VCM normal
Cobalamina seacuterica (nivel de B12) Es el test diagnoacutestico rutinario inicial estaacutendar Es un test ampliamente disponible de bajo coste y automatizado Sin embargo presenta algunas limitaciones
-- Existencia de varias teacutecnicas y ausencia de un gold standard por lo que hay diferentes liacutemites de referencia
-- Variacioacuten intraindividual muy alta
La OMS publicoacute en 2008 las conclusiones de un grupo teacutecnico consultado sobre el deacuteficit de cobalamina y folato
El grupo reconocioacute que no existen unos umbrales universalmente reconocidos para definir el deacuteficit de ambas vitaminas y expresaron la necesidad de un consenso
Devalia V Hamilton MS and Molloy AM on behalf of the British Committee for standards in haematology Guidelines for the diagnosis and treatment of cobalamin and folate disorders Br J Haematol 2014 166(4) 496-513
Schrier SL Diagnosis and treatment of vitamin B12 and folate deficiency UpToDate Last updated Jun 25 2014
de Benoist B Conclusions of a WHO Technical Consultation on folate and vitamin B12 deficiencies Food Nutr Bull 200829(2 Suppl)S238ndash44Congreso Nacional Laboratorio Cliacutenico
2018
Tomado de Tefferi A Li C En Atlas of Clinical Hematology Publicado por JO Armitage Philadelphia Current Medicine 2004
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
Int Jnl Lab Hem 2007 29 327ndash334
Clin Lab 201662343-347
In ourstudy mean MCVrMCV ratio of healthy controls is130 as microcytic anemia irondeficiency anemia is121 as also macrocytic anemia vitamin B12 deficiencyanemia is 115
Congreso Nacional Laboratorio Cliacutenico
2018
Sualeh Muslim Khan Muhammad Akbar Agha
Mean cell volume of reticulocytemdashA new parameter for diagnosing sub-clinical cobalamin deficiency in blood donors Int J Lab Hem 20181ndash4
The Abbott CELL-DYN Sapphire Hematology System uses multi-angle polarized scatter separation (MAPSS) and focused flow impedance technologies
Congreso Nacional Laboratorio Cliacutenico
2018
MCVr at 985 fL yielded the highest Youdenrsquos index at sensitivity of 82 specificity of 828 AUC 0847 ( 95 CI 803-891)
Khan SM Agha MA Mean cell volume of reticulocyte-A new parameter for diagnosing sub-clinical cobalamin deficiency in blood donors
Int J Lab Hem 20181ndash4 2018 Jul 13 doi 101111ijlh12899
Congreso Nacional Laboratorio Cliacutenico
2018
Role of Cell Population Data in the detection of folate and cobalamin deficiency
J Nieto et al
XXXI st International Symposium on Technological Innovations in Laboratory Hematology ISLH 2018 10-12 May 2018 Brussels Belgium
M-V-NRET and SD-VNRET are the best discriminatory single parameters to distinguish between patients with B9B12 deficiency and reference subjects M-V-NRETAUC=0823 sensitivity 78 and specificity 86
AUC=0852 sensitivity 55 and specificity 60
Conclusions The CPD parameters of Volume and Light Scatter (M and SD of LALS angle) that inform about size and intracellular structure of RBCs provided very useful information for the detection of B9B12 deficiency
Congreso Nacional Laboratorio Cliacutenico
2018
Cell Population Data
bull Paraacutemetros poblacionales de los leucocitos
bull Describen la morfologiacutea tamantildeo
estructuras citoplasmaacuteticas
nuacutecleo aacutecidos nucleacuteicos
bull Son datos numeacutericos con los que se construyen los ejes de lo diagramas de dispersioacuten de los leucocitos
bull Dependen de la tecnologiacutea
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
High Sensitivity New Parameters for the Detection of Vitamin B12 and Folate Deficiencies Blood 2008 1125379
B12 def vs
Normals
Mann
Withney T-Test
ROC
AUC Sens Specif Cutoff signifROC
MCV p=03156 p=09533 0577
MPV p=00001 0802 792 806 lt83 p=00001
NE Mean
Volume plt00001 0862 833 778 gt1403 p=00001
MO Mean
Volume plt00001 0829 625 889 gt1723 p=00001
MRV p=00113 0705 50 964 gt1133 p=00051
Folate def vs
Normals
Mann
Withney T-Test
ROC
AUC Sens Specif Cut-off signifROC
MCV p=00798 p=06461 0665
MPV plt00001 0832 81 806 lt83 p=00001
NE Mean
Volume p=00008 087 952 694 gt1402 p=00001
MO Mean
Volume p=00002 0801 667 833 gt1696 p=00001
MRV p=00054 0731 476 964 gt1133 p=00019
The Mean Neutrophil Volume (MNE V) and Mean Monocyte Volume (MMOV) may be used for the detection of megaloblastic neutrophils and monocytes MNEV and MMOV have significantly higher sensitivity than the previous information from the red cells (MCV) detecting B12 or folate deficiency because they are not affected by the presence at the same time of Iron deficiency or other reasons of anemia
Congreso Nacional Laboratorio Cliacutenico
2018
POSTER 733
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
CPD Sysmex XN
NE SSC complejidad
NE SFL aacutecidos nucleacuteicos
NE FSC tamantildeo
NE WX
NE WY
NE WZ
MO X
MO Y
MO Z
MO WX
MO WY
MO WZ
LY X
LY Y
LY Z
LY WX
LY WY
LY WZCongreso Nacio
nal Laboratorio Cliacutenico 2018
As MCV is the mean which is calculated it is insensitive to the presence of a small number of macrocytes
Further macrocytosis can be obscured by concomitant disorders that can cause microcytosis resulting inmasked megaloblastic anaemia (MA) for example iron deficiency hereditary elliptocytosis alpha and betathalassemia
This study was undertaken to evaluate the role of NEUT-X and NEUT-Y in detecting MA on peripheral blood andalso see whether other forms of macrocytic anaemia can be differentiated from MA
In MA the peripheral blood smear shows cytopenia with macroovalocytes and hypersegmented
neutrophils (gt5 lobes in 5 neutrophils six lobes nuclei or lobe average of gt35)
In conclusion our study shows that higher values of NEUT-X and NEUT-Y in MA patients in spite of low ornormal MCV high RDW may be used to not only reveal the masked cases of MA with concomitant irondeficiency but also separate them from the broader macrocytic anaemia group
Peripheral smear remains diagnostic however making smear for all the suspicious cases is a cumbersomeand tedious procedure Thus these parameters emerge as more reliable and stable parameters in themodern laboratories which in future may replace the older screening tools
Congreso Nacional Laboratorio Cliacutenico
2018
A favor Eficiencia Operativa
Mejora el proceso del Laboratorio
Mejor informacioacuten al Cliacutenico al mismo coste
Mejora la informacioacuten
Informa sobre la eritropoyesis deteccioacuten precoz de estados carenciales
Ayuda al cliacutenico
Estado real del paciente
En contraParaacutemetros de investigacioacuten
Dificultad de standarizar dependencia teacutecnica
Control de calidadCongreso Nacional Laboratorio Cliacutenico
2018
Poblacioacuten sana caucaacutesica
Congreso Nacional Laboratorio Cliacutenico
2018
A Saacutenchez Salinas AM Garciacutea Hernaacutendez A Martiacutenez Mariacuten V Cabantildeas PerianesSindrome anemico Medicine 201612(20)1127-35
Congreso Nacional Laboratorio Cliacutenico
2018
Anemias carenciales
Anemia ferropeacutenicaTincioacuten de Perls en meacutedula osea(hemosiderina y sideroblastos negativos)Sideremia baja saturacioacuten de transferrina disminuiacuteda ferritina seacuterica baja receptor soluble de transferrina(aumentado) y protoporfirinaeritrocitaria libre (aumentada)Anemia megaloblaacutesticaVitamina B12 seacuterica disminuida folato seacuterico normal o aumentado y folato intraeritrocitario disminuido se observan en la deficiencia de vitamina B12Folato seacuterico e intraeritrocitariodisminuidos y vitamina B12 seacuterica normal se encuentran en la deficiencia de folato
Congreso Nacional Laboratorio Cliacutenico
2018
Actualizacioacuten en la interpretacioacuten de las anemias carenciales iquestQueacute hay de nuevo en el siglo XXI
La gran novedad consiste en que podemos evitar que un sujeto sano lleguea padecer una anemia carencial utilizando los paraacutemetros del hemogramaavanzadohelliphellip
helliphellip y no soacutelo contamos con la serie rojahelliphelliphellip
Congreso Nacional Laboratorio Cliacutenico
2018
AM Garcia Hernandez A Sanchez Salinas V Cabanas Perianes M Blanquer Blanquer Protocolo diagnostico diferencial del sindromeAnemico Medicine 201612(20)1170-4
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
Total YLD resulting from all causes of anemia by country
Kassebaum NJ et al Blood 2014123615-624 copy2014 by American Society of Hematology
Congreso Nacional Laboratorio Cliacutenico
2018
Clamaschella C Iron deficiency anemia N Engl J Med 20153721832-43
Congreso Nacional Laboratorio Cliacutenico
2018
Iron Cycle
Fleming RE Ponka P N Engl J Med 2012366348-359Congreso Nacional Laboratorio Cliacutenico
2018
Camaschella C N Engl J Med 20153721832-43Congreso Nacio
nal Laboratorio Cliacutenico 2018
G Lippi amp M Plebani Recent developments and innovations in red blood cells diagnostics Journal of Laboratory and Precision Medicine 2018DOI 1021037jlpm20180709 AOP
Innovative erythrocyte parametersThese innovative parameters most typically include automated reticulocyte andnucleated RBC counts hemoglobinization of reticulocytes and RBC reticulocytehemoglobin content reticulocyte maturation automatic analysis and calculationof microcytic and hypochromic RBC
The various combination of these different parameters not only may be useful tocomplement clinical history physical examination and results of moreconventional laboratory investigations (ie CBC ferritin transferrin ironhaptoglobin folic acid and vitamin B12 among others) for investigating theunderlying cause(s) of anemia
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
Biomarcadores de Eritroyesis
Urrechaga E Borque L Escanero JF Biomarkers of hypochromia the contemporary assessment of
Iron status and erythropoiesis Journal of Biomedicine and Biotechnology
httpdxdoiorg1011552013603786
Abreviatura
(unidades)
Compantildeiacutea
RBC Hipocromos Hypo () Siemens
Hb Reticulocitaria CHr (pg) Siemens
RBC Hipocromos HPO () Abbott
Hb Reticulocitaria media MCHr (pg) Abbott
RBC Hipocromos Hypo He () Sysmex
Hb Reticulocitaria equivalente Ret He (pg) Sysmex
Low Hb density
Contenido de Hb Reticulocitaria
Expresioacuten Hb reticulocitaria
LHD ()
RHCc (pg)
RHE (pg)
Beckman Coulter
Horiba ABX
Mindray
Congreso Nacional Laboratorio Cliacutenico
2018
Informacioacuten avanzada valor antildeadido
Reticulocitos Eritrocitos
bull Permanecen en la sangre 1-2 diacuteas hasta que se convierten en eritrocitos maduros
bull El contenido de hemoglobinapuede reflejar la cantidad de hierro disponible de maneraefectiva
bull Refleja la calidad de la eritropoyesis en el periodoinmediato
bull Permanecen en la sangre 90-120 diacuteas
bull Las diversas subpoblacionespueden reflejar el status feacuterrico en las pasadas semanas
bull MCV MCH son las medias del
conjunto de RBC las de fracciones indican la contribucioacuten de los diversos tipos de RBC a las medias
Congreso Nacional Laboratorio Cliacutenico
2018
Angulo alto
Dispersioacuten lateral Hb
Angulo bajo
Dispersioacuten frontal VOLUMEN
LASER Absorbancia Fluorescencia
RNA contenido
Citometriacutea
Congreso Nacional Laboratorio Cliacutenico
2018
RETICULOCITOS
Compantildeiacutea Instrumento Meacutetodo Colorante Paraacutemetros
Abbott CELLDYN Ruby
CELLDYN
Sapphire
Absorbancia
Fluorescencia
Nuevo azul
metileno
Sybr II
IRF
IRF MCHr MCVr
Beckman
Coulter
UniCell DxH
LH series
Impedancia
citometriacutea de flujo
VCS
Nuevo azul
metileno
Nuevo azul
metileno
IRF MRVHLRRSf
IRF MRV
MSCVHLR
Horiba ABX Pentra
DX120
Impedancia
citometriacutea de flujo
fluorescencia
Naranja de tiazol IRF MRV RETH
RHbC
Siemens ADVIA 120 Absorbancia
Scatter
Oxazine 750 IRF MCVr CHr
Sysmex XE5000 XN Fluorescencia Polimetina IRF RetHe ΔHeCongreso Nacional Laboratorio Cliacutenico
2018
Los reticulocitos precursores de los eritrocitos madurangeneralmente a lo largo de unos dos diacuteas El recuento dereticulocitos es por lo tanto una medida de la cantidad dela eritropoyesis en la meacutedulaParaacutemetros derivados de los reticulocitos los describenmorfoloacutegicamente tamantildeo contenido en Hemoglobinacantidad de material geneacuteticoDe esta forma al referirse a caracteriacutesticas de losreticulocitos es la calidad de la eritropoyesis la que puedeser evaluada
La Hb reticulocitaria se relaciona con la cantidad de hierro disponible efectivamente para laeritropoyesis un valor bajo indica que el aporte es deficitario respecto a la demanda en el momentoactual 28-30 pg
Congreso Nacional Laboratorio Cliacutenico
2018
MCV MCH son los valores medios de volumen y Hb en toda la poblacioacuten RBC
No informan acerca de las ceacutelulas individuales
Ni de la variedad de eacutestas anisocitosis policromasia
Congreso Nacional Laboratorio Cliacutenico
2018
Se cuentan el nuacutemero de pulsos de 36-360fL y el nuacutemero de partiacuteculas que tienen el mismo tamantildeo y se trasladan los resultados a una graacutefica de Volumen Nuacutemero de ceacutelulasSe obtiene el histograma de RBC que proporciona
bull Nuacutemero de RBC el nuacutemero de pulsos dentro de este rango de tamantildeos
bull MCV se corresponde con la media del histograma de RBC
bull RDW o ADE Ancho de Distribucioacuten del histograma de RBC se corresponde con el coeficiente de variacioacuten de la curva
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
Abbott Sapphire lo calcula en el 50 de la altura del pico del histogramaSysmex y Mindray al 20 desde la base del histogramaSiemens calcula la anchura del pico comprendido entre 60 y 120 fL
Aunque RDW ADE generalmente se entiendecomo coeficiente de variacioacuten de ladistribucioacuten de los voluacutemenes de loseritrocitos algunos analizadoreshematoloacutegicos lo calculan desde la medicioacutendirecta de la anchura de la distribucioacuten
Congreso Nacional Laboratorio Cliacutenico
2018
G Lippi amp M Plebani
Recent developments and innovations in red blood cells diagnostics
Journal of Laboratory and Precision Medicine 2018
DOI 1021037jlpm20180709 AOPCongreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
copy 2012 Mindray Confidential 26
HDWHYPERHYPO
HDW HGB Distribution Width
HDW is the distribution width of Hgb histogram
Congreso Nacional Laboratorio Cliacutenico
2018
copy 2012 Mindray Confidential 27
MCHrHDWHYPERHYPOMCHr Mean RET HGB Concentration
Congreso Nacional Laboratorio Cliacutenico
2018
Histograma RBC el mapa de Mie
28 41
Congreso Nacional Laboratorio Cliacutenico
2018
Abbott Mindray Siemens
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
Severe Iron Deficiency Anemia Female 34 years
19 th March 18 th April
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
SysmexRBCHe erythrocyte Hb equivalentRetHe reticulocyte Hb equivalent(content)
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
MIC
MAC
HPO HPR
Congreso Nacional Laboratorio Cliacutenico
2018
copy 2012 Mindray Confidential 36
MINDRAY MCHrHDWHYPERHYPO
MCHr Mean RET HGB Concentration
HDW HGB Distribution Width
HYPER The percentage of hyperchromicred blood cells
HYPO The percentage of hypochromic red blood cells
Thalassemia screeningIDA treatment monitoringIDA screening
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
Hipocromo
Hipercroacutemico onormocroacutemico
iquestConcentracioacuten o contenido de Hemoglobina
Hipocroacutemiconormocroacutemico
Abbott Mindray Siemens Hypo CONCENTRACIOacuteN Hblt280gL
Sysmex Hypo CONTENIDO Hblt 17 pg
Congreso Nacional Laboratorio Cliacutenico
2018
Low Hb Density
Microcytic Factor Maf = (HbMCV)100
Nuevo moacutedulo transductor muacuteltiple con laacuteser de diodo y dos sensores oacutepticos
Anaacutelisis de hasta 50000 ceacutelulas con 7 paraacutemetros tecnoloacutegicos (leucocitos reticulocitos eritroblastos)
1 Volumen digital
2 Conductividad digital
3 5 aacutengulos de dispersioacuten de luz laacuteser digital
bull MALS (Median Angle Light Scatter)
bull UMALS (Upper Median Angle Light Scatter) 20deg a 43deg
bull LMALS (Lower Median Angle Light Scatter) 09deg a 19deg
bull LALS (Low Angle Light Scatter) asymp 51deg
bull AL2 (Axial Light Loss) 0deg a 05deg
Congreso Nacional Laboratorio Cliacutenico
2018
Hierro es un elemento criacutetico para elfuncionamiento oacuteptimo y supervivenciade las ceacutelulas
Disfuncioacuten mitocondrialActividad enzimaacutetica afectadaProteiacutenas de transporte y estructuralesproteins
Capacidad fiacutesica mermadaCapacidad de trabajo reducidaCapacidades cognitivas afectadasMorbilidad y mortalidad
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
It is generally assumed that worldwide ldquoat least half the anemia is due tonutritional iron deficiencyrdquo and that ldquoup to a prevalence of iron deficiency anemiaof 40 the prevalence of iron deficiency will be about 25 times that of anemiardquoHowever it is evident from the foregoing discussion that there are considerablevariations in both of these ratios depending on the age and sex of the peoplebeing studied the region of the world in which they live and the prevalence ratesof other causes of anemia
WHO Department of Nutrition for Health and DevelopmentAssessing the iron status of populations including literature reviews report of a Joint World Health OrganizationCenters for DiseaseControl and Prevention Technical Consultation on the Assessment of Iron Status at the Population Level Geneva Switzerland 6ndash8 April2004 ndash 2nd ed
Congreso Nacional Laboratorio Cliacutenico
2018
Estaacute bien establecido que la anemia produce una miriacuteada de secuelas tanto fiacutesicas comopsicoloacutegicas
Pero los efecto deleteacutereos se deben al deficit de hierro que es un evento previo a que seestablezca la anemia
El deacuteficit de hierrro auacuten sin anemia tiene efectos negativos en el desarrollo cognitivo y fiacutesico
Rattehalli D et al Iron deficiency without anemia do not wait for the Hemoglobin to drop
Health Policy and Technology 2013 2 45-48Congreso Nacio
nal Laboratorio Cliacutenico 2018
SuominenP et al Serum transferrin receptor and transferrin receptor-ferritin index identify healthy subjects with subclinical iron deficits Blood 1998 92 2934ndash9Halwachs-Baumann G Diagnosis of anaemia old things rearranged Wien Med Wochenschr 2012 162478ndash88
Congreso Nacional Laboratorio Cliacutenico
2018
Hemoglobina de reticulocito y su importancia en el diagnoacutestico temprano de anemiaferropeacutenica
Y Maacuterquez-Beniacutetez et al Universidad de BocayaAugust
2018 DOI 1022267rus182003133 aop
El contenido de hemoglobina de reticulocitos (CHr) es un paraacutemetro en la biometriacuteahematoloacutegica automatizada utilizado como un marcador de la biodisponibilidad delhierro en la eritropoyesis
Objetivo Exponer la aplicabilidad de la CHr como un paraacutemetro en el diagnoacutesticoprecoz de la anemia por deficiencia de hierro asiacute como su medicioacuten e interpretacioacuten
Materiales y meacutetodos Se realizoacute la revisioacuten de artiacuteculos cientiacuteficos en ingleacutes y espantildeolen las bases de datos PubMed ScienceDirect LILACS y Medline usando descriptoresvalidados en Medical Subject Headings (MeSH) considerando periodo depublicabilidad del 80 inferior a 5 antildeos
Conclusiones La CHr es un paraacutemetro de gran utilidad en el diagnoacutestico temprano deanemia ferropeacutenica y otras patologiacuteas como deficiencia funcional de hierro estadosde inflamacioacuten croacutenica y enfermedad renal croacutenica
Biomarcador temprano en el diagnoacutestico de deficiencia de hierro antes de presentarsecambios morfoloacutegicos eritrociacuteticosCongreso Nacio
nal Laboratorio Cliacutenico 2018
bull A total of 1105 NES participants (639 men 466 women)bull CHr becomes affected in a relatively early stage in the development of iron deficiency before iron
deficiency anemia and clinical symptoms become apparentbull Therefore this parameter might be useful to identify persons healthy and diseased at risk of
developing iron deficiency anemia and subsequently to apply interventions in order to prevent further development of iron deficiency anemiaCongreso Nacio
nal Laboratorio Cliacutenico 2018
Hb reticulocitaria sensible para detectar la fase inicial del deacuteficit de hierro cuando laeritropoyesis requiere maacutes cantidad que la que recibe ANTES de que la anemia seestablezca
Congreso Nacional Laboratorio Cliacutenico
2018
No ID LID P
RBC 1012L 48 (08) 437 (05) lt00001
Hb gL 135 (6) 131 (12) 0006
MCV fL 922 (21) 902 (38) 0006
MCH pg 324 (07) 306 (22) lt00001
MCHC gL 339 (6) 319 (23) 0001
RDW
Ret He pg
Hypo He
LHD
Ferritin microgL
131 (06)
338 (21)
03 (015)
28 (20)
86 (3)
145 (21)
278 (24)
69 (55)
56 (25)
16 (76)
lt00001
lt00001
lt00001
lt00001
lt00001
AUC 95 CI Cutoff Sensitivity Specificity
LHD 0898 0819-0978 50 859 841
Ret He 0914 0824-1000 299pg 868 857
Hypo He 0934 0856-1000 16 857 921
Clinical value of markers of hypochromia in the detection of latent iron deficiency in non-anemic premenopausal women
No ID Hb gt 120 gL s-ferritin was within reference intervalLatent Iron Defiency Hb gt 120 gL s-ferritin lt 30 μgL
Urrechaga E et al Journal Clin Lab Analysis 2016 30 (5) 623-627
97 women (388) in 250 apparently healthy women had latent IDCongreso Nacional Laboratorio Cliacutenico
2018
Schorer G et al Abstract Jahreskongress der Deutschen Gesellschaft fuumlr Transfusionsmedizin und Immunhaumlmatologie Rostock 15 - 18 September 2009
Congreso Nacional Laboratorio Cliacutenico
2018
Caring for Those Who Share Mitigating Iron Deficiency in Regular Blood DonorsMast Alan E
bull Iron deficiency caused by regular blood donation is a problem facing blood centers Each blood donation removes 200 to 250 mg of iron from the donor Consequently many donors become iron deficient with repeated donation
bull This presents a challenge to blood centers that has become more acute in recent years with the realization that iron deficiency even in the absence of anemia is associated with adverse effects including fatigue and decreased exercise tolerance as well as neurological symptoms such as decreased cognitive function pica and restless leg syndrome
bull REDS-II investigators performed a longitudinal study investigating the iron status of blood donors over a two year period called the REDS-II Donor Iron Status Evaluation (RISE)
bull Results from the baseline analysis of regular donors (e 2 donations per year (females) or e 3 donations per year (males) revealed that over two-thirds of female donors and over one-half of male donors have iron deficiency
Congreso Nacional Laboratorio Cliacutenico
2018
Transfusion 2013 532766-2775
bull We evaluated the diagnostic sensitivity and specificity of red blood cell (RBC) hematology analyzer indices to assess iron status as a part of donor management iron deficient erythropoiesis (IDE) and absence of iron stores (AIS)
bull STUDY DESIGN AND METHODS A total of 1659 male and female donors from the Retrovirus Epidemiology Donor Study-II (REDS-II) Donor Iron Status Evaluation (RISE) study who were either first-timereactivated (FT RA no donations for 2 years) or frequent donors were recruited into a longitudinal study of regular donation of RBCs Of these 1002 donors returned 15 to 24 months later for a final assessment
Absent iron stores (AIS) was defined as plasma ferritin level of less than 12 mgL Logarithm of the ratio of soluble transferrin receptor to ferritin of at least 207 was used to define iron-deficient erythropoiesis (IDE)
bull RESULTS HYPOm and CHr detected IDE with comparable sensitivity 72 versus 69 but differed in specificity HYPOm 68 and CHr 53
For detecting AIS sensitivity was improved to 85 for HYPOm and 81 for CHr but specificity was reduced
Venous Hb had high specificity but poor sensitivity for IDE and AIS A plasma ferritin level of less than 267 mgL was a good surrogate for assessing IDE Congreso Nacio
nal Laboratorio Cliacutenico 2018
Microcytic RBC and reticulocyte mean cell hemoglobin content predicted iron depletion with
sensitivities 70 and 64
specificities of 72 and 78 respectively
When both combined
increased the sensitivity to 82
Congreso Nacional Laboratorio Cliacutenico
2018
Depending on the number of donations during the preceding12 months
Absent iron stores were detected in up to 214 of male and278 of female donors respectively
impaired hemoglobinisation IH was present in up to 64 maleand 167 female donors with 2 and 4 preceding donationsrespectively
The defined CHr cut-off value was 280 pg to detect IH infrequent whole blood donors with AIS leading to a testspecificity of 982 (positive predictive value PPV 577) inmale and of 978 (PPV 829) in female donors
It may help to prevent the development of anemia in frequentblood donors and also can help to decide whether donordeferral or even iron substitution need to be recommended
Congreso Nacional Laboratorio Cliacutenico
2018
Of the 501 blood donors sTfR and Ret-He detected Latent Iron Deficiency in 148 and 135 donors respectively
In comparison to sTfR Ret-He had sensitivity of 927 specificity of 9716 PPV of 931 and NPV of 963
Serum Ferritin TIBC and serum Iron had comparatively lower sensitivity of 8716 797 and 777 respectively
Conclusion Ret-He can be used as a routine screening test to detect LID in blood donors
This could provide an opportunity to make appropriate and timely interventions like dietary changes or drug supplementation
Congreso Nacional Laboratorio Cliacutenico
2018
Singh A Chaudhary R Pandey HC Sonker A Identification of iron status of blood donors by using low hemoglobin density and microcytic anemia factor Asian J Transfus Sci 20181246-50
The main objective of this study was to assess ifLHD and Maf could be used for assessment ofiron status in blood donors and also to establisha cut-off for these two parameters at which atentative iron deficiency could be reportedconclusively
Results LHD and Maf were able to differentiatebetween iron deficient and iron-depleteddonors from normal donorsA cutoff of 918 for LHD was able todifferentiate iron deficient and depleted statefrom normal iron statessensitivity 919 and specificity 71respectivelya cutoff of 1016 for Mafsensitivity 946 and specificity 968
MAf = (MVC Hb) 100
Congreso Nacional Laboratorio Cliacutenico
2018
Hb reticulocitaria sensible para detectar la fase inicial del deacuteficitde hierro cuando la eritropoyesis requiere maacutes cantidad que laque recibe ANTES de que la anemia se establezca
La deteccioacuten precoz del deacuteficit de hierro en la fase del balance negativo demanda aporte contribuye a reducir sus manifestaciones cliacutenicas en los pacientes afectados mejorando la salud puacuteblica
Un tratamiento menos prolongado con suplementos y menor consumo de los recursos sanitaros Contribuye a la eficiencia y sostenibilidad de los servicios sanitarios
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
Buttarello MLaboratory diagnosis of anemia are the old and new red cell parameters useful in classification and treatment howInt Jnl Lab Hem 2016 38 (Suppl 1) 123ndash132
Congreso Nacional Laboratorio Cliacutenico
2018
Buttarello MLaboratory diagnosis of anemia are the old and new red cell parameters useful in classification and treatment howInt Jnl Lab Hem 2016 38 (Suppl 1) 123ndash132
Congreso Nacional Laboratorio Cliacutenico
2018
Ralph Green amp Ananya Datta Mitra Megaloblastic Anemias Nutritional and Other CausesMed Clin N Am 2017 101 297ndash317
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
ANEMIA CARENCIAL CAUSAS
Factores alimentariosConsumir una dieta vegetariana mal planeadaAlimentacioacuten deficiente en los bebeacutesDesnutricioacuten durante el embarazo
Deacuteficit de absorcioacutenAlcoholismo croacutenicoEnfermedad de Crohn celiaquiacutea infeccioacuten otros problemas que le dificulten al cuerpo la digestioacuten de los alimentosAnemia perniciosa (factor intriacutenseco)Cirugiacuteas para extirpar ciertas partes del estoacutemago o el intestino delgado
MedicamentosB12 omeprazol metformina colchicina aminosalicilatos neomicinaFOLATO fenitoiacutena metotrexato sulfasalacina triamtereno pirimetamina trimetoprim con sulfametoxazol barbituacutericos
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
Reacciones metaboacutelicas en las que participan la vitamina B12 y el folato bull la conversioacuten de metilmalonil-CoA a succinil-CoA donde la adenosil-cobalamina actuacutea de
cofactor Por ello un deacuteficit de B12 conlleva un aumento de metilmalonil-CoA y de su producto de hidroacutelisis el aacutecido metilmaloacutenico
bull la siacutentesis de metionina a partir de homocisteina gracias a la metionina sintetasa y a la metil-cobalamina como cofactor En esta misma reaccioacuten el metiltetrahidrofolato es transformado a tetrahidrofolato que es necesario para la siacutentesis de DNA
Congreso Nacional Laboratorio Cliacutenico
2018
Anemia macrociacutetica secundaria a deficiencia de aacutecido foacutelico y de vitamina B12(cobalamina)
La deficiencia de B12 yo aacutecido foacutelico es la causa maacutes frecuente de megaloblastosis
Dentro de distintas funciones generales del metabolismo la vitamina B12 es uncofactor esencial en la siacutentesis de ADN y ARN compromete a todas las ceacutelulas delorganismo
Su deficiencia se manifiesta en oacuterganos con alto recambio celular como la meacutedulaosea y en el sistema nervioso central (SNC) a traveacutes de la siacutentesis de mielina y lareparacioacuten axonal
La deficiencia de cobalamina es responsable de alteraciones hematoloacutegicasneuroloacutegicas neurocognitivas y neuropsiquiaacutetricas
La siacutentesis defectuosa de ADN conduce a la apoptosis y a la hemoacutelisis (intra yextramedular) causantes de la hemopoyesis inefectiva
En meacutedula la siacutentesis ineficiente de DNA causa cambios megaloblaacutesticos comoconsecuencIa anemia y citopenias
Congreso Nacional Laboratorio Cliacutenico
2018
Limitaciones de los meacutetodos diagnoacutesticos claacutesicos
Volumen Corpuscular Medio (VCM) y morfologiacutea de sangre perifeacuterica En una serie de pacientes con deacuteficit de cobalamina soacutelo un 29 teniacutean anemia y soacutelo un 36 teniacutean un VCM gt 100 fL
Un VCM normal no puede ser empleado para rechazar una determinacioacuten de nivel de cobalamina ya que hasta un 25 de casos con manifestaciones neuroloacutegicas cursan con un VCM normal
Cobalamina seacuterica (nivel de B12) Es el test diagnoacutestico rutinario inicial estaacutendar Es un test ampliamente disponible de bajo coste y automatizado Sin embargo presenta algunas limitaciones
-- Existencia de varias teacutecnicas y ausencia de un gold standard por lo que hay diferentes liacutemites de referencia
-- Variacioacuten intraindividual muy alta
La OMS publicoacute en 2008 las conclusiones de un grupo teacutecnico consultado sobre el deacuteficit de cobalamina y folato
El grupo reconocioacute que no existen unos umbrales universalmente reconocidos para definir el deacuteficit de ambas vitaminas y expresaron la necesidad de un consenso
Devalia V Hamilton MS and Molloy AM on behalf of the British Committee for standards in haematology Guidelines for the diagnosis and treatment of cobalamin and folate disorders Br J Haematol 2014 166(4) 496-513
Schrier SL Diagnosis and treatment of vitamin B12 and folate deficiency UpToDate Last updated Jun 25 2014
de Benoist B Conclusions of a WHO Technical Consultation on folate and vitamin B12 deficiencies Food Nutr Bull 200829(2 Suppl)S238ndash44Congreso Nacional Laboratorio Cliacutenico
2018
Tomado de Tefferi A Li C En Atlas of Clinical Hematology Publicado por JO Armitage Philadelphia Current Medicine 2004
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
Int Jnl Lab Hem 2007 29 327ndash334
Clin Lab 201662343-347
In ourstudy mean MCVrMCV ratio of healthy controls is130 as microcytic anemia irondeficiency anemia is121 as also macrocytic anemia vitamin B12 deficiencyanemia is 115
Congreso Nacional Laboratorio Cliacutenico
2018
Sualeh Muslim Khan Muhammad Akbar Agha
Mean cell volume of reticulocytemdashA new parameter for diagnosing sub-clinical cobalamin deficiency in blood donors Int J Lab Hem 20181ndash4
The Abbott CELL-DYN Sapphire Hematology System uses multi-angle polarized scatter separation (MAPSS) and focused flow impedance technologies
Congreso Nacional Laboratorio Cliacutenico
2018
MCVr at 985 fL yielded the highest Youdenrsquos index at sensitivity of 82 specificity of 828 AUC 0847 ( 95 CI 803-891)
Khan SM Agha MA Mean cell volume of reticulocyte-A new parameter for diagnosing sub-clinical cobalamin deficiency in blood donors
Int J Lab Hem 20181ndash4 2018 Jul 13 doi 101111ijlh12899
Congreso Nacional Laboratorio Cliacutenico
2018
Role of Cell Population Data in the detection of folate and cobalamin deficiency
J Nieto et al
XXXI st International Symposium on Technological Innovations in Laboratory Hematology ISLH 2018 10-12 May 2018 Brussels Belgium
M-V-NRET and SD-VNRET are the best discriminatory single parameters to distinguish between patients with B9B12 deficiency and reference subjects M-V-NRETAUC=0823 sensitivity 78 and specificity 86
AUC=0852 sensitivity 55 and specificity 60
Conclusions The CPD parameters of Volume and Light Scatter (M and SD of LALS angle) that inform about size and intracellular structure of RBCs provided very useful information for the detection of B9B12 deficiency
Congreso Nacional Laboratorio Cliacutenico
2018
Cell Population Data
bull Paraacutemetros poblacionales de los leucocitos
bull Describen la morfologiacutea tamantildeo
estructuras citoplasmaacuteticas
nuacutecleo aacutecidos nucleacuteicos
bull Son datos numeacutericos con los que se construyen los ejes de lo diagramas de dispersioacuten de los leucocitos
bull Dependen de la tecnologiacutea
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
High Sensitivity New Parameters for the Detection of Vitamin B12 and Folate Deficiencies Blood 2008 1125379
B12 def vs
Normals
Mann
Withney T-Test
ROC
AUC Sens Specif Cutoff signifROC
MCV p=03156 p=09533 0577
MPV p=00001 0802 792 806 lt83 p=00001
NE Mean
Volume plt00001 0862 833 778 gt1403 p=00001
MO Mean
Volume plt00001 0829 625 889 gt1723 p=00001
MRV p=00113 0705 50 964 gt1133 p=00051
Folate def vs
Normals
Mann
Withney T-Test
ROC
AUC Sens Specif Cut-off signifROC
MCV p=00798 p=06461 0665
MPV plt00001 0832 81 806 lt83 p=00001
NE Mean
Volume p=00008 087 952 694 gt1402 p=00001
MO Mean
Volume p=00002 0801 667 833 gt1696 p=00001
MRV p=00054 0731 476 964 gt1133 p=00019
The Mean Neutrophil Volume (MNE V) and Mean Monocyte Volume (MMOV) may be used for the detection of megaloblastic neutrophils and monocytes MNEV and MMOV have significantly higher sensitivity than the previous information from the red cells (MCV) detecting B12 or folate deficiency because they are not affected by the presence at the same time of Iron deficiency or other reasons of anemia
Congreso Nacional Laboratorio Cliacutenico
2018
POSTER 733
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
CPD Sysmex XN
NE SSC complejidad
NE SFL aacutecidos nucleacuteicos
NE FSC tamantildeo
NE WX
NE WY
NE WZ
MO X
MO Y
MO Z
MO WX
MO WY
MO WZ
LY X
LY Y
LY Z
LY WX
LY WY
LY WZCongreso Nacio
nal Laboratorio Cliacutenico 2018
As MCV is the mean which is calculated it is insensitive to the presence of a small number of macrocytes
Further macrocytosis can be obscured by concomitant disorders that can cause microcytosis resulting inmasked megaloblastic anaemia (MA) for example iron deficiency hereditary elliptocytosis alpha and betathalassemia
This study was undertaken to evaluate the role of NEUT-X and NEUT-Y in detecting MA on peripheral blood andalso see whether other forms of macrocytic anaemia can be differentiated from MA
In MA the peripheral blood smear shows cytopenia with macroovalocytes and hypersegmented
neutrophils (gt5 lobes in 5 neutrophils six lobes nuclei or lobe average of gt35)
In conclusion our study shows that higher values of NEUT-X and NEUT-Y in MA patients in spite of low ornormal MCV high RDW may be used to not only reveal the masked cases of MA with concomitant irondeficiency but also separate them from the broader macrocytic anaemia group
Peripheral smear remains diagnostic however making smear for all the suspicious cases is a cumbersomeand tedious procedure Thus these parameters emerge as more reliable and stable parameters in themodern laboratories which in future may replace the older screening tools
Congreso Nacional Laboratorio Cliacutenico
2018
A favor Eficiencia Operativa
Mejora el proceso del Laboratorio
Mejor informacioacuten al Cliacutenico al mismo coste
Mejora la informacioacuten
Informa sobre la eritropoyesis deteccioacuten precoz de estados carenciales
Ayuda al cliacutenico
Estado real del paciente
En contraParaacutemetros de investigacioacuten
Dificultad de standarizar dependencia teacutecnica
Control de calidadCongreso Nacional Laboratorio Cliacutenico
2018
A Saacutenchez Salinas AM Garciacutea Hernaacutendez A Martiacutenez Mariacuten V Cabantildeas PerianesSindrome anemico Medicine 201612(20)1127-35
Congreso Nacional Laboratorio Cliacutenico
2018
Anemias carenciales
Anemia ferropeacutenicaTincioacuten de Perls en meacutedula osea(hemosiderina y sideroblastos negativos)Sideremia baja saturacioacuten de transferrina disminuiacuteda ferritina seacuterica baja receptor soluble de transferrina(aumentado) y protoporfirinaeritrocitaria libre (aumentada)Anemia megaloblaacutesticaVitamina B12 seacuterica disminuida folato seacuterico normal o aumentado y folato intraeritrocitario disminuido se observan en la deficiencia de vitamina B12Folato seacuterico e intraeritrocitariodisminuidos y vitamina B12 seacuterica normal se encuentran en la deficiencia de folato
Congreso Nacional Laboratorio Cliacutenico
2018
Actualizacioacuten en la interpretacioacuten de las anemias carenciales iquestQueacute hay de nuevo en el siglo XXI
La gran novedad consiste en que podemos evitar que un sujeto sano lleguea padecer una anemia carencial utilizando los paraacutemetros del hemogramaavanzadohelliphellip
helliphellip y no soacutelo contamos con la serie rojahelliphelliphellip
Congreso Nacional Laboratorio Cliacutenico
2018
AM Garcia Hernandez A Sanchez Salinas V Cabanas Perianes M Blanquer Blanquer Protocolo diagnostico diferencial del sindromeAnemico Medicine 201612(20)1170-4
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
Total YLD resulting from all causes of anemia by country
Kassebaum NJ et al Blood 2014123615-624 copy2014 by American Society of Hematology
Congreso Nacional Laboratorio Cliacutenico
2018
Clamaschella C Iron deficiency anemia N Engl J Med 20153721832-43
Congreso Nacional Laboratorio Cliacutenico
2018
Iron Cycle
Fleming RE Ponka P N Engl J Med 2012366348-359Congreso Nacional Laboratorio Cliacutenico
2018
Camaschella C N Engl J Med 20153721832-43Congreso Nacio
nal Laboratorio Cliacutenico 2018
G Lippi amp M Plebani Recent developments and innovations in red blood cells diagnostics Journal of Laboratory and Precision Medicine 2018DOI 1021037jlpm20180709 AOP
Innovative erythrocyte parametersThese innovative parameters most typically include automated reticulocyte andnucleated RBC counts hemoglobinization of reticulocytes and RBC reticulocytehemoglobin content reticulocyte maturation automatic analysis and calculationof microcytic and hypochromic RBC
The various combination of these different parameters not only may be useful tocomplement clinical history physical examination and results of moreconventional laboratory investigations (ie CBC ferritin transferrin ironhaptoglobin folic acid and vitamin B12 among others) for investigating theunderlying cause(s) of anemia
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
Biomarcadores de Eritroyesis
Urrechaga E Borque L Escanero JF Biomarkers of hypochromia the contemporary assessment of
Iron status and erythropoiesis Journal of Biomedicine and Biotechnology
httpdxdoiorg1011552013603786
Abreviatura
(unidades)
Compantildeiacutea
RBC Hipocromos Hypo () Siemens
Hb Reticulocitaria CHr (pg) Siemens
RBC Hipocromos HPO () Abbott
Hb Reticulocitaria media MCHr (pg) Abbott
RBC Hipocromos Hypo He () Sysmex
Hb Reticulocitaria equivalente Ret He (pg) Sysmex
Low Hb density
Contenido de Hb Reticulocitaria
Expresioacuten Hb reticulocitaria
LHD ()
RHCc (pg)
RHE (pg)
Beckman Coulter
Horiba ABX
Mindray
Congreso Nacional Laboratorio Cliacutenico
2018
Informacioacuten avanzada valor antildeadido
Reticulocitos Eritrocitos
bull Permanecen en la sangre 1-2 diacuteas hasta que se convierten en eritrocitos maduros
bull El contenido de hemoglobinapuede reflejar la cantidad de hierro disponible de maneraefectiva
bull Refleja la calidad de la eritropoyesis en el periodoinmediato
bull Permanecen en la sangre 90-120 diacuteas
bull Las diversas subpoblacionespueden reflejar el status feacuterrico en las pasadas semanas
bull MCV MCH son las medias del
conjunto de RBC las de fracciones indican la contribucioacuten de los diversos tipos de RBC a las medias
Congreso Nacional Laboratorio Cliacutenico
2018
Angulo alto
Dispersioacuten lateral Hb
Angulo bajo
Dispersioacuten frontal VOLUMEN
LASER Absorbancia Fluorescencia
RNA contenido
Citometriacutea
Congreso Nacional Laboratorio Cliacutenico
2018
RETICULOCITOS
Compantildeiacutea Instrumento Meacutetodo Colorante Paraacutemetros
Abbott CELLDYN Ruby
CELLDYN
Sapphire
Absorbancia
Fluorescencia
Nuevo azul
metileno
Sybr II
IRF
IRF MCHr MCVr
Beckman
Coulter
UniCell DxH
LH series
Impedancia
citometriacutea de flujo
VCS
Nuevo azul
metileno
Nuevo azul
metileno
IRF MRVHLRRSf
IRF MRV
MSCVHLR
Horiba ABX Pentra
DX120
Impedancia
citometriacutea de flujo
fluorescencia
Naranja de tiazol IRF MRV RETH
RHbC
Siemens ADVIA 120 Absorbancia
Scatter
Oxazine 750 IRF MCVr CHr
Sysmex XE5000 XN Fluorescencia Polimetina IRF RetHe ΔHeCongreso Nacional Laboratorio Cliacutenico
2018
Los reticulocitos precursores de los eritrocitos madurangeneralmente a lo largo de unos dos diacuteas El recuento dereticulocitos es por lo tanto una medida de la cantidad dela eritropoyesis en la meacutedulaParaacutemetros derivados de los reticulocitos los describenmorfoloacutegicamente tamantildeo contenido en Hemoglobinacantidad de material geneacuteticoDe esta forma al referirse a caracteriacutesticas de losreticulocitos es la calidad de la eritropoyesis la que puedeser evaluada
La Hb reticulocitaria se relaciona con la cantidad de hierro disponible efectivamente para laeritropoyesis un valor bajo indica que el aporte es deficitario respecto a la demanda en el momentoactual 28-30 pg
Congreso Nacional Laboratorio Cliacutenico
2018
MCV MCH son los valores medios de volumen y Hb en toda la poblacioacuten RBC
No informan acerca de las ceacutelulas individuales
Ni de la variedad de eacutestas anisocitosis policromasia
Congreso Nacional Laboratorio Cliacutenico
2018
Se cuentan el nuacutemero de pulsos de 36-360fL y el nuacutemero de partiacuteculas que tienen el mismo tamantildeo y se trasladan los resultados a una graacutefica de Volumen Nuacutemero de ceacutelulasSe obtiene el histograma de RBC que proporciona
bull Nuacutemero de RBC el nuacutemero de pulsos dentro de este rango de tamantildeos
bull MCV se corresponde con la media del histograma de RBC
bull RDW o ADE Ancho de Distribucioacuten del histograma de RBC se corresponde con el coeficiente de variacioacuten de la curva
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
Abbott Sapphire lo calcula en el 50 de la altura del pico del histogramaSysmex y Mindray al 20 desde la base del histogramaSiemens calcula la anchura del pico comprendido entre 60 y 120 fL
Aunque RDW ADE generalmente se entiendecomo coeficiente de variacioacuten de ladistribucioacuten de los voluacutemenes de loseritrocitos algunos analizadoreshematoloacutegicos lo calculan desde la medicioacutendirecta de la anchura de la distribucioacuten
Congreso Nacional Laboratorio Cliacutenico
2018
G Lippi amp M Plebani
Recent developments and innovations in red blood cells diagnostics
Journal of Laboratory and Precision Medicine 2018
DOI 1021037jlpm20180709 AOPCongreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
copy 2012 Mindray Confidential 26
HDWHYPERHYPO
HDW HGB Distribution Width
HDW is the distribution width of Hgb histogram
Congreso Nacional Laboratorio Cliacutenico
2018
copy 2012 Mindray Confidential 27
MCHrHDWHYPERHYPOMCHr Mean RET HGB Concentration
Congreso Nacional Laboratorio Cliacutenico
2018
Histograma RBC el mapa de Mie
28 41
Congreso Nacional Laboratorio Cliacutenico
2018
Abbott Mindray Siemens
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
Severe Iron Deficiency Anemia Female 34 years
19 th March 18 th April
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
SysmexRBCHe erythrocyte Hb equivalentRetHe reticulocyte Hb equivalent(content)
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
MIC
MAC
HPO HPR
Congreso Nacional Laboratorio Cliacutenico
2018
copy 2012 Mindray Confidential 36
MINDRAY MCHrHDWHYPERHYPO
MCHr Mean RET HGB Concentration
HDW HGB Distribution Width
HYPER The percentage of hyperchromicred blood cells
HYPO The percentage of hypochromic red blood cells
Thalassemia screeningIDA treatment monitoringIDA screening
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
Hipocromo
Hipercroacutemico onormocroacutemico
iquestConcentracioacuten o contenido de Hemoglobina
Hipocroacutemiconormocroacutemico
Abbott Mindray Siemens Hypo CONCENTRACIOacuteN Hblt280gL
Sysmex Hypo CONTENIDO Hblt 17 pg
Congreso Nacional Laboratorio Cliacutenico
2018
Low Hb Density
Microcytic Factor Maf = (HbMCV)100
Nuevo moacutedulo transductor muacuteltiple con laacuteser de diodo y dos sensores oacutepticos
Anaacutelisis de hasta 50000 ceacutelulas con 7 paraacutemetros tecnoloacutegicos (leucocitos reticulocitos eritroblastos)
1 Volumen digital
2 Conductividad digital
3 5 aacutengulos de dispersioacuten de luz laacuteser digital
bull MALS (Median Angle Light Scatter)
bull UMALS (Upper Median Angle Light Scatter) 20deg a 43deg
bull LMALS (Lower Median Angle Light Scatter) 09deg a 19deg
bull LALS (Low Angle Light Scatter) asymp 51deg
bull AL2 (Axial Light Loss) 0deg a 05deg
Congreso Nacional Laboratorio Cliacutenico
2018
Hierro es un elemento criacutetico para elfuncionamiento oacuteptimo y supervivenciade las ceacutelulas
Disfuncioacuten mitocondrialActividad enzimaacutetica afectadaProteiacutenas de transporte y estructuralesproteins
Capacidad fiacutesica mermadaCapacidad de trabajo reducidaCapacidades cognitivas afectadasMorbilidad y mortalidad
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
It is generally assumed that worldwide ldquoat least half the anemia is due tonutritional iron deficiencyrdquo and that ldquoup to a prevalence of iron deficiency anemiaof 40 the prevalence of iron deficiency will be about 25 times that of anemiardquoHowever it is evident from the foregoing discussion that there are considerablevariations in both of these ratios depending on the age and sex of the peoplebeing studied the region of the world in which they live and the prevalence ratesof other causes of anemia
WHO Department of Nutrition for Health and DevelopmentAssessing the iron status of populations including literature reviews report of a Joint World Health OrganizationCenters for DiseaseControl and Prevention Technical Consultation on the Assessment of Iron Status at the Population Level Geneva Switzerland 6ndash8 April2004 ndash 2nd ed
Congreso Nacional Laboratorio Cliacutenico
2018
Estaacute bien establecido que la anemia produce una miriacuteada de secuelas tanto fiacutesicas comopsicoloacutegicas
Pero los efecto deleteacutereos se deben al deficit de hierro que es un evento previo a que seestablezca la anemia
El deacuteficit de hierrro auacuten sin anemia tiene efectos negativos en el desarrollo cognitivo y fiacutesico
Rattehalli D et al Iron deficiency without anemia do not wait for the Hemoglobin to drop
Health Policy and Technology 2013 2 45-48Congreso Nacio
nal Laboratorio Cliacutenico 2018
SuominenP et al Serum transferrin receptor and transferrin receptor-ferritin index identify healthy subjects with subclinical iron deficits Blood 1998 92 2934ndash9Halwachs-Baumann G Diagnosis of anaemia old things rearranged Wien Med Wochenschr 2012 162478ndash88
Congreso Nacional Laboratorio Cliacutenico
2018
Hemoglobina de reticulocito y su importancia en el diagnoacutestico temprano de anemiaferropeacutenica
Y Maacuterquez-Beniacutetez et al Universidad de BocayaAugust
2018 DOI 1022267rus182003133 aop
El contenido de hemoglobina de reticulocitos (CHr) es un paraacutemetro en la biometriacuteahematoloacutegica automatizada utilizado como un marcador de la biodisponibilidad delhierro en la eritropoyesis
Objetivo Exponer la aplicabilidad de la CHr como un paraacutemetro en el diagnoacutesticoprecoz de la anemia por deficiencia de hierro asiacute como su medicioacuten e interpretacioacuten
Materiales y meacutetodos Se realizoacute la revisioacuten de artiacuteculos cientiacuteficos en ingleacutes y espantildeolen las bases de datos PubMed ScienceDirect LILACS y Medline usando descriptoresvalidados en Medical Subject Headings (MeSH) considerando periodo depublicabilidad del 80 inferior a 5 antildeos
Conclusiones La CHr es un paraacutemetro de gran utilidad en el diagnoacutestico temprano deanemia ferropeacutenica y otras patologiacuteas como deficiencia funcional de hierro estadosde inflamacioacuten croacutenica y enfermedad renal croacutenica
Biomarcador temprano en el diagnoacutestico de deficiencia de hierro antes de presentarsecambios morfoloacutegicos eritrociacuteticosCongreso Nacio
nal Laboratorio Cliacutenico 2018
bull A total of 1105 NES participants (639 men 466 women)bull CHr becomes affected in a relatively early stage in the development of iron deficiency before iron
deficiency anemia and clinical symptoms become apparentbull Therefore this parameter might be useful to identify persons healthy and diseased at risk of
developing iron deficiency anemia and subsequently to apply interventions in order to prevent further development of iron deficiency anemiaCongreso Nacio
nal Laboratorio Cliacutenico 2018
Hb reticulocitaria sensible para detectar la fase inicial del deacuteficit de hierro cuando laeritropoyesis requiere maacutes cantidad que la que recibe ANTES de que la anemia seestablezca
Congreso Nacional Laboratorio Cliacutenico
2018
No ID LID P
RBC 1012L 48 (08) 437 (05) lt00001
Hb gL 135 (6) 131 (12) 0006
MCV fL 922 (21) 902 (38) 0006
MCH pg 324 (07) 306 (22) lt00001
MCHC gL 339 (6) 319 (23) 0001
RDW
Ret He pg
Hypo He
LHD
Ferritin microgL
131 (06)
338 (21)
03 (015)
28 (20)
86 (3)
145 (21)
278 (24)
69 (55)
56 (25)
16 (76)
lt00001
lt00001
lt00001
lt00001
lt00001
AUC 95 CI Cutoff Sensitivity Specificity
LHD 0898 0819-0978 50 859 841
Ret He 0914 0824-1000 299pg 868 857
Hypo He 0934 0856-1000 16 857 921
Clinical value of markers of hypochromia in the detection of latent iron deficiency in non-anemic premenopausal women
No ID Hb gt 120 gL s-ferritin was within reference intervalLatent Iron Defiency Hb gt 120 gL s-ferritin lt 30 μgL
Urrechaga E et al Journal Clin Lab Analysis 2016 30 (5) 623-627
97 women (388) in 250 apparently healthy women had latent IDCongreso Nacional Laboratorio Cliacutenico
2018
Schorer G et al Abstract Jahreskongress der Deutschen Gesellschaft fuumlr Transfusionsmedizin und Immunhaumlmatologie Rostock 15 - 18 September 2009
Congreso Nacional Laboratorio Cliacutenico
2018
Caring for Those Who Share Mitigating Iron Deficiency in Regular Blood DonorsMast Alan E
bull Iron deficiency caused by regular blood donation is a problem facing blood centers Each blood donation removes 200 to 250 mg of iron from the donor Consequently many donors become iron deficient with repeated donation
bull This presents a challenge to blood centers that has become more acute in recent years with the realization that iron deficiency even in the absence of anemia is associated with adverse effects including fatigue and decreased exercise tolerance as well as neurological symptoms such as decreased cognitive function pica and restless leg syndrome
bull REDS-II investigators performed a longitudinal study investigating the iron status of blood donors over a two year period called the REDS-II Donor Iron Status Evaluation (RISE)
bull Results from the baseline analysis of regular donors (e 2 donations per year (females) or e 3 donations per year (males) revealed that over two-thirds of female donors and over one-half of male donors have iron deficiency
Congreso Nacional Laboratorio Cliacutenico
2018
Transfusion 2013 532766-2775
bull We evaluated the diagnostic sensitivity and specificity of red blood cell (RBC) hematology analyzer indices to assess iron status as a part of donor management iron deficient erythropoiesis (IDE) and absence of iron stores (AIS)
bull STUDY DESIGN AND METHODS A total of 1659 male and female donors from the Retrovirus Epidemiology Donor Study-II (REDS-II) Donor Iron Status Evaluation (RISE) study who were either first-timereactivated (FT RA no donations for 2 years) or frequent donors were recruited into a longitudinal study of regular donation of RBCs Of these 1002 donors returned 15 to 24 months later for a final assessment
Absent iron stores (AIS) was defined as plasma ferritin level of less than 12 mgL Logarithm of the ratio of soluble transferrin receptor to ferritin of at least 207 was used to define iron-deficient erythropoiesis (IDE)
bull RESULTS HYPOm and CHr detected IDE with comparable sensitivity 72 versus 69 but differed in specificity HYPOm 68 and CHr 53
For detecting AIS sensitivity was improved to 85 for HYPOm and 81 for CHr but specificity was reduced
Venous Hb had high specificity but poor sensitivity for IDE and AIS A plasma ferritin level of less than 267 mgL was a good surrogate for assessing IDE Congreso Nacio
nal Laboratorio Cliacutenico 2018
Microcytic RBC and reticulocyte mean cell hemoglobin content predicted iron depletion with
sensitivities 70 and 64
specificities of 72 and 78 respectively
When both combined
increased the sensitivity to 82
Congreso Nacional Laboratorio Cliacutenico
2018
Depending on the number of donations during the preceding12 months
Absent iron stores were detected in up to 214 of male and278 of female donors respectively
impaired hemoglobinisation IH was present in up to 64 maleand 167 female donors with 2 and 4 preceding donationsrespectively
The defined CHr cut-off value was 280 pg to detect IH infrequent whole blood donors with AIS leading to a testspecificity of 982 (positive predictive value PPV 577) inmale and of 978 (PPV 829) in female donors
It may help to prevent the development of anemia in frequentblood donors and also can help to decide whether donordeferral or even iron substitution need to be recommended
Congreso Nacional Laboratorio Cliacutenico
2018
Of the 501 blood donors sTfR and Ret-He detected Latent Iron Deficiency in 148 and 135 donors respectively
In comparison to sTfR Ret-He had sensitivity of 927 specificity of 9716 PPV of 931 and NPV of 963
Serum Ferritin TIBC and serum Iron had comparatively lower sensitivity of 8716 797 and 777 respectively
Conclusion Ret-He can be used as a routine screening test to detect LID in blood donors
This could provide an opportunity to make appropriate and timely interventions like dietary changes or drug supplementation
Congreso Nacional Laboratorio Cliacutenico
2018
Singh A Chaudhary R Pandey HC Sonker A Identification of iron status of blood donors by using low hemoglobin density and microcytic anemia factor Asian J Transfus Sci 20181246-50
The main objective of this study was to assess ifLHD and Maf could be used for assessment ofiron status in blood donors and also to establisha cut-off for these two parameters at which atentative iron deficiency could be reportedconclusively
Results LHD and Maf were able to differentiatebetween iron deficient and iron-depleteddonors from normal donorsA cutoff of 918 for LHD was able todifferentiate iron deficient and depleted statefrom normal iron statessensitivity 919 and specificity 71respectivelya cutoff of 1016 for Mafsensitivity 946 and specificity 968
MAf = (MVC Hb) 100
Congreso Nacional Laboratorio Cliacutenico
2018
Hb reticulocitaria sensible para detectar la fase inicial del deacuteficitde hierro cuando la eritropoyesis requiere maacutes cantidad que laque recibe ANTES de que la anemia se establezca
La deteccioacuten precoz del deacuteficit de hierro en la fase del balance negativo demanda aporte contribuye a reducir sus manifestaciones cliacutenicas en los pacientes afectados mejorando la salud puacuteblica
Un tratamiento menos prolongado con suplementos y menor consumo de los recursos sanitaros Contribuye a la eficiencia y sostenibilidad de los servicios sanitarios
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
Buttarello MLaboratory diagnosis of anemia are the old and new red cell parameters useful in classification and treatment howInt Jnl Lab Hem 2016 38 (Suppl 1) 123ndash132
Congreso Nacional Laboratorio Cliacutenico
2018
Buttarello MLaboratory diagnosis of anemia are the old and new red cell parameters useful in classification and treatment howInt Jnl Lab Hem 2016 38 (Suppl 1) 123ndash132
Congreso Nacional Laboratorio Cliacutenico
2018
Ralph Green amp Ananya Datta Mitra Megaloblastic Anemias Nutritional and Other CausesMed Clin N Am 2017 101 297ndash317
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
ANEMIA CARENCIAL CAUSAS
Factores alimentariosConsumir una dieta vegetariana mal planeadaAlimentacioacuten deficiente en los bebeacutesDesnutricioacuten durante el embarazo
Deacuteficit de absorcioacutenAlcoholismo croacutenicoEnfermedad de Crohn celiaquiacutea infeccioacuten otros problemas que le dificulten al cuerpo la digestioacuten de los alimentosAnemia perniciosa (factor intriacutenseco)Cirugiacuteas para extirpar ciertas partes del estoacutemago o el intestino delgado
MedicamentosB12 omeprazol metformina colchicina aminosalicilatos neomicinaFOLATO fenitoiacutena metotrexato sulfasalacina triamtereno pirimetamina trimetoprim con sulfametoxazol barbituacutericos
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
Reacciones metaboacutelicas en las que participan la vitamina B12 y el folato bull la conversioacuten de metilmalonil-CoA a succinil-CoA donde la adenosil-cobalamina actuacutea de
cofactor Por ello un deacuteficit de B12 conlleva un aumento de metilmalonil-CoA y de su producto de hidroacutelisis el aacutecido metilmaloacutenico
bull la siacutentesis de metionina a partir de homocisteina gracias a la metionina sintetasa y a la metil-cobalamina como cofactor En esta misma reaccioacuten el metiltetrahidrofolato es transformado a tetrahidrofolato que es necesario para la siacutentesis de DNA
Congreso Nacional Laboratorio Cliacutenico
2018
Anemia macrociacutetica secundaria a deficiencia de aacutecido foacutelico y de vitamina B12(cobalamina)
La deficiencia de B12 yo aacutecido foacutelico es la causa maacutes frecuente de megaloblastosis
Dentro de distintas funciones generales del metabolismo la vitamina B12 es uncofactor esencial en la siacutentesis de ADN y ARN compromete a todas las ceacutelulas delorganismo
Su deficiencia se manifiesta en oacuterganos con alto recambio celular como la meacutedulaosea y en el sistema nervioso central (SNC) a traveacutes de la siacutentesis de mielina y lareparacioacuten axonal
La deficiencia de cobalamina es responsable de alteraciones hematoloacutegicasneuroloacutegicas neurocognitivas y neuropsiquiaacutetricas
La siacutentesis defectuosa de ADN conduce a la apoptosis y a la hemoacutelisis (intra yextramedular) causantes de la hemopoyesis inefectiva
En meacutedula la siacutentesis ineficiente de DNA causa cambios megaloblaacutesticos comoconsecuencIa anemia y citopenias
Congreso Nacional Laboratorio Cliacutenico
2018
Limitaciones de los meacutetodos diagnoacutesticos claacutesicos
Volumen Corpuscular Medio (VCM) y morfologiacutea de sangre perifeacuterica En una serie de pacientes con deacuteficit de cobalamina soacutelo un 29 teniacutean anemia y soacutelo un 36 teniacutean un VCM gt 100 fL
Un VCM normal no puede ser empleado para rechazar una determinacioacuten de nivel de cobalamina ya que hasta un 25 de casos con manifestaciones neuroloacutegicas cursan con un VCM normal
Cobalamina seacuterica (nivel de B12) Es el test diagnoacutestico rutinario inicial estaacutendar Es un test ampliamente disponible de bajo coste y automatizado Sin embargo presenta algunas limitaciones
-- Existencia de varias teacutecnicas y ausencia de un gold standard por lo que hay diferentes liacutemites de referencia
-- Variacioacuten intraindividual muy alta
La OMS publicoacute en 2008 las conclusiones de un grupo teacutecnico consultado sobre el deacuteficit de cobalamina y folato
El grupo reconocioacute que no existen unos umbrales universalmente reconocidos para definir el deacuteficit de ambas vitaminas y expresaron la necesidad de un consenso
Devalia V Hamilton MS and Molloy AM on behalf of the British Committee for standards in haematology Guidelines for the diagnosis and treatment of cobalamin and folate disorders Br J Haematol 2014 166(4) 496-513
Schrier SL Diagnosis and treatment of vitamin B12 and folate deficiency UpToDate Last updated Jun 25 2014
de Benoist B Conclusions of a WHO Technical Consultation on folate and vitamin B12 deficiencies Food Nutr Bull 200829(2 Suppl)S238ndash44Congreso Nacional Laboratorio Cliacutenico
2018
Tomado de Tefferi A Li C En Atlas of Clinical Hematology Publicado por JO Armitage Philadelphia Current Medicine 2004
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
Int Jnl Lab Hem 2007 29 327ndash334
Clin Lab 201662343-347
In ourstudy mean MCVrMCV ratio of healthy controls is130 as microcytic anemia irondeficiency anemia is121 as also macrocytic anemia vitamin B12 deficiencyanemia is 115
Congreso Nacional Laboratorio Cliacutenico
2018
Sualeh Muslim Khan Muhammad Akbar Agha
Mean cell volume of reticulocytemdashA new parameter for diagnosing sub-clinical cobalamin deficiency in blood donors Int J Lab Hem 20181ndash4
The Abbott CELL-DYN Sapphire Hematology System uses multi-angle polarized scatter separation (MAPSS) and focused flow impedance technologies
Congreso Nacional Laboratorio Cliacutenico
2018
MCVr at 985 fL yielded the highest Youdenrsquos index at sensitivity of 82 specificity of 828 AUC 0847 ( 95 CI 803-891)
Khan SM Agha MA Mean cell volume of reticulocyte-A new parameter for diagnosing sub-clinical cobalamin deficiency in blood donors
Int J Lab Hem 20181ndash4 2018 Jul 13 doi 101111ijlh12899
Congreso Nacional Laboratorio Cliacutenico
2018
Role of Cell Population Data in the detection of folate and cobalamin deficiency
J Nieto et al
XXXI st International Symposium on Technological Innovations in Laboratory Hematology ISLH 2018 10-12 May 2018 Brussels Belgium
M-V-NRET and SD-VNRET are the best discriminatory single parameters to distinguish between patients with B9B12 deficiency and reference subjects M-V-NRETAUC=0823 sensitivity 78 and specificity 86
AUC=0852 sensitivity 55 and specificity 60
Conclusions The CPD parameters of Volume and Light Scatter (M and SD of LALS angle) that inform about size and intracellular structure of RBCs provided very useful information for the detection of B9B12 deficiency
Congreso Nacional Laboratorio Cliacutenico
2018
Cell Population Data
bull Paraacutemetros poblacionales de los leucocitos
bull Describen la morfologiacutea tamantildeo
estructuras citoplasmaacuteticas
nuacutecleo aacutecidos nucleacuteicos
bull Son datos numeacutericos con los que se construyen los ejes de lo diagramas de dispersioacuten de los leucocitos
bull Dependen de la tecnologiacutea
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
High Sensitivity New Parameters for the Detection of Vitamin B12 and Folate Deficiencies Blood 2008 1125379
B12 def vs
Normals
Mann
Withney T-Test
ROC
AUC Sens Specif Cutoff signifROC
MCV p=03156 p=09533 0577
MPV p=00001 0802 792 806 lt83 p=00001
NE Mean
Volume plt00001 0862 833 778 gt1403 p=00001
MO Mean
Volume plt00001 0829 625 889 gt1723 p=00001
MRV p=00113 0705 50 964 gt1133 p=00051
Folate def vs
Normals
Mann
Withney T-Test
ROC
AUC Sens Specif Cut-off signifROC
MCV p=00798 p=06461 0665
MPV plt00001 0832 81 806 lt83 p=00001
NE Mean
Volume p=00008 087 952 694 gt1402 p=00001
MO Mean
Volume p=00002 0801 667 833 gt1696 p=00001
MRV p=00054 0731 476 964 gt1133 p=00019
The Mean Neutrophil Volume (MNE V) and Mean Monocyte Volume (MMOV) may be used for the detection of megaloblastic neutrophils and monocytes MNEV and MMOV have significantly higher sensitivity than the previous information from the red cells (MCV) detecting B12 or folate deficiency because they are not affected by the presence at the same time of Iron deficiency or other reasons of anemia
Congreso Nacional Laboratorio Cliacutenico
2018
POSTER 733
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
CPD Sysmex XN
NE SSC complejidad
NE SFL aacutecidos nucleacuteicos
NE FSC tamantildeo
NE WX
NE WY
NE WZ
MO X
MO Y
MO Z
MO WX
MO WY
MO WZ
LY X
LY Y
LY Z
LY WX
LY WY
LY WZCongreso Nacio
nal Laboratorio Cliacutenico 2018
As MCV is the mean which is calculated it is insensitive to the presence of a small number of macrocytes
Further macrocytosis can be obscured by concomitant disorders that can cause microcytosis resulting inmasked megaloblastic anaemia (MA) for example iron deficiency hereditary elliptocytosis alpha and betathalassemia
This study was undertaken to evaluate the role of NEUT-X and NEUT-Y in detecting MA on peripheral blood andalso see whether other forms of macrocytic anaemia can be differentiated from MA
In MA the peripheral blood smear shows cytopenia with macroovalocytes and hypersegmented
neutrophils (gt5 lobes in 5 neutrophils six lobes nuclei or lobe average of gt35)
In conclusion our study shows that higher values of NEUT-X and NEUT-Y in MA patients in spite of low ornormal MCV high RDW may be used to not only reveal the masked cases of MA with concomitant irondeficiency but also separate them from the broader macrocytic anaemia group
Peripheral smear remains diagnostic however making smear for all the suspicious cases is a cumbersomeand tedious procedure Thus these parameters emerge as more reliable and stable parameters in themodern laboratories which in future may replace the older screening tools
Congreso Nacional Laboratorio Cliacutenico
2018
A favor Eficiencia Operativa
Mejora el proceso del Laboratorio
Mejor informacioacuten al Cliacutenico al mismo coste
Mejora la informacioacuten
Informa sobre la eritropoyesis deteccioacuten precoz de estados carenciales
Ayuda al cliacutenico
Estado real del paciente
En contraParaacutemetros de investigacioacuten
Dificultad de standarizar dependencia teacutecnica
Control de calidadCongreso Nacional Laboratorio Cliacutenico
2018
Anemias carenciales
Anemia ferropeacutenicaTincioacuten de Perls en meacutedula osea(hemosiderina y sideroblastos negativos)Sideremia baja saturacioacuten de transferrina disminuiacuteda ferritina seacuterica baja receptor soluble de transferrina(aumentado) y protoporfirinaeritrocitaria libre (aumentada)Anemia megaloblaacutesticaVitamina B12 seacuterica disminuida folato seacuterico normal o aumentado y folato intraeritrocitario disminuido se observan en la deficiencia de vitamina B12Folato seacuterico e intraeritrocitariodisminuidos y vitamina B12 seacuterica normal se encuentran en la deficiencia de folato
Congreso Nacional Laboratorio Cliacutenico
2018
Actualizacioacuten en la interpretacioacuten de las anemias carenciales iquestQueacute hay de nuevo en el siglo XXI
La gran novedad consiste en que podemos evitar que un sujeto sano lleguea padecer una anemia carencial utilizando los paraacutemetros del hemogramaavanzadohelliphellip
helliphellip y no soacutelo contamos con la serie rojahelliphelliphellip
Congreso Nacional Laboratorio Cliacutenico
2018
AM Garcia Hernandez A Sanchez Salinas V Cabanas Perianes M Blanquer Blanquer Protocolo diagnostico diferencial del sindromeAnemico Medicine 201612(20)1170-4
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
Total YLD resulting from all causes of anemia by country
Kassebaum NJ et al Blood 2014123615-624 copy2014 by American Society of Hematology
Congreso Nacional Laboratorio Cliacutenico
2018
Clamaschella C Iron deficiency anemia N Engl J Med 20153721832-43
Congreso Nacional Laboratorio Cliacutenico
2018
Iron Cycle
Fleming RE Ponka P N Engl J Med 2012366348-359Congreso Nacional Laboratorio Cliacutenico
2018
Camaschella C N Engl J Med 20153721832-43Congreso Nacio
nal Laboratorio Cliacutenico 2018
G Lippi amp M Plebani Recent developments and innovations in red blood cells diagnostics Journal of Laboratory and Precision Medicine 2018DOI 1021037jlpm20180709 AOP
Innovative erythrocyte parametersThese innovative parameters most typically include automated reticulocyte andnucleated RBC counts hemoglobinization of reticulocytes and RBC reticulocytehemoglobin content reticulocyte maturation automatic analysis and calculationof microcytic and hypochromic RBC
The various combination of these different parameters not only may be useful tocomplement clinical history physical examination and results of moreconventional laboratory investigations (ie CBC ferritin transferrin ironhaptoglobin folic acid and vitamin B12 among others) for investigating theunderlying cause(s) of anemia
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
Biomarcadores de Eritroyesis
Urrechaga E Borque L Escanero JF Biomarkers of hypochromia the contemporary assessment of
Iron status and erythropoiesis Journal of Biomedicine and Biotechnology
httpdxdoiorg1011552013603786
Abreviatura
(unidades)
Compantildeiacutea
RBC Hipocromos Hypo () Siemens
Hb Reticulocitaria CHr (pg) Siemens
RBC Hipocromos HPO () Abbott
Hb Reticulocitaria media MCHr (pg) Abbott
RBC Hipocromos Hypo He () Sysmex
Hb Reticulocitaria equivalente Ret He (pg) Sysmex
Low Hb density
Contenido de Hb Reticulocitaria
Expresioacuten Hb reticulocitaria
LHD ()
RHCc (pg)
RHE (pg)
Beckman Coulter
Horiba ABX
Mindray
Congreso Nacional Laboratorio Cliacutenico
2018
Informacioacuten avanzada valor antildeadido
Reticulocitos Eritrocitos
bull Permanecen en la sangre 1-2 diacuteas hasta que se convierten en eritrocitos maduros
bull El contenido de hemoglobinapuede reflejar la cantidad de hierro disponible de maneraefectiva
bull Refleja la calidad de la eritropoyesis en el periodoinmediato
bull Permanecen en la sangre 90-120 diacuteas
bull Las diversas subpoblacionespueden reflejar el status feacuterrico en las pasadas semanas
bull MCV MCH son las medias del
conjunto de RBC las de fracciones indican la contribucioacuten de los diversos tipos de RBC a las medias
Congreso Nacional Laboratorio Cliacutenico
2018
Angulo alto
Dispersioacuten lateral Hb
Angulo bajo
Dispersioacuten frontal VOLUMEN
LASER Absorbancia Fluorescencia
RNA contenido
Citometriacutea
Congreso Nacional Laboratorio Cliacutenico
2018
RETICULOCITOS
Compantildeiacutea Instrumento Meacutetodo Colorante Paraacutemetros
Abbott CELLDYN Ruby
CELLDYN
Sapphire
Absorbancia
Fluorescencia
Nuevo azul
metileno
Sybr II
IRF
IRF MCHr MCVr
Beckman
Coulter
UniCell DxH
LH series
Impedancia
citometriacutea de flujo
VCS
Nuevo azul
metileno
Nuevo azul
metileno
IRF MRVHLRRSf
IRF MRV
MSCVHLR
Horiba ABX Pentra
DX120
Impedancia
citometriacutea de flujo
fluorescencia
Naranja de tiazol IRF MRV RETH
RHbC
Siemens ADVIA 120 Absorbancia
Scatter
Oxazine 750 IRF MCVr CHr
Sysmex XE5000 XN Fluorescencia Polimetina IRF RetHe ΔHeCongreso Nacional Laboratorio Cliacutenico
2018
Los reticulocitos precursores de los eritrocitos madurangeneralmente a lo largo de unos dos diacuteas El recuento dereticulocitos es por lo tanto una medida de la cantidad dela eritropoyesis en la meacutedulaParaacutemetros derivados de los reticulocitos los describenmorfoloacutegicamente tamantildeo contenido en Hemoglobinacantidad de material geneacuteticoDe esta forma al referirse a caracteriacutesticas de losreticulocitos es la calidad de la eritropoyesis la que puedeser evaluada
La Hb reticulocitaria se relaciona con la cantidad de hierro disponible efectivamente para laeritropoyesis un valor bajo indica que el aporte es deficitario respecto a la demanda en el momentoactual 28-30 pg
Congreso Nacional Laboratorio Cliacutenico
2018
MCV MCH son los valores medios de volumen y Hb en toda la poblacioacuten RBC
No informan acerca de las ceacutelulas individuales
Ni de la variedad de eacutestas anisocitosis policromasia
Congreso Nacional Laboratorio Cliacutenico
2018
Se cuentan el nuacutemero de pulsos de 36-360fL y el nuacutemero de partiacuteculas que tienen el mismo tamantildeo y se trasladan los resultados a una graacutefica de Volumen Nuacutemero de ceacutelulasSe obtiene el histograma de RBC que proporciona
bull Nuacutemero de RBC el nuacutemero de pulsos dentro de este rango de tamantildeos
bull MCV se corresponde con la media del histograma de RBC
bull RDW o ADE Ancho de Distribucioacuten del histograma de RBC se corresponde con el coeficiente de variacioacuten de la curva
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
Abbott Sapphire lo calcula en el 50 de la altura del pico del histogramaSysmex y Mindray al 20 desde la base del histogramaSiemens calcula la anchura del pico comprendido entre 60 y 120 fL
Aunque RDW ADE generalmente se entiendecomo coeficiente de variacioacuten de ladistribucioacuten de los voluacutemenes de loseritrocitos algunos analizadoreshematoloacutegicos lo calculan desde la medicioacutendirecta de la anchura de la distribucioacuten
Congreso Nacional Laboratorio Cliacutenico
2018
G Lippi amp M Plebani
Recent developments and innovations in red blood cells diagnostics
Journal of Laboratory and Precision Medicine 2018
DOI 1021037jlpm20180709 AOPCongreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
copy 2012 Mindray Confidential 26
HDWHYPERHYPO
HDW HGB Distribution Width
HDW is the distribution width of Hgb histogram
Congreso Nacional Laboratorio Cliacutenico
2018
copy 2012 Mindray Confidential 27
MCHrHDWHYPERHYPOMCHr Mean RET HGB Concentration
Congreso Nacional Laboratorio Cliacutenico
2018
Histograma RBC el mapa de Mie
28 41
Congreso Nacional Laboratorio Cliacutenico
2018
Abbott Mindray Siemens
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
Severe Iron Deficiency Anemia Female 34 years
19 th March 18 th April
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
SysmexRBCHe erythrocyte Hb equivalentRetHe reticulocyte Hb equivalent(content)
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
MIC
MAC
HPO HPR
Congreso Nacional Laboratorio Cliacutenico
2018
copy 2012 Mindray Confidential 36
MINDRAY MCHrHDWHYPERHYPO
MCHr Mean RET HGB Concentration
HDW HGB Distribution Width
HYPER The percentage of hyperchromicred blood cells
HYPO The percentage of hypochromic red blood cells
Thalassemia screeningIDA treatment monitoringIDA screening
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
Hipocromo
Hipercroacutemico onormocroacutemico
iquestConcentracioacuten o contenido de Hemoglobina
Hipocroacutemiconormocroacutemico
Abbott Mindray Siemens Hypo CONCENTRACIOacuteN Hblt280gL
Sysmex Hypo CONTENIDO Hblt 17 pg
Congreso Nacional Laboratorio Cliacutenico
2018
Low Hb Density
Microcytic Factor Maf = (HbMCV)100
Nuevo moacutedulo transductor muacuteltiple con laacuteser de diodo y dos sensores oacutepticos
Anaacutelisis de hasta 50000 ceacutelulas con 7 paraacutemetros tecnoloacutegicos (leucocitos reticulocitos eritroblastos)
1 Volumen digital
2 Conductividad digital
3 5 aacutengulos de dispersioacuten de luz laacuteser digital
bull MALS (Median Angle Light Scatter)
bull UMALS (Upper Median Angle Light Scatter) 20deg a 43deg
bull LMALS (Lower Median Angle Light Scatter) 09deg a 19deg
bull LALS (Low Angle Light Scatter) asymp 51deg
bull AL2 (Axial Light Loss) 0deg a 05deg
Congreso Nacional Laboratorio Cliacutenico
2018
Hierro es un elemento criacutetico para elfuncionamiento oacuteptimo y supervivenciade las ceacutelulas
Disfuncioacuten mitocondrialActividad enzimaacutetica afectadaProteiacutenas de transporte y estructuralesproteins
Capacidad fiacutesica mermadaCapacidad de trabajo reducidaCapacidades cognitivas afectadasMorbilidad y mortalidad
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
It is generally assumed that worldwide ldquoat least half the anemia is due tonutritional iron deficiencyrdquo and that ldquoup to a prevalence of iron deficiency anemiaof 40 the prevalence of iron deficiency will be about 25 times that of anemiardquoHowever it is evident from the foregoing discussion that there are considerablevariations in both of these ratios depending on the age and sex of the peoplebeing studied the region of the world in which they live and the prevalence ratesof other causes of anemia
WHO Department of Nutrition for Health and DevelopmentAssessing the iron status of populations including literature reviews report of a Joint World Health OrganizationCenters for DiseaseControl and Prevention Technical Consultation on the Assessment of Iron Status at the Population Level Geneva Switzerland 6ndash8 April2004 ndash 2nd ed
Congreso Nacional Laboratorio Cliacutenico
2018
Estaacute bien establecido que la anemia produce una miriacuteada de secuelas tanto fiacutesicas comopsicoloacutegicas
Pero los efecto deleteacutereos se deben al deficit de hierro que es un evento previo a que seestablezca la anemia
El deacuteficit de hierrro auacuten sin anemia tiene efectos negativos en el desarrollo cognitivo y fiacutesico
Rattehalli D et al Iron deficiency without anemia do not wait for the Hemoglobin to drop
Health Policy and Technology 2013 2 45-48Congreso Nacio
nal Laboratorio Cliacutenico 2018
SuominenP et al Serum transferrin receptor and transferrin receptor-ferritin index identify healthy subjects with subclinical iron deficits Blood 1998 92 2934ndash9Halwachs-Baumann G Diagnosis of anaemia old things rearranged Wien Med Wochenschr 2012 162478ndash88
Congreso Nacional Laboratorio Cliacutenico
2018
Hemoglobina de reticulocito y su importancia en el diagnoacutestico temprano de anemiaferropeacutenica
Y Maacuterquez-Beniacutetez et al Universidad de BocayaAugust
2018 DOI 1022267rus182003133 aop
El contenido de hemoglobina de reticulocitos (CHr) es un paraacutemetro en la biometriacuteahematoloacutegica automatizada utilizado como un marcador de la biodisponibilidad delhierro en la eritropoyesis
Objetivo Exponer la aplicabilidad de la CHr como un paraacutemetro en el diagnoacutesticoprecoz de la anemia por deficiencia de hierro asiacute como su medicioacuten e interpretacioacuten
Materiales y meacutetodos Se realizoacute la revisioacuten de artiacuteculos cientiacuteficos en ingleacutes y espantildeolen las bases de datos PubMed ScienceDirect LILACS y Medline usando descriptoresvalidados en Medical Subject Headings (MeSH) considerando periodo depublicabilidad del 80 inferior a 5 antildeos
Conclusiones La CHr es un paraacutemetro de gran utilidad en el diagnoacutestico temprano deanemia ferropeacutenica y otras patologiacuteas como deficiencia funcional de hierro estadosde inflamacioacuten croacutenica y enfermedad renal croacutenica
Biomarcador temprano en el diagnoacutestico de deficiencia de hierro antes de presentarsecambios morfoloacutegicos eritrociacuteticosCongreso Nacio
nal Laboratorio Cliacutenico 2018
bull A total of 1105 NES participants (639 men 466 women)bull CHr becomes affected in a relatively early stage in the development of iron deficiency before iron
deficiency anemia and clinical symptoms become apparentbull Therefore this parameter might be useful to identify persons healthy and diseased at risk of
developing iron deficiency anemia and subsequently to apply interventions in order to prevent further development of iron deficiency anemiaCongreso Nacio
nal Laboratorio Cliacutenico 2018
Hb reticulocitaria sensible para detectar la fase inicial del deacuteficit de hierro cuando laeritropoyesis requiere maacutes cantidad que la que recibe ANTES de que la anemia seestablezca
Congreso Nacional Laboratorio Cliacutenico
2018
No ID LID P
RBC 1012L 48 (08) 437 (05) lt00001
Hb gL 135 (6) 131 (12) 0006
MCV fL 922 (21) 902 (38) 0006
MCH pg 324 (07) 306 (22) lt00001
MCHC gL 339 (6) 319 (23) 0001
RDW
Ret He pg
Hypo He
LHD
Ferritin microgL
131 (06)
338 (21)
03 (015)
28 (20)
86 (3)
145 (21)
278 (24)
69 (55)
56 (25)
16 (76)
lt00001
lt00001
lt00001
lt00001
lt00001
AUC 95 CI Cutoff Sensitivity Specificity
LHD 0898 0819-0978 50 859 841
Ret He 0914 0824-1000 299pg 868 857
Hypo He 0934 0856-1000 16 857 921
Clinical value of markers of hypochromia in the detection of latent iron deficiency in non-anemic premenopausal women
No ID Hb gt 120 gL s-ferritin was within reference intervalLatent Iron Defiency Hb gt 120 gL s-ferritin lt 30 μgL
Urrechaga E et al Journal Clin Lab Analysis 2016 30 (5) 623-627
97 women (388) in 250 apparently healthy women had latent IDCongreso Nacional Laboratorio Cliacutenico
2018
Schorer G et al Abstract Jahreskongress der Deutschen Gesellschaft fuumlr Transfusionsmedizin und Immunhaumlmatologie Rostock 15 - 18 September 2009
Congreso Nacional Laboratorio Cliacutenico
2018
Caring for Those Who Share Mitigating Iron Deficiency in Regular Blood DonorsMast Alan E
bull Iron deficiency caused by regular blood donation is a problem facing blood centers Each blood donation removes 200 to 250 mg of iron from the donor Consequently many donors become iron deficient with repeated donation
bull This presents a challenge to blood centers that has become more acute in recent years with the realization that iron deficiency even in the absence of anemia is associated with adverse effects including fatigue and decreased exercise tolerance as well as neurological symptoms such as decreased cognitive function pica and restless leg syndrome
bull REDS-II investigators performed a longitudinal study investigating the iron status of blood donors over a two year period called the REDS-II Donor Iron Status Evaluation (RISE)
bull Results from the baseline analysis of regular donors (e 2 donations per year (females) or e 3 donations per year (males) revealed that over two-thirds of female donors and over one-half of male donors have iron deficiency
Congreso Nacional Laboratorio Cliacutenico
2018
Transfusion 2013 532766-2775
bull We evaluated the diagnostic sensitivity and specificity of red blood cell (RBC) hematology analyzer indices to assess iron status as a part of donor management iron deficient erythropoiesis (IDE) and absence of iron stores (AIS)
bull STUDY DESIGN AND METHODS A total of 1659 male and female donors from the Retrovirus Epidemiology Donor Study-II (REDS-II) Donor Iron Status Evaluation (RISE) study who were either first-timereactivated (FT RA no donations for 2 years) or frequent donors were recruited into a longitudinal study of regular donation of RBCs Of these 1002 donors returned 15 to 24 months later for a final assessment
Absent iron stores (AIS) was defined as plasma ferritin level of less than 12 mgL Logarithm of the ratio of soluble transferrin receptor to ferritin of at least 207 was used to define iron-deficient erythropoiesis (IDE)
bull RESULTS HYPOm and CHr detected IDE with comparable sensitivity 72 versus 69 but differed in specificity HYPOm 68 and CHr 53
For detecting AIS sensitivity was improved to 85 for HYPOm and 81 for CHr but specificity was reduced
Venous Hb had high specificity but poor sensitivity for IDE and AIS A plasma ferritin level of less than 267 mgL was a good surrogate for assessing IDE Congreso Nacio
nal Laboratorio Cliacutenico 2018
Microcytic RBC and reticulocyte mean cell hemoglobin content predicted iron depletion with
sensitivities 70 and 64
specificities of 72 and 78 respectively
When both combined
increased the sensitivity to 82
Congreso Nacional Laboratorio Cliacutenico
2018
Depending on the number of donations during the preceding12 months
Absent iron stores were detected in up to 214 of male and278 of female donors respectively
impaired hemoglobinisation IH was present in up to 64 maleand 167 female donors with 2 and 4 preceding donationsrespectively
The defined CHr cut-off value was 280 pg to detect IH infrequent whole blood donors with AIS leading to a testspecificity of 982 (positive predictive value PPV 577) inmale and of 978 (PPV 829) in female donors
It may help to prevent the development of anemia in frequentblood donors and also can help to decide whether donordeferral or even iron substitution need to be recommended
Congreso Nacional Laboratorio Cliacutenico
2018
Of the 501 blood donors sTfR and Ret-He detected Latent Iron Deficiency in 148 and 135 donors respectively
In comparison to sTfR Ret-He had sensitivity of 927 specificity of 9716 PPV of 931 and NPV of 963
Serum Ferritin TIBC and serum Iron had comparatively lower sensitivity of 8716 797 and 777 respectively
Conclusion Ret-He can be used as a routine screening test to detect LID in blood donors
This could provide an opportunity to make appropriate and timely interventions like dietary changes or drug supplementation
Congreso Nacional Laboratorio Cliacutenico
2018
Singh A Chaudhary R Pandey HC Sonker A Identification of iron status of blood donors by using low hemoglobin density and microcytic anemia factor Asian J Transfus Sci 20181246-50
The main objective of this study was to assess ifLHD and Maf could be used for assessment ofiron status in blood donors and also to establisha cut-off for these two parameters at which atentative iron deficiency could be reportedconclusively
Results LHD and Maf were able to differentiatebetween iron deficient and iron-depleteddonors from normal donorsA cutoff of 918 for LHD was able todifferentiate iron deficient and depleted statefrom normal iron statessensitivity 919 and specificity 71respectivelya cutoff of 1016 for Mafsensitivity 946 and specificity 968
MAf = (MVC Hb) 100
Congreso Nacional Laboratorio Cliacutenico
2018
Hb reticulocitaria sensible para detectar la fase inicial del deacuteficitde hierro cuando la eritropoyesis requiere maacutes cantidad que laque recibe ANTES de que la anemia se establezca
La deteccioacuten precoz del deacuteficit de hierro en la fase del balance negativo demanda aporte contribuye a reducir sus manifestaciones cliacutenicas en los pacientes afectados mejorando la salud puacuteblica
Un tratamiento menos prolongado con suplementos y menor consumo de los recursos sanitaros Contribuye a la eficiencia y sostenibilidad de los servicios sanitarios
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
Buttarello MLaboratory diagnosis of anemia are the old and new red cell parameters useful in classification and treatment howInt Jnl Lab Hem 2016 38 (Suppl 1) 123ndash132
Congreso Nacional Laboratorio Cliacutenico
2018
Buttarello MLaboratory diagnosis of anemia are the old and new red cell parameters useful in classification and treatment howInt Jnl Lab Hem 2016 38 (Suppl 1) 123ndash132
Congreso Nacional Laboratorio Cliacutenico
2018
Ralph Green amp Ananya Datta Mitra Megaloblastic Anemias Nutritional and Other CausesMed Clin N Am 2017 101 297ndash317
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
ANEMIA CARENCIAL CAUSAS
Factores alimentariosConsumir una dieta vegetariana mal planeadaAlimentacioacuten deficiente en los bebeacutesDesnutricioacuten durante el embarazo
Deacuteficit de absorcioacutenAlcoholismo croacutenicoEnfermedad de Crohn celiaquiacutea infeccioacuten otros problemas que le dificulten al cuerpo la digestioacuten de los alimentosAnemia perniciosa (factor intriacutenseco)Cirugiacuteas para extirpar ciertas partes del estoacutemago o el intestino delgado
MedicamentosB12 omeprazol metformina colchicina aminosalicilatos neomicinaFOLATO fenitoiacutena metotrexato sulfasalacina triamtereno pirimetamina trimetoprim con sulfametoxazol barbituacutericos
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
Reacciones metaboacutelicas en las que participan la vitamina B12 y el folato bull la conversioacuten de metilmalonil-CoA a succinil-CoA donde la adenosil-cobalamina actuacutea de
cofactor Por ello un deacuteficit de B12 conlleva un aumento de metilmalonil-CoA y de su producto de hidroacutelisis el aacutecido metilmaloacutenico
bull la siacutentesis de metionina a partir de homocisteina gracias a la metionina sintetasa y a la metil-cobalamina como cofactor En esta misma reaccioacuten el metiltetrahidrofolato es transformado a tetrahidrofolato que es necesario para la siacutentesis de DNA
Congreso Nacional Laboratorio Cliacutenico
2018
Anemia macrociacutetica secundaria a deficiencia de aacutecido foacutelico y de vitamina B12(cobalamina)
La deficiencia de B12 yo aacutecido foacutelico es la causa maacutes frecuente de megaloblastosis
Dentro de distintas funciones generales del metabolismo la vitamina B12 es uncofactor esencial en la siacutentesis de ADN y ARN compromete a todas las ceacutelulas delorganismo
Su deficiencia se manifiesta en oacuterganos con alto recambio celular como la meacutedulaosea y en el sistema nervioso central (SNC) a traveacutes de la siacutentesis de mielina y lareparacioacuten axonal
La deficiencia de cobalamina es responsable de alteraciones hematoloacutegicasneuroloacutegicas neurocognitivas y neuropsiquiaacutetricas
La siacutentesis defectuosa de ADN conduce a la apoptosis y a la hemoacutelisis (intra yextramedular) causantes de la hemopoyesis inefectiva
En meacutedula la siacutentesis ineficiente de DNA causa cambios megaloblaacutesticos comoconsecuencIa anemia y citopenias
Congreso Nacional Laboratorio Cliacutenico
2018
Limitaciones de los meacutetodos diagnoacutesticos claacutesicos
Volumen Corpuscular Medio (VCM) y morfologiacutea de sangre perifeacuterica En una serie de pacientes con deacuteficit de cobalamina soacutelo un 29 teniacutean anemia y soacutelo un 36 teniacutean un VCM gt 100 fL
Un VCM normal no puede ser empleado para rechazar una determinacioacuten de nivel de cobalamina ya que hasta un 25 de casos con manifestaciones neuroloacutegicas cursan con un VCM normal
Cobalamina seacuterica (nivel de B12) Es el test diagnoacutestico rutinario inicial estaacutendar Es un test ampliamente disponible de bajo coste y automatizado Sin embargo presenta algunas limitaciones
-- Existencia de varias teacutecnicas y ausencia de un gold standard por lo que hay diferentes liacutemites de referencia
-- Variacioacuten intraindividual muy alta
La OMS publicoacute en 2008 las conclusiones de un grupo teacutecnico consultado sobre el deacuteficit de cobalamina y folato
El grupo reconocioacute que no existen unos umbrales universalmente reconocidos para definir el deacuteficit de ambas vitaminas y expresaron la necesidad de un consenso
Devalia V Hamilton MS and Molloy AM on behalf of the British Committee for standards in haematology Guidelines for the diagnosis and treatment of cobalamin and folate disorders Br J Haematol 2014 166(4) 496-513
Schrier SL Diagnosis and treatment of vitamin B12 and folate deficiency UpToDate Last updated Jun 25 2014
de Benoist B Conclusions of a WHO Technical Consultation on folate and vitamin B12 deficiencies Food Nutr Bull 200829(2 Suppl)S238ndash44Congreso Nacional Laboratorio Cliacutenico
2018
Tomado de Tefferi A Li C En Atlas of Clinical Hematology Publicado por JO Armitage Philadelphia Current Medicine 2004
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
Int Jnl Lab Hem 2007 29 327ndash334
Clin Lab 201662343-347
In ourstudy mean MCVrMCV ratio of healthy controls is130 as microcytic anemia irondeficiency anemia is121 as also macrocytic anemia vitamin B12 deficiencyanemia is 115
Congreso Nacional Laboratorio Cliacutenico
2018
Sualeh Muslim Khan Muhammad Akbar Agha
Mean cell volume of reticulocytemdashA new parameter for diagnosing sub-clinical cobalamin deficiency in blood donors Int J Lab Hem 20181ndash4
The Abbott CELL-DYN Sapphire Hematology System uses multi-angle polarized scatter separation (MAPSS) and focused flow impedance technologies
Congreso Nacional Laboratorio Cliacutenico
2018
MCVr at 985 fL yielded the highest Youdenrsquos index at sensitivity of 82 specificity of 828 AUC 0847 ( 95 CI 803-891)
Khan SM Agha MA Mean cell volume of reticulocyte-A new parameter for diagnosing sub-clinical cobalamin deficiency in blood donors
Int J Lab Hem 20181ndash4 2018 Jul 13 doi 101111ijlh12899
Congreso Nacional Laboratorio Cliacutenico
2018
Role of Cell Population Data in the detection of folate and cobalamin deficiency
J Nieto et al
XXXI st International Symposium on Technological Innovations in Laboratory Hematology ISLH 2018 10-12 May 2018 Brussels Belgium
M-V-NRET and SD-VNRET are the best discriminatory single parameters to distinguish between patients with B9B12 deficiency and reference subjects M-V-NRETAUC=0823 sensitivity 78 and specificity 86
AUC=0852 sensitivity 55 and specificity 60
Conclusions The CPD parameters of Volume and Light Scatter (M and SD of LALS angle) that inform about size and intracellular structure of RBCs provided very useful information for the detection of B9B12 deficiency
Congreso Nacional Laboratorio Cliacutenico
2018
Cell Population Data
bull Paraacutemetros poblacionales de los leucocitos
bull Describen la morfologiacutea tamantildeo
estructuras citoplasmaacuteticas
nuacutecleo aacutecidos nucleacuteicos
bull Son datos numeacutericos con los que se construyen los ejes de lo diagramas de dispersioacuten de los leucocitos
bull Dependen de la tecnologiacutea
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
High Sensitivity New Parameters for the Detection of Vitamin B12 and Folate Deficiencies Blood 2008 1125379
B12 def vs
Normals
Mann
Withney T-Test
ROC
AUC Sens Specif Cutoff signifROC
MCV p=03156 p=09533 0577
MPV p=00001 0802 792 806 lt83 p=00001
NE Mean
Volume plt00001 0862 833 778 gt1403 p=00001
MO Mean
Volume plt00001 0829 625 889 gt1723 p=00001
MRV p=00113 0705 50 964 gt1133 p=00051
Folate def vs
Normals
Mann
Withney T-Test
ROC
AUC Sens Specif Cut-off signifROC
MCV p=00798 p=06461 0665
MPV plt00001 0832 81 806 lt83 p=00001
NE Mean
Volume p=00008 087 952 694 gt1402 p=00001
MO Mean
Volume p=00002 0801 667 833 gt1696 p=00001
MRV p=00054 0731 476 964 gt1133 p=00019
The Mean Neutrophil Volume (MNE V) and Mean Monocyte Volume (MMOV) may be used for the detection of megaloblastic neutrophils and monocytes MNEV and MMOV have significantly higher sensitivity than the previous information from the red cells (MCV) detecting B12 or folate deficiency because they are not affected by the presence at the same time of Iron deficiency or other reasons of anemia
Congreso Nacional Laboratorio Cliacutenico
2018
POSTER 733
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
CPD Sysmex XN
NE SSC complejidad
NE SFL aacutecidos nucleacuteicos
NE FSC tamantildeo
NE WX
NE WY
NE WZ
MO X
MO Y
MO Z
MO WX
MO WY
MO WZ
LY X
LY Y
LY Z
LY WX
LY WY
LY WZCongreso Nacio
nal Laboratorio Cliacutenico 2018
As MCV is the mean which is calculated it is insensitive to the presence of a small number of macrocytes
Further macrocytosis can be obscured by concomitant disorders that can cause microcytosis resulting inmasked megaloblastic anaemia (MA) for example iron deficiency hereditary elliptocytosis alpha and betathalassemia
This study was undertaken to evaluate the role of NEUT-X and NEUT-Y in detecting MA on peripheral blood andalso see whether other forms of macrocytic anaemia can be differentiated from MA
In MA the peripheral blood smear shows cytopenia with macroovalocytes and hypersegmented
neutrophils (gt5 lobes in 5 neutrophils six lobes nuclei or lobe average of gt35)
In conclusion our study shows that higher values of NEUT-X and NEUT-Y in MA patients in spite of low ornormal MCV high RDW may be used to not only reveal the masked cases of MA with concomitant irondeficiency but also separate them from the broader macrocytic anaemia group
Peripheral smear remains diagnostic however making smear for all the suspicious cases is a cumbersomeand tedious procedure Thus these parameters emerge as more reliable and stable parameters in themodern laboratories which in future may replace the older screening tools
Congreso Nacional Laboratorio Cliacutenico
2018
A favor Eficiencia Operativa
Mejora el proceso del Laboratorio
Mejor informacioacuten al Cliacutenico al mismo coste
Mejora la informacioacuten
Informa sobre la eritropoyesis deteccioacuten precoz de estados carenciales
Ayuda al cliacutenico
Estado real del paciente
En contraParaacutemetros de investigacioacuten
Dificultad de standarizar dependencia teacutecnica
Control de calidadCongreso Nacional Laboratorio Cliacutenico
2018
Actualizacioacuten en la interpretacioacuten de las anemias carenciales iquestQueacute hay de nuevo en el siglo XXI
La gran novedad consiste en que podemos evitar que un sujeto sano lleguea padecer una anemia carencial utilizando los paraacutemetros del hemogramaavanzadohelliphellip
helliphellip y no soacutelo contamos con la serie rojahelliphelliphellip
Congreso Nacional Laboratorio Cliacutenico
2018
AM Garcia Hernandez A Sanchez Salinas V Cabanas Perianes M Blanquer Blanquer Protocolo diagnostico diferencial del sindromeAnemico Medicine 201612(20)1170-4
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
Total YLD resulting from all causes of anemia by country
Kassebaum NJ et al Blood 2014123615-624 copy2014 by American Society of Hematology
Congreso Nacional Laboratorio Cliacutenico
2018
Clamaschella C Iron deficiency anemia N Engl J Med 20153721832-43
Congreso Nacional Laboratorio Cliacutenico
2018
Iron Cycle
Fleming RE Ponka P N Engl J Med 2012366348-359Congreso Nacional Laboratorio Cliacutenico
2018
Camaschella C N Engl J Med 20153721832-43Congreso Nacio
nal Laboratorio Cliacutenico 2018
G Lippi amp M Plebani Recent developments and innovations in red blood cells diagnostics Journal of Laboratory and Precision Medicine 2018DOI 1021037jlpm20180709 AOP
Innovative erythrocyte parametersThese innovative parameters most typically include automated reticulocyte andnucleated RBC counts hemoglobinization of reticulocytes and RBC reticulocytehemoglobin content reticulocyte maturation automatic analysis and calculationof microcytic and hypochromic RBC
The various combination of these different parameters not only may be useful tocomplement clinical history physical examination and results of moreconventional laboratory investigations (ie CBC ferritin transferrin ironhaptoglobin folic acid and vitamin B12 among others) for investigating theunderlying cause(s) of anemia
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
Biomarcadores de Eritroyesis
Urrechaga E Borque L Escanero JF Biomarkers of hypochromia the contemporary assessment of
Iron status and erythropoiesis Journal of Biomedicine and Biotechnology
httpdxdoiorg1011552013603786
Abreviatura
(unidades)
Compantildeiacutea
RBC Hipocromos Hypo () Siemens
Hb Reticulocitaria CHr (pg) Siemens
RBC Hipocromos HPO () Abbott
Hb Reticulocitaria media MCHr (pg) Abbott
RBC Hipocromos Hypo He () Sysmex
Hb Reticulocitaria equivalente Ret He (pg) Sysmex
Low Hb density
Contenido de Hb Reticulocitaria
Expresioacuten Hb reticulocitaria
LHD ()
RHCc (pg)
RHE (pg)
Beckman Coulter
Horiba ABX
Mindray
Congreso Nacional Laboratorio Cliacutenico
2018
Informacioacuten avanzada valor antildeadido
Reticulocitos Eritrocitos
bull Permanecen en la sangre 1-2 diacuteas hasta que se convierten en eritrocitos maduros
bull El contenido de hemoglobinapuede reflejar la cantidad de hierro disponible de maneraefectiva
bull Refleja la calidad de la eritropoyesis en el periodoinmediato
bull Permanecen en la sangre 90-120 diacuteas
bull Las diversas subpoblacionespueden reflejar el status feacuterrico en las pasadas semanas
bull MCV MCH son las medias del
conjunto de RBC las de fracciones indican la contribucioacuten de los diversos tipos de RBC a las medias
Congreso Nacional Laboratorio Cliacutenico
2018
Angulo alto
Dispersioacuten lateral Hb
Angulo bajo
Dispersioacuten frontal VOLUMEN
LASER Absorbancia Fluorescencia
RNA contenido
Citometriacutea
Congreso Nacional Laboratorio Cliacutenico
2018
RETICULOCITOS
Compantildeiacutea Instrumento Meacutetodo Colorante Paraacutemetros
Abbott CELLDYN Ruby
CELLDYN
Sapphire
Absorbancia
Fluorescencia
Nuevo azul
metileno
Sybr II
IRF
IRF MCHr MCVr
Beckman
Coulter
UniCell DxH
LH series
Impedancia
citometriacutea de flujo
VCS
Nuevo azul
metileno
Nuevo azul
metileno
IRF MRVHLRRSf
IRF MRV
MSCVHLR
Horiba ABX Pentra
DX120
Impedancia
citometriacutea de flujo
fluorescencia
Naranja de tiazol IRF MRV RETH
RHbC
Siemens ADVIA 120 Absorbancia
Scatter
Oxazine 750 IRF MCVr CHr
Sysmex XE5000 XN Fluorescencia Polimetina IRF RetHe ΔHeCongreso Nacional Laboratorio Cliacutenico
2018
Los reticulocitos precursores de los eritrocitos madurangeneralmente a lo largo de unos dos diacuteas El recuento dereticulocitos es por lo tanto una medida de la cantidad dela eritropoyesis en la meacutedulaParaacutemetros derivados de los reticulocitos los describenmorfoloacutegicamente tamantildeo contenido en Hemoglobinacantidad de material geneacuteticoDe esta forma al referirse a caracteriacutesticas de losreticulocitos es la calidad de la eritropoyesis la que puedeser evaluada
La Hb reticulocitaria se relaciona con la cantidad de hierro disponible efectivamente para laeritropoyesis un valor bajo indica que el aporte es deficitario respecto a la demanda en el momentoactual 28-30 pg
Congreso Nacional Laboratorio Cliacutenico
2018
MCV MCH son los valores medios de volumen y Hb en toda la poblacioacuten RBC
No informan acerca de las ceacutelulas individuales
Ni de la variedad de eacutestas anisocitosis policromasia
Congreso Nacional Laboratorio Cliacutenico
2018
Se cuentan el nuacutemero de pulsos de 36-360fL y el nuacutemero de partiacuteculas que tienen el mismo tamantildeo y se trasladan los resultados a una graacutefica de Volumen Nuacutemero de ceacutelulasSe obtiene el histograma de RBC que proporciona
bull Nuacutemero de RBC el nuacutemero de pulsos dentro de este rango de tamantildeos
bull MCV se corresponde con la media del histograma de RBC
bull RDW o ADE Ancho de Distribucioacuten del histograma de RBC se corresponde con el coeficiente de variacioacuten de la curva
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
Abbott Sapphire lo calcula en el 50 de la altura del pico del histogramaSysmex y Mindray al 20 desde la base del histogramaSiemens calcula la anchura del pico comprendido entre 60 y 120 fL
Aunque RDW ADE generalmente se entiendecomo coeficiente de variacioacuten de ladistribucioacuten de los voluacutemenes de loseritrocitos algunos analizadoreshematoloacutegicos lo calculan desde la medicioacutendirecta de la anchura de la distribucioacuten
Congreso Nacional Laboratorio Cliacutenico
2018
G Lippi amp M Plebani
Recent developments and innovations in red blood cells diagnostics
Journal of Laboratory and Precision Medicine 2018
DOI 1021037jlpm20180709 AOPCongreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
copy 2012 Mindray Confidential 26
HDWHYPERHYPO
HDW HGB Distribution Width
HDW is the distribution width of Hgb histogram
Congreso Nacional Laboratorio Cliacutenico
2018
copy 2012 Mindray Confidential 27
MCHrHDWHYPERHYPOMCHr Mean RET HGB Concentration
Congreso Nacional Laboratorio Cliacutenico
2018
Histograma RBC el mapa de Mie
28 41
Congreso Nacional Laboratorio Cliacutenico
2018
Abbott Mindray Siemens
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
Severe Iron Deficiency Anemia Female 34 years
19 th March 18 th April
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
SysmexRBCHe erythrocyte Hb equivalentRetHe reticulocyte Hb equivalent(content)
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
MIC
MAC
HPO HPR
Congreso Nacional Laboratorio Cliacutenico
2018
copy 2012 Mindray Confidential 36
MINDRAY MCHrHDWHYPERHYPO
MCHr Mean RET HGB Concentration
HDW HGB Distribution Width
HYPER The percentage of hyperchromicred blood cells
HYPO The percentage of hypochromic red blood cells
Thalassemia screeningIDA treatment monitoringIDA screening
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
Hipocromo
Hipercroacutemico onormocroacutemico
iquestConcentracioacuten o contenido de Hemoglobina
Hipocroacutemiconormocroacutemico
Abbott Mindray Siemens Hypo CONCENTRACIOacuteN Hblt280gL
Sysmex Hypo CONTENIDO Hblt 17 pg
Congreso Nacional Laboratorio Cliacutenico
2018
Low Hb Density
Microcytic Factor Maf = (HbMCV)100
Nuevo moacutedulo transductor muacuteltiple con laacuteser de diodo y dos sensores oacutepticos
Anaacutelisis de hasta 50000 ceacutelulas con 7 paraacutemetros tecnoloacutegicos (leucocitos reticulocitos eritroblastos)
1 Volumen digital
2 Conductividad digital
3 5 aacutengulos de dispersioacuten de luz laacuteser digital
bull MALS (Median Angle Light Scatter)
bull UMALS (Upper Median Angle Light Scatter) 20deg a 43deg
bull LMALS (Lower Median Angle Light Scatter) 09deg a 19deg
bull LALS (Low Angle Light Scatter) asymp 51deg
bull AL2 (Axial Light Loss) 0deg a 05deg
Congreso Nacional Laboratorio Cliacutenico
2018
Hierro es un elemento criacutetico para elfuncionamiento oacuteptimo y supervivenciade las ceacutelulas
Disfuncioacuten mitocondrialActividad enzimaacutetica afectadaProteiacutenas de transporte y estructuralesproteins
Capacidad fiacutesica mermadaCapacidad de trabajo reducidaCapacidades cognitivas afectadasMorbilidad y mortalidad
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
It is generally assumed that worldwide ldquoat least half the anemia is due tonutritional iron deficiencyrdquo and that ldquoup to a prevalence of iron deficiency anemiaof 40 the prevalence of iron deficiency will be about 25 times that of anemiardquoHowever it is evident from the foregoing discussion that there are considerablevariations in both of these ratios depending on the age and sex of the peoplebeing studied the region of the world in which they live and the prevalence ratesof other causes of anemia
WHO Department of Nutrition for Health and DevelopmentAssessing the iron status of populations including literature reviews report of a Joint World Health OrganizationCenters for DiseaseControl and Prevention Technical Consultation on the Assessment of Iron Status at the Population Level Geneva Switzerland 6ndash8 April2004 ndash 2nd ed
Congreso Nacional Laboratorio Cliacutenico
2018
Estaacute bien establecido que la anemia produce una miriacuteada de secuelas tanto fiacutesicas comopsicoloacutegicas
Pero los efecto deleteacutereos se deben al deficit de hierro que es un evento previo a que seestablezca la anemia
El deacuteficit de hierrro auacuten sin anemia tiene efectos negativos en el desarrollo cognitivo y fiacutesico
Rattehalli D et al Iron deficiency without anemia do not wait for the Hemoglobin to drop
Health Policy and Technology 2013 2 45-48Congreso Nacio
nal Laboratorio Cliacutenico 2018
SuominenP et al Serum transferrin receptor and transferrin receptor-ferritin index identify healthy subjects with subclinical iron deficits Blood 1998 92 2934ndash9Halwachs-Baumann G Diagnosis of anaemia old things rearranged Wien Med Wochenschr 2012 162478ndash88
Congreso Nacional Laboratorio Cliacutenico
2018
Hemoglobina de reticulocito y su importancia en el diagnoacutestico temprano de anemiaferropeacutenica
Y Maacuterquez-Beniacutetez et al Universidad de BocayaAugust
2018 DOI 1022267rus182003133 aop
El contenido de hemoglobina de reticulocitos (CHr) es un paraacutemetro en la biometriacuteahematoloacutegica automatizada utilizado como un marcador de la biodisponibilidad delhierro en la eritropoyesis
Objetivo Exponer la aplicabilidad de la CHr como un paraacutemetro en el diagnoacutesticoprecoz de la anemia por deficiencia de hierro asiacute como su medicioacuten e interpretacioacuten
Materiales y meacutetodos Se realizoacute la revisioacuten de artiacuteculos cientiacuteficos en ingleacutes y espantildeolen las bases de datos PubMed ScienceDirect LILACS y Medline usando descriptoresvalidados en Medical Subject Headings (MeSH) considerando periodo depublicabilidad del 80 inferior a 5 antildeos
Conclusiones La CHr es un paraacutemetro de gran utilidad en el diagnoacutestico temprano deanemia ferropeacutenica y otras patologiacuteas como deficiencia funcional de hierro estadosde inflamacioacuten croacutenica y enfermedad renal croacutenica
Biomarcador temprano en el diagnoacutestico de deficiencia de hierro antes de presentarsecambios morfoloacutegicos eritrociacuteticosCongreso Nacio
nal Laboratorio Cliacutenico 2018
bull A total of 1105 NES participants (639 men 466 women)bull CHr becomes affected in a relatively early stage in the development of iron deficiency before iron
deficiency anemia and clinical symptoms become apparentbull Therefore this parameter might be useful to identify persons healthy and diseased at risk of
developing iron deficiency anemia and subsequently to apply interventions in order to prevent further development of iron deficiency anemiaCongreso Nacio
nal Laboratorio Cliacutenico 2018
Hb reticulocitaria sensible para detectar la fase inicial del deacuteficit de hierro cuando laeritropoyesis requiere maacutes cantidad que la que recibe ANTES de que la anemia seestablezca
Congreso Nacional Laboratorio Cliacutenico
2018
No ID LID P
RBC 1012L 48 (08) 437 (05) lt00001
Hb gL 135 (6) 131 (12) 0006
MCV fL 922 (21) 902 (38) 0006
MCH pg 324 (07) 306 (22) lt00001
MCHC gL 339 (6) 319 (23) 0001
RDW
Ret He pg
Hypo He
LHD
Ferritin microgL
131 (06)
338 (21)
03 (015)
28 (20)
86 (3)
145 (21)
278 (24)
69 (55)
56 (25)
16 (76)
lt00001
lt00001
lt00001
lt00001
lt00001
AUC 95 CI Cutoff Sensitivity Specificity
LHD 0898 0819-0978 50 859 841
Ret He 0914 0824-1000 299pg 868 857
Hypo He 0934 0856-1000 16 857 921
Clinical value of markers of hypochromia in the detection of latent iron deficiency in non-anemic premenopausal women
No ID Hb gt 120 gL s-ferritin was within reference intervalLatent Iron Defiency Hb gt 120 gL s-ferritin lt 30 μgL
Urrechaga E et al Journal Clin Lab Analysis 2016 30 (5) 623-627
97 women (388) in 250 apparently healthy women had latent IDCongreso Nacional Laboratorio Cliacutenico
2018
Schorer G et al Abstract Jahreskongress der Deutschen Gesellschaft fuumlr Transfusionsmedizin und Immunhaumlmatologie Rostock 15 - 18 September 2009
Congreso Nacional Laboratorio Cliacutenico
2018
Caring for Those Who Share Mitigating Iron Deficiency in Regular Blood DonorsMast Alan E
bull Iron deficiency caused by regular blood donation is a problem facing blood centers Each blood donation removes 200 to 250 mg of iron from the donor Consequently many donors become iron deficient with repeated donation
bull This presents a challenge to blood centers that has become more acute in recent years with the realization that iron deficiency even in the absence of anemia is associated with adverse effects including fatigue and decreased exercise tolerance as well as neurological symptoms such as decreased cognitive function pica and restless leg syndrome
bull REDS-II investigators performed a longitudinal study investigating the iron status of blood donors over a two year period called the REDS-II Donor Iron Status Evaluation (RISE)
bull Results from the baseline analysis of regular donors (e 2 donations per year (females) or e 3 donations per year (males) revealed that over two-thirds of female donors and over one-half of male donors have iron deficiency
Congreso Nacional Laboratorio Cliacutenico
2018
Transfusion 2013 532766-2775
bull We evaluated the diagnostic sensitivity and specificity of red blood cell (RBC) hematology analyzer indices to assess iron status as a part of donor management iron deficient erythropoiesis (IDE) and absence of iron stores (AIS)
bull STUDY DESIGN AND METHODS A total of 1659 male and female donors from the Retrovirus Epidemiology Donor Study-II (REDS-II) Donor Iron Status Evaluation (RISE) study who were either first-timereactivated (FT RA no donations for 2 years) or frequent donors were recruited into a longitudinal study of regular donation of RBCs Of these 1002 donors returned 15 to 24 months later for a final assessment
Absent iron stores (AIS) was defined as plasma ferritin level of less than 12 mgL Logarithm of the ratio of soluble transferrin receptor to ferritin of at least 207 was used to define iron-deficient erythropoiesis (IDE)
bull RESULTS HYPOm and CHr detected IDE with comparable sensitivity 72 versus 69 but differed in specificity HYPOm 68 and CHr 53
For detecting AIS sensitivity was improved to 85 for HYPOm and 81 for CHr but specificity was reduced
Venous Hb had high specificity but poor sensitivity for IDE and AIS A plasma ferritin level of less than 267 mgL was a good surrogate for assessing IDE Congreso Nacio
nal Laboratorio Cliacutenico 2018
Microcytic RBC and reticulocyte mean cell hemoglobin content predicted iron depletion with
sensitivities 70 and 64
specificities of 72 and 78 respectively
When both combined
increased the sensitivity to 82
Congreso Nacional Laboratorio Cliacutenico
2018
Depending on the number of donations during the preceding12 months
Absent iron stores were detected in up to 214 of male and278 of female donors respectively
impaired hemoglobinisation IH was present in up to 64 maleand 167 female donors with 2 and 4 preceding donationsrespectively
The defined CHr cut-off value was 280 pg to detect IH infrequent whole blood donors with AIS leading to a testspecificity of 982 (positive predictive value PPV 577) inmale and of 978 (PPV 829) in female donors
It may help to prevent the development of anemia in frequentblood donors and also can help to decide whether donordeferral or even iron substitution need to be recommended
Congreso Nacional Laboratorio Cliacutenico
2018
Of the 501 blood donors sTfR and Ret-He detected Latent Iron Deficiency in 148 and 135 donors respectively
In comparison to sTfR Ret-He had sensitivity of 927 specificity of 9716 PPV of 931 and NPV of 963
Serum Ferritin TIBC and serum Iron had comparatively lower sensitivity of 8716 797 and 777 respectively
Conclusion Ret-He can be used as a routine screening test to detect LID in blood donors
This could provide an opportunity to make appropriate and timely interventions like dietary changes or drug supplementation
Congreso Nacional Laboratorio Cliacutenico
2018
Singh A Chaudhary R Pandey HC Sonker A Identification of iron status of blood donors by using low hemoglobin density and microcytic anemia factor Asian J Transfus Sci 20181246-50
The main objective of this study was to assess ifLHD and Maf could be used for assessment ofiron status in blood donors and also to establisha cut-off for these two parameters at which atentative iron deficiency could be reportedconclusively
Results LHD and Maf were able to differentiatebetween iron deficient and iron-depleteddonors from normal donorsA cutoff of 918 for LHD was able todifferentiate iron deficient and depleted statefrom normal iron statessensitivity 919 and specificity 71respectivelya cutoff of 1016 for Mafsensitivity 946 and specificity 968
MAf = (MVC Hb) 100
Congreso Nacional Laboratorio Cliacutenico
2018
Hb reticulocitaria sensible para detectar la fase inicial del deacuteficitde hierro cuando la eritropoyesis requiere maacutes cantidad que laque recibe ANTES de que la anemia se establezca
La deteccioacuten precoz del deacuteficit de hierro en la fase del balance negativo demanda aporte contribuye a reducir sus manifestaciones cliacutenicas en los pacientes afectados mejorando la salud puacuteblica
Un tratamiento menos prolongado con suplementos y menor consumo de los recursos sanitaros Contribuye a la eficiencia y sostenibilidad de los servicios sanitarios
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
Buttarello MLaboratory diagnosis of anemia are the old and new red cell parameters useful in classification and treatment howInt Jnl Lab Hem 2016 38 (Suppl 1) 123ndash132
Congreso Nacional Laboratorio Cliacutenico
2018
Buttarello MLaboratory diagnosis of anemia are the old and new red cell parameters useful in classification and treatment howInt Jnl Lab Hem 2016 38 (Suppl 1) 123ndash132
Congreso Nacional Laboratorio Cliacutenico
2018
Ralph Green amp Ananya Datta Mitra Megaloblastic Anemias Nutritional and Other CausesMed Clin N Am 2017 101 297ndash317
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
ANEMIA CARENCIAL CAUSAS
Factores alimentariosConsumir una dieta vegetariana mal planeadaAlimentacioacuten deficiente en los bebeacutesDesnutricioacuten durante el embarazo
Deacuteficit de absorcioacutenAlcoholismo croacutenicoEnfermedad de Crohn celiaquiacutea infeccioacuten otros problemas que le dificulten al cuerpo la digestioacuten de los alimentosAnemia perniciosa (factor intriacutenseco)Cirugiacuteas para extirpar ciertas partes del estoacutemago o el intestino delgado
MedicamentosB12 omeprazol metformina colchicina aminosalicilatos neomicinaFOLATO fenitoiacutena metotrexato sulfasalacina triamtereno pirimetamina trimetoprim con sulfametoxazol barbituacutericos
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
Reacciones metaboacutelicas en las que participan la vitamina B12 y el folato bull la conversioacuten de metilmalonil-CoA a succinil-CoA donde la adenosil-cobalamina actuacutea de
cofactor Por ello un deacuteficit de B12 conlleva un aumento de metilmalonil-CoA y de su producto de hidroacutelisis el aacutecido metilmaloacutenico
bull la siacutentesis de metionina a partir de homocisteina gracias a la metionina sintetasa y a la metil-cobalamina como cofactor En esta misma reaccioacuten el metiltetrahidrofolato es transformado a tetrahidrofolato que es necesario para la siacutentesis de DNA
Congreso Nacional Laboratorio Cliacutenico
2018
Anemia macrociacutetica secundaria a deficiencia de aacutecido foacutelico y de vitamina B12(cobalamina)
La deficiencia de B12 yo aacutecido foacutelico es la causa maacutes frecuente de megaloblastosis
Dentro de distintas funciones generales del metabolismo la vitamina B12 es uncofactor esencial en la siacutentesis de ADN y ARN compromete a todas las ceacutelulas delorganismo
Su deficiencia se manifiesta en oacuterganos con alto recambio celular como la meacutedulaosea y en el sistema nervioso central (SNC) a traveacutes de la siacutentesis de mielina y lareparacioacuten axonal
La deficiencia de cobalamina es responsable de alteraciones hematoloacutegicasneuroloacutegicas neurocognitivas y neuropsiquiaacutetricas
La siacutentesis defectuosa de ADN conduce a la apoptosis y a la hemoacutelisis (intra yextramedular) causantes de la hemopoyesis inefectiva
En meacutedula la siacutentesis ineficiente de DNA causa cambios megaloblaacutesticos comoconsecuencIa anemia y citopenias
Congreso Nacional Laboratorio Cliacutenico
2018
Limitaciones de los meacutetodos diagnoacutesticos claacutesicos
Volumen Corpuscular Medio (VCM) y morfologiacutea de sangre perifeacuterica En una serie de pacientes con deacuteficit de cobalamina soacutelo un 29 teniacutean anemia y soacutelo un 36 teniacutean un VCM gt 100 fL
Un VCM normal no puede ser empleado para rechazar una determinacioacuten de nivel de cobalamina ya que hasta un 25 de casos con manifestaciones neuroloacutegicas cursan con un VCM normal
Cobalamina seacuterica (nivel de B12) Es el test diagnoacutestico rutinario inicial estaacutendar Es un test ampliamente disponible de bajo coste y automatizado Sin embargo presenta algunas limitaciones
-- Existencia de varias teacutecnicas y ausencia de un gold standard por lo que hay diferentes liacutemites de referencia
-- Variacioacuten intraindividual muy alta
La OMS publicoacute en 2008 las conclusiones de un grupo teacutecnico consultado sobre el deacuteficit de cobalamina y folato
El grupo reconocioacute que no existen unos umbrales universalmente reconocidos para definir el deacuteficit de ambas vitaminas y expresaron la necesidad de un consenso
Devalia V Hamilton MS and Molloy AM on behalf of the British Committee for standards in haematology Guidelines for the diagnosis and treatment of cobalamin and folate disorders Br J Haematol 2014 166(4) 496-513
Schrier SL Diagnosis and treatment of vitamin B12 and folate deficiency UpToDate Last updated Jun 25 2014
de Benoist B Conclusions of a WHO Technical Consultation on folate and vitamin B12 deficiencies Food Nutr Bull 200829(2 Suppl)S238ndash44Congreso Nacional Laboratorio Cliacutenico
2018
Tomado de Tefferi A Li C En Atlas of Clinical Hematology Publicado por JO Armitage Philadelphia Current Medicine 2004
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
Int Jnl Lab Hem 2007 29 327ndash334
Clin Lab 201662343-347
In ourstudy mean MCVrMCV ratio of healthy controls is130 as microcytic anemia irondeficiency anemia is121 as also macrocytic anemia vitamin B12 deficiencyanemia is 115
Congreso Nacional Laboratorio Cliacutenico
2018
Sualeh Muslim Khan Muhammad Akbar Agha
Mean cell volume of reticulocytemdashA new parameter for diagnosing sub-clinical cobalamin deficiency in blood donors Int J Lab Hem 20181ndash4
The Abbott CELL-DYN Sapphire Hematology System uses multi-angle polarized scatter separation (MAPSS) and focused flow impedance technologies
Congreso Nacional Laboratorio Cliacutenico
2018
MCVr at 985 fL yielded the highest Youdenrsquos index at sensitivity of 82 specificity of 828 AUC 0847 ( 95 CI 803-891)
Khan SM Agha MA Mean cell volume of reticulocyte-A new parameter for diagnosing sub-clinical cobalamin deficiency in blood donors
Int J Lab Hem 20181ndash4 2018 Jul 13 doi 101111ijlh12899
Congreso Nacional Laboratorio Cliacutenico
2018
Role of Cell Population Data in the detection of folate and cobalamin deficiency
J Nieto et al
XXXI st International Symposium on Technological Innovations in Laboratory Hematology ISLH 2018 10-12 May 2018 Brussels Belgium
M-V-NRET and SD-VNRET are the best discriminatory single parameters to distinguish between patients with B9B12 deficiency and reference subjects M-V-NRETAUC=0823 sensitivity 78 and specificity 86
AUC=0852 sensitivity 55 and specificity 60
Conclusions The CPD parameters of Volume and Light Scatter (M and SD of LALS angle) that inform about size and intracellular structure of RBCs provided very useful information for the detection of B9B12 deficiency
Congreso Nacional Laboratorio Cliacutenico
2018
Cell Population Data
bull Paraacutemetros poblacionales de los leucocitos
bull Describen la morfologiacutea tamantildeo
estructuras citoplasmaacuteticas
nuacutecleo aacutecidos nucleacuteicos
bull Son datos numeacutericos con los que se construyen los ejes de lo diagramas de dispersioacuten de los leucocitos
bull Dependen de la tecnologiacutea
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
High Sensitivity New Parameters for the Detection of Vitamin B12 and Folate Deficiencies Blood 2008 1125379
B12 def vs
Normals
Mann
Withney T-Test
ROC
AUC Sens Specif Cutoff signifROC
MCV p=03156 p=09533 0577
MPV p=00001 0802 792 806 lt83 p=00001
NE Mean
Volume plt00001 0862 833 778 gt1403 p=00001
MO Mean
Volume plt00001 0829 625 889 gt1723 p=00001
MRV p=00113 0705 50 964 gt1133 p=00051
Folate def vs
Normals
Mann
Withney T-Test
ROC
AUC Sens Specif Cut-off signifROC
MCV p=00798 p=06461 0665
MPV plt00001 0832 81 806 lt83 p=00001
NE Mean
Volume p=00008 087 952 694 gt1402 p=00001
MO Mean
Volume p=00002 0801 667 833 gt1696 p=00001
MRV p=00054 0731 476 964 gt1133 p=00019
The Mean Neutrophil Volume (MNE V) and Mean Monocyte Volume (MMOV) may be used for the detection of megaloblastic neutrophils and monocytes MNEV and MMOV have significantly higher sensitivity than the previous information from the red cells (MCV) detecting B12 or folate deficiency because they are not affected by the presence at the same time of Iron deficiency or other reasons of anemia
Congreso Nacional Laboratorio Cliacutenico
2018
POSTER 733
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
CPD Sysmex XN
NE SSC complejidad
NE SFL aacutecidos nucleacuteicos
NE FSC tamantildeo
NE WX
NE WY
NE WZ
MO X
MO Y
MO Z
MO WX
MO WY
MO WZ
LY X
LY Y
LY Z
LY WX
LY WY
LY WZCongreso Nacio
nal Laboratorio Cliacutenico 2018
As MCV is the mean which is calculated it is insensitive to the presence of a small number of macrocytes
Further macrocytosis can be obscured by concomitant disorders that can cause microcytosis resulting inmasked megaloblastic anaemia (MA) for example iron deficiency hereditary elliptocytosis alpha and betathalassemia
This study was undertaken to evaluate the role of NEUT-X and NEUT-Y in detecting MA on peripheral blood andalso see whether other forms of macrocytic anaemia can be differentiated from MA
In MA the peripheral blood smear shows cytopenia with macroovalocytes and hypersegmented
neutrophils (gt5 lobes in 5 neutrophils six lobes nuclei or lobe average of gt35)
In conclusion our study shows that higher values of NEUT-X and NEUT-Y in MA patients in spite of low ornormal MCV high RDW may be used to not only reveal the masked cases of MA with concomitant irondeficiency but also separate them from the broader macrocytic anaemia group
Peripheral smear remains diagnostic however making smear for all the suspicious cases is a cumbersomeand tedious procedure Thus these parameters emerge as more reliable and stable parameters in themodern laboratories which in future may replace the older screening tools
Congreso Nacional Laboratorio Cliacutenico
2018
A favor Eficiencia Operativa
Mejora el proceso del Laboratorio
Mejor informacioacuten al Cliacutenico al mismo coste
Mejora la informacioacuten
Informa sobre la eritropoyesis deteccioacuten precoz de estados carenciales
Ayuda al cliacutenico
Estado real del paciente
En contraParaacutemetros de investigacioacuten
Dificultad de standarizar dependencia teacutecnica
Control de calidadCongreso Nacional Laboratorio Cliacutenico
2018
AM Garcia Hernandez A Sanchez Salinas V Cabanas Perianes M Blanquer Blanquer Protocolo diagnostico diferencial del sindromeAnemico Medicine 201612(20)1170-4
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
Total YLD resulting from all causes of anemia by country
Kassebaum NJ et al Blood 2014123615-624 copy2014 by American Society of Hematology
Congreso Nacional Laboratorio Cliacutenico
2018
Clamaschella C Iron deficiency anemia N Engl J Med 20153721832-43
Congreso Nacional Laboratorio Cliacutenico
2018
Iron Cycle
Fleming RE Ponka P N Engl J Med 2012366348-359Congreso Nacional Laboratorio Cliacutenico
2018
Camaschella C N Engl J Med 20153721832-43Congreso Nacio
nal Laboratorio Cliacutenico 2018
G Lippi amp M Plebani Recent developments and innovations in red blood cells diagnostics Journal of Laboratory and Precision Medicine 2018DOI 1021037jlpm20180709 AOP
Innovative erythrocyte parametersThese innovative parameters most typically include automated reticulocyte andnucleated RBC counts hemoglobinization of reticulocytes and RBC reticulocytehemoglobin content reticulocyte maturation automatic analysis and calculationof microcytic and hypochromic RBC
The various combination of these different parameters not only may be useful tocomplement clinical history physical examination and results of moreconventional laboratory investigations (ie CBC ferritin transferrin ironhaptoglobin folic acid and vitamin B12 among others) for investigating theunderlying cause(s) of anemia
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
Biomarcadores de Eritroyesis
Urrechaga E Borque L Escanero JF Biomarkers of hypochromia the contemporary assessment of
Iron status and erythropoiesis Journal of Biomedicine and Biotechnology
httpdxdoiorg1011552013603786
Abreviatura
(unidades)
Compantildeiacutea
RBC Hipocromos Hypo () Siemens
Hb Reticulocitaria CHr (pg) Siemens
RBC Hipocromos HPO () Abbott
Hb Reticulocitaria media MCHr (pg) Abbott
RBC Hipocromos Hypo He () Sysmex
Hb Reticulocitaria equivalente Ret He (pg) Sysmex
Low Hb density
Contenido de Hb Reticulocitaria
Expresioacuten Hb reticulocitaria
LHD ()
RHCc (pg)
RHE (pg)
Beckman Coulter
Horiba ABX
Mindray
Congreso Nacional Laboratorio Cliacutenico
2018
Informacioacuten avanzada valor antildeadido
Reticulocitos Eritrocitos
bull Permanecen en la sangre 1-2 diacuteas hasta que se convierten en eritrocitos maduros
bull El contenido de hemoglobinapuede reflejar la cantidad de hierro disponible de maneraefectiva
bull Refleja la calidad de la eritropoyesis en el periodoinmediato
bull Permanecen en la sangre 90-120 diacuteas
bull Las diversas subpoblacionespueden reflejar el status feacuterrico en las pasadas semanas
bull MCV MCH son las medias del
conjunto de RBC las de fracciones indican la contribucioacuten de los diversos tipos de RBC a las medias
Congreso Nacional Laboratorio Cliacutenico
2018
Angulo alto
Dispersioacuten lateral Hb
Angulo bajo
Dispersioacuten frontal VOLUMEN
LASER Absorbancia Fluorescencia
RNA contenido
Citometriacutea
Congreso Nacional Laboratorio Cliacutenico
2018
RETICULOCITOS
Compantildeiacutea Instrumento Meacutetodo Colorante Paraacutemetros
Abbott CELLDYN Ruby
CELLDYN
Sapphire
Absorbancia
Fluorescencia
Nuevo azul
metileno
Sybr II
IRF
IRF MCHr MCVr
Beckman
Coulter
UniCell DxH
LH series
Impedancia
citometriacutea de flujo
VCS
Nuevo azul
metileno
Nuevo azul
metileno
IRF MRVHLRRSf
IRF MRV
MSCVHLR
Horiba ABX Pentra
DX120
Impedancia
citometriacutea de flujo
fluorescencia
Naranja de tiazol IRF MRV RETH
RHbC
Siemens ADVIA 120 Absorbancia
Scatter
Oxazine 750 IRF MCVr CHr
Sysmex XE5000 XN Fluorescencia Polimetina IRF RetHe ΔHeCongreso Nacional Laboratorio Cliacutenico
2018
Los reticulocitos precursores de los eritrocitos madurangeneralmente a lo largo de unos dos diacuteas El recuento dereticulocitos es por lo tanto una medida de la cantidad dela eritropoyesis en la meacutedulaParaacutemetros derivados de los reticulocitos los describenmorfoloacutegicamente tamantildeo contenido en Hemoglobinacantidad de material geneacuteticoDe esta forma al referirse a caracteriacutesticas de losreticulocitos es la calidad de la eritropoyesis la que puedeser evaluada
La Hb reticulocitaria se relaciona con la cantidad de hierro disponible efectivamente para laeritropoyesis un valor bajo indica que el aporte es deficitario respecto a la demanda en el momentoactual 28-30 pg
Congreso Nacional Laboratorio Cliacutenico
2018
MCV MCH son los valores medios de volumen y Hb en toda la poblacioacuten RBC
No informan acerca de las ceacutelulas individuales
Ni de la variedad de eacutestas anisocitosis policromasia
Congreso Nacional Laboratorio Cliacutenico
2018
Se cuentan el nuacutemero de pulsos de 36-360fL y el nuacutemero de partiacuteculas que tienen el mismo tamantildeo y se trasladan los resultados a una graacutefica de Volumen Nuacutemero de ceacutelulasSe obtiene el histograma de RBC que proporciona
bull Nuacutemero de RBC el nuacutemero de pulsos dentro de este rango de tamantildeos
bull MCV se corresponde con la media del histograma de RBC
bull RDW o ADE Ancho de Distribucioacuten del histograma de RBC se corresponde con el coeficiente de variacioacuten de la curva
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
Abbott Sapphire lo calcula en el 50 de la altura del pico del histogramaSysmex y Mindray al 20 desde la base del histogramaSiemens calcula la anchura del pico comprendido entre 60 y 120 fL
Aunque RDW ADE generalmente se entiendecomo coeficiente de variacioacuten de ladistribucioacuten de los voluacutemenes de loseritrocitos algunos analizadoreshematoloacutegicos lo calculan desde la medicioacutendirecta de la anchura de la distribucioacuten
Congreso Nacional Laboratorio Cliacutenico
2018
G Lippi amp M Plebani
Recent developments and innovations in red blood cells diagnostics
Journal of Laboratory and Precision Medicine 2018
DOI 1021037jlpm20180709 AOPCongreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
copy 2012 Mindray Confidential 26
HDWHYPERHYPO
HDW HGB Distribution Width
HDW is the distribution width of Hgb histogram
Congreso Nacional Laboratorio Cliacutenico
2018
copy 2012 Mindray Confidential 27
MCHrHDWHYPERHYPOMCHr Mean RET HGB Concentration
Congreso Nacional Laboratorio Cliacutenico
2018
Histograma RBC el mapa de Mie
28 41
Congreso Nacional Laboratorio Cliacutenico
2018
Abbott Mindray Siemens
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
Severe Iron Deficiency Anemia Female 34 years
19 th March 18 th April
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
SysmexRBCHe erythrocyte Hb equivalentRetHe reticulocyte Hb equivalent(content)
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
MIC
MAC
HPO HPR
Congreso Nacional Laboratorio Cliacutenico
2018
copy 2012 Mindray Confidential 36
MINDRAY MCHrHDWHYPERHYPO
MCHr Mean RET HGB Concentration
HDW HGB Distribution Width
HYPER The percentage of hyperchromicred blood cells
HYPO The percentage of hypochromic red blood cells
Thalassemia screeningIDA treatment monitoringIDA screening
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
Hipocromo
Hipercroacutemico onormocroacutemico
iquestConcentracioacuten o contenido de Hemoglobina
Hipocroacutemiconormocroacutemico
Abbott Mindray Siemens Hypo CONCENTRACIOacuteN Hblt280gL
Sysmex Hypo CONTENIDO Hblt 17 pg
Congreso Nacional Laboratorio Cliacutenico
2018
Low Hb Density
Microcytic Factor Maf = (HbMCV)100
Nuevo moacutedulo transductor muacuteltiple con laacuteser de diodo y dos sensores oacutepticos
Anaacutelisis de hasta 50000 ceacutelulas con 7 paraacutemetros tecnoloacutegicos (leucocitos reticulocitos eritroblastos)
1 Volumen digital
2 Conductividad digital
3 5 aacutengulos de dispersioacuten de luz laacuteser digital
bull MALS (Median Angle Light Scatter)
bull UMALS (Upper Median Angle Light Scatter) 20deg a 43deg
bull LMALS (Lower Median Angle Light Scatter) 09deg a 19deg
bull LALS (Low Angle Light Scatter) asymp 51deg
bull AL2 (Axial Light Loss) 0deg a 05deg
Congreso Nacional Laboratorio Cliacutenico
2018
Hierro es un elemento criacutetico para elfuncionamiento oacuteptimo y supervivenciade las ceacutelulas
Disfuncioacuten mitocondrialActividad enzimaacutetica afectadaProteiacutenas de transporte y estructuralesproteins
Capacidad fiacutesica mermadaCapacidad de trabajo reducidaCapacidades cognitivas afectadasMorbilidad y mortalidad
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
It is generally assumed that worldwide ldquoat least half the anemia is due tonutritional iron deficiencyrdquo and that ldquoup to a prevalence of iron deficiency anemiaof 40 the prevalence of iron deficiency will be about 25 times that of anemiardquoHowever it is evident from the foregoing discussion that there are considerablevariations in both of these ratios depending on the age and sex of the peoplebeing studied the region of the world in which they live and the prevalence ratesof other causes of anemia
WHO Department of Nutrition for Health and DevelopmentAssessing the iron status of populations including literature reviews report of a Joint World Health OrganizationCenters for DiseaseControl and Prevention Technical Consultation on the Assessment of Iron Status at the Population Level Geneva Switzerland 6ndash8 April2004 ndash 2nd ed
Congreso Nacional Laboratorio Cliacutenico
2018
Estaacute bien establecido que la anemia produce una miriacuteada de secuelas tanto fiacutesicas comopsicoloacutegicas
Pero los efecto deleteacutereos se deben al deficit de hierro que es un evento previo a que seestablezca la anemia
El deacuteficit de hierrro auacuten sin anemia tiene efectos negativos en el desarrollo cognitivo y fiacutesico
Rattehalli D et al Iron deficiency without anemia do not wait for the Hemoglobin to drop
Health Policy and Technology 2013 2 45-48Congreso Nacio
nal Laboratorio Cliacutenico 2018
SuominenP et al Serum transferrin receptor and transferrin receptor-ferritin index identify healthy subjects with subclinical iron deficits Blood 1998 92 2934ndash9Halwachs-Baumann G Diagnosis of anaemia old things rearranged Wien Med Wochenschr 2012 162478ndash88
Congreso Nacional Laboratorio Cliacutenico
2018
Hemoglobina de reticulocito y su importancia en el diagnoacutestico temprano de anemiaferropeacutenica
Y Maacuterquez-Beniacutetez et al Universidad de BocayaAugust
2018 DOI 1022267rus182003133 aop
El contenido de hemoglobina de reticulocitos (CHr) es un paraacutemetro en la biometriacuteahematoloacutegica automatizada utilizado como un marcador de la biodisponibilidad delhierro en la eritropoyesis
Objetivo Exponer la aplicabilidad de la CHr como un paraacutemetro en el diagnoacutesticoprecoz de la anemia por deficiencia de hierro asiacute como su medicioacuten e interpretacioacuten
Materiales y meacutetodos Se realizoacute la revisioacuten de artiacuteculos cientiacuteficos en ingleacutes y espantildeolen las bases de datos PubMed ScienceDirect LILACS y Medline usando descriptoresvalidados en Medical Subject Headings (MeSH) considerando periodo depublicabilidad del 80 inferior a 5 antildeos
Conclusiones La CHr es un paraacutemetro de gran utilidad en el diagnoacutestico temprano deanemia ferropeacutenica y otras patologiacuteas como deficiencia funcional de hierro estadosde inflamacioacuten croacutenica y enfermedad renal croacutenica
Biomarcador temprano en el diagnoacutestico de deficiencia de hierro antes de presentarsecambios morfoloacutegicos eritrociacuteticosCongreso Nacio
nal Laboratorio Cliacutenico 2018
bull A total of 1105 NES participants (639 men 466 women)bull CHr becomes affected in a relatively early stage in the development of iron deficiency before iron
deficiency anemia and clinical symptoms become apparentbull Therefore this parameter might be useful to identify persons healthy and diseased at risk of
developing iron deficiency anemia and subsequently to apply interventions in order to prevent further development of iron deficiency anemiaCongreso Nacio
nal Laboratorio Cliacutenico 2018
Hb reticulocitaria sensible para detectar la fase inicial del deacuteficit de hierro cuando laeritropoyesis requiere maacutes cantidad que la que recibe ANTES de que la anemia seestablezca
Congreso Nacional Laboratorio Cliacutenico
2018
No ID LID P
RBC 1012L 48 (08) 437 (05) lt00001
Hb gL 135 (6) 131 (12) 0006
MCV fL 922 (21) 902 (38) 0006
MCH pg 324 (07) 306 (22) lt00001
MCHC gL 339 (6) 319 (23) 0001
RDW
Ret He pg
Hypo He
LHD
Ferritin microgL
131 (06)
338 (21)
03 (015)
28 (20)
86 (3)
145 (21)
278 (24)
69 (55)
56 (25)
16 (76)
lt00001
lt00001
lt00001
lt00001
lt00001
AUC 95 CI Cutoff Sensitivity Specificity
LHD 0898 0819-0978 50 859 841
Ret He 0914 0824-1000 299pg 868 857
Hypo He 0934 0856-1000 16 857 921
Clinical value of markers of hypochromia in the detection of latent iron deficiency in non-anemic premenopausal women
No ID Hb gt 120 gL s-ferritin was within reference intervalLatent Iron Defiency Hb gt 120 gL s-ferritin lt 30 μgL
Urrechaga E et al Journal Clin Lab Analysis 2016 30 (5) 623-627
97 women (388) in 250 apparently healthy women had latent IDCongreso Nacional Laboratorio Cliacutenico
2018
Schorer G et al Abstract Jahreskongress der Deutschen Gesellschaft fuumlr Transfusionsmedizin und Immunhaumlmatologie Rostock 15 - 18 September 2009
Congreso Nacional Laboratorio Cliacutenico
2018
Caring for Those Who Share Mitigating Iron Deficiency in Regular Blood DonorsMast Alan E
bull Iron deficiency caused by regular blood donation is a problem facing blood centers Each blood donation removes 200 to 250 mg of iron from the donor Consequently many donors become iron deficient with repeated donation
bull This presents a challenge to blood centers that has become more acute in recent years with the realization that iron deficiency even in the absence of anemia is associated with adverse effects including fatigue and decreased exercise tolerance as well as neurological symptoms such as decreased cognitive function pica and restless leg syndrome
bull REDS-II investigators performed a longitudinal study investigating the iron status of blood donors over a two year period called the REDS-II Donor Iron Status Evaluation (RISE)
bull Results from the baseline analysis of regular donors (e 2 donations per year (females) or e 3 donations per year (males) revealed that over two-thirds of female donors and over one-half of male donors have iron deficiency
Congreso Nacional Laboratorio Cliacutenico
2018
Transfusion 2013 532766-2775
bull We evaluated the diagnostic sensitivity and specificity of red blood cell (RBC) hematology analyzer indices to assess iron status as a part of donor management iron deficient erythropoiesis (IDE) and absence of iron stores (AIS)
bull STUDY DESIGN AND METHODS A total of 1659 male and female donors from the Retrovirus Epidemiology Donor Study-II (REDS-II) Donor Iron Status Evaluation (RISE) study who were either first-timereactivated (FT RA no donations for 2 years) or frequent donors were recruited into a longitudinal study of regular donation of RBCs Of these 1002 donors returned 15 to 24 months later for a final assessment
Absent iron stores (AIS) was defined as plasma ferritin level of less than 12 mgL Logarithm of the ratio of soluble transferrin receptor to ferritin of at least 207 was used to define iron-deficient erythropoiesis (IDE)
bull RESULTS HYPOm and CHr detected IDE with comparable sensitivity 72 versus 69 but differed in specificity HYPOm 68 and CHr 53
For detecting AIS sensitivity was improved to 85 for HYPOm and 81 for CHr but specificity was reduced
Venous Hb had high specificity but poor sensitivity for IDE and AIS A plasma ferritin level of less than 267 mgL was a good surrogate for assessing IDE Congreso Nacio
nal Laboratorio Cliacutenico 2018
Microcytic RBC and reticulocyte mean cell hemoglobin content predicted iron depletion with
sensitivities 70 and 64
specificities of 72 and 78 respectively
When both combined
increased the sensitivity to 82
Congreso Nacional Laboratorio Cliacutenico
2018
Depending on the number of donations during the preceding12 months
Absent iron stores were detected in up to 214 of male and278 of female donors respectively
impaired hemoglobinisation IH was present in up to 64 maleand 167 female donors with 2 and 4 preceding donationsrespectively
The defined CHr cut-off value was 280 pg to detect IH infrequent whole blood donors with AIS leading to a testspecificity of 982 (positive predictive value PPV 577) inmale and of 978 (PPV 829) in female donors
It may help to prevent the development of anemia in frequentblood donors and also can help to decide whether donordeferral or even iron substitution need to be recommended
Congreso Nacional Laboratorio Cliacutenico
2018
Of the 501 blood donors sTfR and Ret-He detected Latent Iron Deficiency in 148 and 135 donors respectively
In comparison to sTfR Ret-He had sensitivity of 927 specificity of 9716 PPV of 931 and NPV of 963
Serum Ferritin TIBC and serum Iron had comparatively lower sensitivity of 8716 797 and 777 respectively
Conclusion Ret-He can be used as a routine screening test to detect LID in blood donors
This could provide an opportunity to make appropriate and timely interventions like dietary changes or drug supplementation
Congreso Nacional Laboratorio Cliacutenico
2018
Singh A Chaudhary R Pandey HC Sonker A Identification of iron status of blood donors by using low hemoglobin density and microcytic anemia factor Asian J Transfus Sci 20181246-50
The main objective of this study was to assess ifLHD and Maf could be used for assessment ofiron status in blood donors and also to establisha cut-off for these two parameters at which atentative iron deficiency could be reportedconclusively
Results LHD and Maf were able to differentiatebetween iron deficient and iron-depleteddonors from normal donorsA cutoff of 918 for LHD was able todifferentiate iron deficient and depleted statefrom normal iron statessensitivity 919 and specificity 71respectivelya cutoff of 1016 for Mafsensitivity 946 and specificity 968
MAf = (MVC Hb) 100
Congreso Nacional Laboratorio Cliacutenico
2018
Hb reticulocitaria sensible para detectar la fase inicial del deacuteficitde hierro cuando la eritropoyesis requiere maacutes cantidad que laque recibe ANTES de que la anemia se establezca
La deteccioacuten precoz del deacuteficit de hierro en la fase del balance negativo demanda aporte contribuye a reducir sus manifestaciones cliacutenicas en los pacientes afectados mejorando la salud puacuteblica
Un tratamiento menos prolongado con suplementos y menor consumo de los recursos sanitaros Contribuye a la eficiencia y sostenibilidad de los servicios sanitarios
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
Buttarello MLaboratory diagnosis of anemia are the old and new red cell parameters useful in classification and treatment howInt Jnl Lab Hem 2016 38 (Suppl 1) 123ndash132
Congreso Nacional Laboratorio Cliacutenico
2018
Buttarello MLaboratory diagnosis of anemia are the old and new red cell parameters useful in classification and treatment howInt Jnl Lab Hem 2016 38 (Suppl 1) 123ndash132
Congreso Nacional Laboratorio Cliacutenico
2018
Ralph Green amp Ananya Datta Mitra Megaloblastic Anemias Nutritional and Other CausesMed Clin N Am 2017 101 297ndash317
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
ANEMIA CARENCIAL CAUSAS
Factores alimentariosConsumir una dieta vegetariana mal planeadaAlimentacioacuten deficiente en los bebeacutesDesnutricioacuten durante el embarazo
Deacuteficit de absorcioacutenAlcoholismo croacutenicoEnfermedad de Crohn celiaquiacutea infeccioacuten otros problemas que le dificulten al cuerpo la digestioacuten de los alimentosAnemia perniciosa (factor intriacutenseco)Cirugiacuteas para extirpar ciertas partes del estoacutemago o el intestino delgado
MedicamentosB12 omeprazol metformina colchicina aminosalicilatos neomicinaFOLATO fenitoiacutena metotrexato sulfasalacina triamtereno pirimetamina trimetoprim con sulfametoxazol barbituacutericos
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
Reacciones metaboacutelicas en las que participan la vitamina B12 y el folato bull la conversioacuten de metilmalonil-CoA a succinil-CoA donde la adenosil-cobalamina actuacutea de
cofactor Por ello un deacuteficit de B12 conlleva un aumento de metilmalonil-CoA y de su producto de hidroacutelisis el aacutecido metilmaloacutenico
bull la siacutentesis de metionina a partir de homocisteina gracias a la metionina sintetasa y a la metil-cobalamina como cofactor En esta misma reaccioacuten el metiltetrahidrofolato es transformado a tetrahidrofolato que es necesario para la siacutentesis de DNA
Congreso Nacional Laboratorio Cliacutenico
2018
Anemia macrociacutetica secundaria a deficiencia de aacutecido foacutelico y de vitamina B12(cobalamina)
La deficiencia de B12 yo aacutecido foacutelico es la causa maacutes frecuente de megaloblastosis
Dentro de distintas funciones generales del metabolismo la vitamina B12 es uncofactor esencial en la siacutentesis de ADN y ARN compromete a todas las ceacutelulas delorganismo
Su deficiencia se manifiesta en oacuterganos con alto recambio celular como la meacutedulaosea y en el sistema nervioso central (SNC) a traveacutes de la siacutentesis de mielina y lareparacioacuten axonal
La deficiencia de cobalamina es responsable de alteraciones hematoloacutegicasneuroloacutegicas neurocognitivas y neuropsiquiaacutetricas
La siacutentesis defectuosa de ADN conduce a la apoptosis y a la hemoacutelisis (intra yextramedular) causantes de la hemopoyesis inefectiva
En meacutedula la siacutentesis ineficiente de DNA causa cambios megaloblaacutesticos comoconsecuencIa anemia y citopenias
Congreso Nacional Laboratorio Cliacutenico
2018
Limitaciones de los meacutetodos diagnoacutesticos claacutesicos
Volumen Corpuscular Medio (VCM) y morfologiacutea de sangre perifeacuterica En una serie de pacientes con deacuteficit de cobalamina soacutelo un 29 teniacutean anemia y soacutelo un 36 teniacutean un VCM gt 100 fL
Un VCM normal no puede ser empleado para rechazar una determinacioacuten de nivel de cobalamina ya que hasta un 25 de casos con manifestaciones neuroloacutegicas cursan con un VCM normal
Cobalamina seacuterica (nivel de B12) Es el test diagnoacutestico rutinario inicial estaacutendar Es un test ampliamente disponible de bajo coste y automatizado Sin embargo presenta algunas limitaciones
-- Existencia de varias teacutecnicas y ausencia de un gold standard por lo que hay diferentes liacutemites de referencia
-- Variacioacuten intraindividual muy alta
La OMS publicoacute en 2008 las conclusiones de un grupo teacutecnico consultado sobre el deacuteficit de cobalamina y folato
El grupo reconocioacute que no existen unos umbrales universalmente reconocidos para definir el deacuteficit de ambas vitaminas y expresaron la necesidad de un consenso
Devalia V Hamilton MS and Molloy AM on behalf of the British Committee for standards in haematology Guidelines for the diagnosis and treatment of cobalamin and folate disorders Br J Haematol 2014 166(4) 496-513
Schrier SL Diagnosis and treatment of vitamin B12 and folate deficiency UpToDate Last updated Jun 25 2014
de Benoist B Conclusions of a WHO Technical Consultation on folate and vitamin B12 deficiencies Food Nutr Bull 200829(2 Suppl)S238ndash44Congreso Nacional Laboratorio Cliacutenico
2018
Tomado de Tefferi A Li C En Atlas of Clinical Hematology Publicado por JO Armitage Philadelphia Current Medicine 2004
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
Int Jnl Lab Hem 2007 29 327ndash334
Clin Lab 201662343-347
In ourstudy mean MCVrMCV ratio of healthy controls is130 as microcytic anemia irondeficiency anemia is121 as also macrocytic anemia vitamin B12 deficiencyanemia is 115
Congreso Nacional Laboratorio Cliacutenico
2018
Sualeh Muslim Khan Muhammad Akbar Agha
Mean cell volume of reticulocytemdashA new parameter for diagnosing sub-clinical cobalamin deficiency in blood donors Int J Lab Hem 20181ndash4
The Abbott CELL-DYN Sapphire Hematology System uses multi-angle polarized scatter separation (MAPSS) and focused flow impedance technologies
Congreso Nacional Laboratorio Cliacutenico
2018
MCVr at 985 fL yielded the highest Youdenrsquos index at sensitivity of 82 specificity of 828 AUC 0847 ( 95 CI 803-891)
Khan SM Agha MA Mean cell volume of reticulocyte-A new parameter for diagnosing sub-clinical cobalamin deficiency in blood donors
Int J Lab Hem 20181ndash4 2018 Jul 13 doi 101111ijlh12899
Congreso Nacional Laboratorio Cliacutenico
2018
Role of Cell Population Data in the detection of folate and cobalamin deficiency
J Nieto et al
XXXI st International Symposium on Technological Innovations in Laboratory Hematology ISLH 2018 10-12 May 2018 Brussels Belgium
M-V-NRET and SD-VNRET are the best discriminatory single parameters to distinguish between patients with B9B12 deficiency and reference subjects M-V-NRETAUC=0823 sensitivity 78 and specificity 86
AUC=0852 sensitivity 55 and specificity 60
Conclusions The CPD parameters of Volume and Light Scatter (M and SD of LALS angle) that inform about size and intracellular structure of RBCs provided very useful information for the detection of B9B12 deficiency
Congreso Nacional Laboratorio Cliacutenico
2018
Cell Population Data
bull Paraacutemetros poblacionales de los leucocitos
bull Describen la morfologiacutea tamantildeo
estructuras citoplasmaacuteticas
nuacutecleo aacutecidos nucleacuteicos
bull Son datos numeacutericos con los que se construyen los ejes de lo diagramas de dispersioacuten de los leucocitos
bull Dependen de la tecnologiacutea
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
High Sensitivity New Parameters for the Detection of Vitamin B12 and Folate Deficiencies Blood 2008 1125379
B12 def vs
Normals
Mann
Withney T-Test
ROC
AUC Sens Specif Cutoff signifROC
MCV p=03156 p=09533 0577
MPV p=00001 0802 792 806 lt83 p=00001
NE Mean
Volume plt00001 0862 833 778 gt1403 p=00001
MO Mean
Volume plt00001 0829 625 889 gt1723 p=00001
MRV p=00113 0705 50 964 gt1133 p=00051
Folate def vs
Normals
Mann
Withney T-Test
ROC
AUC Sens Specif Cut-off signifROC
MCV p=00798 p=06461 0665
MPV plt00001 0832 81 806 lt83 p=00001
NE Mean
Volume p=00008 087 952 694 gt1402 p=00001
MO Mean
Volume p=00002 0801 667 833 gt1696 p=00001
MRV p=00054 0731 476 964 gt1133 p=00019
The Mean Neutrophil Volume (MNE V) and Mean Monocyte Volume (MMOV) may be used for the detection of megaloblastic neutrophils and monocytes MNEV and MMOV have significantly higher sensitivity than the previous information from the red cells (MCV) detecting B12 or folate deficiency because they are not affected by the presence at the same time of Iron deficiency or other reasons of anemia
Congreso Nacional Laboratorio Cliacutenico
2018
POSTER 733
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
CPD Sysmex XN
NE SSC complejidad
NE SFL aacutecidos nucleacuteicos
NE FSC tamantildeo
NE WX
NE WY
NE WZ
MO X
MO Y
MO Z
MO WX
MO WY
MO WZ
LY X
LY Y
LY Z
LY WX
LY WY
LY WZCongreso Nacio
nal Laboratorio Cliacutenico 2018
As MCV is the mean which is calculated it is insensitive to the presence of a small number of macrocytes
Further macrocytosis can be obscured by concomitant disorders that can cause microcytosis resulting inmasked megaloblastic anaemia (MA) for example iron deficiency hereditary elliptocytosis alpha and betathalassemia
This study was undertaken to evaluate the role of NEUT-X and NEUT-Y in detecting MA on peripheral blood andalso see whether other forms of macrocytic anaemia can be differentiated from MA
In MA the peripheral blood smear shows cytopenia with macroovalocytes and hypersegmented
neutrophils (gt5 lobes in 5 neutrophils six lobes nuclei or lobe average of gt35)
In conclusion our study shows that higher values of NEUT-X and NEUT-Y in MA patients in spite of low ornormal MCV high RDW may be used to not only reveal the masked cases of MA with concomitant irondeficiency but also separate them from the broader macrocytic anaemia group
Peripheral smear remains diagnostic however making smear for all the suspicious cases is a cumbersomeand tedious procedure Thus these parameters emerge as more reliable and stable parameters in themodern laboratories which in future may replace the older screening tools
Congreso Nacional Laboratorio Cliacutenico
2018
A favor Eficiencia Operativa
Mejora el proceso del Laboratorio
Mejor informacioacuten al Cliacutenico al mismo coste
Mejora la informacioacuten
Informa sobre la eritropoyesis deteccioacuten precoz de estados carenciales
Ayuda al cliacutenico
Estado real del paciente
En contraParaacutemetros de investigacioacuten
Dificultad de standarizar dependencia teacutecnica
Control de calidadCongreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
Total YLD resulting from all causes of anemia by country
Kassebaum NJ et al Blood 2014123615-624 copy2014 by American Society of Hematology
Congreso Nacional Laboratorio Cliacutenico
2018
Clamaschella C Iron deficiency anemia N Engl J Med 20153721832-43
Congreso Nacional Laboratorio Cliacutenico
2018
Iron Cycle
Fleming RE Ponka P N Engl J Med 2012366348-359Congreso Nacional Laboratorio Cliacutenico
2018
Camaschella C N Engl J Med 20153721832-43Congreso Nacio
nal Laboratorio Cliacutenico 2018
G Lippi amp M Plebani Recent developments and innovations in red blood cells diagnostics Journal of Laboratory and Precision Medicine 2018DOI 1021037jlpm20180709 AOP
Innovative erythrocyte parametersThese innovative parameters most typically include automated reticulocyte andnucleated RBC counts hemoglobinization of reticulocytes and RBC reticulocytehemoglobin content reticulocyte maturation automatic analysis and calculationof microcytic and hypochromic RBC
The various combination of these different parameters not only may be useful tocomplement clinical history physical examination and results of moreconventional laboratory investigations (ie CBC ferritin transferrin ironhaptoglobin folic acid and vitamin B12 among others) for investigating theunderlying cause(s) of anemia
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
Biomarcadores de Eritroyesis
Urrechaga E Borque L Escanero JF Biomarkers of hypochromia the contemporary assessment of
Iron status and erythropoiesis Journal of Biomedicine and Biotechnology
httpdxdoiorg1011552013603786
Abreviatura
(unidades)
Compantildeiacutea
RBC Hipocromos Hypo () Siemens
Hb Reticulocitaria CHr (pg) Siemens
RBC Hipocromos HPO () Abbott
Hb Reticulocitaria media MCHr (pg) Abbott
RBC Hipocromos Hypo He () Sysmex
Hb Reticulocitaria equivalente Ret He (pg) Sysmex
Low Hb density
Contenido de Hb Reticulocitaria
Expresioacuten Hb reticulocitaria
LHD ()
RHCc (pg)
RHE (pg)
Beckman Coulter
Horiba ABX
Mindray
Congreso Nacional Laboratorio Cliacutenico
2018
Informacioacuten avanzada valor antildeadido
Reticulocitos Eritrocitos
bull Permanecen en la sangre 1-2 diacuteas hasta que se convierten en eritrocitos maduros
bull El contenido de hemoglobinapuede reflejar la cantidad de hierro disponible de maneraefectiva
bull Refleja la calidad de la eritropoyesis en el periodoinmediato
bull Permanecen en la sangre 90-120 diacuteas
bull Las diversas subpoblacionespueden reflejar el status feacuterrico en las pasadas semanas
bull MCV MCH son las medias del
conjunto de RBC las de fracciones indican la contribucioacuten de los diversos tipos de RBC a las medias
Congreso Nacional Laboratorio Cliacutenico
2018
Angulo alto
Dispersioacuten lateral Hb
Angulo bajo
Dispersioacuten frontal VOLUMEN
LASER Absorbancia Fluorescencia
RNA contenido
Citometriacutea
Congreso Nacional Laboratorio Cliacutenico
2018
RETICULOCITOS
Compantildeiacutea Instrumento Meacutetodo Colorante Paraacutemetros
Abbott CELLDYN Ruby
CELLDYN
Sapphire
Absorbancia
Fluorescencia
Nuevo azul
metileno
Sybr II
IRF
IRF MCHr MCVr
Beckman
Coulter
UniCell DxH
LH series
Impedancia
citometriacutea de flujo
VCS
Nuevo azul
metileno
Nuevo azul
metileno
IRF MRVHLRRSf
IRF MRV
MSCVHLR
Horiba ABX Pentra
DX120
Impedancia
citometriacutea de flujo
fluorescencia
Naranja de tiazol IRF MRV RETH
RHbC
Siemens ADVIA 120 Absorbancia
Scatter
Oxazine 750 IRF MCVr CHr
Sysmex XE5000 XN Fluorescencia Polimetina IRF RetHe ΔHeCongreso Nacional Laboratorio Cliacutenico
2018
Los reticulocitos precursores de los eritrocitos madurangeneralmente a lo largo de unos dos diacuteas El recuento dereticulocitos es por lo tanto una medida de la cantidad dela eritropoyesis en la meacutedulaParaacutemetros derivados de los reticulocitos los describenmorfoloacutegicamente tamantildeo contenido en Hemoglobinacantidad de material geneacuteticoDe esta forma al referirse a caracteriacutesticas de losreticulocitos es la calidad de la eritropoyesis la que puedeser evaluada
La Hb reticulocitaria se relaciona con la cantidad de hierro disponible efectivamente para laeritropoyesis un valor bajo indica que el aporte es deficitario respecto a la demanda en el momentoactual 28-30 pg
Congreso Nacional Laboratorio Cliacutenico
2018
MCV MCH son los valores medios de volumen y Hb en toda la poblacioacuten RBC
No informan acerca de las ceacutelulas individuales
Ni de la variedad de eacutestas anisocitosis policromasia
Congreso Nacional Laboratorio Cliacutenico
2018
Se cuentan el nuacutemero de pulsos de 36-360fL y el nuacutemero de partiacuteculas que tienen el mismo tamantildeo y se trasladan los resultados a una graacutefica de Volumen Nuacutemero de ceacutelulasSe obtiene el histograma de RBC que proporciona
bull Nuacutemero de RBC el nuacutemero de pulsos dentro de este rango de tamantildeos
bull MCV se corresponde con la media del histograma de RBC
bull RDW o ADE Ancho de Distribucioacuten del histograma de RBC se corresponde con el coeficiente de variacioacuten de la curva
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
Abbott Sapphire lo calcula en el 50 de la altura del pico del histogramaSysmex y Mindray al 20 desde la base del histogramaSiemens calcula la anchura del pico comprendido entre 60 y 120 fL
Aunque RDW ADE generalmente se entiendecomo coeficiente de variacioacuten de ladistribucioacuten de los voluacutemenes de loseritrocitos algunos analizadoreshematoloacutegicos lo calculan desde la medicioacutendirecta de la anchura de la distribucioacuten
Congreso Nacional Laboratorio Cliacutenico
2018
G Lippi amp M Plebani
Recent developments and innovations in red blood cells diagnostics
Journal of Laboratory and Precision Medicine 2018
DOI 1021037jlpm20180709 AOPCongreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
copy 2012 Mindray Confidential 26
HDWHYPERHYPO
HDW HGB Distribution Width
HDW is the distribution width of Hgb histogram
Congreso Nacional Laboratorio Cliacutenico
2018
copy 2012 Mindray Confidential 27
MCHrHDWHYPERHYPOMCHr Mean RET HGB Concentration
Congreso Nacional Laboratorio Cliacutenico
2018
Histograma RBC el mapa de Mie
28 41
Congreso Nacional Laboratorio Cliacutenico
2018
Abbott Mindray Siemens
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
Severe Iron Deficiency Anemia Female 34 years
19 th March 18 th April
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
SysmexRBCHe erythrocyte Hb equivalentRetHe reticulocyte Hb equivalent(content)
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
MIC
MAC
HPO HPR
Congreso Nacional Laboratorio Cliacutenico
2018
copy 2012 Mindray Confidential 36
MINDRAY MCHrHDWHYPERHYPO
MCHr Mean RET HGB Concentration
HDW HGB Distribution Width
HYPER The percentage of hyperchromicred blood cells
HYPO The percentage of hypochromic red blood cells
Thalassemia screeningIDA treatment monitoringIDA screening
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
Hipocromo
Hipercroacutemico onormocroacutemico
iquestConcentracioacuten o contenido de Hemoglobina
Hipocroacutemiconormocroacutemico
Abbott Mindray Siemens Hypo CONCENTRACIOacuteN Hblt280gL
Sysmex Hypo CONTENIDO Hblt 17 pg
Congreso Nacional Laboratorio Cliacutenico
2018
Low Hb Density
Microcytic Factor Maf = (HbMCV)100
Nuevo moacutedulo transductor muacuteltiple con laacuteser de diodo y dos sensores oacutepticos
Anaacutelisis de hasta 50000 ceacutelulas con 7 paraacutemetros tecnoloacutegicos (leucocitos reticulocitos eritroblastos)
1 Volumen digital
2 Conductividad digital
3 5 aacutengulos de dispersioacuten de luz laacuteser digital
bull MALS (Median Angle Light Scatter)
bull UMALS (Upper Median Angle Light Scatter) 20deg a 43deg
bull LMALS (Lower Median Angle Light Scatter) 09deg a 19deg
bull LALS (Low Angle Light Scatter) asymp 51deg
bull AL2 (Axial Light Loss) 0deg a 05deg
Congreso Nacional Laboratorio Cliacutenico
2018
Hierro es un elemento criacutetico para elfuncionamiento oacuteptimo y supervivenciade las ceacutelulas
Disfuncioacuten mitocondrialActividad enzimaacutetica afectadaProteiacutenas de transporte y estructuralesproteins
Capacidad fiacutesica mermadaCapacidad de trabajo reducidaCapacidades cognitivas afectadasMorbilidad y mortalidad
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
It is generally assumed that worldwide ldquoat least half the anemia is due tonutritional iron deficiencyrdquo and that ldquoup to a prevalence of iron deficiency anemiaof 40 the prevalence of iron deficiency will be about 25 times that of anemiardquoHowever it is evident from the foregoing discussion that there are considerablevariations in both of these ratios depending on the age and sex of the peoplebeing studied the region of the world in which they live and the prevalence ratesof other causes of anemia
WHO Department of Nutrition for Health and DevelopmentAssessing the iron status of populations including literature reviews report of a Joint World Health OrganizationCenters for DiseaseControl and Prevention Technical Consultation on the Assessment of Iron Status at the Population Level Geneva Switzerland 6ndash8 April2004 ndash 2nd ed
Congreso Nacional Laboratorio Cliacutenico
2018
Estaacute bien establecido que la anemia produce una miriacuteada de secuelas tanto fiacutesicas comopsicoloacutegicas
Pero los efecto deleteacutereos se deben al deficit de hierro que es un evento previo a que seestablezca la anemia
El deacuteficit de hierrro auacuten sin anemia tiene efectos negativos en el desarrollo cognitivo y fiacutesico
Rattehalli D et al Iron deficiency without anemia do not wait for the Hemoglobin to drop
Health Policy and Technology 2013 2 45-48Congreso Nacio
nal Laboratorio Cliacutenico 2018
SuominenP et al Serum transferrin receptor and transferrin receptor-ferritin index identify healthy subjects with subclinical iron deficits Blood 1998 92 2934ndash9Halwachs-Baumann G Diagnosis of anaemia old things rearranged Wien Med Wochenschr 2012 162478ndash88
Congreso Nacional Laboratorio Cliacutenico
2018
Hemoglobina de reticulocito y su importancia en el diagnoacutestico temprano de anemiaferropeacutenica
Y Maacuterquez-Beniacutetez et al Universidad de BocayaAugust
2018 DOI 1022267rus182003133 aop
El contenido de hemoglobina de reticulocitos (CHr) es un paraacutemetro en la biometriacuteahematoloacutegica automatizada utilizado como un marcador de la biodisponibilidad delhierro en la eritropoyesis
Objetivo Exponer la aplicabilidad de la CHr como un paraacutemetro en el diagnoacutesticoprecoz de la anemia por deficiencia de hierro asiacute como su medicioacuten e interpretacioacuten
Materiales y meacutetodos Se realizoacute la revisioacuten de artiacuteculos cientiacuteficos en ingleacutes y espantildeolen las bases de datos PubMed ScienceDirect LILACS y Medline usando descriptoresvalidados en Medical Subject Headings (MeSH) considerando periodo depublicabilidad del 80 inferior a 5 antildeos
Conclusiones La CHr es un paraacutemetro de gran utilidad en el diagnoacutestico temprano deanemia ferropeacutenica y otras patologiacuteas como deficiencia funcional de hierro estadosde inflamacioacuten croacutenica y enfermedad renal croacutenica
Biomarcador temprano en el diagnoacutestico de deficiencia de hierro antes de presentarsecambios morfoloacutegicos eritrociacuteticosCongreso Nacio
nal Laboratorio Cliacutenico 2018
bull A total of 1105 NES participants (639 men 466 women)bull CHr becomes affected in a relatively early stage in the development of iron deficiency before iron
deficiency anemia and clinical symptoms become apparentbull Therefore this parameter might be useful to identify persons healthy and diseased at risk of
developing iron deficiency anemia and subsequently to apply interventions in order to prevent further development of iron deficiency anemiaCongreso Nacio
nal Laboratorio Cliacutenico 2018
Hb reticulocitaria sensible para detectar la fase inicial del deacuteficit de hierro cuando laeritropoyesis requiere maacutes cantidad que la que recibe ANTES de que la anemia seestablezca
Congreso Nacional Laboratorio Cliacutenico
2018
No ID LID P
RBC 1012L 48 (08) 437 (05) lt00001
Hb gL 135 (6) 131 (12) 0006
MCV fL 922 (21) 902 (38) 0006
MCH pg 324 (07) 306 (22) lt00001
MCHC gL 339 (6) 319 (23) 0001
RDW
Ret He pg
Hypo He
LHD
Ferritin microgL
131 (06)
338 (21)
03 (015)
28 (20)
86 (3)
145 (21)
278 (24)
69 (55)
56 (25)
16 (76)
lt00001
lt00001
lt00001
lt00001
lt00001
AUC 95 CI Cutoff Sensitivity Specificity
LHD 0898 0819-0978 50 859 841
Ret He 0914 0824-1000 299pg 868 857
Hypo He 0934 0856-1000 16 857 921
Clinical value of markers of hypochromia in the detection of latent iron deficiency in non-anemic premenopausal women
No ID Hb gt 120 gL s-ferritin was within reference intervalLatent Iron Defiency Hb gt 120 gL s-ferritin lt 30 μgL
Urrechaga E et al Journal Clin Lab Analysis 2016 30 (5) 623-627
97 women (388) in 250 apparently healthy women had latent IDCongreso Nacional Laboratorio Cliacutenico
2018
Schorer G et al Abstract Jahreskongress der Deutschen Gesellschaft fuumlr Transfusionsmedizin und Immunhaumlmatologie Rostock 15 - 18 September 2009
Congreso Nacional Laboratorio Cliacutenico
2018
Caring for Those Who Share Mitigating Iron Deficiency in Regular Blood DonorsMast Alan E
bull Iron deficiency caused by regular blood donation is a problem facing blood centers Each blood donation removes 200 to 250 mg of iron from the donor Consequently many donors become iron deficient with repeated donation
bull This presents a challenge to blood centers that has become more acute in recent years with the realization that iron deficiency even in the absence of anemia is associated with adverse effects including fatigue and decreased exercise tolerance as well as neurological symptoms such as decreased cognitive function pica and restless leg syndrome
bull REDS-II investigators performed a longitudinal study investigating the iron status of blood donors over a two year period called the REDS-II Donor Iron Status Evaluation (RISE)
bull Results from the baseline analysis of regular donors (e 2 donations per year (females) or e 3 donations per year (males) revealed that over two-thirds of female donors and over one-half of male donors have iron deficiency
Congreso Nacional Laboratorio Cliacutenico
2018
Transfusion 2013 532766-2775
bull We evaluated the diagnostic sensitivity and specificity of red blood cell (RBC) hematology analyzer indices to assess iron status as a part of donor management iron deficient erythropoiesis (IDE) and absence of iron stores (AIS)
bull STUDY DESIGN AND METHODS A total of 1659 male and female donors from the Retrovirus Epidemiology Donor Study-II (REDS-II) Donor Iron Status Evaluation (RISE) study who were either first-timereactivated (FT RA no donations for 2 years) or frequent donors were recruited into a longitudinal study of regular donation of RBCs Of these 1002 donors returned 15 to 24 months later for a final assessment
Absent iron stores (AIS) was defined as plasma ferritin level of less than 12 mgL Logarithm of the ratio of soluble transferrin receptor to ferritin of at least 207 was used to define iron-deficient erythropoiesis (IDE)
bull RESULTS HYPOm and CHr detected IDE with comparable sensitivity 72 versus 69 but differed in specificity HYPOm 68 and CHr 53
For detecting AIS sensitivity was improved to 85 for HYPOm and 81 for CHr but specificity was reduced
Venous Hb had high specificity but poor sensitivity for IDE and AIS A plasma ferritin level of less than 267 mgL was a good surrogate for assessing IDE Congreso Nacio
nal Laboratorio Cliacutenico 2018
Microcytic RBC and reticulocyte mean cell hemoglobin content predicted iron depletion with
sensitivities 70 and 64
specificities of 72 and 78 respectively
When both combined
increased the sensitivity to 82
Congreso Nacional Laboratorio Cliacutenico
2018
Depending on the number of donations during the preceding12 months
Absent iron stores were detected in up to 214 of male and278 of female donors respectively
impaired hemoglobinisation IH was present in up to 64 maleand 167 female donors with 2 and 4 preceding donationsrespectively
The defined CHr cut-off value was 280 pg to detect IH infrequent whole blood donors with AIS leading to a testspecificity of 982 (positive predictive value PPV 577) inmale and of 978 (PPV 829) in female donors
It may help to prevent the development of anemia in frequentblood donors and also can help to decide whether donordeferral or even iron substitution need to be recommended
Congreso Nacional Laboratorio Cliacutenico
2018
Of the 501 blood donors sTfR and Ret-He detected Latent Iron Deficiency in 148 and 135 donors respectively
In comparison to sTfR Ret-He had sensitivity of 927 specificity of 9716 PPV of 931 and NPV of 963
Serum Ferritin TIBC and serum Iron had comparatively lower sensitivity of 8716 797 and 777 respectively
Conclusion Ret-He can be used as a routine screening test to detect LID in blood donors
This could provide an opportunity to make appropriate and timely interventions like dietary changes or drug supplementation
Congreso Nacional Laboratorio Cliacutenico
2018
Singh A Chaudhary R Pandey HC Sonker A Identification of iron status of blood donors by using low hemoglobin density and microcytic anemia factor Asian J Transfus Sci 20181246-50
The main objective of this study was to assess ifLHD and Maf could be used for assessment ofiron status in blood donors and also to establisha cut-off for these two parameters at which atentative iron deficiency could be reportedconclusively
Results LHD and Maf were able to differentiatebetween iron deficient and iron-depleteddonors from normal donorsA cutoff of 918 for LHD was able todifferentiate iron deficient and depleted statefrom normal iron statessensitivity 919 and specificity 71respectivelya cutoff of 1016 for Mafsensitivity 946 and specificity 968
MAf = (MVC Hb) 100
Congreso Nacional Laboratorio Cliacutenico
2018
Hb reticulocitaria sensible para detectar la fase inicial del deacuteficitde hierro cuando la eritropoyesis requiere maacutes cantidad que laque recibe ANTES de que la anemia se establezca
La deteccioacuten precoz del deacuteficit de hierro en la fase del balance negativo demanda aporte contribuye a reducir sus manifestaciones cliacutenicas en los pacientes afectados mejorando la salud puacuteblica
Un tratamiento menos prolongado con suplementos y menor consumo de los recursos sanitaros Contribuye a la eficiencia y sostenibilidad de los servicios sanitarios
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
Buttarello MLaboratory diagnosis of anemia are the old and new red cell parameters useful in classification and treatment howInt Jnl Lab Hem 2016 38 (Suppl 1) 123ndash132
Congreso Nacional Laboratorio Cliacutenico
2018
Buttarello MLaboratory diagnosis of anemia are the old and new red cell parameters useful in classification and treatment howInt Jnl Lab Hem 2016 38 (Suppl 1) 123ndash132
Congreso Nacional Laboratorio Cliacutenico
2018
Ralph Green amp Ananya Datta Mitra Megaloblastic Anemias Nutritional and Other CausesMed Clin N Am 2017 101 297ndash317
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
ANEMIA CARENCIAL CAUSAS
Factores alimentariosConsumir una dieta vegetariana mal planeadaAlimentacioacuten deficiente en los bebeacutesDesnutricioacuten durante el embarazo
Deacuteficit de absorcioacutenAlcoholismo croacutenicoEnfermedad de Crohn celiaquiacutea infeccioacuten otros problemas que le dificulten al cuerpo la digestioacuten de los alimentosAnemia perniciosa (factor intriacutenseco)Cirugiacuteas para extirpar ciertas partes del estoacutemago o el intestino delgado
MedicamentosB12 omeprazol metformina colchicina aminosalicilatos neomicinaFOLATO fenitoiacutena metotrexato sulfasalacina triamtereno pirimetamina trimetoprim con sulfametoxazol barbituacutericos
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
Reacciones metaboacutelicas en las que participan la vitamina B12 y el folato bull la conversioacuten de metilmalonil-CoA a succinil-CoA donde la adenosil-cobalamina actuacutea de
cofactor Por ello un deacuteficit de B12 conlleva un aumento de metilmalonil-CoA y de su producto de hidroacutelisis el aacutecido metilmaloacutenico
bull la siacutentesis de metionina a partir de homocisteina gracias a la metionina sintetasa y a la metil-cobalamina como cofactor En esta misma reaccioacuten el metiltetrahidrofolato es transformado a tetrahidrofolato que es necesario para la siacutentesis de DNA
Congreso Nacional Laboratorio Cliacutenico
2018
Anemia macrociacutetica secundaria a deficiencia de aacutecido foacutelico y de vitamina B12(cobalamina)
La deficiencia de B12 yo aacutecido foacutelico es la causa maacutes frecuente de megaloblastosis
Dentro de distintas funciones generales del metabolismo la vitamina B12 es uncofactor esencial en la siacutentesis de ADN y ARN compromete a todas las ceacutelulas delorganismo
Su deficiencia se manifiesta en oacuterganos con alto recambio celular como la meacutedulaosea y en el sistema nervioso central (SNC) a traveacutes de la siacutentesis de mielina y lareparacioacuten axonal
La deficiencia de cobalamina es responsable de alteraciones hematoloacutegicasneuroloacutegicas neurocognitivas y neuropsiquiaacutetricas
La siacutentesis defectuosa de ADN conduce a la apoptosis y a la hemoacutelisis (intra yextramedular) causantes de la hemopoyesis inefectiva
En meacutedula la siacutentesis ineficiente de DNA causa cambios megaloblaacutesticos comoconsecuencIa anemia y citopenias
Congreso Nacional Laboratorio Cliacutenico
2018
Limitaciones de los meacutetodos diagnoacutesticos claacutesicos
Volumen Corpuscular Medio (VCM) y morfologiacutea de sangre perifeacuterica En una serie de pacientes con deacuteficit de cobalamina soacutelo un 29 teniacutean anemia y soacutelo un 36 teniacutean un VCM gt 100 fL
Un VCM normal no puede ser empleado para rechazar una determinacioacuten de nivel de cobalamina ya que hasta un 25 de casos con manifestaciones neuroloacutegicas cursan con un VCM normal
Cobalamina seacuterica (nivel de B12) Es el test diagnoacutestico rutinario inicial estaacutendar Es un test ampliamente disponible de bajo coste y automatizado Sin embargo presenta algunas limitaciones
-- Existencia de varias teacutecnicas y ausencia de un gold standard por lo que hay diferentes liacutemites de referencia
-- Variacioacuten intraindividual muy alta
La OMS publicoacute en 2008 las conclusiones de un grupo teacutecnico consultado sobre el deacuteficit de cobalamina y folato
El grupo reconocioacute que no existen unos umbrales universalmente reconocidos para definir el deacuteficit de ambas vitaminas y expresaron la necesidad de un consenso
Devalia V Hamilton MS and Molloy AM on behalf of the British Committee for standards in haematology Guidelines for the diagnosis and treatment of cobalamin and folate disorders Br J Haematol 2014 166(4) 496-513
Schrier SL Diagnosis and treatment of vitamin B12 and folate deficiency UpToDate Last updated Jun 25 2014
de Benoist B Conclusions of a WHO Technical Consultation on folate and vitamin B12 deficiencies Food Nutr Bull 200829(2 Suppl)S238ndash44Congreso Nacional Laboratorio Cliacutenico
2018
Tomado de Tefferi A Li C En Atlas of Clinical Hematology Publicado por JO Armitage Philadelphia Current Medicine 2004
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
Int Jnl Lab Hem 2007 29 327ndash334
Clin Lab 201662343-347
In ourstudy mean MCVrMCV ratio of healthy controls is130 as microcytic anemia irondeficiency anemia is121 as also macrocytic anemia vitamin B12 deficiencyanemia is 115
Congreso Nacional Laboratorio Cliacutenico
2018
Sualeh Muslim Khan Muhammad Akbar Agha
Mean cell volume of reticulocytemdashA new parameter for diagnosing sub-clinical cobalamin deficiency in blood donors Int J Lab Hem 20181ndash4
The Abbott CELL-DYN Sapphire Hematology System uses multi-angle polarized scatter separation (MAPSS) and focused flow impedance technologies
Congreso Nacional Laboratorio Cliacutenico
2018
MCVr at 985 fL yielded the highest Youdenrsquos index at sensitivity of 82 specificity of 828 AUC 0847 ( 95 CI 803-891)
Khan SM Agha MA Mean cell volume of reticulocyte-A new parameter for diagnosing sub-clinical cobalamin deficiency in blood donors
Int J Lab Hem 20181ndash4 2018 Jul 13 doi 101111ijlh12899
Congreso Nacional Laboratorio Cliacutenico
2018
Role of Cell Population Data in the detection of folate and cobalamin deficiency
J Nieto et al
XXXI st International Symposium on Technological Innovations in Laboratory Hematology ISLH 2018 10-12 May 2018 Brussels Belgium
M-V-NRET and SD-VNRET are the best discriminatory single parameters to distinguish between patients with B9B12 deficiency and reference subjects M-V-NRETAUC=0823 sensitivity 78 and specificity 86
AUC=0852 sensitivity 55 and specificity 60
Conclusions The CPD parameters of Volume and Light Scatter (M and SD of LALS angle) that inform about size and intracellular structure of RBCs provided very useful information for the detection of B9B12 deficiency
Congreso Nacional Laboratorio Cliacutenico
2018
Cell Population Data
bull Paraacutemetros poblacionales de los leucocitos
bull Describen la morfologiacutea tamantildeo
estructuras citoplasmaacuteticas
nuacutecleo aacutecidos nucleacuteicos
bull Son datos numeacutericos con los que se construyen los ejes de lo diagramas de dispersioacuten de los leucocitos
bull Dependen de la tecnologiacutea
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
High Sensitivity New Parameters for the Detection of Vitamin B12 and Folate Deficiencies Blood 2008 1125379
B12 def vs
Normals
Mann
Withney T-Test
ROC
AUC Sens Specif Cutoff signifROC
MCV p=03156 p=09533 0577
MPV p=00001 0802 792 806 lt83 p=00001
NE Mean
Volume plt00001 0862 833 778 gt1403 p=00001
MO Mean
Volume plt00001 0829 625 889 gt1723 p=00001
MRV p=00113 0705 50 964 gt1133 p=00051
Folate def vs
Normals
Mann
Withney T-Test
ROC
AUC Sens Specif Cut-off signifROC
MCV p=00798 p=06461 0665
MPV plt00001 0832 81 806 lt83 p=00001
NE Mean
Volume p=00008 087 952 694 gt1402 p=00001
MO Mean
Volume p=00002 0801 667 833 gt1696 p=00001
MRV p=00054 0731 476 964 gt1133 p=00019
The Mean Neutrophil Volume (MNE V) and Mean Monocyte Volume (MMOV) may be used for the detection of megaloblastic neutrophils and monocytes MNEV and MMOV have significantly higher sensitivity than the previous information from the red cells (MCV) detecting B12 or folate deficiency because they are not affected by the presence at the same time of Iron deficiency or other reasons of anemia
Congreso Nacional Laboratorio Cliacutenico
2018
POSTER 733
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
CPD Sysmex XN
NE SSC complejidad
NE SFL aacutecidos nucleacuteicos
NE FSC tamantildeo
NE WX
NE WY
NE WZ
MO X
MO Y
MO Z
MO WX
MO WY
MO WZ
LY X
LY Y
LY Z
LY WX
LY WY
LY WZCongreso Nacio
nal Laboratorio Cliacutenico 2018
As MCV is the mean which is calculated it is insensitive to the presence of a small number of macrocytes
Further macrocytosis can be obscured by concomitant disorders that can cause microcytosis resulting inmasked megaloblastic anaemia (MA) for example iron deficiency hereditary elliptocytosis alpha and betathalassemia
This study was undertaken to evaluate the role of NEUT-X and NEUT-Y in detecting MA on peripheral blood andalso see whether other forms of macrocytic anaemia can be differentiated from MA
In MA the peripheral blood smear shows cytopenia with macroovalocytes and hypersegmented
neutrophils (gt5 lobes in 5 neutrophils six lobes nuclei or lobe average of gt35)
In conclusion our study shows that higher values of NEUT-X and NEUT-Y in MA patients in spite of low ornormal MCV high RDW may be used to not only reveal the masked cases of MA with concomitant irondeficiency but also separate them from the broader macrocytic anaemia group
Peripheral smear remains diagnostic however making smear for all the suspicious cases is a cumbersomeand tedious procedure Thus these parameters emerge as more reliable and stable parameters in themodern laboratories which in future may replace the older screening tools
Congreso Nacional Laboratorio Cliacutenico
2018
A favor Eficiencia Operativa
Mejora el proceso del Laboratorio
Mejor informacioacuten al Cliacutenico al mismo coste
Mejora la informacioacuten
Informa sobre la eritropoyesis deteccioacuten precoz de estados carenciales
Ayuda al cliacutenico
Estado real del paciente
En contraParaacutemetros de investigacioacuten
Dificultad de standarizar dependencia teacutecnica
Control de calidadCongreso Nacional Laboratorio Cliacutenico
2018
Total YLD resulting from all causes of anemia by country
Kassebaum NJ et al Blood 2014123615-624 copy2014 by American Society of Hematology
Congreso Nacional Laboratorio Cliacutenico
2018
Clamaschella C Iron deficiency anemia N Engl J Med 20153721832-43
Congreso Nacional Laboratorio Cliacutenico
2018
Iron Cycle
Fleming RE Ponka P N Engl J Med 2012366348-359Congreso Nacional Laboratorio Cliacutenico
2018
Camaschella C N Engl J Med 20153721832-43Congreso Nacio
nal Laboratorio Cliacutenico 2018
G Lippi amp M Plebani Recent developments and innovations in red blood cells diagnostics Journal of Laboratory and Precision Medicine 2018DOI 1021037jlpm20180709 AOP
Innovative erythrocyte parametersThese innovative parameters most typically include automated reticulocyte andnucleated RBC counts hemoglobinization of reticulocytes and RBC reticulocytehemoglobin content reticulocyte maturation automatic analysis and calculationof microcytic and hypochromic RBC
The various combination of these different parameters not only may be useful tocomplement clinical history physical examination and results of moreconventional laboratory investigations (ie CBC ferritin transferrin ironhaptoglobin folic acid and vitamin B12 among others) for investigating theunderlying cause(s) of anemia
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
Biomarcadores de Eritroyesis
Urrechaga E Borque L Escanero JF Biomarkers of hypochromia the contemporary assessment of
Iron status and erythropoiesis Journal of Biomedicine and Biotechnology
httpdxdoiorg1011552013603786
Abreviatura
(unidades)
Compantildeiacutea
RBC Hipocromos Hypo () Siemens
Hb Reticulocitaria CHr (pg) Siemens
RBC Hipocromos HPO () Abbott
Hb Reticulocitaria media MCHr (pg) Abbott
RBC Hipocromos Hypo He () Sysmex
Hb Reticulocitaria equivalente Ret He (pg) Sysmex
Low Hb density
Contenido de Hb Reticulocitaria
Expresioacuten Hb reticulocitaria
LHD ()
RHCc (pg)
RHE (pg)
Beckman Coulter
Horiba ABX
Mindray
Congreso Nacional Laboratorio Cliacutenico
2018
Informacioacuten avanzada valor antildeadido
Reticulocitos Eritrocitos
bull Permanecen en la sangre 1-2 diacuteas hasta que se convierten en eritrocitos maduros
bull El contenido de hemoglobinapuede reflejar la cantidad de hierro disponible de maneraefectiva
bull Refleja la calidad de la eritropoyesis en el periodoinmediato
bull Permanecen en la sangre 90-120 diacuteas
bull Las diversas subpoblacionespueden reflejar el status feacuterrico en las pasadas semanas
bull MCV MCH son las medias del
conjunto de RBC las de fracciones indican la contribucioacuten de los diversos tipos de RBC a las medias
Congreso Nacional Laboratorio Cliacutenico
2018
Angulo alto
Dispersioacuten lateral Hb
Angulo bajo
Dispersioacuten frontal VOLUMEN
LASER Absorbancia Fluorescencia
RNA contenido
Citometriacutea
Congreso Nacional Laboratorio Cliacutenico
2018
RETICULOCITOS
Compantildeiacutea Instrumento Meacutetodo Colorante Paraacutemetros
Abbott CELLDYN Ruby
CELLDYN
Sapphire
Absorbancia
Fluorescencia
Nuevo azul
metileno
Sybr II
IRF
IRF MCHr MCVr
Beckman
Coulter
UniCell DxH
LH series
Impedancia
citometriacutea de flujo
VCS
Nuevo azul
metileno
Nuevo azul
metileno
IRF MRVHLRRSf
IRF MRV
MSCVHLR
Horiba ABX Pentra
DX120
Impedancia
citometriacutea de flujo
fluorescencia
Naranja de tiazol IRF MRV RETH
RHbC
Siemens ADVIA 120 Absorbancia
Scatter
Oxazine 750 IRF MCVr CHr
Sysmex XE5000 XN Fluorescencia Polimetina IRF RetHe ΔHeCongreso Nacional Laboratorio Cliacutenico
2018
Los reticulocitos precursores de los eritrocitos madurangeneralmente a lo largo de unos dos diacuteas El recuento dereticulocitos es por lo tanto una medida de la cantidad dela eritropoyesis en la meacutedulaParaacutemetros derivados de los reticulocitos los describenmorfoloacutegicamente tamantildeo contenido en Hemoglobinacantidad de material geneacuteticoDe esta forma al referirse a caracteriacutesticas de losreticulocitos es la calidad de la eritropoyesis la que puedeser evaluada
La Hb reticulocitaria se relaciona con la cantidad de hierro disponible efectivamente para laeritropoyesis un valor bajo indica que el aporte es deficitario respecto a la demanda en el momentoactual 28-30 pg
Congreso Nacional Laboratorio Cliacutenico
2018
MCV MCH son los valores medios de volumen y Hb en toda la poblacioacuten RBC
No informan acerca de las ceacutelulas individuales
Ni de la variedad de eacutestas anisocitosis policromasia
Congreso Nacional Laboratorio Cliacutenico
2018
Se cuentan el nuacutemero de pulsos de 36-360fL y el nuacutemero de partiacuteculas que tienen el mismo tamantildeo y se trasladan los resultados a una graacutefica de Volumen Nuacutemero de ceacutelulasSe obtiene el histograma de RBC que proporciona
bull Nuacutemero de RBC el nuacutemero de pulsos dentro de este rango de tamantildeos
bull MCV se corresponde con la media del histograma de RBC
bull RDW o ADE Ancho de Distribucioacuten del histograma de RBC se corresponde con el coeficiente de variacioacuten de la curva
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
Abbott Sapphire lo calcula en el 50 de la altura del pico del histogramaSysmex y Mindray al 20 desde la base del histogramaSiemens calcula la anchura del pico comprendido entre 60 y 120 fL
Aunque RDW ADE generalmente se entiendecomo coeficiente de variacioacuten de ladistribucioacuten de los voluacutemenes de loseritrocitos algunos analizadoreshematoloacutegicos lo calculan desde la medicioacutendirecta de la anchura de la distribucioacuten
Congreso Nacional Laboratorio Cliacutenico
2018
G Lippi amp M Plebani
Recent developments and innovations in red blood cells diagnostics
Journal of Laboratory and Precision Medicine 2018
DOI 1021037jlpm20180709 AOPCongreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
copy 2012 Mindray Confidential 26
HDWHYPERHYPO
HDW HGB Distribution Width
HDW is the distribution width of Hgb histogram
Congreso Nacional Laboratorio Cliacutenico
2018
copy 2012 Mindray Confidential 27
MCHrHDWHYPERHYPOMCHr Mean RET HGB Concentration
Congreso Nacional Laboratorio Cliacutenico
2018
Histograma RBC el mapa de Mie
28 41
Congreso Nacional Laboratorio Cliacutenico
2018
Abbott Mindray Siemens
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
Severe Iron Deficiency Anemia Female 34 years
19 th March 18 th April
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
SysmexRBCHe erythrocyte Hb equivalentRetHe reticulocyte Hb equivalent(content)
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
MIC
MAC
HPO HPR
Congreso Nacional Laboratorio Cliacutenico
2018
copy 2012 Mindray Confidential 36
MINDRAY MCHrHDWHYPERHYPO
MCHr Mean RET HGB Concentration
HDW HGB Distribution Width
HYPER The percentage of hyperchromicred blood cells
HYPO The percentage of hypochromic red blood cells
Thalassemia screeningIDA treatment monitoringIDA screening
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
Hipocromo
Hipercroacutemico onormocroacutemico
iquestConcentracioacuten o contenido de Hemoglobina
Hipocroacutemiconormocroacutemico
Abbott Mindray Siemens Hypo CONCENTRACIOacuteN Hblt280gL
Sysmex Hypo CONTENIDO Hblt 17 pg
Congreso Nacional Laboratorio Cliacutenico
2018
Low Hb Density
Microcytic Factor Maf = (HbMCV)100
Nuevo moacutedulo transductor muacuteltiple con laacuteser de diodo y dos sensores oacutepticos
Anaacutelisis de hasta 50000 ceacutelulas con 7 paraacutemetros tecnoloacutegicos (leucocitos reticulocitos eritroblastos)
1 Volumen digital
2 Conductividad digital
3 5 aacutengulos de dispersioacuten de luz laacuteser digital
bull MALS (Median Angle Light Scatter)
bull UMALS (Upper Median Angle Light Scatter) 20deg a 43deg
bull LMALS (Lower Median Angle Light Scatter) 09deg a 19deg
bull LALS (Low Angle Light Scatter) asymp 51deg
bull AL2 (Axial Light Loss) 0deg a 05deg
Congreso Nacional Laboratorio Cliacutenico
2018
Hierro es un elemento criacutetico para elfuncionamiento oacuteptimo y supervivenciade las ceacutelulas
Disfuncioacuten mitocondrialActividad enzimaacutetica afectadaProteiacutenas de transporte y estructuralesproteins
Capacidad fiacutesica mermadaCapacidad de trabajo reducidaCapacidades cognitivas afectadasMorbilidad y mortalidad
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
It is generally assumed that worldwide ldquoat least half the anemia is due tonutritional iron deficiencyrdquo and that ldquoup to a prevalence of iron deficiency anemiaof 40 the prevalence of iron deficiency will be about 25 times that of anemiardquoHowever it is evident from the foregoing discussion that there are considerablevariations in both of these ratios depending on the age and sex of the peoplebeing studied the region of the world in which they live and the prevalence ratesof other causes of anemia
WHO Department of Nutrition for Health and DevelopmentAssessing the iron status of populations including literature reviews report of a Joint World Health OrganizationCenters for DiseaseControl and Prevention Technical Consultation on the Assessment of Iron Status at the Population Level Geneva Switzerland 6ndash8 April2004 ndash 2nd ed
Congreso Nacional Laboratorio Cliacutenico
2018
Estaacute bien establecido que la anemia produce una miriacuteada de secuelas tanto fiacutesicas comopsicoloacutegicas
Pero los efecto deleteacutereos se deben al deficit de hierro que es un evento previo a que seestablezca la anemia
El deacuteficit de hierrro auacuten sin anemia tiene efectos negativos en el desarrollo cognitivo y fiacutesico
Rattehalli D et al Iron deficiency without anemia do not wait for the Hemoglobin to drop
Health Policy and Technology 2013 2 45-48Congreso Nacio
nal Laboratorio Cliacutenico 2018
SuominenP et al Serum transferrin receptor and transferrin receptor-ferritin index identify healthy subjects with subclinical iron deficits Blood 1998 92 2934ndash9Halwachs-Baumann G Diagnosis of anaemia old things rearranged Wien Med Wochenschr 2012 162478ndash88
Congreso Nacional Laboratorio Cliacutenico
2018
Hemoglobina de reticulocito y su importancia en el diagnoacutestico temprano de anemiaferropeacutenica
Y Maacuterquez-Beniacutetez et al Universidad de BocayaAugust
2018 DOI 1022267rus182003133 aop
El contenido de hemoglobina de reticulocitos (CHr) es un paraacutemetro en la biometriacuteahematoloacutegica automatizada utilizado como un marcador de la biodisponibilidad delhierro en la eritropoyesis
Objetivo Exponer la aplicabilidad de la CHr como un paraacutemetro en el diagnoacutesticoprecoz de la anemia por deficiencia de hierro asiacute como su medicioacuten e interpretacioacuten
Materiales y meacutetodos Se realizoacute la revisioacuten de artiacuteculos cientiacuteficos en ingleacutes y espantildeolen las bases de datos PubMed ScienceDirect LILACS y Medline usando descriptoresvalidados en Medical Subject Headings (MeSH) considerando periodo depublicabilidad del 80 inferior a 5 antildeos
Conclusiones La CHr es un paraacutemetro de gran utilidad en el diagnoacutestico temprano deanemia ferropeacutenica y otras patologiacuteas como deficiencia funcional de hierro estadosde inflamacioacuten croacutenica y enfermedad renal croacutenica
Biomarcador temprano en el diagnoacutestico de deficiencia de hierro antes de presentarsecambios morfoloacutegicos eritrociacuteticosCongreso Nacio
nal Laboratorio Cliacutenico 2018
bull A total of 1105 NES participants (639 men 466 women)bull CHr becomes affected in a relatively early stage in the development of iron deficiency before iron
deficiency anemia and clinical symptoms become apparentbull Therefore this parameter might be useful to identify persons healthy and diseased at risk of
developing iron deficiency anemia and subsequently to apply interventions in order to prevent further development of iron deficiency anemiaCongreso Nacio
nal Laboratorio Cliacutenico 2018
Hb reticulocitaria sensible para detectar la fase inicial del deacuteficit de hierro cuando laeritropoyesis requiere maacutes cantidad que la que recibe ANTES de que la anemia seestablezca
Congreso Nacional Laboratorio Cliacutenico
2018
No ID LID P
RBC 1012L 48 (08) 437 (05) lt00001
Hb gL 135 (6) 131 (12) 0006
MCV fL 922 (21) 902 (38) 0006
MCH pg 324 (07) 306 (22) lt00001
MCHC gL 339 (6) 319 (23) 0001
RDW
Ret He pg
Hypo He
LHD
Ferritin microgL
131 (06)
338 (21)
03 (015)
28 (20)
86 (3)
145 (21)
278 (24)
69 (55)
56 (25)
16 (76)
lt00001
lt00001
lt00001
lt00001
lt00001
AUC 95 CI Cutoff Sensitivity Specificity
LHD 0898 0819-0978 50 859 841
Ret He 0914 0824-1000 299pg 868 857
Hypo He 0934 0856-1000 16 857 921
Clinical value of markers of hypochromia in the detection of latent iron deficiency in non-anemic premenopausal women
No ID Hb gt 120 gL s-ferritin was within reference intervalLatent Iron Defiency Hb gt 120 gL s-ferritin lt 30 μgL
Urrechaga E et al Journal Clin Lab Analysis 2016 30 (5) 623-627
97 women (388) in 250 apparently healthy women had latent IDCongreso Nacional Laboratorio Cliacutenico
2018
Schorer G et al Abstract Jahreskongress der Deutschen Gesellschaft fuumlr Transfusionsmedizin und Immunhaumlmatologie Rostock 15 - 18 September 2009
Congreso Nacional Laboratorio Cliacutenico
2018
Caring for Those Who Share Mitigating Iron Deficiency in Regular Blood DonorsMast Alan E
bull Iron deficiency caused by regular blood donation is a problem facing blood centers Each blood donation removes 200 to 250 mg of iron from the donor Consequently many donors become iron deficient with repeated donation
bull This presents a challenge to blood centers that has become more acute in recent years with the realization that iron deficiency even in the absence of anemia is associated with adverse effects including fatigue and decreased exercise tolerance as well as neurological symptoms such as decreased cognitive function pica and restless leg syndrome
bull REDS-II investigators performed a longitudinal study investigating the iron status of blood donors over a two year period called the REDS-II Donor Iron Status Evaluation (RISE)
bull Results from the baseline analysis of regular donors (e 2 donations per year (females) or e 3 donations per year (males) revealed that over two-thirds of female donors and over one-half of male donors have iron deficiency
Congreso Nacional Laboratorio Cliacutenico
2018
Transfusion 2013 532766-2775
bull We evaluated the diagnostic sensitivity and specificity of red blood cell (RBC) hematology analyzer indices to assess iron status as a part of donor management iron deficient erythropoiesis (IDE) and absence of iron stores (AIS)
bull STUDY DESIGN AND METHODS A total of 1659 male and female donors from the Retrovirus Epidemiology Donor Study-II (REDS-II) Donor Iron Status Evaluation (RISE) study who were either first-timereactivated (FT RA no donations for 2 years) or frequent donors were recruited into a longitudinal study of regular donation of RBCs Of these 1002 donors returned 15 to 24 months later for a final assessment
Absent iron stores (AIS) was defined as plasma ferritin level of less than 12 mgL Logarithm of the ratio of soluble transferrin receptor to ferritin of at least 207 was used to define iron-deficient erythropoiesis (IDE)
bull RESULTS HYPOm and CHr detected IDE with comparable sensitivity 72 versus 69 but differed in specificity HYPOm 68 and CHr 53
For detecting AIS sensitivity was improved to 85 for HYPOm and 81 for CHr but specificity was reduced
Venous Hb had high specificity but poor sensitivity for IDE and AIS A plasma ferritin level of less than 267 mgL was a good surrogate for assessing IDE Congreso Nacio
nal Laboratorio Cliacutenico 2018
Microcytic RBC and reticulocyte mean cell hemoglobin content predicted iron depletion with
sensitivities 70 and 64
specificities of 72 and 78 respectively
When both combined
increased the sensitivity to 82
Congreso Nacional Laboratorio Cliacutenico
2018
Depending on the number of donations during the preceding12 months
Absent iron stores were detected in up to 214 of male and278 of female donors respectively
impaired hemoglobinisation IH was present in up to 64 maleand 167 female donors with 2 and 4 preceding donationsrespectively
The defined CHr cut-off value was 280 pg to detect IH infrequent whole blood donors with AIS leading to a testspecificity of 982 (positive predictive value PPV 577) inmale and of 978 (PPV 829) in female donors
It may help to prevent the development of anemia in frequentblood donors and also can help to decide whether donordeferral or even iron substitution need to be recommended
Congreso Nacional Laboratorio Cliacutenico
2018
Of the 501 blood donors sTfR and Ret-He detected Latent Iron Deficiency in 148 and 135 donors respectively
In comparison to sTfR Ret-He had sensitivity of 927 specificity of 9716 PPV of 931 and NPV of 963
Serum Ferritin TIBC and serum Iron had comparatively lower sensitivity of 8716 797 and 777 respectively
Conclusion Ret-He can be used as a routine screening test to detect LID in blood donors
This could provide an opportunity to make appropriate and timely interventions like dietary changes or drug supplementation
Congreso Nacional Laboratorio Cliacutenico
2018
Singh A Chaudhary R Pandey HC Sonker A Identification of iron status of blood donors by using low hemoglobin density and microcytic anemia factor Asian J Transfus Sci 20181246-50
The main objective of this study was to assess ifLHD and Maf could be used for assessment ofiron status in blood donors and also to establisha cut-off for these two parameters at which atentative iron deficiency could be reportedconclusively
Results LHD and Maf were able to differentiatebetween iron deficient and iron-depleteddonors from normal donorsA cutoff of 918 for LHD was able todifferentiate iron deficient and depleted statefrom normal iron statessensitivity 919 and specificity 71respectivelya cutoff of 1016 for Mafsensitivity 946 and specificity 968
MAf = (MVC Hb) 100
Congreso Nacional Laboratorio Cliacutenico
2018
Hb reticulocitaria sensible para detectar la fase inicial del deacuteficitde hierro cuando la eritropoyesis requiere maacutes cantidad que laque recibe ANTES de que la anemia se establezca
La deteccioacuten precoz del deacuteficit de hierro en la fase del balance negativo demanda aporte contribuye a reducir sus manifestaciones cliacutenicas en los pacientes afectados mejorando la salud puacuteblica
Un tratamiento menos prolongado con suplementos y menor consumo de los recursos sanitaros Contribuye a la eficiencia y sostenibilidad de los servicios sanitarios
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
Buttarello MLaboratory diagnosis of anemia are the old and new red cell parameters useful in classification and treatment howInt Jnl Lab Hem 2016 38 (Suppl 1) 123ndash132
Congreso Nacional Laboratorio Cliacutenico
2018
Buttarello MLaboratory diagnosis of anemia are the old and new red cell parameters useful in classification and treatment howInt Jnl Lab Hem 2016 38 (Suppl 1) 123ndash132
Congreso Nacional Laboratorio Cliacutenico
2018
Ralph Green amp Ananya Datta Mitra Megaloblastic Anemias Nutritional and Other CausesMed Clin N Am 2017 101 297ndash317
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
ANEMIA CARENCIAL CAUSAS
Factores alimentariosConsumir una dieta vegetariana mal planeadaAlimentacioacuten deficiente en los bebeacutesDesnutricioacuten durante el embarazo
Deacuteficit de absorcioacutenAlcoholismo croacutenicoEnfermedad de Crohn celiaquiacutea infeccioacuten otros problemas que le dificulten al cuerpo la digestioacuten de los alimentosAnemia perniciosa (factor intriacutenseco)Cirugiacuteas para extirpar ciertas partes del estoacutemago o el intestino delgado
MedicamentosB12 omeprazol metformina colchicina aminosalicilatos neomicinaFOLATO fenitoiacutena metotrexato sulfasalacina triamtereno pirimetamina trimetoprim con sulfametoxazol barbituacutericos
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
Reacciones metaboacutelicas en las que participan la vitamina B12 y el folato bull la conversioacuten de metilmalonil-CoA a succinil-CoA donde la adenosil-cobalamina actuacutea de
cofactor Por ello un deacuteficit de B12 conlleva un aumento de metilmalonil-CoA y de su producto de hidroacutelisis el aacutecido metilmaloacutenico
bull la siacutentesis de metionina a partir de homocisteina gracias a la metionina sintetasa y a la metil-cobalamina como cofactor En esta misma reaccioacuten el metiltetrahidrofolato es transformado a tetrahidrofolato que es necesario para la siacutentesis de DNA
Congreso Nacional Laboratorio Cliacutenico
2018
Anemia macrociacutetica secundaria a deficiencia de aacutecido foacutelico y de vitamina B12(cobalamina)
La deficiencia de B12 yo aacutecido foacutelico es la causa maacutes frecuente de megaloblastosis
Dentro de distintas funciones generales del metabolismo la vitamina B12 es uncofactor esencial en la siacutentesis de ADN y ARN compromete a todas las ceacutelulas delorganismo
Su deficiencia se manifiesta en oacuterganos con alto recambio celular como la meacutedulaosea y en el sistema nervioso central (SNC) a traveacutes de la siacutentesis de mielina y lareparacioacuten axonal
La deficiencia de cobalamina es responsable de alteraciones hematoloacutegicasneuroloacutegicas neurocognitivas y neuropsiquiaacutetricas
La siacutentesis defectuosa de ADN conduce a la apoptosis y a la hemoacutelisis (intra yextramedular) causantes de la hemopoyesis inefectiva
En meacutedula la siacutentesis ineficiente de DNA causa cambios megaloblaacutesticos comoconsecuencIa anemia y citopenias
Congreso Nacional Laboratorio Cliacutenico
2018
Limitaciones de los meacutetodos diagnoacutesticos claacutesicos
Volumen Corpuscular Medio (VCM) y morfologiacutea de sangre perifeacuterica En una serie de pacientes con deacuteficit de cobalamina soacutelo un 29 teniacutean anemia y soacutelo un 36 teniacutean un VCM gt 100 fL
Un VCM normal no puede ser empleado para rechazar una determinacioacuten de nivel de cobalamina ya que hasta un 25 de casos con manifestaciones neuroloacutegicas cursan con un VCM normal
Cobalamina seacuterica (nivel de B12) Es el test diagnoacutestico rutinario inicial estaacutendar Es un test ampliamente disponible de bajo coste y automatizado Sin embargo presenta algunas limitaciones
-- Existencia de varias teacutecnicas y ausencia de un gold standard por lo que hay diferentes liacutemites de referencia
-- Variacioacuten intraindividual muy alta
La OMS publicoacute en 2008 las conclusiones de un grupo teacutecnico consultado sobre el deacuteficit de cobalamina y folato
El grupo reconocioacute que no existen unos umbrales universalmente reconocidos para definir el deacuteficit de ambas vitaminas y expresaron la necesidad de un consenso
Devalia V Hamilton MS and Molloy AM on behalf of the British Committee for standards in haematology Guidelines for the diagnosis and treatment of cobalamin and folate disorders Br J Haematol 2014 166(4) 496-513
Schrier SL Diagnosis and treatment of vitamin B12 and folate deficiency UpToDate Last updated Jun 25 2014
de Benoist B Conclusions of a WHO Technical Consultation on folate and vitamin B12 deficiencies Food Nutr Bull 200829(2 Suppl)S238ndash44Congreso Nacional Laboratorio Cliacutenico
2018
Tomado de Tefferi A Li C En Atlas of Clinical Hematology Publicado por JO Armitage Philadelphia Current Medicine 2004
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
Int Jnl Lab Hem 2007 29 327ndash334
Clin Lab 201662343-347
In ourstudy mean MCVrMCV ratio of healthy controls is130 as microcytic anemia irondeficiency anemia is121 as also macrocytic anemia vitamin B12 deficiencyanemia is 115
Congreso Nacional Laboratorio Cliacutenico
2018
Sualeh Muslim Khan Muhammad Akbar Agha
Mean cell volume of reticulocytemdashA new parameter for diagnosing sub-clinical cobalamin deficiency in blood donors Int J Lab Hem 20181ndash4
The Abbott CELL-DYN Sapphire Hematology System uses multi-angle polarized scatter separation (MAPSS) and focused flow impedance technologies
Congreso Nacional Laboratorio Cliacutenico
2018
MCVr at 985 fL yielded the highest Youdenrsquos index at sensitivity of 82 specificity of 828 AUC 0847 ( 95 CI 803-891)
Khan SM Agha MA Mean cell volume of reticulocyte-A new parameter for diagnosing sub-clinical cobalamin deficiency in blood donors
Int J Lab Hem 20181ndash4 2018 Jul 13 doi 101111ijlh12899
Congreso Nacional Laboratorio Cliacutenico
2018
Role of Cell Population Data in the detection of folate and cobalamin deficiency
J Nieto et al
XXXI st International Symposium on Technological Innovations in Laboratory Hematology ISLH 2018 10-12 May 2018 Brussels Belgium
M-V-NRET and SD-VNRET are the best discriminatory single parameters to distinguish between patients with B9B12 deficiency and reference subjects M-V-NRETAUC=0823 sensitivity 78 and specificity 86
AUC=0852 sensitivity 55 and specificity 60
Conclusions The CPD parameters of Volume and Light Scatter (M and SD of LALS angle) that inform about size and intracellular structure of RBCs provided very useful information for the detection of B9B12 deficiency
Congreso Nacional Laboratorio Cliacutenico
2018
Cell Population Data
bull Paraacutemetros poblacionales de los leucocitos
bull Describen la morfologiacutea tamantildeo
estructuras citoplasmaacuteticas
nuacutecleo aacutecidos nucleacuteicos
bull Son datos numeacutericos con los que se construyen los ejes de lo diagramas de dispersioacuten de los leucocitos
bull Dependen de la tecnologiacutea
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
High Sensitivity New Parameters for the Detection of Vitamin B12 and Folate Deficiencies Blood 2008 1125379
B12 def vs
Normals
Mann
Withney T-Test
ROC
AUC Sens Specif Cutoff signifROC
MCV p=03156 p=09533 0577
MPV p=00001 0802 792 806 lt83 p=00001
NE Mean
Volume plt00001 0862 833 778 gt1403 p=00001
MO Mean
Volume plt00001 0829 625 889 gt1723 p=00001
MRV p=00113 0705 50 964 gt1133 p=00051
Folate def vs
Normals
Mann
Withney T-Test
ROC
AUC Sens Specif Cut-off signifROC
MCV p=00798 p=06461 0665
MPV plt00001 0832 81 806 lt83 p=00001
NE Mean
Volume p=00008 087 952 694 gt1402 p=00001
MO Mean
Volume p=00002 0801 667 833 gt1696 p=00001
MRV p=00054 0731 476 964 gt1133 p=00019
The Mean Neutrophil Volume (MNE V) and Mean Monocyte Volume (MMOV) may be used for the detection of megaloblastic neutrophils and monocytes MNEV and MMOV have significantly higher sensitivity than the previous information from the red cells (MCV) detecting B12 or folate deficiency because they are not affected by the presence at the same time of Iron deficiency or other reasons of anemia
Congreso Nacional Laboratorio Cliacutenico
2018
POSTER 733
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
CPD Sysmex XN
NE SSC complejidad
NE SFL aacutecidos nucleacuteicos
NE FSC tamantildeo
NE WX
NE WY
NE WZ
MO X
MO Y
MO Z
MO WX
MO WY
MO WZ
LY X
LY Y
LY Z
LY WX
LY WY
LY WZCongreso Nacio
nal Laboratorio Cliacutenico 2018
As MCV is the mean which is calculated it is insensitive to the presence of a small number of macrocytes
Further macrocytosis can be obscured by concomitant disorders that can cause microcytosis resulting inmasked megaloblastic anaemia (MA) for example iron deficiency hereditary elliptocytosis alpha and betathalassemia
This study was undertaken to evaluate the role of NEUT-X and NEUT-Y in detecting MA on peripheral blood andalso see whether other forms of macrocytic anaemia can be differentiated from MA
In MA the peripheral blood smear shows cytopenia with macroovalocytes and hypersegmented
neutrophils (gt5 lobes in 5 neutrophils six lobes nuclei or lobe average of gt35)
In conclusion our study shows that higher values of NEUT-X and NEUT-Y in MA patients in spite of low ornormal MCV high RDW may be used to not only reveal the masked cases of MA with concomitant irondeficiency but also separate them from the broader macrocytic anaemia group
Peripheral smear remains diagnostic however making smear for all the suspicious cases is a cumbersomeand tedious procedure Thus these parameters emerge as more reliable and stable parameters in themodern laboratories which in future may replace the older screening tools
Congreso Nacional Laboratorio Cliacutenico
2018
A favor Eficiencia Operativa
Mejora el proceso del Laboratorio
Mejor informacioacuten al Cliacutenico al mismo coste
Mejora la informacioacuten
Informa sobre la eritropoyesis deteccioacuten precoz de estados carenciales
Ayuda al cliacutenico
Estado real del paciente
En contraParaacutemetros de investigacioacuten
Dificultad de standarizar dependencia teacutecnica
Control de calidadCongreso Nacional Laboratorio Cliacutenico
2018
Clamaschella C Iron deficiency anemia N Engl J Med 20153721832-43
Congreso Nacional Laboratorio Cliacutenico
2018
Iron Cycle
Fleming RE Ponka P N Engl J Med 2012366348-359Congreso Nacional Laboratorio Cliacutenico
2018
Camaschella C N Engl J Med 20153721832-43Congreso Nacio
nal Laboratorio Cliacutenico 2018
G Lippi amp M Plebani Recent developments and innovations in red blood cells diagnostics Journal of Laboratory and Precision Medicine 2018DOI 1021037jlpm20180709 AOP
Innovative erythrocyte parametersThese innovative parameters most typically include automated reticulocyte andnucleated RBC counts hemoglobinization of reticulocytes and RBC reticulocytehemoglobin content reticulocyte maturation automatic analysis and calculationof microcytic and hypochromic RBC
The various combination of these different parameters not only may be useful tocomplement clinical history physical examination and results of moreconventional laboratory investigations (ie CBC ferritin transferrin ironhaptoglobin folic acid and vitamin B12 among others) for investigating theunderlying cause(s) of anemia
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
Biomarcadores de Eritroyesis
Urrechaga E Borque L Escanero JF Biomarkers of hypochromia the contemporary assessment of
Iron status and erythropoiesis Journal of Biomedicine and Biotechnology
httpdxdoiorg1011552013603786
Abreviatura
(unidades)
Compantildeiacutea
RBC Hipocromos Hypo () Siemens
Hb Reticulocitaria CHr (pg) Siemens
RBC Hipocromos HPO () Abbott
Hb Reticulocitaria media MCHr (pg) Abbott
RBC Hipocromos Hypo He () Sysmex
Hb Reticulocitaria equivalente Ret He (pg) Sysmex
Low Hb density
Contenido de Hb Reticulocitaria
Expresioacuten Hb reticulocitaria
LHD ()
RHCc (pg)
RHE (pg)
Beckman Coulter
Horiba ABX
Mindray
Congreso Nacional Laboratorio Cliacutenico
2018
Informacioacuten avanzada valor antildeadido
Reticulocitos Eritrocitos
bull Permanecen en la sangre 1-2 diacuteas hasta que se convierten en eritrocitos maduros
bull El contenido de hemoglobinapuede reflejar la cantidad de hierro disponible de maneraefectiva
bull Refleja la calidad de la eritropoyesis en el periodoinmediato
bull Permanecen en la sangre 90-120 diacuteas
bull Las diversas subpoblacionespueden reflejar el status feacuterrico en las pasadas semanas
bull MCV MCH son las medias del
conjunto de RBC las de fracciones indican la contribucioacuten de los diversos tipos de RBC a las medias
Congreso Nacional Laboratorio Cliacutenico
2018
Angulo alto
Dispersioacuten lateral Hb
Angulo bajo
Dispersioacuten frontal VOLUMEN
LASER Absorbancia Fluorescencia
RNA contenido
Citometriacutea
Congreso Nacional Laboratorio Cliacutenico
2018
RETICULOCITOS
Compantildeiacutea Instrumento Meacutetodo Colorante Paraacutemetros
Abbott CELLDYN Ruby
CELLDYN
Sapphire
Absorbancia
Fluorescencia
Nuevo azul
metileno
Sybr II
IRF
IRF MCHr MCVr
Beckman
Coulter
UniCell DxH
LH series
Impedancia
citometriacutea de flujo
VCS
Nuevo azul
metileno
Nuevo azul
metileno
IRF MRVHLRRSf
IRF MRV
MSCVHLR
Horiba ABX Pentra
DX120
Impedancia
citometriacutea de flujo
fluorescencia
Naranja de tiazol IRF MRV RETH
RHbC
Siemens ADVIA 120 Absorbancia
Scatter
Oxazine 750 IRF MCVr CHr
Sysmex XE5000 XN Fluorescencia Polimetina IRF RetHe ΔHeCongreso Nacional Laboratorio Cliacutenico
2018
Los reticulocitos precursores de los eritrocitos madurangeneralmente a lo largo de unos dos diacuteas El recuento dereticulocitos es por lo tanto una medida de la cantidad dela eritropoyesis en la meacutedulaParaacutemetros derivados de los reticulocitos los describenmorfoloacutegicamente tamantildeo contenido en Hemoglobinacantidad de material geneacuteticoDe esta forma al referirse a caracteriacutesticas de losreticulocitos es la calidad de la eritropoyesis la que puedeser evaluada
La Hb reticulocitaria se relaciona con la cantidad de hierro disponible efectivamente para laeritropoyesis un valor bajo indica que el aporte es deficitario respecto a la demanda en el momentoactual 28-30 pg
Congreso Nacional Laboratorio Cliacutenico
2018
MCV MCH son los valores medios de volumen y Hb en toda la poblacioacuten RBC
No informan acerca de las ceacutelulas individuales
Ni de la variedad de eacutestas anisocitosis policromasia
Congreso Nacional Laboratorio Cliacutenico
2018
Se cuentan el nuacutemero de pulsos de 36-360fL y el nuacutemero de partiacuteculas que tienen el mismo tamantildeo y se trasladan los resultados a una graacutefica de Volumen Nuacutemero de ceacutelulasSe obtiene el histograma de RBC que proporciona
bull Nuacutemero de RBC el nuacutemero de pulsos dentro de este rango de tamantildeos
bull MCV se corresponde con la media del histograma de RBC
bull RDW o ADE Ancho de Distribucioacuten del histograma de RBC se corresponde con el coeficiente de variacioacuten de la curva
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
Abbott Sapphire lo calcula en el 50 de la altura del pico del histogramaSysmex y Mindray al 20 desde la base del histogramaSiemens calcula la anchura del pico comprendido entre 60 y 120 fL
Aunque RDW ADE generalmente se entiendecomo coeficiente de variacioacuten de ladistribucioacuten de los voluacutemenes de loseritrocitos algunos analizadoreshematoloacutegicos lo calculan desde la medicioacutendirecta de la anchura de la distribucioacuten
Congreso Nacional Laboratorio Cliacutenico
2018
G Lippi amp M Plebani
Recent developments and innovations in red blood cells diagnostics
Journal of Laboratory and Precision Medicine 2018
DOI 1021037jlpm20180709 AOPCongreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
copy 2012 Mindray Confidential 26
HDWHYPERHYPO
HDW HGB Distribution Width
HDW is the distribution width of Hgb histogram
Congreso Nacional Laboratorio Cliacutenico
2018
copy 2012 Mindray Confidential 27
MCHrHDWHYPERHYPOMCHr Mean RET HGB Concentration
Congreso Nacional Laboratorio Cliacutenico
2018
Histograma RBC el mapa de Mie
28 41
Congreso Nacional Laboratorio Cliacutenico
2018
Abbott Mindray Siemens
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
Severe Iron Deficiency Anemia Female 34 years
19 th March 18 th April
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
SysmexRBCHe erythrocyte Hb equivalentRetHe reticulocyte Hb equivalent(content)
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
MIC
MAC
HPO HPR
Congreso Nacional Laboratorio Cliacutenico
2018
copy 2012 Mindray Confidential 36
MINDRAY MCHrHDWHYPERHYPO
MCHr Mean RET HGB Concentration
HDW HGB Distribution Width
HYPER The percentage of hyperchromicred blood cells
HYPO The percentage of hypochromic red blood cells
Thalassemia screeningIDA treatment monitoringIDA screening
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
Hipocromo
Hipercroacutemico onormocroacutemico
iquestConcentracioacuten o contenido de Hemoglobina
Hipocroacutemiconormocroacutemico
Abbott Mindray Siemens Hypo CONCENTRACIOacuteN Hblt280gL
Sysmex Hypo CONTENIDO Hblt 17 pg
Congreso Nacional Laboratorio Cliacutenico
2018
Low Hb Density
Microcytic Factor Maf = (HbMCV)100
Nuevo moacutedulo transductor muacuteltiple con laacuteser de diodo y dos sensores oacutepticos
Anaacutelisis de hasta 50000 ceacutelulas con 7 paraacutemetros tecnoloacutegicos (leucocitos reticulocitos eritroblastos)
1 Volumen digital
2 Conductividad digital
3 5 aacutengulos de dispersioacuten de luz laacuteser digital
bull MALS (Median Angle Light Scatter)
bull UMALS (Upper Median Angle Light Scatter) 20deg a 43deg
bull LMALS (Lower Median Angle Light Scatter) 09deg a 19deg
bull LALS (Low Angle Light Scatter) asymp 51deg
bull AL2 (Axial Light Loss) 0deg a 05deg
Congreso Nacional Laboratorio Cliacutenico
2018
Hierro es un elemento criacutetico para elfuncionamiento oacuteptimo y supervivenciade las ceacutelulas
Disfuncioacuten mitocondrialActividad enzimaacutetica afectadaProteiacutenas de transporte y estructuralesproteins
Capacidad fiacutesica mermadaCapacidad de trabajo reducidaCapacidades cognitivas afectadasMorbilidad y mortalidad
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
It is generally assumed that worldwide ldquoat least half the anemia is due tonutritional iron deficiencyrdquo and that ldquoup to a prevalence of iron deficiency anemiaof 40 the prevalence of iron deficiency will be about 25 times that of anemiardquoHowever it is evident from the foregoing discussion that there are considerablevariations in both of these ratios depending on the age and sex of the peoplebeing studied the region of the world in which they live and the prevalence ratesof other causes of anemia
WHO Department of Nutrition for Health and DevelopmentAssessing the iron status of populations including literature reviews report of a Joint World Health OrganizationCenters for DiseaseControl and Prevention Technical Consultation on the Assessment of Iron Status at the Population Level Geneva Switzerland 6ndash8 April2004 ndash 2nd ed
Congreso Nacional Laboratorio Cliacutenico
2018
Estaacute bien establecido que la anemia produce una miriacuteada de secuelas tanto fiacutesicas comopsicoloacutegicas
Pero los efecto deleteacutereos se deben al deficit de hierro que es un evento previo a que seestablezca la anemia
El deacuteficit de hierrro auacuten sin anemia tiene efectos negativos en el desarrollo cognitivo y fiacutesico
Rattehalli D et al Iron deficiency without anemia do not wait for the Hemoglobin to drop
Health Policy and Technology 2013 2 45-48Congreso Nacio
nal Laboratorio Cliacutenico 2018
SuominenP et al Serum transferrin receptor and transferrin receptor-ferritin index identify healthy subjects with subclinical iron deficits Blood 1998 92 2934ndash9Halwachs-Baumann G Diagnosis of anaemia old things rearranged Wien Med Wochenschr 2012 162478ndash88
Congreso Nacional Laboratorio Cliacutenico
2018
Hemoglobina de reticulocito y su importancia en el diagnoacutestico temprano de anemiaferropeacutenica
Y Maacuterquez-Beniacutetez et al Universidad de BocayaAugust
2018 DOI 1022267rus182003133 aop
El contenido de hemoglobina de reticulocitos (CHr) es un paraacutemetro en la biometriacuteahematoloacutegica automatizada utilizado como un marcador de la biodisponibilidad delhierro en la eritropoyesis
Objetivo Exponer la aplicabilidad de la CHr como un paraacutemetro en el diagnoacutesticoprecoz de la anemia por deficiencia de hierro asiacute como su medicioacuten e interpretacioacuten
Materiales y meacutetodos Se realizoacute la revisioacuten de artiacuteculos cientiacuteficos en ingleacutes y espantildeolen las bases de datos PubMed ScienceDirect LILACS y Medline usando descriptoresvalidados en Medical Subject Headings (MeSH) considerando periodo depublicabilidad del 80 inferior a 5 antildeos
Conclusiones La CHr es un paraacutemetro de gran utilidad en el diagnoacutestico temprano deanemia ferropeacutenica y otras patologiacuteas como deficiencia funcional de hierro estadosde inflamacioacuten croacutenica y enfermedad renal croacutenica
Biomarcador temprano en el diagnoacutestico de deficiencia de hierro antes de presentarsecambios morfoloacutegicos eritrociacuteticosCongreso Nacio
nal Laboratorio Cliacutenico 2018
bull A total of 1105 NES participants (639 men 466 women)bull CHr becomes affected in a relatively early stage in the development of iron deficiency before iron
deficiency anemia and clinical symptoms become apparentbull Therefore this parameter might be useful to identify persons healthy and diseased at risk of
developing iron deficiency anemia and subsequently to apply interventions in order to prevent further development of iron deficiency anemiaCongreso Nacio
nal Laboratorio Cliacutenico 2018
Hb reticulocitaria sensible para detectar la fase inicial del deacuteficit de hierro cuando laeritropoyesis requiere maacutes cantidad que la que recibe ANTES de que la anemia seestablezca
Congreso Nacional Laboratorio Cliacutenico
2018
No ID LID P
RBC 1012L 48 (08) 437 (05) lt00001
Hb gL 135 (6) 131 (12) 0006
MCV fL 922 (21) 902 (38) 0006
MCH pg 324 (07) 306 (22) lt00001
MCHC gL 339 (6) 319 (23) 0001
RDW
Ret He pg
Hypo He
LHD
Ferritin microgL
131 (06)
338 (21)
03 (015)
28 (20)
86 (3)
145 (21)
278 (24)
69 (55)
56 (25)
16 (76)
lt00001
lt00001
lt00001
lt00001
lt00001
AUC 95 CI Cutoff Sensitivity Specificity
LHD 0898 0819-0978 50 859 841
Ret He 0914 0824-1000 299pg 868 857
Hypo He 0934 0856-1000 16 857 921
Clinical value of markers of hypochromia in the detection of latent iron deficiency in non-anemic premenopausal women
No ID Hb gt 120 gL s-ferritin was within reference intervalLatent Iron Defiency Hb gt 120 gL s-ferritin lt 30 μgL
Urrechaga E et al Journal Clin Lab Analysis 2016 30 (5) 623-627
97 women (388) in 250 apparently healthy women had latent IDCongreso Nacional Laboratorio Cliacutenico
2018
Schorer G et al Abstract Jahreskongress der Deutschen Gesellschaft fuumlr Transfusionsmedizin und Immunhaumlmatologie Rostock 15 - 18 September 2009
Congreso Nacional Laboratorio Cliacutenico
2018
Caring for Those Who Share Mitigating Iron Deficiency in Regular Blood DonorsMast Alan E
bull Iron deficiency caused by regular blood donation is a problem facing blood centers Each blood donation removes 200 to 250 mg of iron from the donor Consequently many donors become iron deficient with repeated donation
bull This presents a challenge to blood centers that has become more acute in recent years with the realization that iron deficiency even in the absence of anemia is associated with adverse effects including fatigue and decreased exercise tolerance as well as neurological symptoms such as decreased cognitive function pica and restless leg syndrome
bull REDS-II investigators performed a longitudinal study investigating the iron status of blood donors over a two year period called the REDS-II Donor Iron Status Evaluation (RISE)
bull Results from the baseline analysis of regular donors (e 2 donations per year (females) or e 3 donations per year (males) revealed that over two-thirds of female donors and over one-half of male donors have iron deficiency
Congreso Nacional Laboratorio Cliacutenico
2018
Transfusion 2013 532766-2775
bull We evaluated the diagnostic sensitivity and specificity of red blood cell (RBC) hematology analyzer indices to assess iron status as a part of donor management iron deficient erythropoiesis (IDE) and absence of iron stores (AIS)
bull STUDY DESIGN AND METHODS A total of 1659 male and female donors from the Retrovirus Epidemiology Donor Study-II (REDS-II) Donor Iron Status Evaluation (RISE) study who were either first-timereactivated (FT RA no donations for 2 years) or frequent donors were recruited into a longitudinal study of regular donation of RBCs Of these 1002 donors returned 15 to 24 months later for a final assessment
Absent iron stores (AIS) was defined as plasma ferritin level of less than 12 mgL Logarithm of the ratio of soluble transferrin receptor to ferritin of at least 207 was used to define iron-deficient erythropoiesis (IDE)
bull RESULTS HYPOm and CHr detected IDE with comparable sensitivity 72 versus 69 but differed in specificity HYPOm 68 and CHr 53
For detecting AIS sensitivity was improved to 85 for HYPOm and 81 for CHr but specificity was reduced
Venous Hb had high specificity but poor sensitivity for IDE and AIS A plasma ferritin level of less than 267 mgL was a good surrogate for assessing IDE Congreso Nacio
nal Laboratorio Cliacutenico 2018
Microcytic RBC and reticulocyte mean cell hemoglobin content predicted iron depletion with
sensitivities 70 and 64
specificities of 72 and 78 respectively
When both combined
increased the sensitivity to 82
Congreso Nacional Laboratorio Cliacutenico
2018
Depending on the number of donations during the preceding12 months
Absent iron stores were detected in up to 214 of male and278 of female donors respectively
impaired hemoglobinisation IH was present in up to 64 maleand 167 female donors with 2 and 4 preceding donationsrespectively
The defined CHr cut-off value was 280 pg to detect IH infrequent whole blood donors with AIS leading to a testspecificity of 982 (positive predictive value PPV 577) inmale and of 978 (PPV 829) in female donors
It may help to prevent the development of anemia in frequentblood donors and also can help to decide whether donordeferral or even iron substitution need to be recommended
Congreso Nacional Laboratorio Cliacutenico
2018
Of the 501 blood donors sTfR and Ret-He detected Latent Iron Deficiency in 148 and 135 donors respectively
In comparison to sTfR Ret-He had sensitivity of 927 specificity of 9716 PPV of 931 and NPV of 963
Serum Ferritin TIBC and serum Iron had comparatively lower sensitivity of 8716 797 and 777 respectively
Conclusion Ret-He can be used as a routine screening test to detect LID in blood donors
This could provide an opportunity to make appropriate and timely interventions like dietary changes or drug supplementation
Congreso Nacional Laboratorio Cliacutenico
2018
Singh A Chaudhary R Pandey HC Sonker A Identification of iron status of blood donors by using low hemoglobin density and microcytic anemia factor Asian J Transfus Sci 20181246-50
The main objective of this study was to assess ifLHD and Maf could be used for assessment ofiron status in blood donors and also to establisha cut-off for these two parameters at which atentative iron deficiency could be reportedconclusively
Results LHD and Maf were able to differentiatebetween iron deficient and iron-depleteddonors from normal donorsA cutoff of 918 for LHD was able todifferentiate iron deficient and depleted statefrom normal iron statessensitivity 919 and specificity 71respectivelya cutoff of 1016 for Mafsensitivity 946 and specificity 968
MAf = (MVC Hb) 100
Congreso Nacional Laboratorio Cliacutenico
2018
Hb reticulocitaria sensible para detectar la fase inicial del deacuteficitde hierro cuando la eritropoyesis requiere maacutes cantidad que laque recibe ANTES de que la anemia se establezca
La deteccioacuten precoz del deacuteficit de hierro en la fase del balance negativo demanda aporte contribuye a reducir sus manifestaciones cliacutenicas en los pacientes afectados mejorando la salud puacuteblica
Un tratamiento menos prolongado con suplementos y menor consumo de los recursos sanitaros Contribuye a la eficiencia y sostenibilidad de los servicios sanitarios
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
Buttarello MLaboratory diagnosis of anemia are the old and new red cell parameters useful in classification and treatment howInt Jnl Lab Hem 2016 38 (Suppl 1) 123ndash132
Congreso Nacional Laboratorio Cliacutenico
2018
Buttarello MLaboratory diagnosis of anemia are the old and new red cell parameters useful in classification and treatment howInt Jnl Lab Hem 2016 38 (Suppl 1) 123ndash132
Congreso Nacional Laboratorio Cliacutenico
2018
Ralph Green amp Ananya Datta Mitra Megaloblastic Anemias Nutritional and Other CausesMed Clin N Am 2017 101 297ndash317
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
ANEMIA CARENCIAL CAUSAS
Factores alimentariosConsumir una dieta vegetariana mal planeadaAlimentacioacuten deficiente en los bebeacutesDesnutricioacuten durante el embarazo
Deacuteficit de absorcioacutenAlcoholismo croacutenicoEnfermedad de Crohn celiaquiacutea infeccioacuten otros problemas que le dificulten al cuerpo la digestioacuten de los alimentosAnemia perniciosa (factor intriacutenseco)Cirugiacuteas para extirpar ciertas partes del estoacutemago o el intestino delgado
MedicamentosB12 omeprazol metformina colchicina aminosalicilatos neomicinaFOLATO fenitoiacutena metotrexato sulfasalacina triamtereno pirimetamina trimetoprim con sulfametoxazol barbituacutericos
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
Reacciones metaboacutelicas en las que participan la vitamina B12 y el folato bull la conversioacuten de metilmalonil-CoA a succinil-CoA donde la adenosil-cobalamina actuacutea de
cofactor Por ello un deacuteficit de B12 conlleva un aumento de metilmalonil-CoA y de su producto de hidroacutelisis el aacutecido metilmaloacutenico
bull la siacutentesis de metionina a partir de homocisteina gracias a la metionina sintetasa y a la metil-cobalamina como cofactor En esta misma reaccioacuten el metiltetrahidrofolato es transformado a tetrahidrofolato que es necesario para la siacutentesis de DNA
Congreso Nacional Laboratorio Cliacutenico
2018
Anemia macrociacutetica secundaria a deficiencia de aacutecido foacutelico y de vitamina B12(cobalamina)
La deficiencia de B12 yo aacutecido foacutelico es la causa maacutes frecuente de megaloblastosis
Dentro de distintas funciones generales del metabolismo la vitamina B12 es uncofactor esencial en la siacutentesis de ADN y ARN compromete a todas las ceacutelulas delorganismo
Su deficiencia se manifiesta en oacuterganos con alto recambio celular como la meacutedulaosea y en el sistema nervioso central (SNC) a traveacutes de la siacutentesis de mielina y lareparacioacuten axonal
La deficiencia de cobalamina es responsable de alteraciones hematoloacutegicasneuroloacutegicas neurocognitivas y neuropsiquiaacutetricas
La siacutentesis defectuosa de ADN conduce a la apoptosis y a la hemoacutelisis (intra yextramedular) causantes de la hemopoyesis inefectiva
En meacutedula la siacutentesis ineficiente de DNA causa cambios megaloblaacutesticos comoconsecuencIa anemia y citopenias
Congreso Nacional Laboratorio Cliacutenico
2018
Limitaciones de los meacutetodos diagnoacutesticos claacutesicos
Volumen Corpuscular Medio (VCM) y morfologiacutea de sangre perifeacuterica En una serie de pacientes con deacuteficit de cobalamina soacutelo un 29 teniacutean anemia y soacutelo un 36 teniacutean un VCM gt 100 fL
Un VCM normal no puede ser empleado para rechazar una determinacioacuten de nivel de cobalamina ya que hasta un 25 de casos con manifestaciones neuroloacutegicas cursan con un VCM normal
Cobalamina seacuterica (nivel de B12) Es el test diagnoacutestico rutinario inicial estaacutendar Es un test ampliamente disponible de bajo coste y automatizado Sin embargo presenta algunas limitaciones
-- Existencia de varias teacutecnicas y ausencia de un gold standard por lo que hay diferentes liacutemites de referencia
-- Variacioacuten intraindividual muy alta
La OMS publicoacute en 2008 las conclusiones de un grupo teacutecnico consultado sobre el deacuteficit de cobalamina y folato
El grupo reconocioacute que no existen unos umbrales universalmente reconocidos para definir el deacuteficit de ambas vitaminas y expresaron la necesidad de un consenso
Devalia V Hamilton MS and Molloy AM on behalf of the British Committee for standards in haematology Guidelines for the diagnosis and treatment of cobalamin and folate disorders Br J Haematol 2014 166(4) 496-513
Schrier SL Diagnosis and treatment of vitamin B12 and folate deficiency UpToDate Last updated Jun 25 2014
de Benoist B Conclusions of a WHO Technical Consultation on folate and vitamin B12 deficiencies Food Nutr Bull 200829(2 Suppl)S238ndash44Congreso Nacional Laboratorio Cliacutenico
2018
Tomado de Tefferi A Li C En Atlas of Clinical Hematology Publicado por JO Armitage Philadelphia Current Medicine 2004
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
Int Jnl Lab Hem 2007 29 327ndash334
Clin Lab 201662343-347
In ourstudy mean MCVrMCV ratio of healthy controls is130 as microcytic anemia irondeficiency anemia is121 as also macrocytic anemia vitamin B12 deficiencyanemia is 115
Congreso Nacional Laboratorio Cliacutenico
2018
Sualeh Muslim Khan Muhammad Akbar Agha
Mean cell volume of reticulocytemdashA new parameter for diagnosing sub-clinical cobalamin deficiency in blood donors Int J Lab Hem 20181ndash4
The Abbott CELL-DYN Sapphire Hematology System uses multi-angle polarized scatter separation (MAPSS) and focused flow impedance technologies
Congreso Nacional Laboratorio Cliacutenico
2018
MCVr at 985 fL yielded the highest Youdenrsquos index at sensitivity of 82 specificity of 828 AUC 0847 ( 95 CI 803-891)
Khan SM Agha MA Mean cell volume of reticulocyte-A new parameter for diagnosing sub-clinical cobalamin deficiency in blood donors
Int J Lab Hem 20181ndash4 2018 Jul 13 doi 101111ijlh12899
Congreso Nacional Laboratorio Cliacutenico
2018
Role of Cell Population Data in the detection of folate and cobalamin deficiency
J Nieto et al
XXXI st International Symposium on Technological Innovations in Laboratory Hematology ISLH 2018 10-12 May 2018 Brussels Belgium
M-V-NRET and SD-VNRET are the best discriminatory single parameters to distinguish between patients with B9B12 deficiency and reference subjects M-V-NRETAUC=0823 sensitivity 78 and specificity 86
AUC=0852 sensitivity 55 and specificity 60
Conclusions The CPD parameters of Volume and Light Scatter (M and SD of LALS angle) that inform about size and intracellular structure of RBCs provided very useful information for the detection of B9B12 deficiency
Congreso Nacional Laboratorio Cliacutenico
2018
Cell Population Data
bull Paraacutemetros poblacionales de los leucocitos
bull Describen la morfologiacutea tamantildeo
estructuras citoplasmaacuteticas
nuacutecleo aacutecidos nucleacuteicos
bull Son datos numeacutericos con los que se construyen los ejes de lo diagramas de dispersioacuten de los leucocitos
bull Dependen de la tecnologiacutea
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
High Sensitivity New Parameters for the Detection of Vitamin B12 and Folate Deficiencies Blood 2008 1125379
B12 def vs
Normals
Mann
Withney T-Test
ROC
AUC Sens Specif Cutoff signifROC
MCV p=03156 p=09533 0577
MPV p=00001 0802 792 806 lt83 p=00001
NE Mean
Volume plt00001 0862 833 778 gt1403 p=00001
MO Mean
Volume plt00001 0829 625 889 gt1723 p=00001
MRV p=00113 0705 50 964 gt1133 p=00051
Folate def vs
Normals
Mann
Withney T-Test
ROC
AUC Sens Specif Cut-off signifROC
MCV p=00798 p=06461 0665
MPV plt00001 0832 81 806 lt83 p=00001
NE Mean
Volume p=00008 087 952 694 gt1402 p=00001
MO Mean
Volume p=00002 0801 667 833 gt1696 p=00001
MRV p=00054 0731 476 964 gt1133 p=00019
The Mean Neutrophil Volume (MNE V) and Mean Monocyte Volume (MMOV) may be used for the detection of megaloblastic neutrophils and monocytes MNEV and MMOV have significantly higher sensitivity than the previous information from the red cells (MCV) detecting B12 or folate deficiency because they are not affected by the presence at the same time of Iron deficiency or other reasons of anemia
Congreso Nacional Laboratorio Cliacutenico
2018
POSTER 733
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
CPD Sysmex XN
NE SSC complejidad
NE SFL aacutecidos nucleacuteicos
NE FSC tamantildeo
NE WX
NE WY
NE WZ
MO X
MO Y
MO Z
MO WX
MO WY
MO WZ
LY X
LY Y
LY Z
LY WX
LY WY
LY WZCongreso Nacio
nal Laboratorio Cliacutenico 2018
As MCV is the mean which is calculated it is insensitive to the presence of a small number of macrocytes
Further macrocytosis can be obscured by concomitant disorders that can cause microcytosis resulting inmasked megaloblastic anaemia (MA) for example iron deficiency hereditary elliptocytosis alpha and betathalassemia
This study was undertaken to evaluate the role of NEUT-X and NEUT-Y in detecting MA on peripheral blood andalso see whether other forms of macrocytic anaemia can be differentiated from MA
In MA the peripheral blood smear shows cytopenia with macroovalocytes and hypersegmented
neutrophils (gt5 lobes in 5 neutrophils six lobes nuclei or lobe average of gt35)
In conclusion our study shows that higher values of NEUT-X and NEUT-Y in MA patients in spite of low ornormal MCV high RDW may be used to not only reveal the masked cases of MA with concomitant irondeficiency but also separate them from the broader macrocytic anaemia group
Peripheral smear remains diagnostic however making smear for all the suspicious cases is a cumbersomeand tedious procedure Thus these parameters emerge as more reliable and stable parameters in themodern laboratories which in future may replace the older screening tools
Congreso Nacional Laboratorio Cliacutenico
2018
A favor Eficiencia Operativa
Mejora el proceso del Laboratorio
Mejor informacioacuten al Cliacutenico al mismo coste
Mejora la informacioacuten
Informa sobre la eritropoyesis deteccioacuten precoz de estados carenciales
Ayuda al cliacutenico
Estado real del paciente
En contraParaacutemetros de investigacioacuten
Dificultad de standarizar dependencia teacutecnica
Control de calidadCongreso Nacional Laboratorio Cliacutenico
2018
Iron Cycle
Fleming RE Ponka P N Engl J Med 2012366348-359Congreso Nacional Laboratorio Cliacutenico
2018
Camaschella C N Engl J Med 20153721832-43Congreso Nacio
nal Laboratorio Cliacutenico 2018
G Lippi amp M Plebani Recent developments and innovations in red blood cells diagnostics Journal of Laboratory and Precision Medicine 2018DOI 1021037jlpm20180709 AOP
Innovative erythrocyte parametersThese innovative parameters most typically include automated reticulocyte andnucleated RBC counts hemoglobinization of reticulocytes and RBC reticulocytehemoglobin content reticulocyte maturation automatic analysis and calculationof microcytic and hypochromic RBC
The various combination of these different parameters not only may be useful tocomplement clinical history physical examination and results of moreconventional laboratory investigations (ie CBC ferritin transferrin ironhaptoglobin folic acid and vitamin B12 among others) for investigating theunderlying cause(s) of anemia
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
Biomarcadores de Eritroyesis
Urrechaga E Borque L Escanero JF Biomarkers of hypochromia the contemporary assessment of
Iron status and erythropoiesis Journal of Biomedicine and Biotechnology
httpdxdoiorg1011552013603786
Abreviatura
(unidades)
Compantildeiacutea
RBC Hipocromos Hypo () Siemens
Hb Reticulocitaria CHr (pg) Siemens
RBC Hipocromos HPO () Abbott
Hb Reticulocitaria media MCHr (pg) Abbott
RBC Hipocromos Hypo He () Sysmex
Hb Reticulocitaria equivalente Ret He (pg) Sysmex
Low Hb density
Contenido de Hb Reticulocitaria
Expresioacuten Hb reticulocitaria
LHD ()
RHCc (pg)
RHE (pg)
Beckman Coulter
Horiba ABX
Mindray
Congreso Nacional Laboratorio Cliacutenico
2018
Informacioacuten avanzada valor antildeadido
Reticulocitos Eritrocitos
bull Permanecen en la sangre 1-2 diacuteas hasta que se convierten en eritrocitos maduros
bull El contenido de hemoglobinapuede reflejar la cantidad de hierro disponible de maneraefectiva
bull Refleja la calidad de la eritropoyesis en el periodoinmediato
bull Permanecen en la sangre 90-120 diacuteas
bull Las diversas subpoblacionespueden reflejar el status feacuterrico en las pasadas semanas
bull MCV MCH son las medias del
conjunto de RBC las de fracciones indican la contribucioacuten de los diversos tipos de RBC a las medias
Congreso Nacional Laboratorio Cliacutenico
2018
Angulo alto
Dispersioacuten lateral Hb
Angulo bajo
Dispersioacuten frontal VOLUMEN
LASER Absorbancia Fluorescencia
RNA contenido
Citometriacutea
Congreso Nacional Laboratorio Cliacutenico
2018
RETICULOCITOS
Compantildeiacutea Instrumento Meacutetodo Colorante Paraacutemetros
Abbott CELLDYN Ruby
CELLDYN
Sapphire
Absorbancia
Fluorescencia
Nuevo azul
metileno
Sybr II
IRF
IRF MCHr MCVr
Beckman
Coulter
UniCell DxH
LH series
Impedancia
citometriacutea de flujo
VCS
Nuevo azul
metileno
Nuevo azul
metileno
IRF MRVHLRRSf
IRF MRV
MSCVHLR
Horiba ABX Pentra
DX120
Impedancia
citometriacutea de flujo
fluorescencia
Naranja de tiazol IRF MRV RETH
RHbC
Siemens ADVIA 120 Absorbancia
Scatter
Oxazine 750 IRF MCVr CHr
Sysmex XE5000 XN Fluorescencia Polimetina IRF RetHe ΔHeCongreso Nacional Laboratorio Cliacutenico
2018
Los reticulocitos precursores de los eritrocitos madurangeneralmente a lo largo de unos dos diacuteas El recuento dereticulocitos es por lo tanto una medida de la cantidad dela eritropoyesis en la meacutedulaParaacutemetros derivados de los reticulocitos los describenmorfoloacutegicamente tamantildeo contenido en Hemoglobinacantidad de material geneacuteticoDe esta forma al referirse a caracteriacutesticas de losreticulocitos es la calidad de la eritropoyesis la que puedeser evaluada
La Hb reticulocitaria se relaciona con la cantidad de hierro disponible efectivamente para laeritropoyesis un valor bajo indica que el aporte es deficitario respecto a la demanda en el momentoactual 28-30 pg
Congreso Nacional Laboratorio Cliacutenico
2018
MCV MCH son los valores medios de volumen y Hb en toda la poblacioacuten RBC
No informan acerca de las ceacutelulas individuales
Ni de la variedad de eacutestas anisocitosis policromasia
Congreso Nacional Laboratorio Cliacutenico
2018
Se cuentan el nuacutemero de pulsos de 36-360fL y el nuacutemero de partiacuteculas que tienen el mismo tamantildeo y se trasladan los resultados a una graacutefica de Volumen Nuacutemero de ceacutelulasSe obtiene el histograma de RBC que proporciona
bull Nuacutemero de RBC el nuacutemero de pulsos dentro de este rango de tamantildeos
bull MCV se corresponde con la media del histograma de RBC
bull RDW o ADE Ancho de Distribucioacuten del histograma de RBC se corresponde con el coeficiente de variacioacuten de la curva
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
Abbott Sapphire lo calcula en el 50 de la altura del pico del histogramaSysmex y Mindray al 20 desde la base del histogramaSiemens calcula la anchura del pico comprendido entre 60 y 120 fL
Aunque RDW ADE generalmente se entiendecomo coeficiente de variacioacuten de ladistribucioacuten de los voluacutemenes de loseritrocitos algunos analizadoreshematoloacutegicos lo calculan desde la medicioacutendirecta de la anchura de la distribucioacuten
Congreso Nacional Laboratorio Cliacutenico
2018
G Lippi amp M Plebani
Recent developments and innovations in red blood cells diagnostics
Journal of Laboratory and Precision Medicine 2018
DOI 1021037jlpm20180709 AOPCongreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
copy 2012 Mindray Confidential 26
HDWHYPERHYPO
HDW HGB Distribution Width
HDW is the distribution width of Hgb histogram
Congreso Nacional Laboratorio Cliacutenico
2018
copy 2012 Mindray Confidential 27
MCHrHDWHYPERHYPOMCHr Mean RET HGB Concentration
Congreso Nacional Laboratorio Cliacutenico
2018
Histograma RBC el mapa de Mie
28 41
Congreso Nacional Laboratorio Cliacutenico
2018
Abbott Mindray Siemens
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
Severe Iron Deficiency Anemia Female 34 years
19 th March 18 th April
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
SysmexRBCHe erythrocyte Hb equivalentRetHe reticulocyte Hb equivalent(content)
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
MIC
MAC
HPO HPR
Congreso Nacional Laboratorio Cliacutenico
2018
copy 2012 Mindray Confidential 36
MINDRAY MCHrHDWHYPERHYPO
MCHr Mean RET HGB Concentration
HDW HGB Distribution Width
HYPER The percentage of hyperchromicred blood cells
HYPO The percentage of hypochromic red blood cells
Thalassemia screeningIDA treatment monitoringIDA screening
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
Hipocromo
Hipercroacutemico onormocroacutemico
iquestConcentracioacuten o contenido de Hemoglobina
Hipocroacutemiconormocroacutemico
Abbott Mindray Siemens Hypo CONCENTRACIOacuteN Hblt280gL
Sysmex Hypo CONTENIDO Hblt 17 pg
Congreso Nacional Laboratorio Cliacutenico
2018
Low Hb Density
Microcytic Factor Maf = (HbMCV)100
Nuevo moacutedulo transductor muacuteltiple con laacuteser de diodo y dos sensores oacutepticos
Anaacutelisis de hasta 50000 ceacutelulas con 7 paraacutemetros tecnoloacutegicos (leucocitos reticulocitos eritroblastos)
1 Volumen digital
2 Conductividad digital
3 5 aacutengulos de dispersioacuten de luz laacuteser digital
bull MALS (Median Angle Light Scatter)
bull UMALS (Upper Median Angle Light Scatter) 20deg a 43deg
bull LMALS (Lower Median Angle Light Scatter) 09deg a 19deg
bull LALS (Low Angle Light Scatter) asymp 51deg
bull AL2 (Axial Light Loss) 0deg a 05deg
Congreso Nacional Laboratorio Cliacutenico
2018
Hierro es un elemento criacutetico para elfuncionamiento oacuteptimo y supervivenciade las ceacutelulas
Disfuncioacuten mitocondrialActividad enzimaacutetica afectadaProteiacutenas de transporte y estructuralesproteins
Capacidad fiacutesica mermadaCapacidad de trabajo reducidaCapacidades cognitivas afectadasMorbilidad y mortalidad
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
It is generally assumed that worldwide ldquoat least half the anemia is due tonutritional iron deficiencyrdquo and that ldquoup to a prevalence of iron deficiency anemiaof 40 the prevalence of iron deficiency will be about 25 times that of anemiardquoHowever it is evident from the foregoing discussion that there are considerablevariations in both of these ratios depending on the age and sex of the peoplebeing studied the region of the world in which they live and the prevalence ratesof other causes of anemia
WHO Department of Nutrition for Health and DevelopmentAssessing the iron status of populations including literature reviews report of a Joint World Health OrganizationCenters for DiseaseControl and Prevention Technical Consultation on the Assessment of Iron Status at the Population Level Geneva Switzerland 6ndash8 April2004 ndash 2nd ed
Congreso Nacional Laboratorio Cliacutenico
2018
Estaacute bien establecido que la anemia produce una miriacuteada de secuelas tanto fiacutesicas comopsicoloacutegicas
Pero los efecto deleteacutereos se deben al deficit de hierro que es un evento previo a que seestablezca la anemia
El deacuteficit de hierrro auacuten sin anemia tiene efectos negativos en el desarrollo cognitivo y fiacutesico
Rattehalli D et al Iron deficiency without anemia do not wait for the Hemoglobin to drop
Health Policy and Technology 2013 2 45-48Congreso Nacio
nal Laboratorio Cliacutenico 2018
SuominenP et al Serum transferrin receptor and transferrin receptor-ferritin index identify healthy subjects with subclinical iron deficits Blood 1998 92 2934ndash9Halwachs-Baumann G Diagnosis of anaemia old things rearranged Wien Med Wochenschr 2012 162478ndash88
Congreso Nacional Laboratorio Cliacutenico
2018
Hemoglobina de reticulocito y su importancia en el diagnoacutestico temprano de anemiaferropeacutenica
Y Maacuterquez-Beniacutetez et al Universidad de BocayaAugust
2018 DOI 1022267rus182003133 aop
El contenido de hemoglobina de reticulocitos (CHr) es un paraacutemetro en la biometriacuteahematoloacutegica automatizada utilizado como un marcador de la biodisponibilidad delhierro en la eritropoyesis
Objetivo Exponer la aplicabilidad de la CHr como un paraacutemetro en el diagnoacutesticoprecoz de la anemia por deficiencia de hierro asiacute como su medicioacuten e interpretacioacuten
Materiales y meacutetodos Se realizoacute la revisioacuten de artiacuteculos cientiacuteficos en ingleacutes y espantildeolen las bases de datos PubMed ScienceDirect LILACS y Medline usando descriptoresvalidados en Medical Subject Headings (MeSH) considerando periodo depublicabilidad del 80 inferior a 5 antildeos
Conclusiones La CHr es un paraacutemetro de gran utilidad en el diagnoacutestico temprano deanemia ferropeacutenica y otras patologiacuteas como deficiencia funcional de hierro estadosde inflamacioacuten croacutenica y enfermedad renal croacutenica
Biomarcador temprano en el diagnoacutestico de deficiencia de hierro antes de presentarsecambios morfoloacutegicos eritrociacuteticosCongreso Nacio
nal Laboratorio Cliacutenico 2018
bull A total of 1105 NES participants (639 men 466 women)bull CHr becomes affected in a relatively early stage in the development of iron deficiency before iron
deficiency anemia and clinical symptoms become apparentbull Therefore this parameter might be useful to identify persons healthy and diseased at risk of
developing iron deficiency anemia and subsequently to apply interventions in order to prevent further development of iron deficiency anemiaCongreso Nacio
nal Laboratorio Cliacutenico 2018
Hb reticulocitaria sensible para detectar la fase inicial del deacuteficit de hierro cuando laeritropoyesis requiere maacutes cantidad que la que recibe ANTES de que la anemia seestablezca
Congreso Nacional Laboratorio Cliacutenico
2018
No ID LID P
RBC 1012L 48 (08) 437 (05) lt00001
Hb gL 135 (6) 131 (12) 0006
MCV fL 922 (21) 902 (38) 0006
MCH pg 324 (07) 306 (22) lt00001
MCHC gL 339 (6) 319 (23) 0001
RDW
Ret He pg
Hypo He
LHD
Ferritin microgL
131 (06)
338 (21)
03 (015)
28 (20)
86 (3)
145 (21)
278 (24)
69 (55)
56 (25)
16 (76)
lt00001
lt00001
lt00001
lt00001
lt00001
AUC 95 CI Cutoff Sensitivity Specificity
LHD 0898 0819-0978 50 859 841
Ret He 0914 0824-1000 299pg 868 857
Hypo He 0934 0856-1000 16 857 921
Clinical value of markers of hypochromia in the detection of latent iron deficiency in non-anemic premenopausal women
No ID Hb gt 120 gL s-ferritin was within reference intervalLatent Iron Defiency Hb gt 120 gL s-ferritin lt 30 μgL
Urrechaga E et al Journal Clin Lab Analysis 2016 30 (5) 623-627
97 women (388) in 250 apparently healthy women had latent IDCongreso Nacional Laboratorio Cliacutenico
2018
Schorer G et al Abstract Jahreskongress der Deutschen Gesellschaft fuumlr Transfusionsmedizin und Immunhaumlmatologie Rostock 15 - 18 September 2009
Congreso Nacional Laboratorio Cliacutenico
2018
Caring for Those Who Share Mitigating Iron Deficiency in Regular Blood DonorsMast Alan E
bull Iron deficiency caused by regular blood donation is a problem facing blood centers Each blood donation removes 200 to 250 mg of iron from the donor Consequently many donors become iron deficient with repeated donation
bull This presents a challenge to blood centers that has become more acute in recent years with the realization that iron deficiency even in the absence of anemia is associated with adverse effects including fatigue and decreased exercise tolerance as well as neurological symptoms such as decreased cognitive function pica and restless leg syndrome
bull REDS-II investigators performed a longitudinal study investigating the iron status of blood donors over a two year period called the REDS-II Donor Iron Status Evaluation (RISE)
bull Results from the baseline analysis of regular donors (e 2 donations per year (females) or e 3 donations per year (males) revealed that over two-thirds of female donors and over one-half of male donors have iron deficiency
Congreso Nacional Laboratorio Cliacutenico
2018
Transfusion 2013 532766-2775
bull We evaluated the diagnostic sensitivity and specificity of red blood cell (RBC) hematology analyzer indices to assess iron status as a part of donor management iron deficient erythropoiesis (IDE) and absence of iron stores (AIS)
bull STUDY DESIGN AND METHODS A total of 1659 male and female donors from the Retrovirus Epidemiology Donor Study-II (REDS-II) Donor Iron Status Evaluation (RISE) study who were either first-timereactivated (FT RA no donations for 2 years) or frequent donors were recruited into a longitudinal study of regular donation of RBCs Of these 1002 donors returned 15 to 24 months later for a final assessment
Absent iron stores (AIS) was defined as plasma ferritin level of less than 12 mgL Logarithm of the ratio of soluble transferrin receptor to ferritin of at least 207 was used to define iron-deficient erythropoiesis (IDE)
bull RESULTS HYPOm and CHr detected IDE with comparable sensitivity 72 versus 69 but differed in specificity HYPOm 68 and CHr 53
For detecting AIS sensitivity was improved to 85 for HYPOm and 81 for CHr but specificity was reduced
Venous Hb had high specificity but poor sensitivity for IDE and AIS A plasma ferritin level of less than 267 mgL was a good surrogate for assessing IDE Congreso Nacio
nal Laboratorio Cliacutenico 2018
Microcytic RBC and reticulocyte mean cell hemoglobin content predicted iron depletion with
sensitivities 70 and 64
specificities of 72 and 78 respectively
When both combined
increased the sensitivity to 82
Congreso Nacional Laboratorio Cliacutenico
2018
Depending on the number of donations during the preceding12 months
Absent iron stores were detected in up to 214 of male and278 of female donors respectively
impaired hemoglobinisation IH was present in up to 64 maleand 167 female donors with 2 and 4 preceding donationsrespectively
The defined CHr cut-off value was 280 pg to detect IH infrequent whole blood donors with AIS leading to a testspecificity of 982 (positive predictive value PPV 577) inmale and of 978 (PPV 829) in female donors
It may help to prevent the development of anemia in frequentblood donors and also can help to decide whether donordeferral or even iron substitution need to be recommended
Congreso Nacional Laboratorio Cliacutenico
2018
Of the 501 blood donors sTfR and Ret-He detected Latent Iron Deficiency in 148 and 135 donors respectively
In comparison to sTfR Ret-He had sensitivity of 927 specificity of 9716 PPV of 931 and NPV of 963
Serum Ferritin TIBC and serum Iron had comparatively lower sensitivity of 8716 797 and 777 respectively
Conclusion Ret-He can be used as a routine screening test to detect LID in blood donors
This could provide an opportunity to make appropriate and timely interventions like dietary changes or drug supplementation
Congreso Nacional Laboratorio Cliacutenico
2018
Singh A Chaudhary R Pandey HC Sonker A Identification of iron status of blood donors by using low hemoglobin density and microcytic anemia factor Asian J Transfus Sci 20181246-50
The main objective of this study was to assess ifLHD and Maf could be used for assessment ofiron status in blood donors and also to establisha cut-off for these two parameters at which atentative iron deficiency could be reportedconclusively
Results LHD and Maf were able to differentiatebetween iron deficient and iron-depleteddonors from normal donorsA cutoff of 918 for LHD was able todifferentiate iron deficient and depleted statefrom normal iron statessensitivity 919 and specificity 71respectivelya cutoff of 1016 for Mafsensitivity 946 and specificity 968
MAf = (MVC Hb) 100
Congreso Nacional Laboratorio Cliacutenico
2018
Hb reticulocitaria sensible para detectar la fase inicial del deacuteficitde hierro cuando la eritropoyesis requiere maacutes cantidad que laque recibe ANTES de que la anemia se establezca
La deteccioacuten precoz del deacuteficit de hierro en la fase del balance negativo demanda aporte contribuye a reducir sus manifestaciones cliacutenicas en los pacientes afectados mejorando la salud puacuteblica
Un tratamiento menos prolongado con suplementos y menor consumo de los recursos sanitaros Contribuye a la eficiencia y sostenibilidad de los servicios sanitarios
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
Buttarello MLaboratory diagnosis of anemia are the old and new red cell parameters useful in classification and treatment howInt Jnl Lab Hem 2016 38 (Suppl 1) 123ndash132
Congreso Nacional Laboratorio Cliacutenico
2018
Buttarello MLaboratory diagnosis of anemia are the old and new red cell parameters useful in classification and treatment howInt Jnl Lab Hem 2016 38 (Suppl 1) 123ndash132
Congreso Nacional Laboratorio Cliacutenico
2018
Ralph Green amp Ananya Datta Mitra Megaloblastic Anemias Nutritional and Other CausesMed Clin N Am 2017 101 297ndash317
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
ANEMIA CARENCIAL CAUSAS
Factores alimentariosConsumir una dieta vegetariana mal planeadaAlimentacioacuten deficiente en los bebeacutesDesnutricioacuten durante el embarazo
Deacuteficit de absorcioacutenAlcoholismo croacutenicoEnfermedad de Crohn celiaquiacutea infeccioacuten otros problemas que le dificulten al cuerpo la digestioacuten de los alimentosAnemia perniciosa (factor intriacutenseco)Cirugiacuteas para extirpar ciertas partes del estoacutemago o el intestino delgado
MedicamentosB12 omeprazol metformina colchicina aminosalicilatos neomicinaFOLATO fenitoiacutena metotrexato sulfasalacina triamtereno pirimetamina trimetoprim con sulfametoxazol barbituacutericos
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
Reacciones metaboacutelicas en las que participan la vitamina B12 y el folato bull la conversioacuten de metilmalonil-CoA a succinil-CoA donde la adenosil-cobalamina actuacutea de
cofactor Por ello un deacuteficit de B12 conlleva un aumento de metilmalonil-CoA y de su producto de hidroacutelisis el aacutecido metilmaloacutenico
bull la siacutentesis de metionina a partir de homocisteina gracias a la metionina sintetasa y a la metil-cobalamina como cofactor En esta misma reaccioacuten el metiltetrahidrofolato es transformado a tetrahidrofolato que es necesario para la siacutentesis de DNA
Congreso Nacional Laboratorio Cliacutenico
2018
Anemia macrociacutetica secundaria a deficiencia de aacutecido foacutelico y de vitamina B12(cobalamina)
La deficiencia de B12 yo aacutecido foacutelico es la causa maacutes frecuente de megaloblastosis
Dentro de distintas funciones generales del metabolismo la vitamina B12 es uncofactor esencial en la siacutentesis de ADN y ARN compromete a todas las ceacutelulas delorganismo
Su deficiencia se manifiesta en oacuterganos con alto recambio celular como la meacutedulaosea y en el sistema nervioso central (SNC) a traveacutes de la siacutentesis de mielina y lareparacioacuten axonal
La deficiencia de cobalamina es responsable de alteraciones hematoloacutegicasneuroloacutegicas neurocognitivas y neuropsiquiaacutetricas
La siacutentesis defectuosa de ADN conduce a la apoptosis y a la hemoacutelisis (intra yextramedular) causantes de la hemopoyesis inefectiva
En meacutedula la siacutentesis ineficiente de DNA causa cambios megaloblaacutesticos comoconsecuencIa anemia y citopenias
Congreso Nacional Laboratorio Cliacutenico
2018
Limitaciones de los meacutetodos diagnoacutesticos claacutesicos
Volumen Corpuscular Medio (VCM) y morfologiacutea de sangre perifeacuterica En una serie de pacientes con deacuteficit de cobalamina soacutelo un 29 teniacutean anemia y soacutelo un 36 teniacutean un VCM gt 100 fL
Un VCM normal no puede ser empleado para rechazar una determinacioacuten de nivel de cobalamina ya que hasta un 25 de casos con manifestaciones neuroloacutegicas cursan con un VCM normal
Cobalamina seacuterica (nivel de B12) Es el test diagnoacutestico rutinario inicial estaacutendar Es un test ampliamente disponible de bajo coste y automatizado Sin embargo presenta algunas limitaciones
-- Existencia de varias teacutecnicas y ausencia de un gold standard por lo que hay diferentes liacutemites de referencia
-- Variacioacuten intraindividual muy alta
La OMS publicoacute en 2008 las conclusiones de un grupo teacutecnico consultado sobre el deacuteficit de cobalamina y folato
El grupo reconocioacute que no existen unos umbrales universalmente reconocidos para definir el deacuteficit de ambas vitaminas y expresaron la necesidad de un consenso
Devalia V Hamilton MS and Molloy AM on behalf of the British Committee for standards in haematology Guidelines for the diagnosis and treatment of cobalamin and folate disorders Br J Haematol 2014 166(4) 496-513
Schrier SL Diagnosis and treatment of vitamin B12 and folate deficiency UpToDate Last updated Jun 25 2014
de Benoist B Conclusions of a WHO Technical Consultation on folate and vitamin B12 deficiencies Food Nutr Bull 200829(2 Suppl)S238ndash44Congreso Nacional Laboratorio Cliacutenico
2018
Tomado de Tefferi A Li C En Atlas of Clinical Hematology Publicado por JO Armitage Philadelphia Current Medicine 2004
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
Int Jnl Lab Hem 2007 29 327ndash334
Clin Lab 201662343-347
In ourstudy mean MCVrMCV ratio of healthy controls is130 as microcytic anemia irondeficiency anemia is121 as also macrocytic anemia vitamin B12 deficiencyanemia is 115
Congreso Nacional Laboratorio Cliacutenico
2018
Sualeh Muslim Khan Muhammad Akbar Agha
Mean cell volume of reticulocytemdashA new parameter for diagnosing sub-clinical cobalamin deficiency in blood donors Int J Lab Hem 20181ndash4
The Abbott CELL-DYN Sapphire Hematology System uses multi-angle polarized scatter separation (MAPSS) and focused flow impedance technologies
Congreso Nacional Laboratorio Cliacutenico
2018
MCVr at 985 fL yielded the highest Youdenrsquos index at sensitivity of 82 specificity of 828 AUC 0847 ( 95 CI 803-891)
Khan SM Agha MA Mean cell volume of reticulocyte-A new parameter for diagnosing sub-clinical cobalamin deficiency in blood donors
Int J Lab Hem 20181ndash4 2018 Jul 13 doi 101111ijlh12899
Congreso Nacional Laboratorio Cliacutenico
2018
Role of Cell Population Data in the detection of folate and cobalamin deficiency
J Nieto et al
XXXI st International Symposium on Technological Innovations in Laboratory Hematology ISLH 2018 10-12 May 2018 Brussels Belgium
M-V-NRET and SD-VNRET are the best discriminatory single parameters to distinguish between patients with B9B12 deficiency and reference subjects M-V-NRETAUC=0823 sensitivity 78 and specificity 86
AUC=0852 sensitivity 55 and specificity 60
Conclusions The CPD parameters of Volume and Light Scatter (M and SD of LALS angle) that inform about size and intracellular structure of RBCs provided very useful information for the detection of B9B12 deficiency
Congreso Nacional Laboratorio Cliacutenico
2018
Cell Population Data
bull Paraacutemetros poblacionales de los leucocitos
bull Describen la morfologiacutea tamantildeo
estructuras citoplasmaacuteticas
nuacutecleo aacutecidos nucleacuteicos
bull Son datos numeacutericos con los que se construyen los ejes de lo diagramas de dispersioacuten de los leucocitos
bull Dependen de la tecnologiacutea
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
High Sensitivity New Parameters for the Detection of Vitamin B12 and Folate Deficiencies Blood 2008 1125379
B12 def vs
Normals
Mann
Withney T-Test
ROC
AUC Sens Specif Cutoff signifROC
MCV p=03156 p=09533 0577
MPV p=00001 0802 792 806 lt83 p=00001
NE Mean
Volume plt00001 0862 833 778 gt1403 p=00001
MO Mean
Volume plt00001 0829 625 889 gt1723 p=00001
MRV p=00113 0705 50 964 gt1133 p=00051
Folate def vs
Normals
Mann
Withney T-Test
ROC
AUC Sens Specif Cut-off signifROC
MCV p=00798 p=06461 0665
MPV plt00001 0832 81 806 lt83 p=00001
NE Mean
Volume p=00008 087 952 694 gt1402 p=00001
MO Mean
Volume p=00002 0801 667 833 gt1696 p=00001
MRV p=00054 0731 476 964 gt1133 p=00019
The Mean Neutrophil Volume (MNE V) and Mean Monocyte Volume (MMOV) may be used for the detection of megaloblastic neutrophils and monocytes MNEV and MMOV have significantly higher sensitivity than the previous information from the red cells (MCV) detecting B12 or folate deficiency because they are not affected by the presence at the same time of Iron deficiency or other reasons of anemia
Congreso Nacional Laboratorio Cliacutenico
2018
POSTER 733
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
CPD Sysmex XN
NE SSC complejidad
NE SFL aacutecidos nucleacuteicos
NE FSC tamantildeo
NE WX
NE WY
NE WZ
MO X
MO Y
MO Z
MO WX
MO WY
MO WZ
LY X
LY Y
LY Z
LY WX
LY WY
LY WZCongreso Nacio
nal Laboratorio Cliacutenico 2018
As MCV is the mean which is calculated it is insensitive to the presence of a small number of macrocytes
Further macrocytosis can be obscured by concomitant disorders that can cause microcytosis resulting inmasked megaloblastic anaemia (MA) for example iron deficiency hereditary elliptocytosis alpha and betathalassemia
This study was undertaken to evaluate the role of NEUT-X and NEUT-Y in detecting MA on peripheral blood andalso see whether other forms of macrocytic anaemia can be differentiated from MA
In MA the peripheral blood smear shows cytopenia with macroovalocytes and hypersegmented
neutrophils (gt5 lobes in 5 neutrophils six lobes nuclei or lobe average of gt35)
In conclusion our study shows that higher values of NEUT-X and NEUT-Y in MA patients in spite of low ornormal MCV high RDW may be used to not only reveal the masked cases of MA with concomitant irondeficiency but also separate them from the broader macrocytic anaemia group
Peripheral smear remains diagnostic however making smear for all the suspicious cases is a cumbersomeand tedious procedure Thus these parameters emerge as more reliable and stable parameters in themodern laboratories which in future may replace the older screening tools
Congreso Nacional Laboratorio Cliacutenico
2018
A favor Eficiencia Operativa
Mejora el proceso del Laboratorio
Mejor informacioacuten al Cliacutenico al mismo coste
Mejora la informacioacuten
Informa sobre la eritropoyesis deteccioacuten precoz de estados carenciales
Ayuda al cliacutenico
Estado real del paciente
En contraParaacutemetros de investigacioacuten
Dificultad de standarizar dependencia teacutecnica
Control de calidadCongreso Nacional Laboratorio Cliacutenico
2018
Camaschella C N Engl J Med 20153721832-43Congreso Nacio
nal Laboratorio Cliacutenico 2018
G Lippi amp M Plebani Recent developments and innovations in red blood cells diagnostics Journal of Laboratory and Precision Medicine 2018DOI 1021037jlpm20180709 AOP
Innovative erythrocyte parametersThese innovative parameters most typically include automated reticulocyte andnucleated RBC counts hemoglobinization of reticulocytes and RBC reticulocytehemoglobin content reticulocyte maturation automatic analysis and calculationof microcytic and hypochromic RBC
The various combination of these different parameters not only may be useful tocomplement clinical history physical examination and results of moreconventional laboratory investigations (ie CBC ferritin transferrin ironhaptoglobin folic acid and vitamin B12 among others) for investigating theunderlying cause(s) of anemia
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
Biomarcadores de Eritroyesis
Urrechaga E Borque L Escanero JF Biomarkers of hypochromia the contemporary assessment of
Iron status and erythropoiesis Journal of Biomedicine and Biotechnology
httpdxdoiorg1011552013603786
Abreviatura
(unidades)
Compantildeiacutea
RBC Hipocromos Hypo () Siemens
Hb Reticulocitaria CHr (pg) Siemens
RBC Hipocromos HPO () Abbott
Hb Reticulocitaria media MCHr (pg) Abbott
RBC Hipocromos Hypo He () Sysmex
Hb Reticulocitaria equivalente Ret He (pg) Sysmex
Low Hb density
Contenido de Hb Reticulocitaria
Expresioacuten Hb reticulocitaria
LHD ()
RHCc (pg)
RHE (pg)
Beckman Coulter
Horiba ABX
Mindray
Congreso Nacional Laboratorio Cliacutenico
2018
Informacioacuten avanzada valor antildeadido
Reticulocitos Eritrocitos
bull Permanecen en la sangre 1-2 diacuteas hasta que se convierten en eritrocitos maduros
bull El contenido de hemoglobinapuede reflejar la cantidad de hierro disponible de maneraefectiva
bull Refleja la calidad de la eritropoyesis en el periodoinmediato
bull Permanecen en la sangre 90-120 diacuteas
bull Las diversas subpoblacionespueden reflejar el status feacuterrico en las pasadas semanas
bull MCV MCH son las medias del
conjunto de RBC las de fracciones indican la contribucioacuten de los diversos tipos de RBC a las medias
Congreso Nacional Laboratorio Cliacutenico
2018
Angulo alto
Dispersioacuten lateral Hb
Angulo bajo
Dispersioacuten frontal VOLUMEN
LASER Absorbancia Fluorescencia
RNA contenido
Citometriacutea
Congreso Nacional Laboratorio Cliacutenico
2018
RETICULOCITOS
Compantildeiacutea Instrumento Meacutetodo Colorante Paraacutemetros
Abbott CELLDYN Ruby
CELLDYN
Sapphire
Absorbancia
Fluorescencia
Nuevo azul
metileno
Sybr II
IRF
IRF MCHr MCVr
Beckman
Coulter
UniCell DxH
LH series
Impedancia
citometriacutea de flujo
VCS
Nuevo azul
metileno
Nuevo azul
metileno
IRF MRVHLRRSf
IRF MRV
MSCVHLR
Horiba ABX Pentra
DX120
Impedancia
citometriacutea de flujo
fluorescencia
Naranja de tiazol IRF MRV RETH
RHbC
Siemens ADVIA 120 Absorbancia
Scatter
Oxazine 750 IRF MCVr CHr
Sysmex XE5000 XN Fluorescencia Polimetina IRF RetHe ΔHeCongreso Nacional Laboratorio Cliacutenico
2018
Los reticulocitos precursores de los eritrocitos madurangeneralmente a lo largo de unos dos diacuteas El recuento dereticulocitos es por lo tanto una medida de la cantidad dela eritropoyesis en la meacutedulaParaacutemetros derivados de los reticulocitos los describenmorfoloacutegicamente tamantildeo contenido en Hemoglobinacantidad de material geneacuteticoDe esta forma al referirse a caracteriacutesticas de losreticulocitos es la calidad de la eritropoyesis la que puedeser evaluada
La Hb reticulocitaria se relaciona con la cantidad de hierro disponible efectivamente para laeritropoyesis un valor bajo indica que el aporte es deficitario respecto a la demanda en el momentoactual 28-30 pg
Congreso Nacional Laboratorio Cliacutenico
2018
MCV MCH son los valores medios de volumen y Hb en toda la poblacioacuten RBC
No informan acerca de las ceacutelulas individuales
Ni de la variedad de eacutestas anisocitosis policromasia
Congreso Nacional Laboratorio Cliacutenico
2018
Se cuentan el nuacutemero de pulsos de 36-360fL y el nuacutemero de partiacuteculas que tienen el mismo tamantildeo y se trasladan los resultados a una graacutefica de Volumen Nuacutemero de ceacutelulasSe obtiene el histograma de RBC que proporciona
bull Nuacutemero de RBC el nuacutemero de pulsos dentro de este rango de tamantildeos
bull MCV se corresponde con la media del histograma de RBC
bull RDW o ADE Ancho de Distribucioacuten del histograma de RBC se corresponde con el coeficiente de variacioacuten de la curva
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
Abbott Sapphire lo calcula en el 50 de la altura del pico del histogramaSysmex y Mindray al 20 desde la base del histogramaSiemens calcula la anchura del pico comprendido entre 60 y 120 fL
Aunque RDW ADE generalmente se entiendecomo coeficiente de variacioacuten de ladistribucioacuten de los voluacutemenes de loseritrocitos algunos analizadoreshematoloacutegicos lo calculan desde la medicioacutendirecta de la anchura de la distribucioacuten
Congreso Nacional Laboratorio Cliacutenico
2018
G Lippi amp M Plebani
Recent developments and innovations in red blood cells diagnostics
Journal of Laboratory and Precision Medicine 2018
DOI 1021037jlpm20180709 AOPCongreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
copy 2012 Mindray Confidential 26
HDWHYPERHYPO
HDW HGB Distribution Width
HDW is the distribution width of Hgb histogram
Congreso Nacional Laboratorio Cliacutenico
2018
copy 2012 Mindray Confidential 27
MCHrHDWHYPERHYPOMCHr Mean RET HGB Concentration
Congreso Nacional Laboratorio Cliacutenico
2018
Histograma RBC el mapa de Mie
28 41
Congreso Nacional Laboratorio Cliacutenico
2018
Abbott Mindray Siemens
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
Severe Iron Deficiency Anemia Female 34 years
19 th March 18 th April
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
SysmexRBCHe erythrocyte Hb equivalentRetHe reticulocyte Hb equivalent(content)
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
MIC
MAC
HPO HPR
Congreso Nacional Laboratorio Cliacutenico
2018
copy 2012 Mindray Confidential 36
MINDRAY MCHrHDWHYPERHYPO
MCHr Mean RET HGB Concentration
HDW HGB Distribution Width
HYPER The percentage of hyperchromicred blood cells
HYPO The percentage of hypochromic red blood cells
Thalassemia screeningIDA treatment monitoringIDA screening
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
Hipocromo
Hipercroacutemico onormocroacutemico
iquestConcentracioacuten o contenido de Hemoglobina
Hipocroacutemiconormocroacutemico
Abbott Mindray Siemens Hypo CONCENTRACIOacuteN Hblt280gL
Sysmex Hypo CONTENIDO Hblt 17 pg
Congreso Nacional Laboratorio Cliacutenico
2018
Low Hb Density
Microcytic Factor Maf = (HbMCV)100
Nuevo moacutedulo transductor muacuteltiple con laacuteser de diodo y dos sensores oacutepticos
Anaacutelisis de hasta 50000 ceacutelulas con 7 paraacutemetros tecnoloacutegicos (leucocitos reticulocitos eritroblastos)
1 Volumen digital
2 Conductividad digital
3 5 aacutengulos de dispersioacuten de luz laacuteser digital
bull MALS (Median Angle Light Scatter)
bull UMALS (Upper Median Angle Light Scatter) 20deg a 43deg
bull LMALS (Lower Median Angle Light Scatter) 09deg a 19deg
bull LALS (Low Angle Light Scatter) asymp 51deg
bull AL2 (Axial Light Loss) 0deg a 05deg
Congreso Nacional Laboratorio Cliacutenico
2018
Hierro es un elemento criacutetico para elfuncionamiento oacuteptimo y supervivenciade las ceacutelulas
Disfuncioacuten mitocondrialActividad enzimaacutetica afectadaProteiacutenas de transporte y estructuralesproteins
Capacidad fiacutesica mermadaCapacidad de trabajo reducidaCapacidades cognitivas afectadasMorbilidad y mortalidad
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
It is generally assumed that worldwide ldquoat least half the anemia is due tonutritional iron deficiencyrdquo and that ldquoup to a prevalence of iron deficiency anemiaof 40 the prevalence of iron deficiency will be about 25 times that of anemiardquoHowever it is evident from the foregoing discussion that there are considerablevariations in both of these ratios depending on the age and sex of the peoplebeing studied the region of the world in which they live and the prevalence ratesof other causes of anemia
WHO Department of Nutrition for Health and DevelopmentAssessing the iron status of populations including literature reviews report of a Joint World Health OrganizationCenters for DiseaseControl and Prevention Technical Consultation on the Assessment of Iron Status at the Population Level Geneva Switzerland 6ndash8 April2004 ndash 2nd ed
Congreso Nacional Laboratorio Cliacutenico
2018
Estaacute bien establecido que la anemia produce una miriacuteada de secuelas tanto fiacutesicas comopsicoloacutegicas
Pero los efecto deleteacutereos se deben al deficit de hierro que es un evento previo a que seestablezca la anemia
El deacuteficit de hierrro auacuten sin anemia tiene efectos negativos en el desarrollo cognitivo y fiacutesico
Rattehalli D et al Iron deficiency without anemia do not wait for the Hemoglobin to drop
Health Policy and Technology 2013 2 45-48Congreso Nacio
nal Laboratorio Cliacutenico 2018
SuominenP et al Serum transferrin receptor and transferrin receptor-ferritin index identify healthy subjects with subclinical iron deficits Blood 1998 92 2934ndash9Halwachs-Baumann G Diagnosis of anaemia old things rearranged Wien Med Wochenschr 2012 162478ndash88
Congreso Nacional Laboratorio Cliacutenico
2018
Hemoglobina de reticulocito y su importancia en el diagnoacutestico temprano de anemiaferropeacutenica
Y Maacuterquez-Beniacutetez et al Universidad de BocayaAugust
2018 DOI 1022267rus182003133 aop
El contenido de hemoglobina de reticulocitos (CHr) es un paraacutemetro en la biometriacuteahematoloacutegica automatizada utilizado como un marcador de la biodisponibilidad delhierro en la eritropoyesis
Objetivo Exponer la aplicabilidad de la CHr como un paraacutemetro en el diagnoacutesticoprecoz de la anemia por deficiencia de hierro asiacute como su medicioacuten e interpretacioacuten
Materiales y meacutetodos Se realizoacute la revisioacuten de artiacuteculos cientiacuteficos en ingleacutes y espantildeolen las bases de datos PubMed ScienceDirect LILACS y Medline usando descriptoresvalidados en Medical Subject Headings (MeSH) considerando periodo depublicabilidad del 80 inferior a 5 antildeos
Conclusiones La CHr es un paraacutemetro de gran utilidad en el diagnoacutestico temprano deanemia ferropeacutenica y otras patologiacuteas como deficiencia funcional de hierro estadosde inflamacioacuten croacutenica y enfermedad renal croacutenica
Biomarcador temprano en el diagnoacutestico de deficiencia de hierro antes de presentarsecambios morfoloacutegicos eritrociacuteticosCongreso Nacio
nal Laboratorio Cliacutenico 2018
bull A total of 1105 NES participants (639 men 466 women)bull CHr becomes affected in a relatively early stage in the development of iron deficiency before iron
deficiency anemia and clinical symptoms become apparentbull Therefore this parameter might be useful to identify persons healthy and diseased at risk of
developing iron deficiency anemia and subsequently to apply interventions in order to prevent further development of iron deficiency anemiaCongreso Nacio
nal Laboratorio Cliacutenico 2018
Hb reticulocitaria sensible para detectar la fase inicial del deacuteficit de hierro cuando laeritropoyesis requiere maacutes cantidad que la que recibe ANTES de que la anemia seestablezca
Congreso Nacional Laboratorio Cliacutenico
2018
No ID LID P
RBC 1012L 48 (08) 437 (05) lt00001
Hb gL 135 (6) 131 (12) 0006
MCV fL 922 (21) 902 (38) 0006
MCH pg 324 (07) 306 (22) lt00001
MCHC gL 339 (6) 319 (23) 0001
RDW
Ret He pg
Hypo He
LHD
Ferritin microgL
131 (06)
338 (21)
03 (015)
28 (20)
86 (3)
145 (21)
278 (24)
69 (55)
56 (25)
16 (76)
lt00001
lt00001
lt00001
lt00001
lt00001
AUC 95 CI Cutoff Sensitivity Specificity
LHD 0898 0819-0978 50 859 841
Ret He 0914 0824-1000 299pg 868 857
Hypo He 0934 0856-1000 16 857 921
Clinical value of markers of hypochromia in the detection of latent iron deficiency in non-anemic premenopausal women
No ID Hb gt 120 gL s-ferritin was within reference intervalLatent Iron Defiency Hb gt 120 gL s-ferritin lt 30 μgL
Urrechaga E et al Journal Clin Lab Analysis 2016 30 (5) 623-627
97 women (388) in 250 apparently healthy women had latent IDCongreso Nacional Laboratorio Cliacutenico
2018
Schorer G et al Abstract Jahreskongress der Deutschen Gesellschaft fuumlr Transfusionsmedizin und Immunhaumlmatologie Rostock 15 - 18 September 2009
Congreso Nacional Laboratorio Cliacutenico
2018
Caring for Those Who Share Mitigating Iron Deficiency in Regular Blood DonorsMast Alan E
bull Iron deficiency caused by regular blood donation is a problem facing blood centers Each blood donation removes 200 to 250 mg of iron from the donor Consequently many donors become iron deficient with repeated donation
bull This presents a challenge to blood centers that has become more acute in recent years with the realization that iron deficiency even in the absence of anemia is associated with adverse effects including fatigue and decreased exercise tolerance as well as neurological symptoms such as decreased cognitive function pica and restless leg syndrome
bull REDS-II investigators performed a longitudinal study investigating the iron status of blood donors over a two year period called the REDS-II Donor Iron Status Evaluation (RISE)
bull Results from the baseline analysis of regular donors (e 2 donations per year (females) or e 3 donations per year (males) revealed that over two-thirds of female donors and over one-half of male donors have iron deficiency
Congreso Nacional Laboratorio Cliacutenico
2018
Transfusion 2013 532766-2775
bull We evaluated the diagnostic sensitivity and specificity of red blood cell (RBC) hematology analyzer indices to assess iron status as a part of donor management iron deficient erythropoiesis (IDE) and absence of iron stores (AIS)
bull STUDY DESIGN AND METHODS A total of 1659 male and female donors from the Retrovirus Epidemiology Donor Study-II (REDS-II) Donor Iron Status Evaluation (RISE) study who were either first-timereactivated (FT RA no donations for 2 years) or frequent donors were recruited into a longitudinal study of regular donation of RBCs Of these 1002 donors returned 15 to 24 months later for a final assessment
Absent iron stores (AIS) was defined as plasma ferritin level of less than 12 mgL Logarithm of the ratio of soluble transferrin receptor to ferritin of at least 207 was used to define iron-deficient erythropoiesis (IDE)
bull RESULTS HYPOm and CHr detected IDE with comparable sensitivity 72 versus 69 but differed in specificity HYPOm 68 and CHr 53
For detecting AIS sensitivity was improved to 85 for HYPOm and 81 for CHr but specificity was reduced
Venous Hb had high specificity but poor sensitivity for IDE and AIS A plasma ferritin level of less than 267 mgL was a good surrogate for assessing IDE Congreso Nacio
nal Laboratorio Cliacutenico 2018
Microcytic RBC and reticulocyte mean cell hemoglobin content predicted iron depletion with
sensitivities 70 and 64
specificities of 72 and 78 respectively
When both combined
increased the sensitivity to 82
Congreso Nacional Laboratorio Cliacutenico
2018
Depending on the number of donations during the preceding12 months
Absent iron stores were detected in up to 214 of male and278 of female donors respectively
impaired hemoglobinisation IH was present in up to 64 maleand 167 female donors with 2 and 4 preceding donationsrespectively
The defined CHr cut-off value was 280 pg to detect IH infrequent whole blood donors with AIS leading to a testspecificity of 982 (positive predictive value PPV 577) inmale and of 978 (PPV 829) in female donors
It may help to prevent the development of anemia in frequentblood donors and also can help to decide whether donordeferral or even iron substitution need to be recommended
Congreso Nacional Laboratorio Cliacutenico
2018
Of the 501 blood donors sTfR and Ret-He detected Latent Iron Deficiency in 148 and 135 donors respectively
In comparison to sTfR Ret-He had sensitivity of 927 specificity of 9716 PPV of 931 and NPV of 963
Serum Ferritin TIBC and serum Iron had comparatively lower sensitivity of 8716 797 and 777 respectively
Conclusion Ret-He can be used as a routine screening test to detect LID in blood donors
This could provide an opportunity to make appropriate and timely interventions like dietary changes or drug supplementation
Congreso Nacional Laboratorio Cliacutenico
2018
Singh A Chaudhary R Pandey HC Sonker A Identification of iron status of blood donors by using low hemoglobin density and microcytic anemia factor Asian J Transfus Sci 20181246-50
The main objective of this study was to assess ifLHD and Maf could be used for assessment ofiron status in blood donors and also to establisha cut-off for these two parameters at which atentative iron deficiency could be reportedconclusively
Results LHD and Maf were able to differentiatebetween iron deficient and iron-depleteddonors from normal donorsA cutoff of 918 for LHD was able todifferentiate iron deficient and depleted statefrom normal iron statessensitivity 919 and specificity 71respectivelya cutoff of 1016 for Mafsensitivity 946 and specificity 968
MAf = (MVC Hb) 100
Congreso Nacional Laboratorio Cliacutenico
2018
Hb reticulocitaria sensible para detectar la fase inicial del deacuteficitde hierro cuando la eritropoyesis requiere maacutes cantidad que laque recibe ANTES de que la anemia se establezca
La deteccioacuten precoz del deacuteficit de hierro en la fase del balance negativo demanda aporte contribuye a reducir sus manifestaciones cliacutenicas en los pacientes afectados mejorando la salud puacuteblica
Un tratamiento menos prolongado con suplementos y menor consumo de los recursos sanitaros Contribuye a la eficiencia y sostenibilidad de los servicios sanitarios
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
Buttarello MLaboratory diagnosis of anemia are the old and new red cell parameters useful in classification and treatment howInt Jnl Lab Hem 2016 38 (Suppl 1) 123ndash132
Congreso Nacional Laboratorio Cliacutenico
2018
Buttarello MLaboratory diagnosis of anemia are the old and new red cell parameters useful in classification and treatment howInt Jnl Lab Hem 2016 38 (Suppl 1) 123ndash132
Congreso Nacional Laboratorio Cliacutenico
2018
Ralph Green amp Ananya Datta Mitra Megaloblastic Anemias Nutritional and Other CausesMed Clin N Am 2017 101 297ndash317
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
ANEMIA CARENCIAL CAUSAS
Factores alimentariosConsumir una dieta vegetariana mal planeadaAlimentacioacuten deficiente en los bebeacutesDesnutricioacuten durante el embarazo
Deacuteficit de absorcioacutenAlcoholismo croacutenicoEnfermedad de Crohn celiaquiacutea infeccioacuten otros problemas que le dificulten al cuerpo la digestioacuten de los alimentosAnemia perniciosa (factor intriacutenseco)Cirugiacuteas para extirpar ciertas partes del estoacutemago o el intestino delgado
MedicamentosB12 omeprazol metformina colchicina aminosalicilatos neomicinaFOLATO fenitoiacutena metotrexato sulfasalacina triamtereno pirimetamina trimetoprim con sulfametoxazol barbituacutericos
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
Reacciones metaboacutelicas en las que participan la vitamina B12 y el folato bull la conversioacuten de metilmalonil-CoA a succinil-CoA donde la adenosil-cobalamina actuacutea de
cofactor Por ello un deacuteficit de B12 conlleva un aumento de metilmalonil-CoA y de su producto de hidroacutelisis el aacutecido metilmaloacutenico
bull la siacutentesis de metionina a partir de homocisteina gracias a la metionina sintetasa y a la metil-cobalamina como cofactor En esta misma reaccioacuten el metiltetrahidrofolato es transformado a tetrahidrofolato que es necesario para la siacutentesis de DNA
Congreso Nacional Laboratorio Cliacutenico
2018
Anemia macrociacutetica secundaria a deficiencia de aacutecido foacutelico y de vitamina B12(cobalamina)
La deficiencia de B12 yo aacutecido foacutelico es la causa maacutes frecuente de megaloblastosis
Dentro de distintas funciones generales del metabolismo la vitamina B12 es uncofactor esencial en la siacutentesis de ADN y ARN compromete a todas las ceacutelulas delorganismo
Su deficiencia se manifiesta en oacuterganos con alto recambio celular como la meacutedulaosea y en el sistema nervioso central (SNC) a traveacutes de la siacutentesis de mielina y lareparacioacuten axonal
La deficiencia de cobalamina es responsable de alteraciones hematoloacutegicasneuroloacutegicas neurocognitivas y neuropsiquiaacutetricas
La siacutentesis defectuosa de ADN conduce a la apoptosis y a la hemoacutelisis (intra yextramedular) causantes de la hemopoyesis inefectiva
En meacutedula la siacutentesis ineficiente de DNA causa cambios megaloblaacutesticos comoconsecuencIa anemia y citopenias
Congreso Nacional Laboratorio Cliacutenico
2018
Limitaciones de los meacutetodos diagnoacutesticos claacutesicos
Volumen Corpuscular Medio (VCM) y morfologiacutea de sangre perifeacuterica En una serie de pacientes con deacuteficit de cobalamina soacutelo un 29 teniacutean anemia y soacutelo un 36 teniacutean un VCM gt 100 fL
Un VCM normal no puede ser empleado para rechazar una determinacioacuten de nivel de cobalamina ya que hasta un 25 de casos con manifestaciones neuroloacutegicas cursan con un VCM normal
Cobalamina seacuterica (nivel de B12) Es el test diagnoacutestico rutinario inicial estaacutendar Es un test ampliamente disponible de bajo coste y automatizado Sin embargo presenta algunas limitaciones
-- Existencia de varias teacutecnicas y ausencia de un gold standard por lo que hay diferentes liacutemites de referencia
-- Variacioacuten intraindividual muy alta
La OMS publicoacute en 2008 las conclusiones de un grupo teacutecnico consultado sobre el deacuteficit de cobalamina y folato
El grupo reconocioacute que no existen unos umbrales universalmente reconocidos para definir el deacuteficit de ambas vitaminas y expresaron la necesidad de un consenso
Devalia V Hamilton MS and Molloy AM on behalf of the British Committee for standards in haematology Guidelines for the diagnosis and treatment of cobalamin and folate disorders Br J Haematol 2014 166(4) 496-513
Schrier SL Diagnosis and treatment of vitamin B12 and folate deficiency UpToDate Last updated Jun 25 2014
de Benoist B Conclusions of a WHO Technical Consultation on folate and vitamin B12 deficiencies Food Nutr Bull 200829(2 Suppl)S238ndash44Congreso Nacional Laboratorio Cliacutenico
2018
Tomado de Tefferi A Li C En Atlas of Clinical Hematology Publicado por JO Armitage Philadelphia Current Medicine 2004
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
Int Jnl Lab Hem 2007 29 327ndash334
Clin Lab 201662343-347
In ourstudy mean MCVrMCV ratio of healthy controls is130 as microcytic anemia irondeficiency anemia is121 as also macrocytic anemia vitamin B12 deficiencyanemia is 115
Congreso Nacional Laboratorio Cliacutenico
2018
Sualeh Muslim Khan Muhammad Akbar Agha
Mean cell volume of reticulocytemdashA new parameter for diagnosing sub-clinical cobalamin deficiency in blood donors Int J Lab Hem 20181ndash4
The Abbott CELL-DYN Sapphire Hematology System uses multi-angle polarized scatter separation (MAPSS) and focused flow impedance technologies
Congreso Nacional Laboratorio Cliacutenico
2018
MCVr at 985 fL yielded the highest Youdenrsquos index at sensitivity of 82 specificity of 828 AUC 0847 ( 95 CI 803-891)
Khan SM Agha MA Mean cell volume of reticulocyte-A new parameter for diagnosing sub-clinical cobalamin deficiency in blood donors
Int J Lab Hem 20181ndash4 2018 Jul 13 doi 101111ijlh12899
Congreso Nacional Laboratorio Cliacutenico
2018
Role of Cell Population Data in the detection of folate and cobalamin deficiency
J Nieto et al
XXXI st International Symposium on Technological Innovations in Laboratory Hematology ISLH 2018 10-12 May 2018 Brussels Belgium
M-V-NRET and SD-VNRET are the best discriminatory single parameters to distinguish between patients with B9B12 deficiency and reference subjects M-V-NRETAUC=0823 sensitivity 78 and specificity 86
AUC=0852 sensitivity 55 and specificity 60
Conclusions The CPD parameters of Volume and Light Scatter (M and SD of LALS angle) that inform about size and intracellular structure of RBCs provided very useful information for the detection of B9B12 deficiency
Congreso Nacional Laboratorio Cliacutenico
2018
Cell Population Data
bull Paraacutemetros poblacionales de los leucocitos
bull Describen la morfologiacutea tamantildeo
estructuras citoplasmaacuteticas
nuacutecleo aacutecidos nucleacuteicos
bull Son datos numeacutericos con los que se construyen los ejes de lo diagramas de dispersioacuten de los leucocitos
bull Dependen de la tecnologiacutea
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
High Sensitivity New Parameters for the Detection of Vitamin B12 and Folate Deficiencies Blood 2008 1125379
B12 def vs
Normals
Mann
Withney T-Test
ROC
AUC Sens Specif Cutoff signifROC
MCV p=03156 p=09533 0577
MPV p=00001 0802 792 806 lt83 p=00001
NE Mean
Volume plt00001 0862 833 778 gt1403 p=00001
MO Mean
Volume plt00001 0829 625 889 gt1723 p=00001
MRV p=00113 0705 50 964 gt1133 p=00051
Folate def vs
Normals
Mann
Withney T-Test
ROC
AUC Sens Specif Cut-off signifROC
MCV p=00798 p=06461 0665
MPV plt00001 0832 81 806 lt83 p=00001
NE Mean
Volume p=00008 087 952 694 gt1402 p=00001
MO Mean
Volume p=00002 0801 667 833 gt1696 p=00001
MRV p=00054 0731 476 964 gt1133 p=00019
The Mean Neutrophil Volume (MNE V) and Mean Monocyte Volume (MMOV) may be used for the detection of megaloblastic neutrophils and monocytes MNEV and MMOV have significantly higher sensitivity than the previous information from the red cells (MCV) detecting B12 or folate deficiency because they are not affected by the presence at the same time of Iron deficiency or other reasons of anemia
Congreso Nacional Laboratorio Cliacutenico
2018
POSTER 733
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
CPD Sysmex XN
NE SSC complejidad
NE SFL aacutecidos nucleacuteicos
NE FSC tamantildeo
NE WX
NE WY
NE WZ
MO X
MO Y
MO Z
MO WX
MO WY
MO WZ
LY X
LY Y
LY Z
LY WX
LY WY
LY WZCongreso Nacio
nal Laboratorio Cliacutenico 2018
As MCV is the mean which is calculated it is insensitive to the presence of a small number of macrocytes
Further macrocytosis can be obscured by concomitant disorders that can cause microcytosis resulting inmasked megaloblastic anaemia (MA) for example iron deficiency hereditary elliptocytosis alpha and betathalassemia
This study was undertaken to evaluate the role of NEUT-X and NEUT-Y in detecting MA on peripheral blood andalso see whether other forms of macrocytic anaemia can be differentiated from MA
In MA the peripheral blood smear shows cytopenia with macroovalocytes and hypersegmented
neutrophils (gt5 lobes in 5 neutrophils six lobes nuclei or lobe average of gt35)
In conclusion our study shows that higher values of NEUT-X and NEUT-Y in MA patients in spite of low ornormal MCV high RDW may be used to not only reveal the masked cases of MA with concomitant irondeficiency but also separate them from the broader macrocytic anaemia group
Peripheral smear remains diagnostic however making smear for all the suspicious cases is a cumbersomeand tedious procedure Thus these parameters emerge as more reliable and stable parameters in themodern laboratories which in future may replace the older screening tools
Congreso Nacional Laboratorio Cliacutenico
2018
A favor Eficiencia Operativa
Mejora el proceso del Laboratorio
Mejor informacioacuten al Cliacutenico al mismo coste
Mejora la informacioacuten
Informa sobre la eritropoyesis deteccioacuten precoz de estados carenciales
Ayuda al cliacutenico
Estado real del paciente
En contraParaacutemetros de investigacioacuten
Dificultad de standarizar dependencia teacutecnica
Control de calidadCongreso Nacional Laboratorio Cliacutenico
2018
G Lippi amp M Plebani Recent developments and innovations in red blood cells diagnostics Journal of Laboratory and Precision Medicine 2018DOI 1021037jlpm20180709 AOP
Innovative erythrocyte parametersThese innovative parameters most typically include automated reticulocyte andnucleated RBC counts hemoglobinization of reticulocytes and RBC reticulocytehemoglobin content reticulocyte maturation automatic analysis and calculationof microcytic and hypochromic RBC
The various combination of these different parameters not only may be useful tocomplement clinical history physical examination and results of moreconventional laboratory investigations (ie CBC ferritin transferrin ironhaptoglobin folic acid and vitamin B12 among others) for investigating theunderlying cause(s) of anemia
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
Biomarcadores de Eritroyesis
Urrechaga E Borque L Escanero JF Biomarkers of hypochromia the contemporary assessment of
Iron status and erythropoiesis Journal of Biomedicine and Biotechnology
httpdxdoiorg1011552013603786
Abreviatura
(unidades)
Compantildeiacutea
RBC Hipocromos Hypo () Siemens
Hb Reticulocitaria CHr (pg) Siemens
RBC Hipocromos HPO () Abbott
Hb Reticulocitaria media MCHr (pg) Abbott
RBC Hipocromos Hypo He () Sysmex
Hb Reticulocitaria equivalente Ret He (pg) Sysmex
Low Hb density
Contenido de Hb Reticulocitaria
Expresioacuten Hb reticulocitaria
LHD ()
RHCc (pg)
RHE (pg)
Beckman Coulter
Horiba ABX
Mindray
Congreso Nacional Laboratorio Cliacutenico
2018
Informacioacuten avanzada valor antildeadido
Reticulocitos Eritrocitos
bull Permanecen en la sangre 1-2 diacuteas hasta que se convierten en eritrocitos maduros
bull El contenido de hemoglobinapuede reflejar la cantidad de hierro disponible de maneraefectiva
bull Refleja la calidad de la eritropoyesis en el periodoinmediato
bull Permanecen en la sangre 90-120 diacuteas
bull Las diversas subpoblacionespueden reflejar el status feacuterrico en las pasadas semanas
bull MCV MCH son las medias del
conjunto de RBC las de fracciones indican la contribucioacuten de los diversos tipos de RBC a las medias
Congreso Nacional Laboratorio Cliacutenico
2018
Angulo alto
Dispersioacuten lateral Hb
Angulo bajo
Dispersioacuten frontal VOLUMEN
LASER Absorbancia Fluorescencia
RNA contenido
Citometriacutea
Congreso Nacional Laboratorio Cliacutenico
2018
RETICULOCITOS
Compantildeiacutea Instrumento Meacutetodo Colorante Paraacutemetros
Abbott CELLDYN Ruby
CELLDYN
Sapphire
Absorbancia
Fluorescencia
Nuevo azul
metileno
Sybr II
IRF
IRF MCHr MCVr
Beckman
Coulter
UniCell DxH
LH series
Impedancia
citometriacutea de flujo
VCS
Nuevo azul
metileno
Nuevo azul
metileno
IRF MRVHLRRSf
IRF MRV
MSCVHLR
Horiba ABX Pentra
DX120
Impedancia
citometriacutea de flujo
fluorescencia
Naranja de tiazol IRF MRV RETH
RHbC
Siemens ADVIA 120 Absorbancia
Scatter
Oxazine 750 IRF MCVr CHr
Sysmex XE5000 XN Fluorescencia Polimetina IRF RetHe ΔHeCongreso Nacional Laboratorio Cliacutenico
2018
Los reticulocitos precursores de los eritrocitos madurangeneralmente a lo largo de unos dos diacuteas El recuento dereticulocitos es por lo tanto una medida de la cantidad dela eritropoyesis en la meacutedulaParaacutemetros derivados de los reticulocitos los describenmorfoloacutegicamente tamantildeo contenido en Hemoglobinacantidad de material geneacuteticoDe esta forma al referirse a caracteriacutesticas de losreticulocitos es la calidad de la eritropoyesis la que puedeser evaluada
La Hb reticulocitaria se relaciona con la cantidad de hierro disponible efectivamente para laeritropoyesis un valor bajo indica que el aporte es deficitario respecto a la demanda en el momentoactual 28-30 pg
Congreso Nacional Laboratorio Cliacutenico
2018
MCV MCH son los valores medios de volumen y Hb en toda la poblacioacuten RBC
No informan acerca de las ceacutelulas individuales
Ni de la variedad de eacutestas anisocitosis policromasia
Congreso Nacional Laboratorio Cliacutenico
2018
Se cuentan el nuacutemero de pulsos de 36-360fL y el nuacutemero de partiacuteculas que tienen el mismo tamantildeo y se trasladan los resultados a una graacutefica de Volumen Nuacutemero de ceacutelulasSe obtiene el histograma de RBC que proporciona
bull Nuacutemero de RBC el nuacutemero de pulsos dentro de este rango de tamantildeos
bull MCV se corresponde con la media del histograma de RBC
bull RDW o ADE Ancho de Distribucioacuten del histograma de RBC se corresponde con el coeficiente de variacioacuten de la curva
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
Abbott Sapphire lo calcula en el 50 de la altura del pico del histogramaSysmex y Mindray al 20 desde la base del histogramaSiemens calcula la anchura del pico comprendido entre 60 y 120 fL
Aunque RDW ADE generalmente se entiendecomo coeficiente de variacioacuten de ladistribucioacuten de los voluacutemenes de loseritrocitos algunos analizadoreshematoloacutegicos lo calculan desde la medicioacutendirecta de la anchura de la distribucioacuten
Congreso Nacional Laboratorio Cliacutenico
2018
G Lippi amp M Plebani
Recent developments and innovations in red blood cells diagnostics
Journal of Laboratory and Precision Medicine 2018
DOI 1021037jlpm20180709 AOPCongreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
copy 2012 Mindray Confidential 26
HDWHYPERHYPO
HDW HGB Distribution Width
HDW is the distribution width of Hgb histogram
Congreso Nacional Laboratorio Cliacutenico
2018
copy 2012 Mindray Confidential 27
MCHrHDWHYPERHYPOMCHr Mean RET HGB Concentration
Congreso Nacional Laboratorio Cliacutenico
2018
Histograma RBC el mapa de Mie
28 41
Congreso Nacional Laboratorio Cliacutenico
2018
Abbott Mindray Siemens
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
Severe Iron Deficiency Anemia Female 34 years
19 th March 18 th April
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
SysmexRBCHe erythrocyte Hb equivalentRetHe reticulocyte Hb equivalent(content)
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
MIC
MAC
HPO HPR
Congreso Nacional Laboratorio Cliacutenico
2018
copy 2012 Mindray Confidential 36
MINDRAY MCHrHDWHYPERHYPO
MCHr Mean RET HGB Concentration
HDW HGB Distribution Width
HYPER The percentage of hyperchromicred blood cells
HYPO The percentage of hypochromic red blood cells
Thalassemia screeningIDA treatment monitoringIDA screening
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
Hipocromo
Hipercroacutemico onormocroacutemico
iquestConcentracioacuten o contenido de Hemoglobina
Hipocroacutemiconormocroacutemico
Abbott Mindray Siemens Hypo CONCENTRACIOacuteN Hblt280gL
Sysmex Hypo CONTENIDO Hblt 17 pg
Congreso Nacional Laboratorio Cliacutenico
2018
Low Hb Density
Microcytic Factor Maf = (HbMCV)100
Nuevo moacutedulo transductor muacuteltiple con laacuteser de diodo y dos sensores oacutepticos
Anaacutelisis de hasta 50000 ceacutelulas con 7 paraacutemetros tecnoloacutegicos (leucocitos reticulocitos eritroblastos)
1 Volumen digital
2 Conductividad digital
3 5 aacutengulos de dispersioacuten de luz laacuteser digital
bull MALS (Median Angle Light Scatter)
bull UMALS (Upper Median Angle Light Scatter) 20deg a 43deg
bull LMALS (Lower Median Angle Light Scatter) 09deg a 19deg
bull LALS (Low Angle Light Scatter) asymp 51deg
bull AL2 (Axial Light Loss) 0deg a 05deg
Congreso Nacional Laboratorio Cliacutenico
2018
Hierro es un elemento criacutetico para elfuncionamiento oacuteptimo y supervivenciade las ceacutelulas
Disfuncioacuten mitocondrialActividad enzimaacutetica afectadaProteiacutenas de transporte y estructuralesproteins
Capacidad fiacutesica mermadaCapacidad de trabajo reducidaCapacidades cognitivas afectadasMorbilidad y mortalidad
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
It is generally assumed that worldwide ldquoat least half the anemia is due tonutritional iron deficiencyrdquo and that ldquoup to a prevalence of iron deficiency anemiaof 40 the prevalence of iron deficiency will be about 25 times that of anemiardquoHowever it is evident from the foregoing discussion that there are considerablevariations in both of these ratios depending on the age and sex of the peoplebeing studied the region of the world in which they live and the prevalence ratesof other causes of anemia
WHO Department of Nutrition for Health and DevelopmentAssessing the iron status of populations including literature reviews report of a Joint World Health OrganizationCenters for DiseaseControl and Prevention Technical Consultation on the Assessment of Iron Status at the Population Level Geneva Switzerland 6ndash8 April2004 ndash 2nd ed
Congreso Nacional Laboratorio Cliacutenico
2018
Estaacute bien establecido que la anemia produce una miriacuteada de secuelas tanto fiacutesicas comopsicoloacutegicas
Pero los efecto deleteacutereos se deben al deficit de hierro que es un evento previo a que seestablezca la anemia
El deacuteficit de hierrro auacuten sin anemia tiene efectos negativos en el desarrollo cognitivo y fiacutesico
Rattehalli D et al Iron deficiency without anemia do not wait for the Hemoglobin to drop
Health Policy and Technology 2013 2 45-48Congreso Nacio
nal Laboratorio Cliacutenico 2018
SuominenP et al Serum transferrin receptor and transferrin receptor-ferritin index identify healthy subjects with subclinical iron deficits Blood 1998 92 2934ndash9Halwachs-Baumann G Diagnosis of anaemia old things rearranged Wien Med Wochenschr 2012 162478ndash88
Congreso Nacional Laboratorio Cliacutenico
2018
Hemoglobina de reticulocito y su importancia en el diagnoacutestico temprano de anemiaferropeacutenica
Y Maacuterquez-Beniacutetez et al Universidad de BocayaAugust
2018 DOI 1022267rus182003133 aop
El contenido de hemoglobina de reticulocitos (CHr) es un paraacutemetro en la biometriacuteahematoloacutegica automatizada utilizado como un marcador de la biodisponibilidad delhierro en la eritropoyesis
Objetivo Exponer la aplicabilidad de la CHr como un paraacutemetro en el diagnoacutesticoprecoz de la anemia por deficiencia de hierro asiacute como su medicioacuten e interpretacioacuten
Materiales y meacutetodos Se realizoacute la revisioacuten de artiacuteculos cientiacuteficos en ingleacutes y espantildeolen las bases de datos PubMed ScienceDirect LILACS y Medline usando descriptoresvalidados en Medical Subject Headings (MeSH) considerando periodo depublicabilidad del 80 inferior a 5 antildeos
Conclusiones La CHr es un paraacutemetro de gran utilidad en el diagnoacutestico temprano deanemia ferropeacutenica y otras patologiacuteas como deficiencia funcional de hierro estadosde inflamacioacuten croacutenica y enfermedad renal croacutenica
Biomarcador temprano en el diagnoacutestico de deficiencia de hierro antes de presentarsecambios morfoloacutegicos eritrociacuteticosCongreso Nacio
nal Laboratorio Cliacutenico 2018
bull A total of 1105 NES participants (639 men 466 women)bull CHr becomes affected in a relatively early stage in the development of iron deficiency before iron
deficiency anemia and clinical symptoms become apparentbull Therefore this parameter might be useful to identify persons healthy and diseased at risk of
developing iron deficiency anemia and subsequently to apply interventions in order to prevent further development of iron deficiency anemiaCongreso Nacio
nal Laboratorio Cliacutenico 2018
Hb reticulocitaria sensible para detectar la fase inicial del deacuteficit de hierro cuando laeritropoyesis requiere maacutes cantidad que la que recibe ANTES de que la anemia seestablezca
Congreso Nacional Laboratorio Cliacutenico
2018
No ID LID P
RBC 1012L 48 (08) 437 (05) lt00001
Hb gL 135 (6) 131 (12) 0006
MCV fL 922 (21) 902 (38) 0006
MCH pg 324 (07) 306 (22) lt00001
MCHC gL 339 (6) 319 (23) 0001
RDW
Ret He pg
Hypo He
LHD
Ferritin microgL
131 (06)
338 (21)
03 (015)
28 (20)
86 (3)
145 (21)
278 (24)
69 (55)
56 (25)
16 (76)
lt00001
lt00001
lt00001
lt00001
lt00001
AUC 95 CI Cutoff Sensitivity Specificity
LHD 0898 0819-0978 50 859 841
Ret He 0914 0824-1000 299pg 868 857
Hypo He 0934 0856-1000 16 857 921
Clinical value of markers of hypochromia in the detection of latent iron deficiency in non-anemic premenopausal women
No ID Hb gt 120 gL s-ferritin was within reference intervalLatent Iron Defiency Hb gt 120 gL s-ferritin lt 30 μgL
Urrechaga E et al Journal Clin Lab Analysis 2016 30 (5) 623-627
97 women (388) in 250 apparently healthy women had latent IDCongreso Nacional Laboratorio Cliacutenico
2018
Schorer G et al Abstract Jahreskongress der Deutschen Gesellschaft fuumlr Transfusionsmedizin und Immunhaumlmatologie Rostock 15 - 18 September 2009
Congreso Nacional Laboratorio Cliacutenico
2018
Caring for Those Who Share Mitigating Iron Deficiency in Regular Blood DonorsMast Alan E
bull Iron deficiency caused by regular blood donation is a problem facing blood centers Each blood donation removes 200 to 250 mg of iron from the donor Consequently many donors become iron deficient with repeated donation
bull This presents a challenge to blood centers that has become more acute in recent years with the realization that iron deficiency even in the absence of anemia is associated with adverse effects including fatigue and decreased exercise tolerance as well as neurological symptoms such as decreased cognitive function pica and restless leg syndrome
bull REDS-II investigators performed a longitudinal study investigating the iron status of blood donors over a two year period called the REDS-II Donor Iron Status Evaluation (RISE)
bull Results from the baseline analysis of regular donors (e 2 donations per year (females) or e 3 donations per year (males) revealed that over two-thirds of female donors and over one-half of male donors have iron deficiency
Congreso Nacional Laboratorio Cliacutenico
2018
Transfusion 2013 532766-2775
bull We evaluated the diagnostic sensitivity and specificity of red blood cell (RBC) hematology analyzer indices to assess iron status as a part of donor management iron deficient erythropoiesis (IDE) and absence of iron stores (AIS)
bull STUDY DESIGN AND METHODS A total of 1659 male and female donors from the Retrovirus Epidemiology Donor Study-II (REDS-II) Donor Iron Status Evaluation (RISE) study who were either first-timereactivated (FT RA no donations for 2 years) or frequent donors were recruited into a longitudinal study of regular donation of RBCs Of these 1002 donors returned 15 to 24 months later for a final assessment
Absent iron stores (AIS) was defined as plasma ferritin level of less than 12 mgL Logarithm of the ratio of soluble transferrin receptor to ferritin of at least 207 was used to define iron-deficient erythropoiesis (IDE)
bull RESULTS HYPOm and CHr detected IDE with comparable sensitivity 72 versus 69 but differed in specificity HYPOm 68 and CHr 53
For detecting AIS sensitivity was improved to 85 for HYPOm and 81 for CHr but specificity was reduced
Venous Hb had high specificity but poor sensitivity for IDE and AIS A plasma ferritin level of less than 267 mgL was a good surrogate for assessing IDE Congreso Nacio
nal Laboratorio Cliacutenico 2018
Microcytic RBC and reticulocyte mean cell hemoglobin content predicted iron depletion with
sensitivities 70 and 64
specificities of 72 and 78 respectively
When both combined
increased the sensitivity to 82
Congreso Nacional Laboratorio Cliacutenico
2018
Depending on the number of donations during the preceding12 months
Absent iron stores were detected in up to 214 of male and278 of female donors respectively
impaired hemoglobinisation IH was present in up to 64 maleand 167 female donors with 2 and 4 preceding donationsrespectively
The defined CHr cut-off value was 280 pg to detect IH infrequent whole blood donors with AIS leading to a testspecificity of 982 (positive predictive value PPV 577) inmale and of 978 (PPV 829) in female donors
It may help to prevent the development of anemia in frequentblood donors and also can help to decide whether donordeferral or even iron substitution need to be recommended
Congreso Nacional Laboratorio Cliacutenico
2018
Of the 501 blood donors sTfR and Ret-He detected Latent Iron Deficiency in 148 and 135 donors respectively
In comparison to sTfR Ret-He had sensitivity of 927 specificity of 9716 PPV of 931 and NPV of 963
Serum Ferritin TIBC and serum Iron had comparatively lower sensitivity of 8716 797 and 777 respectively
Conclusion Ret-He can be used as a routine screening test to detect LID in blood donors
This could provide an opportunity to make appropriate and timely interventions like dietary changes or drug supplementation
Congreso Nacional Laboratorio Cliacutenico
2018
Singh A Chaudhary R Pandey HC Sonker A Identification of iron status of blood donors by using low hemoglobin density and microcytic anemia factor Asian J Transfus Sci 20181246-50
The main objective of this study was to assess ifLHD and Maf could be used for assessment ofiron status in blood donors and also to establisha cut-off for these two parameters at which atentative iron deficiency could be reportedconclusively
Results LHD and Maf were able to differentiatebetween iron deficient and iron-depleteddonors from normal donorsA cutoff of 918 for LHD was able todifferentiate iron deficient and depleted statefrom normal iron statessensitivity 919 and specificity 71respectivelya cutoff of 1016 for Mafsensitivity 946 and specificity 968
MAf = (MVC Hb) 100
Congreso Nacional Laboratorio Cliacutenico
2018
Hb reticulocitaria sensible para detectar la fase inicial del deacuteficitde hierro cuando la eritropoyesis requiere maacutes cantidad que laque recibe ANTES de que la anemia se establezca
La deteccioacuten precoz del deacuteficit de hierro en la fase del balance negativo demanda aporte contribuye a reducir sus manifestaciones cliacutenicas en los pacientes afectados mejorando la salud puacuteblica
Un tratamiento menos prolongado con suplementos y menor consumo de los recursos sanitaros Contribuye a la eficiencia y sostenibilidad de los servicios sanitarios
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
Buttarello MLaboratory diagnosis of anemia are the old and new red cell parameters useful in classification and treatment howInt Jnl Lab Hem 2016 38 (Suppl 1) 123ndash132
Congreso Nacional Laboratorio Cliacutenico
2018
Buttarello MLaboratory diagnosis of anemia are the old and new red cell parameters useful in classification and treatment howInt Jnl Lab Hem 2016 38 (Suppl 1) 123ndash132
Congreso Nacional Laboratorio Cliacutenico
2018
Ralph Green amp Ananya Datta Mitra Megaloblastic Anemias Nutritional and Other CausesMed Clin N Am 2017 101 297ndash317
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
ANEMIA CARENCIAL CAUSAS
Factores alimentariosConsumir una dieta vegetariana mal planeadaAlimentacioacuten deficiente en los bebeacutesDesnutricioacuten durante el embarazo
Deacuteficit de absorcioacutenAlcoholismo croacutenicoEnfermedad de Crohn celiaquiacutea infeccioacuten otros problemas que le dificulten al cuerpo la digestioacuten de los alimentosAnemia perniciosa (factor intriacutenseco)Cirugiacuteas para extirpar ciertas partes del estoacutemago o el intestino delgado
MedicamentosB12 omeprazol metformina colchicina aminosalicilatos neomicinaFOLATO fenitoiacutena metotrexato sulfasalacina triamtereno pirimetamina trimetoprim con sulfametoxazol barbituacutericos
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
Reacciones metaboacutelicas en las que participan la vitamina B12 y el folato bull la conversioacuten de metilmalonil-CoA a succinil-CoA donde la adenosil-cobalamina actuacutea de
cofactor Por ello un deacuteficit de B12 conlleva un aumento de metilmalonil-CoA y de su producto de hidroacutelisis el aacutecido metilmaloacutenico
bull la siacutentesis de metionina a partir de homocisteina gracias a la metionina sintetasa y a la metil-cobalamina como cofactor En esta misma reaccioacuten el metiltetrahidrofolato es transformado a tetrahidrofolato que es necesario para la siacutentesis de DNA
Congreso Nacional Laboratorio Cliacutenico
2018
Anemia macrociacutetica secundaria a deficiencia de aacutecido foacutelico y de vitamina B12(cobalamina)
La deficiencia de B12 yo aacutecido foacutelico es la causa maacutes frecuente de megaloblastosis
Dentro de distintas funciones generales del metabolismo la vitamina B12 es uncofactor esencial en la siacutentesis de ADN y ARN compromete a todas las ceacutelulas delorganismo
Su deficiencia se manifiesta en oacuterganos con alto recambio celular como la meacutedulaosea y en el sistema nervioso central (SNC) a traveacutes de la siacutentesis de mielina y lareparacioacuten axonal
La deficiencia de cobalamina es responsable de alteraciones hematoloacutegicasneuroloacutegicas neurocognitivas y neuropsiquiaacutetricas
La siacutentesis defectuosa de ADN conduce a la apoptosis y a la hemoacutelisis (intra yextramedular) causantes de la hemopoyesis inefectiva
En meacutedula la siacutentesis ineficiente de DNA causa cambios megaloblaacutesticos comoconsecuencIa anemia y citopenias
Congreso Nacional Laboratorio Cliacutenico
2018
Limitaciones de los meacutetodos diagnoacutesticos claacutesicos
Volumen Corpuscular Medio (VCM) y morfologiacutea de sangre perifeacuterica En una serie de pacientes con deacuteficit de cobalamina soacutelo un 29 teniacutean anemia y soacutelo un 36 teniacutean un VCM gt 100 fL
Un VCM normal no puede ser empleado para rechazar una determinacioacuten de nivel de cobalamina ya que hasta un 25 de casos con manifestaciones neuroloacutegicas cursan con un VCM normal
Cobalamina seacuterica (nivel de B12) Es el test diagnoacutestico rutinario inicial estaacutendar Es un test ampliamente disponible de bajo coste y automatizado Sin embargo presenta algunas limitaciones
-- Existencia de varias teacutecnicas y ausencia de un gold standard por lo que hay diferentes liacutemites de referencia
-- Variacioacuten intraindividual muy alta
La OMS publicoacute en 2008 las conclusiones de un grupo teacutecnico consultado sobre el deacuteficit de cobalamina y folato
El grupo reconocioacute que no existen unos umbrales universalmente reconocidos para definir el deacuteficit de ambas vitaminas y expresaron la necesidad de un consenso
Devalia V Hamilton MS and Molloy AM on behalf of the British Committee for standards in haematology Guidelines for the diagnosis and treatment of cobalamin and folate disorders Br J Haematol 2014 166(4) 496-513
Schrier SL Diagnosis and treatment of vitamin B12 and folate deficiency UpToDate Last updated Jun 25 2014
de Benoist B Conclusions of a WHO Technical Consultation on folate and vitamin B12 deficiencies Food Nutr Bull 200829(2 Suppl)S238ndash44Congreso Nacional Laboratorio Cliacutenico
2018
Tomado de Tefferi A Li C En Atlas of Clinical Hematology Publicado por JO Armitage Philadelphia Current Medicine 2004
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
Int Jnl Lab Hem 2007 29 327ndash334
Clin Lab 201662343-347
In ourstudy mean MCVrMCV ratio of healthy controls is130 as microcytic anemia irondeficiency anemia is121 as also macrocytic anemia vitamin B12 deficiencyanemia is 115
Congreso Nacional Laboratorio Cliacutenico
2018
Sualeh Muslim Khan Muhammad Akbar Agha
Mean cell volume of reticulocytemdashA new parameter for diagnosing sub-clinical cobalamin deficiency in blood donors Int J Lab Hem 20181ndash4
The Abbott CELL-DYN Sapphire Hematology System uses multi-angle polarized scatter separation (MAPSS) and focused flow impedance technologies
Congreso Nacional Laboratorio Cliacutenico
2018
MCVr at 985 fL yielded the highest Youdenrsquos index at sensitivity of 82 specificity of 828 AUC 0847 ( 95 CI 803-891)
Khan SM Agha MA Mean cell volume of reticulocyte-A new parameter for diagnosing sub-clinical cobalamin deficiency in blood donors
Int J Lab Hem 20181ndash4 2018 Jul 13 doi 101111ijlh12899
Congreso Nacional Laboratorio Cliacutenico
2018
Role of Cell Population Data in the detection of folate and cobalamin deficiency
J Nieto et al
XXXI st International Symposium on Technological Innovations in Laboratory Hematology ISLH 2018 10-12 May 2018 Brussels Belgium
M-V-NRET and SD-VNRET are the best discriminatory single parameters to distinguish between patients with B9B12 deficiency and reference subjects M-V-NRETAUC=0823 sensitivity 78 and specificity 86
AUC=0852 sensitivity 55 and specificity 60
Conclusions The CPD parameters of Volume and Light Scatter (M and SD of LALS angle) that inform about size and intracellular structure of RBCs provided very useful information for the detection of B9B12 deficiency
Congreso Nacional Laboratorio Cliacutenico
2018
Cell Population Data
bull Paraacutemetros poblacionales de los leucocitos
bull Describen la morfologiacutea tamantildeo
estructuras citoplasmaacuteticas
nuacutecleo aacutecidos nucleacuteicos
bull Son datos numeacutericos con los que se construyen los ejes de lo diagramas de dispersioacuten de los leucocitos
bull Dependen de la tecnologiacutea
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
High Sensitivity New Parameters for the Detection of Vitamin B12 and Folate Deficiencies Blood 2008 1125379
B12 def vs
Normals
Mann
Withney T-Test
ROC
AUC Sens Specif Cutoff signifROC
MCV p=03156 p=09533 0577
MPV p=00001 0802 792 806 lt83 p=00001
NE Mean
Volume plt00001 0862 833 778 gt1403 p=00001
MO Mean
Volume plt00001 0829 625 889 gt1723 p=00001
MRV p=00113 0705 50 964 gt1133 p=00051
Folate def vs
Normals
Mann
Withney T-Test
ROC
AUC Sens Specif Cut-off signifROC
MCV p=00798 p=06461 0665
MPV plt00001 0832 81 806 lt83 p=00001
NE Mean
Volume p=00008 087 952 694 gt1402 p=00001
MO Mean
Volume p=00002 0801 667 833 gt1696 p=00001
MRV p=00054 0731 476 964 gt1133 p=00019
The Mean Neutrophil Volume (MNE V) and Mean Monocyte Volume (MMOV) may be used for the detection of megaloblastic neutrophils and monocytes MNEV and MMOV have significantly higher sensitivity than the previous information from the red cells (MCV) detecting B12 or folate deficiency because they are not affected by the presence at the same time of Iron deficiency or other reasons of anemia
Congreso Nacional Laboratorio Cliacutenico
2018
POSTER 733
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
CPD Sysmex XN
NE SSC complejidad
NE SFL aacutecidos nucleacuteicos
NE FSC tamantildeo
NE WX
NE WY
NE WZ
MO X
MO Y
MO Z
MO WX
MO WY
MO WZ
LY X
LY Y
LY Z
LY WX
LY WY
LY WZCongreso Nacio
nal Laboratorio Cliacutenico 2018
As MCV is the mean which is calculated it is insensitive to the presence of a small number of macrocytes
Further macrocytosis can be obscured by concomitant disorders that can cause microcytosis resulting inmasked megaloblastic anaemia (MA) for example iron deficiency hereditary elliptocytosis alpha and betathalassemia
This study was undertaken to evaluate the role of NEUT-X and NEUT-Y in detecting MA on peripheral blood andalso see whether other forms of macrocytic anaemia can be differentiated from MA
In MA the peripheral blood smear shows cytopenia with macroovalocytes and hypersegmented
neutrophils (gt5 lobes in 5 neutrophils six lobes nuclei or lobe average of gt35)
In conclusion our study shows that higher values of NEUT-X and NEUT-Y in MA patients in spite of low ornormal MCV high RDW may be used to not only reveal the masked cases of MA with concomitant irondeficiency but also separate them from the broader macrocytic anaemia group
Peripheral smear remains diagnostic however making smear for all the suspicious cases is a cumbersomeand tedious procedure Thus these parameters emerge as more reliable and stable parameters in themodern laboratories which in future may replace the older screening tools
Congreso Nacional Laboratorio Cliacutenico
2018
A favor Eficiencia Operativa
Mejora el proceso del Laboratorio
Mejor informacioacuten al Cliacutenico al mismo coste
Mejora la informacioacuten
Informa sobre la eritropoyesis deteccioacuten precoz de estados carenciales
Ayuda al cliacutenico
Estado real del paciente
En contraParaacutemetros de investigacioacuten
Dificultad de standarizar dependencia teacutecnica
Control de calidadCongreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
Biomarcadores de Eritroyesis
Urrechaga E Borque L Escanero JF Biomarkers of hypochromia the contemporary assessment of
Iron status and erythropoiesis Journal of Biomedicine and Biotechnology
httpdxdoiorg1011552013603786
Abreviatura
(unidades)
Compantildeiacutea
RBC Hipocromos Hypo () Siemens
Hb Reticulocitaria CHr (pg) Siemens
RBC Hipocromos HPO () Abbott
Hb Reticulocitaria media MCHr (pg) Abbott
RBC Hipocromos Hypo He () Sysmex
Hb Reticulocitaria equivalente Ret He (pg) Sysmex
Low Hb density
Contenido de Hb Reticulocitaria
Expresioacuten Hb reticulocitaria
LHD ()
RHCc (pg)
RHE (pg)
Beckman Coulter
Horiba ABX
Mindray
Congreso Nacional Laboratorio Cliacutenico
2018
Informacioacuten avanzada valor antildeadido
Reticulocitos Eritrocitos
bull Permanecen en la sangre 1-2 diacuteas hasta que se convierten en eritrocitos maduros
bull El contenido de hemoglobinapuede reflejar la cantidad de hierro disponible de maneraefectiva
bull Refleja la calidad de la eritropoyesis en el periodoinmediato
bull Permanecen en la sangre 90-120 diacuteas
bull Las diversas subpoblacionespueden reflejar el status feacuterrico en las pasadas semanas
bull MCV MCH son las medias del
conjunto de RBC las de fracciones indican la contribucioacuten de los diversos tipos de RBC a las medias
Congreso Nacional Laboratorio Cliacutenico
2018
Angulo alto
Dispersioacuten lateral Hb
Angulo bajo
Dispersioacuten frontal VOLUMEN
LASER Absorbancia Fluorescencia
RNA contenido
Citometriacutea
Congreso Nacional Laboratorio Cliacutenico
2018
RETICULOCITOS
Compantildeiacutea Instrumento Meacutetodo Colorante Paraacutemetros
Abbott CELLDYN Ruby
CELLDYN
Sapphire
Absorbancia
Fluorescencia
Nuevo azul
metileno
Sybr II
IRF
IRF MCHr MCVr
Beckman
Coulter
UniCell DxH
LH series
Impedancia
citometriacutea de flujo
VCS
Nuevo azul
metileno
Nuevo azul
metileno
IRF MRVHLRRSf
IRF MRV
MSCVHLR
Horiba ABX Pentra
DX120
Impedancia
citometriacutea de flujo
fluorescencia
Naranja de tiazol IRF MRV RETH
RHbC
Siemens ADVIA 120 Absorbancia
Scatter
Oxazine 750 IRF MCVr CHr
Sysmex XE5000 XN Fluorescencia Polimetina IRF RetHe ΔHeCongreso Nacional Laboratorio Cliacutenico
2018
Los reticulocitos precursores de los eritrocitos madurangeneralmente a lo largo de unos dos diacuteas El recuento dereticulocitos es por lo tanto una medida de la cantidad dela eritropoyesis en la meacutedulaParaacutemetros derivados de los reticulocitos los describenmorfoloacutegicamente tamantildeo contenido en Hemoglobinacantidad de material geneacuteticoDe esta forma al referirse a caracteriacutesticas de losreticulocitos es la calidad de la eritropoyesis la que puedeser evaluada
La Hb reticulocitaria se relaciona con la cantidad de hierro disponible efectivamente para laeritropoyesis un valor bajo indica que el aporte es deficitario respecto a la demanda en el momentoactual 28-30 pg
Congreso Nacional Laboratorio Cliacutenico
2018
MCV MCH son los valores medios de volumen y Hb en toda la poblacioacuten RBC
No informan acerca de las ceacutelulas individuales
Ni de la variedad de eacutestas anisocitosis policromasia
Congreso Nacional Laboratorio Cliacutenico
2018
Se cuentan el nuacutemero de pulsos de 36-360fL y el nuacutemero de partiacuteculas que tienen el mismo tamantildeo y se trasladan los resultados a una graacutefica de Volumen Nuacutemero de ceacutelulasSe obtiene el histograma de RBC que proporciona
bull Nuacutemero de RBC el nuacutemero de pulsos dentro de este rango de tamantildeos
bull MCV se corresponde con la media del histograma de RBC
bull RDW o ADE Ancho de Distribucioacuten del histograma de RBC se corresponde con el coeficiente de variacioacuten de la curva
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
Abbott Sapphire lo calcula en el 50 de la altura del pico del histogramaSysmex y Mindray al 20 desde la base del histogramaSiemens calcula la anchura del pico comprendido entre 60 y 120 fL
Aunque RDW ADE generalmente se entiendecomo coeficiente de variacioacuten de ladistribucioacuten de los voluacutemenes de loseritrocitos algunos analizadoreshematoloacutegicos lo calculan desde la medicioacutendirecta de la anchura de la distribucioacuten
Congreso Nacional Laboratorio Cliacutenico
2018
G Lippi amp M Plebani
Recent developments and innovations in red blood cells diagnostics
Journal of Laboratory and Precision Medicine 2018
DOI 1021037jlpm20180709 AOPCongreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
copy 2012 Mindray Confidential 26
HDWHYPERHYPO
HDW HGB Distribution Width
HDW is the distribution width of Hgb histogram
Congreso Nacional Laboratorio Cliacutenico
2018
copy 2012 Mindray Confidential 27
MCHrHDWHYPERHYPOMCHr Mean RET HGB Concentration
Congreso Nacional Laboratorio Cliacutenico
2018
Histograma RBC el mapa de Mie
28 41
Congreso Nacional Laboratorio Cliacutenico
2018
Abbott Mindray Siemens
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
Severe Iron Deficiency Anemia Female 34 years
19 th March 18 th April
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
SysmexRBCHe erythrocyte Hb equivalentRetHe reticulocyte Hb equivalent(content)
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
MIC
MAC
HPO HPR
Congreso Nacional Laboratorio Cliacutenico
2018
copy 2012 Mindray Confidential 36
MINDRAY MCHrHDWHYPERHYPO
MCHr Mean RET HGB Concentration
HDW HGB Distribution Width
HYPER The percentage of hyperchromicred blood cells
HYPO The percentage of hypochromic red blood cells
Thalassemia screeningIDA treatment monitoringIDA screening
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
Hipocromo
Hipercroacutemico onormocroacutemico
iquestConcentracioacuten o contenido de Hemoglobina
Hipocroacutemiconormocroacutemico
Abbott Mindray Siemens Hypo CONCENTRACIOacuteN Hblt280gL
Sysmex Hypo CONTENIDO Hblt 17 pg
Congreso Nacional Laboratorio Cliacutenico
2018
Low Hb Density
Microcytic Factor Maf = (HbMCV)100
Nuevo moacutedulo transductor muacuteltiple con laacuteser de diodo y dos sensores oacutepticos
Anaacutelisis de hasta 50000 ceacutelulas con 7 paraacutemetros tecnoloacutegicos (leucocitos reticulocitos eritroblastos)
1 Volumen digital
2 Conductividad digital
3 5 aacutengulos de dispersioacuten de luz laacuteser digital
bull MALS (Median Angle Light Scatter)
bull UMALS (Upper Median Angle Light Scatter) 20deg a 43deg
bull LMALS (Lower Median Angle Light Scatter) 09deg a 19deg
bull LALS (Low Angle Light Scatter) asymp 51deg
bull AL2 (Axial Light Loss) 0deg a 05deg
Congreso Nacional Laboratorio Cliacutenico
2018
Hierro es un elemento criacutetico para elfuncionamiento oacuteptimo y supervivenciade las ceacutelulas
Disfuncioacuten mitocondrialActividad enzimaacutetica afectadaProteiacutenas de transporte y estructuralesproteins
Capacidad fiacutesica mermadaCapacidad de trabajo reducidaCapacidades cognitivas afectadasMorbilidad y mortalidad
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
It is generally assumed that worldwide ldquoat least half the anemia is due tonutritional iron deficiencyrdquo and that ldquoup to a prevalence of iron deficiency anemiaof 40 the prevalence of iron deficiency will be about 25 times that of anemiardquoHowever it is evident from the foregoing discussion that there are considerablevariations in both of these ratios depending on the age and sex of the peoplebeing studied the region of the world in which they live and the prevalence ratesof other causes of anemia
WHO Department of Nutrition for Health and DevelopmentAssessing the iron status of populations including literature reviews report of a Joint World Health OrganizationCenters for DiseaseControl and Prevention Technical Consultation on the Assessment of Iron Status at the Population Level Geneva Switzerland 6ndash8 April2004 ndash 2nd ed
Congreso Nacional Laboratorio Cliacutenico
2018
Estaacute bien establecido que la anemia produce una miriacuteada de secuelas tanto fiacutesicas comopsicoloacutegicas
Pero los efecto deleteacutereos se deben al deficit de hierro que es un evento previo a que seestablezca la anemia
El deacuteficit de hierrro auacuten sin anemia tiene efectos negativos en el desarrollo cognitivo y fiacutesico
Rattehalli D et al Iron deficiency without anemia do not wait for the Hemoglobin to drop
Health Policy and Technology 2013 2 45-48Congreso Nacio
nal Laboratorio Cliacutenico 2018
SuominenP et al Serum transferrin receptor and transferrin receptor-ferritin index identify healthy subjects with subclinical iron deficits Blood 1998 92 2934ndash9Halwachs-Baumann G Diagnosis of anaemia old things rearranged Wien Med Wochenschr 2012 162478ndash88
Congreso Nacional Laboratorio Cliacutenico
2018
Hemoglobina de reticulocito y su importancia en el diagnoacutestico temprano de anemiaferropeacutenica
Y Maacuterquez-Beniacutetez et al Universidad de BocayaAugust
2018 DOI 1022267rus182003133 aop
El contenido de hemoglobina de reticulocitos (CHr) es un paraacutemetro en la biometriacuteahematoloacutegica automatizada utilizado como un marcador de la biodisponibilidad delhierro en la eritropoyesis
Objetivo Exponer la aplicabilidad de la CHr como un paraacutemetro en el diagnoacutesticoprecoz de la anemia por deficiencia de hierro asiacute como su medicioacuten e interpretacioacuten
Materiales y meacutetodos Se realizoacute la revisioacuten de artiacuteculos cientiacuteficos en ingleacutes y espantildeolen las bases de datos PubMed ScienceDirect LILACS y Medline usando descriptoresvalidados en Medical Subject Headings (MeSH) considerando periodo depublicabilidad del 80 inferior a 5 antildeos
Conclusiones La CHr es un paraacutemetro de gran utilidad en el diagnoacutestico temprano deanemia ferropeacutenica y otras patologiacuteas como deficiencia funcional de hierro estadosde inflamacioacuten croacutenica y enfermedad renal croacutenica
Biomarcador temprano en el diagnoacutestico de deficiencia de hierro antes de presentarsecambios morfoloacutegicos eritrociacuteticosCongreso Nacio
nal Laboratorio Cliacutenico 2018
bull A total of 1105 NES participants (639 men 466 women)bull CHr becomes affected in a relatively early stage in the development of iron deficiency before iron
deficiency anemia and clinical symptoms become apparentbull Therefore this parameter might be useful to identify persons healthy and diseased at risk of
developing iron deficiency anemia and subsequently to apply interventions in order to prevent further development of iron deficiency anemiaCongreso Nacio
nal Laboratorio Cliacutenico 2018
Hb reticulocitaria sensible para detectar la fase inicial del deacuteficit de hierro cuando laeritropoyesis requiere maacutes cantidad que la que recibe ANTES de que la anemia seestablezca
Congreso Nacional Laboratorio Cliacutenico
2018
No ID LID P
RBC 1012L 48 (08) 437 (05) lt00001
Hb gL 135 (6) 131 (12) 0006
MCV fL 922 (21) 902 (38) 0006
MCH pg 324 (07) 306 (22) lt00001
MCHC gL 339 (6) 319 (23) 0001
RDW
Ret He pg
Hypo He
LHD
Ferritin microgL
131 (06)
338 (21)
03 (015)
28 (20)
86 (3)
145 (21)
278 (24)
69 (55)
56 (25)
16 (76)
lt00001
lt00001
lt00001
lt00001
lt00001
AUC 95 CI Cutoff Sensitivity Specificity
LHD 0898 0819-0978 50 859 841
Ret He 0914 0824-1000 299pg 868 857
Hypo He 0934 0856-1000 16 857 921
Clinical value of markers of hypochromia in the detection of latent iron deficiency in non-anemic premenopausal women
No ID Hb gt 120 gL s-ferritin was within reference intervalLatent Iron Defiency Hb gt 120 gL s-ferritin lt 30 μgL
Urrechaga E et al Journal Clin Lab Analysis 2016 30 (5) 623-627
97 women (388) in 250 apparently healthy women had latent IDCongreso Nacional Laboratorio Cliacutenico
2018
Schorer G et al Abstract Jahreskongress der Deutschen Gesellschaft fuumlr Transfusionsmedizin und Immunhaumlmatologie Rostock 15 - 18 September 2009
Congreso Nacional Laboratorio Cliacutenico
2018
Caring for Those Who Share Mitigating Iron Deficiency in Regular Blood DonorsMast Alan E
bull Iron deficiency caused by regular blood donation is a problem facing blood centers Each blood donation removes 200 to 250 mg of iron from the donor Consequently many donors become iron deficient with repeated donation
bull This presents a challenge to blood centers that has become more acute in recent years with the realization that iron deficiency even in the absence of anemia is associated with adverse effects including fatigue and decreased exercise tolerance as well as neurological symptoms such as decreased cognitive function pica and restless leg syndrome
bull REDS-II investigators performed a longitudinal study investigating the iron status of blood donors over a two year period called the REDS-II Donor Iron Status Evaluation (RISE)
bull Results from the baseline analysis of regular donors (e 2 donations per year (females) or e 3 donations per year (males) revealed that over two-thirds of female donors and over one-half of male donors have iron deficiency
Congreso Nacional Laboratorio Cliacutenico
2018
Transfusion 2013 532766-2775
bull We evaluated the diagnostic sensitivity and specificity of red blood cell (RBC) hematology analyzer indices to assess iron status as a part of donor management iron deficient erythropoiesis (IDE) and absence of iron stores (AIS)
bull STUDY DESIGN AND METHODS A total of 1659 male and female donors from the Retrovirus Epidemiology Donor Study-II (REDS-II) Donor Iron Status Evaluation (RISE) study who were either first-timereactivated (FT RA no donations for 2 years) or frequent donors were recruited into a longitudinal study of regular donation of RBCs Of these 1002 donors returned 15 to 24 months later for a final assessment
Absent iron stores (AIS) was defined as plasma ferritin level of less than 12 mgL Logarithm of the ratio of soluble transferrin receptor to ferritin of at least 207 was used to define iron-deficient erythropoiesis (IDE)
bull RESULTS HYPOm and CHr detected IDE with comparable sensitivity 72 versus 69 but differed in specificity HYPOm 68 and CHr 53
For detecting AIS sensitivity was improved to 85 for HYPOm and 81 for CHr but specificity was reduced
Venous Hb had high specificity but poor sensitivity for IDE and AIS A plasma ferritin level of less than 267 mgL was a good surrogate for assessing IDE Congreso Nacio
nal Laboratorio Cliacutenico 2018
Microcytic RBC and reticulocyte mean cell hemoglobin content predicted iron depletion with
sensitivities 70 and 64
specificities of 72 and 78 respectively
When both combined
increased the sensitivity to 82
Congreso Nacional Laboratorio Cliacutenico
2018
Depending on the number of donations during the preceding12 months
Absent iron stores were detected in up to 214 of male and278 of female donors respectively
impaired hemoglobinisation IH was present in up to 64 maleand 167 female donors with 2 and 4 preceding donationsrespectively
The defined CHr cut-off value was 280 pg to detect IH infrequent whole blood donors with AIS leading to a testspecificity of 982 (positive predictive value PPV 577) inmale and of 978 (PPV 829) in female donors
It may help to prevent the development of anemia in frequentblood donors and also can help to decide whether donordeferral or even iron substitution need to be recommended
Congreso Nacional Laboratorio Cliacutenico
2018
Of the 501 blood donors sTfR and Ret-He detected Latent Iron Deficiency in 148 and 135 donors respectively
In comparison to sTfR Ret-He had sensitivity of 927 specificity of 9716 PPV of 931 and NPV of 963
Serum Ferritin TIBC and serum Iron had comparatively lower sensitivity of 8716 797 and 777 respectively
Conclusion Ret-He can be used as a routine screening test to detect LID in blood donors
This could provide an opportunity to make appropriate and timely interventions like dietary changes or drug supplementation
Congreso Nacional Laboratorio Cliacutenico
2018
Singh A Chaudhary R Pandey HC Sonker A Identification of iron status of blood donors by using low hemoglobin density and microcytic anemia factor Asian J Transfus Sci 20181246-50
The main objective of this study was to assess ifLHD and Maf could be used for assessment ofiron status in blood donors and also to establisha cut-off for these two parameters at which atentative iron deficiency could be reportedconclusively
Results LHD and Maf were able to differentiatebetween iron deficient and iron-depleteddonors from normal donorsA cutoff of 918 for LHD was able todifferentiate iron deficient and depleted statefrom normal iron statessensitivity 919 and specificity 71respectivelya cutoff of 1016 for Mafsensitivity 946 and specificity 968
MAf = (MVC Hb) 100
Congreso Nacional Laboratorio Cliacutenico
2018
Hb reticulocitaria sensible para detectar la fase inicial del deacuteficitde hierro cuando la eritropoyesis requiere maacutes cantidad que laque recibe ANTES de que la anemia se establezca
La deteccioacuten precoz del deacuteficit de hierro en la fase del balance negativo demanda aporte contribuye a reducir sus manifestaciones cliacutenicas en los pacientes afectados mejorando la salud puacuteblica
Un tratamiento menos prolongado con suplementos y menor consumo de los recursos sanitaros Contribuye a la eficiencia y sostenibilidad de los servicios sanitarios
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
Buttarello MLaboratory diagnosis of anemia are the old and new red cell parameters useful in classification and treatment howInt Jnl Lab Hem 2016 38 (Suppl 1) 123ndash132
Congreso Nacional Laboratorio Cliacutenico
2018
Buttarello MLaboratory diagnosis of anemia are the old and new red cell parameters useful in classification and treatment howInt Jnl Lab Hem 2016 38 (Suppl 1) 123ndash132
Congreso Nacional Laboratorio Cliacutenico
2018
Ralph Green amp Ananya Datta Mitra Megaloblastic Anemias Nutritional and Other CausesMed Clin N Am 2017 101 297ndash317
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
ANEMIA CARENCIAL CAUSAS
Factores alimentariosConsumir una dieta vegetariana mal planeadaAlimentacioacuten deficiente en los bebeacutesDesnutricioacuten durante el embarazo
Deacuteficit de absorcioacutenAlcoholismo croacutenicoEnfermedad de Crohn celiaquiacutea infeccioacuten otros problemas que le dificulten al cuerpo la digestioacuten de los alimentosAnemia perniciosa (factor intriacutenseco)Cirugiacuteas para extirpar ciertas partes del estoacutemago o el intestino delgado
MedicamentosB12 omeprazol metformina colchicina aminosalicilatos neomicinaFOLATO fenitoiacutena metotrexato sulfasalacina triamtereno pirimetamina trimetoprim con sulfametoxazol barbituacutericos
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
Reacciones metaboacutelicas en las que participan la vitamina B12 y el folato bull la conversioacuten de metilmalonil-CoA a succinil-CoA donde la adenosil-cobalamina actuacutea de
cofactor Por ello un deacuteficit de B12 conlleva un aumento de metilmalonil-CoA y de su producto de hidroacutelisis el aacutecido metilmaloacutenico
bull la siacutentesis de metionina a partir de homocisteina gracias a la metionina sintetasa y a la metil-cobalamina como cofactor En esta misma reaccioacuten el metiltetrahidrofolato es transformado a tetrahidrofolato que es necesario para la siacutentesis de DNA
Congreso Nacional Laboratorio Cliacutenico
2018
Anemia macrociacutetica secundaria a deficiencia de aacutecido foacutelico y de vitamina B12(cobalamina)
La deficiencia de B12 yo aacutecido foacutelico es la causa maacutes frecuente de megaloblastosis
Dentro de distintas funciones generales del metabolismo la vitamina B12 es uncofactor esencial en la siacutentesis de ADN y ARN compromete a todas las ceacutelulas delorganismo
Su deficiencia se manifiesta en oacuterganos con alto recambio celular como la meacutedulaosea y en el sistema nervioso central (SNC) a traveacutes de la siacutentesis de mielina y lareparacioacuten axonal
La deficiencia de cobalamina es responsable de alteraciones hematoloacutegicasneuroloacutegicas neurocognitivas y neuropsiquiaacutetricas
La siacutentesis defectuosa de ADN conduce a la apoptosis y a la hemoacutelisis (intra yextramedular) causantes de la hemopoyesis inefectiva
En meacutedula la siacutentesis ineficiente de DNA causa cambios megaloblaacutesticos comoconsecuencIa anemia y citopenias
Congreso Nacional Laboratorio Cliacutenico
2018
Limitaciones de los meacutetodos diagnoacutesticos claacutesicos
Volumen Corpuscular Medio (VCM) y morfologiacutea de sangre perifeacuterica En una serie de pacientes con deacuteficit de cobalamina soacutelo un 29 teniacutean anemia y soacutelo un 36 teniacutean un VCM gt 100 fL
Un VCM normal no puede ser empleado para rechazar una determinacioacuten de nivel de cobalamina ya que hasta un 25 de casos con manifestaciones neuroloacutegicas cursan con un VCM normal
Cobalamina seacuterica (nivel de B12) Es el test diagnoacutestico rutinario inicial estaacutendar Es un test ampliamente disponible de bajo coste y automatizado Sin embargo presenta algunas limitaciones
-- Existencia de varias teacutecnicas y ausencia de un gold standard por lo que hay diferentes liacutemites de referencia
-- Variacioacuten intraindividual muy alta
La OMS publicoacute en 2008 las conclusiones de un grupo teacutecnico consultado sobre el deacuteficit de cobalamina y folato
El grupo reconocioacute que no existen unos umbrales universalmente reconocidos para definir el deacuteficit de ambas vitaminas y expresaron la necesidad de un consenso
Devalia V Hamilton MS and Molloy AM on behalf of the British Committee for standards in haematology Guidelines for the diagnosis and treatment of cobalamin and folate disorders Br J Haematol 2014 166(4) 496-513
Schrier SL Diagnosis and treatment of vitamin B12 and folate deficiency UpToDate Last updated Jun 25 2014
de Benoist B Conclusions of a WHO Technical Consultation on folate and vitamin B12 deficiencies Food Nutr Bull 200829(2 Suppl)S238ndash44Congreso Nacional Laboratorio Cliacutenico
2018
Tomado de Tefferi A Li C En Atlas of Clinical Hematology Publicado por JO Armitage Philadelphia Current Medicine 2004
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
Int Jnl Lab Hem 2007 29 327ndash334
Clin Lab 201662343-347
In ourstudy mean MCVrMCV ratio of healthy controls is130 as microcytic anemia irondeficiency anemia is121 as also macrocytic anemia vitamin B12 deficiencyanemia is 115
Congreso Nacional Laboratorio Cliacutenico
2018
Sualeh Muslim Khan Muhammad Akbar Agha
Mean cell volume of reticulocytemdashA new parameter for diagnosing sub-clinical cobalamin deficiency in blood donors Int J Lab Hem 20181ndash4
The Abbott CELL-DYN Sapphire Hematology System uses multi-angle polarized scatter separation (MAPSS) and focused flow impedance technologies
Congreso Nacional Laboratorio Cliacutenico
2018
MCVr at 985 fL yielded the highest Youdenrsquos index at sensitivity of 82 specificity of 828 AUC 0847 ( 95 CI 803-891)
Khan SM Agha MA Mean cell volume of reticulocyte-A new parameter for diagnosing sub-clinical cobalamin deficiency in blood donors
Int J Lab Hem 20181ndash4 2018 Jul 13 doi 101111ijlh12899
Congreso Nacional Laboratorio Cliacutenico
2018
Role of Cell Population Data in the detection of folate and cobalamin deficiency
J Nieto et al
XXXI st International Symposium on Technological Innovations in Laboratory Hematology ISLH 2018 10-12 May 2018 Brussels Belgium
M-V-NRET and SD-VNRET are the best discriminatory single parameters to distinguish between patients with B9B12 deficiency and reference subjects M-V-NRETAUC=0823 sensitivity 78 and specificity 86
AUC=0852 sensitivity 55 and specificity 60
Conclusions The CPD parameters of Volume and Light Scatter (M and SD of LALS angle) that inform about size and intracellular structure of RBCs provided very useful information for the detection of B9B12 deficiency
Congreso Nacional Laboratorio Cliacutenico
2018
Cell Population Data
bull Paraacutemetros poblacionales de los leucocitos
bull Describen la morfologiacutea tamantildeo
estructuras citoplasmaacuteticas
nuacutecleo aacutecidos nucleacuteicos
bull Son datos numeacutericos con los que se construyen los ejes de lo diagramas de dispersioacuten de los leucocitos
bull Dependen de la tecnologiacutea
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
High Sensitivity New Parameters for the Detection of Vitamin B12 and Folate Deficiencies Blood 2008 1125379
B12 def vs
Normals
Mann
Withney T-Test
ROC
AUC Sens Specif Cutoff signifROC
MCV p=03156 p=09533 0577
MPV p=00001 0802 792 806 lt83 p=00001
NE Mean
Volume plt00001 0862 833 778 gt1403 p=00001
MO Mean
Volume plt00001 0829 625 889 gt1723 p=00001
MRV p=00113 0705 50 964 gt1133 p=00051
Folate def vs
Normals
Mann
Withney T-Test
ROC
AUC Sens Specif Cut-off signifROC
MCV p=00798 p=06461 0665
MPV plt00001 0832 81 806 lt83 p=00001
NE Mean
Volume p=00008 087 952 694 gt1402 p=00001
MO Mean
Volume p=00002 0801 667 833 gt1696 p=00001
MRV p=00054 0731 476 964 gt1133 p=00019
The Mean Neutrophil Volume (MNE V) and Mean Monocyte Volume (MMOV) may be used for the detection of megaloblastic neutrophils and monocytes MNEV and MMOV have significantly higher sensitivity than the previous information from the red cells (MCV) detecting B12 or folate deficiency because they are not affected by the presence at the same time of Iron deficiency or other reasons of anemia
Congreso Nacional Laboratorio Cliacutenico
2018
POSTER 733
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
CPD Sysmex XN
NE SSC complejidad
NE SFL aacutecidos nucleacuteicos
NE FSC tamantildeo
NE WX
NE WY
NE WZ
MO X
MO Y
MO Z
MO WX
MO WY
MO WZ
LY X
LY Y
LY Z
LY WX
LY WY
LY WZCongreso Nacio
nal Laboratorio Cliacutenico 2018
As MCV is the mean which is calculated it is insensitive to the presence of a small number of macrocytes
Further macrocytosis can be obscured by concomitant disorders that can cause microcytosis resulting inmasked megaloblastic anaemia (MA) for example iron deficiency hereditary elliptocytosis alpha and betathalassemia
This study was undertaken to evaluate the role of NEUT-X and NEUT-Y in detecting MA on peripheral blood andalso see whether other forms of macrocytic anaemia can be differentiated from MA
In MA the peripheral blood smear shows cytopenia with macroovalocytes and hypersegmented
neutrophils (gt5 lobes in 5 neutrophils six lobes nuclei or lobe average of gt35)
In conclusion our study shows that higher values of NEUT-X and NEUT-Y in MA patients in spite of low ornormal MCV high RDW may be used to not only reveal the masked cases of MA with concomitant irondeficiency but also separate them from the broader macrocytic anaemia group
Peripheral smear remains diagnostic however making smear for all the suspicious cases is a cumbersomeand tedious procedure Thus these parameters emerge as more reliable and stable parameters in themodern laboratories which in future may replace the older screening tools
Congreso Nacional Laboratorio Cliacutenico
2018
A favor Eficiencia Operativa
Mejora el proceso del Laboratorio
Mejor informacioacuten al Cliacutenico al mismo coste
Mejora la informacioacuten
Informa sobre la eritropoyesis deteccioacuten precoz de estados carenciales
Ayuda al cliacutenico
Estado real del paciente
En contraParaacutemetros de investigacioacuten
Dificultad de standarizar dependencia teacutecnica
Control de calidadCongreso Nacional Laboratorio Cliacutenico
2018
Biomarcadores de Eritroyesis
Urrechaga E Borque L Escanero JF Biomarkers of hypochromia the contemporary assessment of
Iron status and erythropoiesis Journal of Biomedicine and Biotechnology
httpdxdoiorg1011552013603786
Abreviatura
(unidades)
Compantildeiacutea
RBC Hipocromos Hypo () Siemens
Hb Reticulocitaria CHr (pg) Siemens
RBC Hipocromos HPO () Abbott
Hb Reticulocitaria media MCHr (pg) Abbott
RBC Hipocromos Hypo He () Sysmex
Hb Reticulocitaria equivalente Ret He (pg) Sysmex
Low Hb density
Contenido de Hb Reticulocitaria
Expresioacuten Hb reticulocitaria
LHD ()
RHCc (pg)
RHE (pg)
Beckman Coulter
Horiba ABX
Mindray
Congreso Nacional Laboratorio Cliacutenico
2018
Informacioacuten avanzada valor antildeadido
Reticulocitos Eritrocitos
bull Permanecen en la sangre 1-2 diacuteas hasta que se convierten en eritrocitos maduros
bull El contenido de hemoglobinapuede reflejar la cantidad de hierro disponible de maneraefectiva
bull Refleja la calidad de la eritropoyesis en el periodoinmediato
bull Permanecen en la sangre 90-120 diacuteas
bull Las diversas subpoblacionespueden reflejar el status feacuterrico en las pasadas semanas
bull MCV MCH son las medias del
conjunto de RBC las de fracciones indican la contribucioacuten de los diversos tipos de RBC a las medias
Congreso Nacional Laboratorio Cliacutenico
2018
Angulo alto
Dispersioacuten lateral Hb
Angulo bajo
Dispersioacuten frontal VOLUMEN
LASER Absorbancia Fluorescencia
RNA contenido
Citometriacutea
Congreso Nacional Laboratorio Cliacutenico
2018
RETICULOCITOS
Compantildeiacutea Instrumento Meacutetodo Colorante Paraacutemetros
Abbott CELLDYN Ruby
CELLDYN
Sapphire
Absorbancia
Fluorescencia
Nuevo azul
metileno
Sybr II
IRF
IRF MCHr MCVr
Beckman
Coulter
UniCell DxH
LH series
Impedancia
citometriacutea de flujo
VCS
Nuevo azul
metileno
Nuevo azul
metileno
IRF MRVHLRRSf
IRF MRV
MSCVHLR
Horiba ABX Pentra
DX120
Impedancia
citometriacutea de flujo
fluorescencia
Naranja de tiazol IRF MRV RETH
RHbC
Siemens ADVIA 120 Absorbancia
Scatter
Oxazine 750 IRF MCVr CHr
Sysmex XE5000 XN Fluorescencia Polimetina IRF RetHe ΔHeCongreso Nacional Laboratorio Cliacutenico
2018
Los reticulocitos precursores de los eritrocitos madurangeneralmente a lo largo de unos dos diacuteas El recuento dereticulocitos es por lo tanto una medida de la cantidad dela eritropoyesis en la meacutedulaParaacutemetros derivados de los reticulocitos los describenmorfoloacutegicamente tamantildeo contenido en Hemoglobinacantidad de material geneacuteticoDe esta forma al referirse a caracteriacutesticas de losreticulocitos es la calidad de la eritropoyesis la que puedeser evaluada
La Hb reticulocitaria se relaciona con la cantidad de hierro disponible efectivamente para laeritropoyesis un valor bajo indica que el aporte es deficitario respecto a la demanda en el momentoactual 28-30 pg
Congreso Nacional Laboratorio Cliacutenico
2018
MCV MCH son los valores medios de volumen y Hb en toda la poblacioacuten RBC
No informan acerca de las ceacutelulas individuales
Ni de la variedad de eacutestas anisocitosis policromasia
Congreso Nacional Laboratorio Cliacutenico
2018
Se cuentan el nuacutemero de pulsos de 36-360fL y el nuacutemero de partiacuteculas que tienen el mismo tamantildeo y se trasladan los resultados a una graacutefica de Volumen Nuacutemero de ceacutelulasSe obtiene el histograma de RBC que proporciona
bull Nuacutemero de RBC el nuacutemero de pulsos dentro de este rango de tamantildeos
bull MCV se corresponde con la media del histograma de RBC
bull RDW o ADE Ancho de Distribucioacuten del histograma de RBC se corresponde con el coeficiente de variacioacuten de la curva
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
Abbott Sapphire lo calcula en el 50 de la altura del pico del histogramaSysmex y Mindray al 20 desde la base del histogramaSiemens calcula la anchura del pico comprendido entre 60 y 120 fL
Aunque RDW ADE generalmente se entiendecomo coeficiente de variacioacuten de ladistribucioacuten de los voluacutemenes de loseritrocitos algunos analizadoreshematoloacutegicos lo calculan desde la medicioacutendirecta de la anchura de la distribucioacuten
Congreso Nacional Laboratorio Cliacutenico
2018
G Lippi amp M Plebani
Recent developments and innovations in red blood cells diagnostics
Journal of Laboratory and Precision Medicine 2018
DOI 1021037jlpm20180709 AOPCongreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
copy 2012 Mindray Confidential 26
HDWHYPERHYPO
HDW HGB Distribution Width
HDW is the distribution width of Hgb histogram
Congreso Nacional Laboratorio Cliacutenico
2018
copy 2012 Mindray Confidential 27
MCHrHDWHYPERHYPOMCHr Mean RET HGB Concentration
Congreso Nacional Laboratorio Cliacutenico
2018
Histograma RBC el mapa de Mie
28 41
Congreso Nacional Laboratorio Cliacutenico
2018
Abbott Mindray Siemens
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
Severe Iron Deficiency Anemia Female 34 years
19 th March 18 th April
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
SysmexRBCHe erythrocyte Hb equivalentRetHe reticulocyte Hb equivalent(content)
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
MIC
MAC
HPO HPR
Congreso Nacional Laboratorio Cliacutenico
2018
copy 2012 Mindray Confidential 36
MINDRAY MCHrHDWHYPERHYPO
MCHr Mean RET HGB Concentration
HDW HGB Distribution Width
HYPER The percentage of hyperchromicred blood cells
HYPO The percentage of hypochromic red blood cells
Thalassemia screeningIDA treatment monitoringIDA screening
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
Hipocromo
Hipercroacutemico onormocroacutemico
iquestConcentracioacuten o contenido de Hemoglobina
Hipocroacutemiconormocroacutemico
Abbott Mindray Siemens Hypo CONCENTRACIOacuteN Hblt280gL
Sysmex Hypo CONTENIDO Hblt 17 pg
Congreso Nacional Laboratorio Cliacutenico
2018
Low Hb Density
Microcytic Factor Maf = (HbMCV)100
Nuevo moacutedulo transductor muacuteltiple con laacuteser de diodo y dos sensores oacutepticos
Anaacutelisis de hasta 50000 ceacutelulas con 7 paraacutemetros tecnoloacutegicos (leucocitos reticulocitos eritroblastos)
1 Volumen digital
2 Conductividad digital
3 5 aacutengulos de dispersioacuten de luz laacuteser digital
bull MALS (Median Angle Light Scatter)
bull UMALS (Upper Median Angle Light Scatter) 20deg a 43deg
bull LMALS (Lower Median Angle Light Scatter) 09deg a 19deg
bull LALS (Low Angle Light Scatter) asymp 51deg
bull AL2 (Axial Light Loss) 0deg a 05deg
Congreso Nacional Laboratorio Cliacutenico
2018
Hierro es un elemento criacutetico para elfuncionamiento oacuteptimo y supervivenciade las ceacutelulas
Disfuncioacuten mitocondrialActividad enzimaacutetica afectadaProteiacutenas de transporte y estructuralesproteins
Capacidad fiacutesica mermadaCapacidad de trabajo reducidaCapacidades cognitivas afectadasMorbilidad y mortalidad
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
It is generally assumed that worldwide ldquoat least half the anemia is due tonutritional iron deficiencyrdquo and that ldquoup to a prevalence of iron deficiency anemiaof 40 the prevalence of iron deficiency will be about 25 times that of anemiardquoHowever it is evident from the foregoing discussion that there are considerablevariations in both of these ratios depending on the age and sex of the peoplebeing studied the region of the world in which they live and the prevalence ratesof other causes of anemia
WHO Department of Nutrition for Health and DevelopmentAssessing the iron status of populations including literature reviews report of a Joint World Health OrganizationCenters for DiseaseControl and Prevention Technical Consultation on the Assessment of Iron Status at the Population Level Geneva Switzerland 6ndash8 April2004 ndash 2nd ed
Congreso Nacional Laboratorio Cliacutenico
2018
Estaacute bien establecido que la anemia produce una miriacuteada de secuelas tanto fiacutesicas comopsicoloacutegicas
Pero los efecto deleteacutereos se deben al deficit de hierro que es un evento previo a que seestablezca la anemia
El deacuteficit de hierrro auacuten sin anemia tiene efectos negativos en el desarrollo cognitivo y fiacutesico
Rattehalli D et al Iron deficiency without anemia do not wait for the Hemoglobin to drop
Health Policy and Technology 2013 2 45-48Congreso Nacio
nal Laboratorio Cliacutenico 2018
SuominenP et al Serum transferrin receptor and transferrin receptor-ferritin index identify healthy subjects with subclinical iron deficits Blood 1998 92 2934ndash9Halwachs-Baumann G Diagnosis of anaemia old things rearranged Wien Med Wochenschr 2012 162478ndash88
Congreso Nacional Laboratorio Cliacutenico
2018
Hemoglobina de reticulocito y su importancia en el diagnoacutestico temprano de anemiaferropeacutenica
Y Maacuterquez-Beniacutetez et al Universidad de BocayaAugust
2018 DOI 1022267rus182003133 aop
El contenido de hemoglobina de reticulocitos (CHr) es un paraacutemetro en la biometriacuteahematoloacutegica automatizada utilizado como un marcador de la biodisponibilidad delhierro en la eritropoyesis
Objetivo Exponer la aplicabilidad de la CHr como un paraacutemetro en el diagnoacutesticoprecoz de la anemia por deficiencia de hierro asiacute como su medicioacuten e interpretacioacuten
Materiales y meacutetodos Se realizoacute la revisioacuten de artiacuteculos cientiacuteficos en ingleacutes y espantildeolen las bases de datos PubMed ScienceDirect LILACS y Medline usando descriptoresvalidados en Medical Subject Headings (MeSH) considerando periodo depublicabilidad del 80 inferior a 5 antildeos
Conclusiones La CHr es un paraacutemetro de gran utilidad en el diagnoacutestico temprano deanemia ferropeacutenica y otras patologiacuteas como deficiencia funcional de hierro estadosde inflamacioacuten croacutenica y enfermedad renal croacutenica
Biomarcador temprano en el diagnoacutestico de deficiencia de hierro antes de presentarsecambios morfoloacutegicos eritrociacuteticosCongreso Nacio
nal Laboratorio Cliacutenico 2018
bull A total of 1105 NES participants (639 men 466 women)bull CHr becomes affected in a relatively early stage in the development of iron deficiency before iron
deficiency anemia and clinical symptoms become apparentbull Therefore this parameter might be useful to identify persons healthy and diseased at risk of
developing iron deficiency anemia and subsequently to apply interventions in order to prevent further development of iron deficiency anemiaCongreso Nacio
nal Laboratorio Cliacutenico 2018
Hb reticulocitaria sensible para detectar la fase inicial del deacuteficit de hierro cuando laeritropoyesis requiere maacutes cantidad que la que recibe ANTES de que la anemia seestablezca
Congreso Nacional Laboratorio Cliacutenico
2018
No ID LID P
RBC 1012L 48 (08) 437 (05) lt00001
Hb gL 135 (6) 131 (12) 0006
MCV fL 922 (21) 902 (38) 0006
MCH pg 324 (07) 306 (22) lt00001
MCHC gL 339 (6) 319 (23) 0001
RDW
Ret He pg
Hypo He
LHD
Ferritin microgL
131 (06)
338 (21)
03 (015)
28 (20)
86 (3)
145 (21)
278 (24)
69 (55)
56 (25)
16 (76)
lt00001
lt00001
lt00001
lt00001
lt00001
AUC 95 CI Cutoff Sensitivity Specificity
LHD 0898 0819-0978 50 859 841
Ret He 0914 0824-1000 299pg 868 857
Hypo He 0934 0856-1000 16 857 921
Clinical value of markers of hypochromia in the detection of latent iron deficiency in non-anemic premenopausal women
No ID Hb gt 120 gL s-ferritin was within reference intervalLatent Iron Defiency Hb gt 120 gL s-ferritin lt 30 μgL
Urrechaga E et al Journal Clin Lab Analysis 2016 30 (5) 623-627
97 women (388) in 250 apparently healthy women had latent IDCongreso Nacional Laboratorio Cliacutenico
2018
Schorer G et al Abstract Jahreskongress der Deutschen Gesellschaft fuumlr Transfusionsmedizin und Immunhaumlmatologie Rostock 15 - 18 September 2009
Congreso Nacional Laboratorio Cliacutenico
2018
Caring for Those Who Share Mitigating Iron Deficiency in Regular Blood DonorsMast Alan E
bull Iron deficiency caused by regular blood donation is a problem facing blood centers Each blood donation removes 200 to 250 mg of iron from the donor Consequently many donors become iron deficient with repeated donation
bull This presents a challenge to blood centers that has become more acute in recent years with the realization that iron deficiency even in the absence of anemia is associated with adverse effects including fatigue and decreased exercise tolerance as well as neurological symptoms such as decreased cognitive function pica and restless leg syndrome
bull REDS-II investigators performed a longitudinal study investigating the iron status of blood donors over a two year period called the REDS-II Donor Iron Status Evaluation (RISE)
bull Results from the baseline analysis of regular donors (e 2 donations per year (females) or e 3 donations per year (males) revealed that over two-thirds of female donors and over one-half of male donors have iron deficiency
Congreso Nacional Laboratorio Cliacutenico
2018
Transfusion 2013 532766-2775
bull We evaluated the diagnostic sensitivity and specificity of red blood cell (RBC) hematology analyzer indices to assess iron status as a part of donor management iron deficient erythropoiesis (IDE) and absence of iron stores (AIS)
bull STUDY DESIGN AND METHODS A total of 1659 male and female donors from the Retrovirus Epidemiology Donor Study-II (REDS-II) Donor Iron Status Evaluation (RISE) study who were either first-timereactivated (FT RA no donations for 2 years) or frequent donors were recruited into a longitudinal study of regular donation of RBCs Of these 1002 donors returned 15 to 24 months later for a final assessment
Absent iron stores (AIS) was defined as plasma ferritin level of less than 12 mgL Logarithm of the ratio of soluble transferrin receptor to ferritin of at least 207 was used to define iron-deficient erythropoiesis (IDE)
bull RESULTS HYPOm and CHr detected IDE with comparable sensitivity 72 versus 69 but differed in specificity HYPOm 68 and CHr 53
For detecting AIS sensitivity was improved to 85 for HYPOm and 81 for CHr but specificity was reduced
Venous Hb had high specificity but poor sensitivity for IDE and AIS A plasma ferritin level of less than 267 mgL was a good surrogate for assessing IDE Congreso Nacio
nal Laboratorio Cliacutenico 2018
Microcytic RBC and reticulocyte mean cell hemoglobin content predicted iron depletion with
sensitivities 70 and 64
specificities of 72 and 78 respectively
When both combined
increased the sensitivity to 82
Congreso Nacional Laboratorio Cliacutenico
2018
Depending on the number of donations during the preceding12 months
Absent iron stores were detected in up to 214 of male and278 of female donors respectively
impaired hemoglobinisation IH was present in up to 64 maleand 167 female donors with 2 and 4 preceding donationsrespectively
The defined CHr cut-off value was 280 pg to detect IH infrequent whole blood donors with AIS leading to a testspecificity of 982 (positive predictive value PPV 577) inmale and of 978 (PPV 829) in female donors
It may help to prevent the development of anemia in frequentblood donors and also can help to decide whether donordeferral or even iron substitution need to be recommended
Congreso Nacional Laboratorio Cliacutenico
2018
Of the 501 blood donors sTfR and Ret-He detected Latent Iron Deficiency in 148 and 135 donors respectively
In comparison to sTfR Ret-He had sensitivity of 927 specificity of 9716 PPV of 931 and NPV of 963
Serum Ferritin TIBC and serum Iron had comparatively lower sensitivity of 8716 797 and 777 respectively
Conclusion Ret-He can be used as a routine screening test to detect LID in blood donors
This could provide an opportunity to make appropriate and timely interventions like dietary changes or drug supplementation
Congreso Nacional Laboratorio Cliacutenico
2018
Singh A Chaudhary R Pandey HC Sonker A Identification of iron status of blood donors by using low hemoglobin density and microcytic anemia factor Asian J Transfus Sci 20181246-50
The main objective of this study was to assess ifLHD and Maf could be used for assessment ofiron status in blood donors and also to establisha cut-off for these two parameters at which atentative iron deficiency could be reportedconclusively
Results LHD and Maf were able to differentiatebetween iron deficient and iron-depleteddonors from normal donorsA cutoff of 918 for LHD was able todifferentiate iron deficient and depleted statefrom normal iron statessensitivity 919 and specificity 71respectivelya cutoff of 1016 for Mafsensitivity 946 and specificity 968
MAf = (MVC Hb) 100
Congreso Nacional Laboratorio Cliacutenico
2018
Hb reticulocitaria sensible para detectar la fase inicial del deacuteficitde hierro cuando la eritropoyesis requiere maacutes cantidad que laque recibe ANTES de que la anemia se establezca
La deteccioacuten precoz del deacuteficit de hierro en la fase del balance negativo demanda aporte contribuye a reducir sus manifestaciones cliacutenicas en los pacientes afectados mejorando la salud puacuteblica
Un tratamiento menos prolongado con suplementos y menor consumo de los recursos sanitaros Contribuye a la eficiencia y sostenibilidad de los servicios sanitarios
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
Buttarello MLaboratory diagnosis of anemia are the old and new red cell parameters useful in classification and treatment howInt Jnl Lab Hem 2016 38 (Suppl 1) 123ndash132
Congreso Nacional Laboratorio Cliacutenico
2018
Buttarello MLaboratory diagnosis of anemia are the old and new red cell parameters useful in classification and treatment howInt Jnl Lab Hem 2016 38 (Suppl 1) 123ndash132
Congreso Nacional Laboratorio Cliacutenico
2018
Ralph Green amp Ananya Datta Mitra Megaloblastic Anemias Nutritional and Other CausesMed Clin N Am 2017 101 297ndash317
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
ANEMIA CARENCIAL CAUSAS
Factores alimentariosConsumir una dieta vegetariana mal planeadaAlimentacioacuten deficiente en los bebeacutesDesnutricioacuten durante el embarazo
Deacuteficit de absorcioacutenAlcoholismo croacutenicoEnfermedad de Crohn celiaquiacutea infeccioacuten otros problemas que le dificulten al cuerpo la digestioacuten de los alimentosAnemia perniciosa (factor intriacutenseco)Cirugiacuteas para extirpar ciertas partes del estoacutemago o el intestino delgado
MedicamentosB12 omeprazol metformina colchicina aminosalicilatos neomicinaFOLATO fenitoiacutena metotrexato sulfasalacina triamtereno pirimetamina trimetoprim con sulfametoxazol barbituacutericos
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
Reacciones metaboacutelicas en las que participan la vitamina B12 y el folato bull la conversioacuten de metilmalonil-CoA a succinil-CoA donde la adenosil-cobalamina actuacutea de
cofactor Por ello un deacuteficit de B12 conlleva un aumento de metilmalonil-CoA y de su producto de hidroacutelisis el aacutecido metilmaloacutenico
bull la siacutentesis de metionina a partir de homocisteina gracias a la metionina sintetasa y a la metil-cobalamina como cofactor En esta misma reaccioacuten el metiltetrahidrofolato es transformado a tetrahidrofolato que es necesario para la siacutentesis de DNA
Congreso Nacional Laboratorio Cliacutenico
2018
Anemia macrociacutetica secundaria a deficiencia de aacutecido foacutelico y de vitamina B12(cobalamina)
La deficiencia de B12 yo aacutecido foacutelico es la causa maacutes frecuente de megaloblastosis
Dentro de distintas funciones generales del metabolismo la vitamina B12 es uncofactor esencial en la siacutentesis de ADN y ARN compromete a todas las ceacutelulas delorganismo
Su deficiencia se manifiesta en oacuterganos con alto recambio celular como la meacutedulaosea y en el sistema nervioso central (SNC) a traveacutes de la siacutentesis de mielina y lareparacioacuten axonal
La deficiencia de cobalamina es responsable de alteraciones hematoloacutegicasneuroloacutegicas neurocognitivas y neuropsiquiaacutetricas
La siacutentesis defectuosa de ADN conduce a la apoptosis y a la hemoacutelisis (intra yextramedular) causantes de la hemopoyesis inefectiva
En meacutedula la siacutentesis ineficiente de DNA causa cambios megaloblaacutesticos comoconsecuencIa anemia y citopenias
Congreso Nacional Laboratorio Cliacutenico
2018
Limitaciones de los meacutetodos diagnoacutesticos claacutesicos
Volumen Corpuscular Medio (VCM) y morfologiacutea de sangre perifeacuterica En una serie de pacientes con deacuteficit de cobalamina soacutelo un 29 teniacutean anemia y soacutelo un 36 teniacutean un VCM gt 100 fL
Un VCM normal no puede ser empleado para rechazar una determinacioacuten de nivel de cobalamina ya que hasta un 25 de casos con manifestaciones neuroloacutegicas cursan con un VCM normal
Cobalamina seacuterica (nivel de B12) Es el test diagnoacutestico rutinario inicial estaacutendar Es un test ampliamente disponible de bajo coste y automatizado Sin embargo presenta algunas limitaciones
-- Existencia de varias teacutecnicas y ausencia de un gold standard por lo que hay diferentes liacutemites de referencia
-- Variacioacuten intraindividual muy alta
La OMS publicoacute en 2008 las conclusiones de un grupo teacutecnico consultado sobre el deacuteficit de cobalamina y folato
El grupo reconocioacute que no existen unos umbrales universalmente reconocidos para definir el deacuteficit de ambas vitaminas y expresaron la necesidad de un consenso
Devalia V Hamilton MS and Molloy AM on behalf of the British Committee for standards in haematology Guidelines for the diagnosis and treatment of cobalamin and folate disorders Br J Haematol 2014 166(4) 496-513
Schrier SL Diagnosis and treatment of vitamin B12 and folate deficiency UpToDate Last updated Jun 25 2014
de Benoist B Conclusions of a WHO Technical Consultation on folate and vitamin B12 deficiencies Food Nutr Bull 200829(2 Suppl)S238ndash44Congreso Nacional Laboratorio Cliacutenico
2018
Tomado de Tefferi A Li C En Atlas of Clinical Hematology Publicado por JO Armitage Philadelphia Current Medicine 2004
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
Int Jnl Lab Hem 2007 29 327ndash334
Clin Lab 201662343-347
In ourstudy mean MCVrMCV ratio of healthy controls is130 as microcytic anemia irondeficiency anemia is121 as also macrocytic anemia vitamin B12 deficiencyanemia is 115
Congreso Nacional Laboratorio Cliacutenico
2018
Sualeh Muslim Khan Muhammad Akbar Agha
Mean cell volume of reticulocytemdashA new parameter for diagnosing sub-clinical cobalamin deficiency in blood donors Int J Lab Hem 20181ndash4
The Abbott CELL-DYN Sapphire Hematology System uses multi-angle polarized scatter separation (MAPSS) and focused flow impedance technologies
Congreso Nacional Laboratorio Cliacutenico
2018
MCVr at 985 fL yielded the highest Youdenrsquos index at sensitivity of 82 specificity of 828 AUC 0847 ( 95 CI 803-891)
Khan SM Agha MA Mean cell volume of reticulocyte-A new parameter for diagnosing sub-clinical cobalamin deficiency in blood donors
Int J Lab Hem 20181ndash4 2018 Jul 13 doi 101111ijlh12899
Congreso Nacional Laboratorio Cliacutenico
2018
Role of Cell Population Data in the detection of folate and cobalamin deficiency
J Nieto et al
XXXI st International Symposium on Technological Innovations in Laboratory Hematology ISLH 2018 10-12 May 2018 Brussels Belgium
M-V-NRET and SD-VNRET are the best discriminatory single parameters to distinguish between patients with B9B12 deficiency and reference subjects M-V-NRETAUC=0823 sensitivity 78 and specificity 86
AUC=0852 sensitivity 55 and specificity 60
Conclusions The CPD parameters of Volume and Light Scatter (M and SD of LALS angle) that inform about size and intracellular structure of RBCs provided very useful information for the detection of B9B12 deficiency
Congreso Nacional Laboratorio Cliacutenico
2018
Cell Population Data
bull Paraacutemetros poblacionales de los leucocitos
bull Describen la morfologiacutea tamantildeo
estructuras citoplasmaacuteticas
nuacutecleo aacutecidos nucleacuteicos
bull Son datos numeacutericos con los que se construyen los ejes de lo diagramas de dispersioacuten de los leucocitos
bull Dependen de la tecnologiacutea
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
High Sensitivity New Parameters for the Detection of Vitamin B12 and Folate Deficiencies Blood 2008 1125379
B12 def vs
Normals
Mann
Withney T-Test
ROC
AUC Sens Specif Cutoff signifROC
MCV p=03156 p=09533 0577
MPV p=00001 0802 792 806 lt83 p=00001
NE Mean
Volume plt00001 0862 833 778 gt1403 p=00001
MO Mean
Volume plt00001 0829 625 889 gt1723 p=00001
MRV p=00113 0705 50 964 gt1133 p=00051
Folate def vs
Normals
Mann
Withney T-Test
ROC
AUC Sens Specif Cut-off signifROC
MCV p=00798 p=06461 0665
MPV plt00001 0832 81 806 lt83 p=00001
NE Mean
Volume p=00008 087 952 694 gt1402 p=00001
MO Mean
Volume p=00002 0801 667 833 gt1696 p=00001
MRV p=00054 0731 476 964 gt1133 p=00019
The Mean Neutrophil Volume (MNE V) and Mean Monocyte Volume (MMOV) may be used for the detection of megaloblastic neutrophils and monocytes MNEV and MMOV have significantly higher sensitivity than the previous information from the red cells (MCV) detecting B12 or folate deficiency because they are not affected by the presence at the same time of Iron deficiency or other reasons of anemia
Congreso Nacional Laboratorio Cliacutenico
2018
POSTER 733
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
CPD Sysmex XN
NE SSC complejidad
NE SFL aacutecidos nucleacuteicos
NE FSC tamantildeo
NE WX
NE WY
NE WZ
MO X
MO Y
MO Z
MO WX
MO WY
MO WZ
LY X
LY Y
LY Z
LY WX
LY WY
LY WZCongreso Nacio
nal Laboratorio Cliacutenico 2018
As MCV is the mean which is calculated it is insensitive to the presence of a small number of macrocytes
Further macrocytosis can be obscured by concomitant disorders that can cause microcytosis resulting inmasked megaloblastic anaemia (MA) for example iron deficiency hereditary elliptocytosis alpha and betathalassemia
This study was undertaken to evaluate the role of NEUT-X and NEUT-Y in detecting MA on peripheral blood andalso see whether other forms of macrocytic anaemia can be differentiated from MA
In MA the peripheral blood smear shows cytopenia with macroovalocytes and hypersegmented
neutrophils (gt5 lobes in 5 neutrophils six lobes nuclei or lobe average of gt35)
In conclusion our study shows that higher values of NEUT-X and NEUT-Y in MA patients in spite of low ornormal MCV high RDW may be used to not only reveal the masked cases of MA with concomitant irondeficiency but also separate them from the broader macrocytic anaemia group
Peripheral smear remains diagnostic however making smear for all the suspicious cases is a cumbersomeand tedious procedure Thus these parameters emerge as more reliable and stable parameters in themodern laboratories which in future may replace the older screening tools
Congreso Nacional Laboratorio Cliacutenico
2018
A favor Eficiencia Operativa
Mejora el proceso del Laboratorio
Mejor informacioacuten al Cliacutenico al mismo coste
Mejora la informacioacuten
Informa sobre la eritropoyesis deteccioacuten precoz de estados carenciales
Ayuda al cliacutenico
Estado real del paciente
En contraParaacutemetros de investigacioacuten
Dificultad de standarizar dependencia teacutecnica
Control de calidadCongreso Nacional Laboratorio Cliacutenico
2018
Informacioacuten avanzada valor antildeadido
Reticulocitos Eritrocitos
bull Permanecen en la sangre 1-2 diacuteas hasta que se convierten en eritrocitos maduros
bull El contenido de hemoglobinapuede reflejar la cantidad de hierro disponible de maneraefectiva
bull Refleja la calidad de la eritropoyesis en el periodoinmediato
bull Permanecen en la sangre 90-120 diacuteas
bull Las diversas subpoblacionespueden reflejar el status feacuterrico en las pasadas semanas
bull MCV MCH son las medias del
conjunto de RBC las de fracciones indican la contribucioacuten de los diversos tipos de RBC a las medias
Congreso Nacional Laboratorio Cliacutenico
2018
Angulo alto
Dispersioacuten lateral Hb
Angulo bajo
Dispersioacuten frontal VOLUMEN
LASER Absorbancia Fluorescencia
RNA contenido
Citometriacutea
Congreso Nacional Laboratorio Cliacutenico
2018
RETICULOCITOS
Compantildeiacutea Instrumento Meacutetodo Colorante Paraacutemetros
Abbott CELLDYN Ruby
CELLDYN
Sapphire
Absorbancia
Fluorescencia
Nuevo azul
metileno
Sybr II
IRF
IRF MCHr MCVr
Beckman
Coulter
UniCell DxH
LH series
Impedancia
citometriacutea de flujo
VCS
Nuevo azul
metileno
Nuevo azul
metileno
IRF MRVHLRRSf
IRF MRV
MSCVHLR
Horiba ABX Pentra
DX120
Impedancia
citometriacutea de flujo
fluorescencia
Naranja de tiazol IRF MRV RETH
RHbC
Siemens ADVIA 120 Absorbancia
Scatter
Oxazine 750 IRF MCVr CHr
Sysmex XE5000 XN Fluorescencia Polimetina IRF RetHe ΔHeCongreso Nacional Laboratorio Cliacutenico
2018
Los reticulocitos precursores de los eritrocitos madurangeneralmente a lo largo de unos dos diacuteas El recuento dereticulocitos es por lo tanto una medida de la cantidad dela eritropoyesis en la meacutedulaParaacutemetros derivados de los reticulocitos los describenmorfoloacutegicamente tamantildeo contenido en Hemoglobinacantidad de material geneacuteticoDe esta forma al referirse a caracteriacutesticas de losreticulocitos es la calidad de la eritropoyesis la que puedeser evaluada
La Hb reticulocitaria se relaciona con la cantidad de hierro disponible efectivamente para laeritropoyesis un valor bajo indica que el aporte es deficitario respecto a la demanda en el momentoactual 28-30 pg
Congreso Nacional Laboratorio Cliacutenico
2018
MCV MCH son los valores medios de volumen y Hb en toda la poblacioacuten RBC
No informan acerca de las ceacutelulas individuales
Ni de la variedad de eacutestas anisocitosis policromasia
Congreso Nacional Laboratorio Cliacutenico
2018
Se cuentan el nuacutemero de pulsos de 36-360fL y el nuacutemero de partiacuteculas que tienen el mismo tamantildeo y se trasladan los resultados a una graacutefica de Volumen Nuacutemero de ceacutelulasSe obtiene el histograma de RBC que proporciona
bull Nuacutemero de RBC el nuacutemero de pulsos dentro de este rango de tamantildeos
bull MCV se corresponde con la media del histograma de RBC
bull RDW o ADE Ancho de Distribucioacuten del histograma de RBC se corresponde con el coeficiente de variacioacuten de la curva
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
Abbott Sapphire lo calcula en el 50 de la altura del pico del histogramaSysmex y Mindray al 20 desde la base del histogramaSiemens calcula la anchura del pico comprendido entre 60 y 120 fL
Aunque RDW ADE generalmente se entiendecomo coeficiente de variacioacuten de ladistribucioacuten de los voluacutemenes de loseritrocitos algunos analizadoreshematoloacutegicos lo calculan desde la medicioacutendirecta de la anchura de la distribucioacuten
Congreso Nacional Laboratorio Cliacutenico
2018
G Lippi amp M Plebani
Recent developments and innovations in red blood cells diagnostics
Journal of Laboratory and Precision Medicine 2018
DOI 1021037jlpm20180709 AOPCongreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
copy 2012 Mindray Confidential 26
HDWHYPERHYPO
HDW HGB Distribution Width
HDW is the distribution width of Hgb histogram
Congreso Nacional Laboratorio Cliacutenico
2018
copy 2012 Mindray Confidential 27
MCHrHDWHYPERHYPOMCHr Mean RET HGB Concentration
Congreso Nacional Laboratorio Cliacutenico
2018
Histograma RBC el mapa de Mie
28 41
Congreso Nacional Laboratorio Cliacutenico
2018
Abbott Mindray Siemens
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
Severe Iron Deficiency Anemia Female 34 years
19 th March 18 th April
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
SysmexRBCHe erythrocyte Hb equivalentRetHe reticulocyte Hb equivalent(content)
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
MIC
MAC
HPO HPR
Congreso Nacional Laboratorio Cliacutenico
2018
copy 2012 Mindray Confidential 36
MINDRAY MCHrHDWHYPERHYPO
MCHr Mean RET HGB Concentration
HDW HGB Distribution Width
HYPER The percentage of hyperchromicred blood cells
HYPO The percentage of hypochromic red blood cells
Thalassemia screeningIDA treatment monitoringIDA screening
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
Hipocromo
Hipercroacutemico onormocroacutemico
iquestConcentracioacuten o contenido de Hemoglobina
Hipocroacutemiconormocroacutemico
Abbott Mindray Siemens Hypo CONCENTRACIOacuteN Hblt280gL
Sysmex Hypo CONTENIDO Hblt 17 pg
Congreso Nacional Laboratorio Cliacutenico
2018
Low Hb Density
Microcytic Factor Maf = (HbMCV)100
Nuevo moacutedulo transductor muacuteltiple con laacuteser de diodo y dos sensores oacutepticos
Anaacutelisis de hasta 50000 ceacutelulas con 7 paraacutemetros tecnoloacutegicos (leucocitos reticulocitos eritroblastos)
1 Volumen digital
2 Conductividad digital
3 5 aacutengulos de dispersioacuten de luz laacuteser digital
bull MALS (Median Angle Light Scatter)
bull UMALS (Upper Median Angle Light Scatter) 20deg a 43deg
bull LMALS (Lower Median Angle Light Scatter) 09deg a 19deg
bull LALS (Low Angle Light Scatter) asymp 51deg
bull AL2 (Axial Light Loss) 0deg a 05deg
Congreso Nacional Laboratorio Cliacutenico
2018
Hierro es un elemento criacutetico para elfuncionamiento oacuteptimo y supervivenciade las ceacutelulas
Disfuncioacuten mitocondrialActividad enzimaacutetica afectadaProteiacutenas de transporte y estructuralesproteins
Capacidad fiacutesica mermadaCapacidad de trabajo reducidaCapacidades cognitivas afectadasMorbilidad y mortalidad
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
It is generally assumed that worldwide ldquoat least half the anemia is due tonutritional iron deficiencyrdquo and that ldquoup to a prevalence of iron deficiency anemiaof 40 the prevalence of iron deficiency will be about 25 times that of anemiardquoHowever it is evident from the foregoing discussion that there are considerablevariations in both of these ratios depending on the age and sex of the peoplebeing studied the region of the world in which they live and the prevalence ratesof other causes of anemia
WHO Department of Nutrition for Health and DevelopmentAssessing the iron status of populations including literature reviews report of a Joint World Health OrganizationCenters for DiseaseControl and Prevention Technical Consultation on the Assessment of Iron Status at the Population Level Geneva Switzerland 6ndash8 April2004 ndash 2nd ed
Congreso Nacional Laboratorio Cliacutenico
2018
Estaacute bien establecido que la anemia produce una miriacuteada de secuelas tanto fiacutesicas comopsicoloacutegicas
Pero los efecto deleteacutereos se deben al deficit de hierro que es un evento previo a que seestablezca la anemia
El deacuteficit de hierrro auacuten sin anemia tiene efectos negativos en el desarrollo cognitivo y fiacutesico
Rattehalli D et al Iron deficiency without anemia do not wait for the Hemoglobin to drop
Health Policy and Technology 2013 2 45-48Congreso Nacio
nal Laboratorio Cliacutenico 2018
SuominenP et al Serum transferrin receptor and transferrin receptor-ferritin index identify healthy subjects with subclinical iron deficits Blood 1998 92 2934ndash9Halwachs-Baumann G Diagnosis of anaemia old things rearranged Wien Med Wochenschr 2012 162478ndash88
Congreso Nacional Laboratorio Cliacutenico
2018
Hemoglobina de reticulocito y su importancia en el diagnoacutestico temprano de anemiaferropeacutenica
Y Maacuterquez-Beniacutetez et al Universidad de BocayaAugust
2018 DOI 1022267rus182003133 aop
El contenido de hemoglobina de reticulocitos (CHr) es un paraacutemetro en la biometriacuteahematoloacutegica automatizada utilizado como un marcador de la biodisponibilidad delhierro en la eritropoyesis
Objetivo Exponer la aplicabilidad de la CHr como un paraacutemetro en el diagnoacutesticoprecoz de la anemia por deficiencia de hierro asiacute como su medicioacuten e interpretacioacuten
Materiales y meacutetodos Se realizoacute la revisioacuten de artiacuteculos cientiacuteficos en ingleacutes y espantildeolen las bases de datos PubMed ScienceDirect LILACS y Medline usando descriptoresvalidados en Medical Subject Headings (MeSH) considerando periodo depublicabilidad del 80 inferior a 5 antildeos
Conclusiones La CHr es un paraacutemetro de gran utilidad en el diagnoacutestico temprano deanemia ferropeacutenica y otras patologiacuteas como deficiencia funcional de hierro estadosde inflamacioacuten croacutenica y enfermedad renal croacutenica
Biomarcador temprano en el diagnoacutestico de deficiencia de hierro antes de presentarsecambios morfoloacutegicos eritrociacuteticosCongreso Nacio
nal Laboratorio Cliacutenico 2018
bull A total of 1105 NES participants (639 men 466 women)bull CHr becomes affected in a relatively early stage in the development of iron deficiency before iron
deficiency anemia and clinical symptoms become apparentbull Therefore this parameter might be useful to identify persons healthy and diseased at risk of
developing iron deficiency anemia and subsequently to apply interventions in order to prevent further development of iron deficiency anemiaCongreso Nacio
nal Laboratorio Cliacutenico 2018
Hb reticulocitaria sensible para detectar la fase inicial del deacuteficit de hierro cuando laeritropoyesis requiere maacutes cantidad que la que recibe ANTES de que la anemia seestablezca
Congreso Nacional Laboratorio Cliacutenico
2018
No ID LID P
RBC 1012L 48 (08) 437 (05) lt00001
Hb gL 135 (6) 131 (12) 0006
MCV fL 922 (21) 902 (38) 0006
MCH pg 324 (07) 306 (22) lt00001
MCHC gL 339 (6) 319 (23) 0001
RDW
Ret He pg
Hypo He
LHD
Ferritin microgL
131 (06)
338 (21)
03 (015)
28 (20)
86 (3)
145 (21)
278 (24)
69 (55)
56 (25)
16 (76)
lt00001
lt00001
lt00001
lt00001
lt00001
AUC 95 CI Cutoff Sensitivity Specificity
LHD 0898 0819-0978 50 859 841
Ret He 0914 0824-1000 299pg 868 857
Hypo He 0934 0856-1000 16 857 921
Clinical value of markers of hypochromia in the detection of latent iron deficiency in non-anemic premenopausal women
No ID Hb gt 120 gL s-ferritin was within reference intervalLatent Iron Defiency Hb gt 120 gL s-ferritin lt 30 μgL
Urrechaga E et al Journal Clin Lab Analysis 2016 30 (5) 623-627
97 women (388) in 250 apparently healthy women had latent IDCongreso Nacional Laboratorio Cliacutenico
2018
Schorer G et al Abstract Jahreskongress der Deutschen Gesellschaft fuumlr Transfusionsmedizin und Immunhaumlmatologie Rostock 15 - 18 September 2009
Congreso Nacional Laboratorio Cliacutenico
2018
Caring for Those Who Share Mitigating Iron Deficiency in Regular Blood DonorsMast Alan E
bull Iron deficiency caused by regular blood donation is a problem facing blood centers Each blood donation removes 200 to 250 mg of iron from the donor Consequently many donors become iron deficient with repeated donation
bull This presents a challenge to blood centers that has become more acute in recent years with the realization that iron deficiency even in the absence of anemia is associated with adverse effects including fatigue and decreased exercise tolerance as well as neurological symptoms such as decreased cognitive function pica and restless leg syndrome
bull REDS-II investigators performed a longitudinal study investigating the iron status of blood donors over a two year period called the REDS-II Donor Iron Status Evaluation (RISE)
bull Results from the baseline analysis of regular donors (e 2 donations per year (females) or e 3 donations per year (males) revealed that over two-thirds of female donors and over one-half of male donors have iron deficiency
Congreso Nacional Laboratorio Cliacutenico
2018
Transfusion 2013 532766-2775
bull We evaluated the diagnostic sensitivity and specificity of red blood cell (RBC) hematology analyzer indices to assess iron status as a part of donor management iron deficient erythropoiesis (IDE) and absence of iron stores (AIS)
bull STUDY DESIGN AND METHODS A total of 1659 male and female donors from the Retrovirus Epidemiology Donor Study-II (REDS-II) Donor Iron Status Evaluation (RISE) study who were either first-timereactivated (FT RA no donations for 2 years) or frequent donors were recruited into a longitudinal study of regular donation of RBCs Of these 1002 donors returned 15 to 24 months later for a final assessment
Absent iron stores (AIS) was defined as plasma ferritin level of less than 12 mgL Logarithm of the ratio of soluble transferrin receptor to ferritin of at least 207 was used to define iron-deficient erythropoiesis (IDE)
bull RESULTS HYPOm and CHr detected IDE with comparable sensitivity 72 versus 69 but differed in specificity HYPOm 68 and CHr 53
For detecting AIS sensitivity was improved to 85 for HYPOm and 81 for CHr but specificity was reduced
Venous Hb had high specificity but poor sensitivity for IDE and AIS A plasma ferritin level of less than 267 mgL was a good surrogate for assessing IDE Congreso Nacio
nal Laboratorio Cliacutenico 2018
Microcytic RBC and reticulocyte mean cell hemoglobin content predicted iron depletion with
sensitivities 70 and 64
specificities of 72 and 78 respectively
When both combined
increased the sensitivity to 82
Congreso Nacional Laboratorio Cliacutenico
2018
Depending on the number of donations during the preceding12 months
Absent iron stores were detected in up to 214 of male and278 of female donors respectively
impaired hemoglobinisation IH was present in up to 64 maleand 167 female donors with 2 and 4 preceding donationsrespectively
The defined CHr cut-off value was 280 pg to detect IH infrequent whole blood donors with AIS leading to a testspecificity of 982 (positive predictive value PPV 577) inmale and of 978 (PPV 829) in female donors
It may help to prevent the development of anemia in frequentblood donors and also can help to decide whether donordeferral or even iron substitution need to be recommended
Congreso Nacional Laboratorio Cliacutenico
2018
Of the 501 blood donors sTfR and Ret-He detected Latent Iron Deficiency in 148 and 135 donors respectively
In comparison to sTfR Ret-He had sensitivity of 927 specificity of 9716 PPV of 931 and NPV of 963
Serum Ferritin TIBC and serum Iron had comparatively lower sensitivity of 8716 797 and 777 respectively
Conclusion Ret-He can be used as a routine screening test to detect LID in blood donors
This could provide an opportunity to make appropriate and timely interventions like dietary changes or drug supplementation
Congreso Nacional Laboratorio Cliacutenico
2018
Singh A Chaudhary R Pandey HC Sonker A Identification of iron status of blood donors by using low hemoglobin density and microcytic anemia factor Asian J Transfus Sci 20181246-50
The main objective of this study was to assess ifLHD and Maf could be used for assessment ofiron status in blood donors and also to establisha cut-off for these two parameters at which atentative iron deficiency could be reportedconclusively
Results LHD and Maf were able to differentiatebetween iron deficient and iron-depleteddonors from normal donorsA cutoff of 918 for LHD was able todifferentiate iron deficient and depleted statefrom normal iron statessensitivity 919 and specificity 71respectivelya cutoff of 1016 for Mafsensitivity 946 and specificity 968
MAf = (MVC Hb) 100
Congreso Nacional Laboratorio Cliacutenico
2018
Hb reticulocitaria sensible para detectar la fase inicial del deacuteficitde hierro cuando la eritropoyesis requiere maacutes cantidad que laque recibe ANTES de que la anemia se establezca
La deteccioacuten precoz del deacuteficit de hierro en la fase del balance negativo demanda aporte contribuye a reducir sus manifestaciones cliacutenicas en los pacientes afectados mejorando la salud puacuteblica
Un tratamiento menos prolongado con suplementos y menor consumo de los recursos sanitaros Contribuye a la eficiencia y sostenibilidad de los servicios sanitarios
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
Buttarello MLaboratory diagnosis of anemia are the old and new red cell parameters useful in classification and treatment howInt Jnl Lab Hem 2016 38 (Suppl 1) 123ndash132
Congreso Nacional Laboratorio Cliacutenico
2018
Buttarello MLaboratory diagnosis of anemia are the old and new red cell parameters useful in classification and treatment howInt Jnl Lab Hem 2016 38 (Suppl 1) 123ndash132
Congreso Nacional Laboratorio Cliacutenico
2018
Ralph Green amp Ananya Datta Mitra Megaloblastic Anemias Nutritional and Other CausesMed Clin N Am 2017 101 297ndash317
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
ANEMIA CARENCIAL CAUSAS
Factores alimentariosConsumir una dieta vegetariana mal planeadaAlimentacioacuten deficiente en los bebeacutesDesnutricioacuten durante el embarazo
Deacuteficit de absorcioacutenAlcoholismo croacutenicoEnfermedad de Crohn celiaquiacutea infeccioacuten otros problemas que le dificulten al cuerpo la digestioacuten de los alimentosAnemia perniciosa (factor intriacutenseco)Cirugiacuteas para extirpar ciertas partes del estoacutemago o el intestino delgado
MedicamentosB12 omeprazol metformina colchicina aminosalicilatos neomicinaFOLATO fenitoiacutena metotrexato sulfasalacina triamtereno pirimetamina trimetoprim con sulfametoxazol barbituacutericos
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
Reacciones metaboacutelicas en las que participan la vitamina B12 y el folato bull la conversioacuten de metilmalonil-CoA a succinil-CoA donde la adenosil-cobalamina actuacutea de
cofactor Por ello un deacuteficit de B12 conlleva un aumento de metilmalonil-CoA y de su producto de hidroacutelisis el aacutecido metilmaloacutenico
bull la siacutentesis de metionina a partir de homocisteina gracias a la metionina sintetasa y a la metil-cobalamina como cofactor En esta misma reaccioacuten el metiltetrahidrofolato es transformado a tetrahidrofolato que es necesario para la siacutentesis de DNA
Congreso Nacional Laboratorio Cliacutenico
2018
Anemia macrociacutetica secundaria a deficiencia de aacutecido foacutelico y de vitamina B12(cobalamina)
La deficiencia de B12 yo aacutecido foacutelico es la causa maacutes frecuente de megaloblastosis
Dentro de distintas funciones generales del metabolismo la vitamina B12 es uncofactor esencial en la siacutentesis de ADN y ARN compromete a todas las ceacutelulas delorganismo
Su deficiencia se manifiesta en oacuterganos con alto recambio celular como la meacutedulaosea y en el sistema nervioso central (SNC) a traveacutes de la siacutentesis de mielina y lareparacioacuten axonal
La deficiencia de cobalamina es responsable de alteraciones hematoloacutegicasneuroloacutegicas neurocognitivas y neuropsiquiaacutetricas
La siacutentesis defectuosa de ADN conduce a la apoptosis y a la hemoacutelisis (intra yextramedular) causantes de la hemopoyesis inefectiva
En meacutedula la siacutentesis ineficiente de DNA causa cambios megaloblaacutesticos comoconsecuencIa anemia y citopenias
Congreso Nacional Laboratorio Cliacutenico
2018
Limitaciones de los meacutetodos diagnoacutesticos claacutesicos
Volumen Corpuscular Medio (VCM) y morfologiacutea de sangre perifeacuterica En una serie de pacientes con deacuteficit de cobalamina soacutelo un 29 teniacutean anemia y soacutelo un 36 teniacutean un VCM gt 100 fL
Un VCM normal no puede ser empleado para rechazar una determinacioacuten de nivel de cobalamina ya que hasta un 25 de casos con manifestaciones neuroloacutegicas cursan con un VCM normal
Cobalamina seacuterica (nivel de B12) Es el test diagnoacutestico rutinario inicial estaacutendar Es un test ampliamente disponible de bajo coste y automatizado Sin embargo presenta algunas limitaciones
-- Existencia de varias teacutecnicas y ausencia de un gold standard por lo que hay diferentes liacutemites de referencia
-- Variacioacuten intraindividual muy alta
La OMS publicoacute en 2008 las conclusiones de un grupo teacutecnico consultado sobre el deacuteficit de cobalamina y folato
El grupo reconocioacute que no existen unos umbrales universalmente reconocidos para definir el deacuteficit de ambas vitaminas y expresaron la necesidad de un consenso
Devalia V Hamilton MS and Molloy AM on behalf of the British Committee for standards in haematology Guidelines for the diagnosis and treatment of cobalamin and folate disorders Br J Haematol 2014 166(4) 496-513
Schrier SL Diagnosis and treatment of vitamin B12 and folate deficiency UpToDate Last updated Jun 25 2014
de Benoist B Conclusions of a WHO Technical Consultation on folate and vitamin B12 deficiencies Food Nutr Bull 200829(2 Suppl)S238ndash44Congreso Nacional Laboratorio Cliacutenico
2018
Tomado de Tefferi A Li C En Atlas of Clinical Hematology Publicado por JO Armitage Philadelphia Current Medicine 2004
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
Int Jnl Lab Hem 2007 29 327ndash334
Clin Lab 201662343-347
In ourstudy mean MCVrMCV ratio of healthy controls is130 as microcytic anemia irondeficiency anemia is121 as also macrocytic anemia vitamin B12 deficiencyanemia is 115
Congreso Nacional Laboratorio Cliacutenico
2018
Sualeh Muslim Khan Muhammad Akbar Agha
Mean cell volume of reticulocytemdashA new parameter for diagnosing sub-clinical cobalamin deficiency in blood donors Int J Lab Hem 20181ndash4
The Abbott CELL-DYN Sapphire Hematology System uses multi-angle polarized scatter separation (MAPSS) and focused flow impedance technologies
Congreso Nacional Laboratorio Cliacutenico
2018
MCVr at 985 fL yielded the highest Youdenrsquos index at sensitivity of 82 specificity of 828 AUC 0847 ( 95 CI 803-891)
Khan SM Agha MA Mean cell volume of reticulocyte-A new parameter for diagnosing sub-clinical cobalamin deficiency in blood donors
Int J Lab Hem 20181ndash4 2018 Jul 13 doi 101111ijlh12899
Congreso Nacional Laboratorio Cliacutenico
2018
Role of Cell Population Data in the detection of folate and cobalamin deficiency
J Nieto et al
XXXI st International Symposium on Technological Innovations in Laboratory Hematology ISLH 2018 10-12 May 2018 Brussels Belgium
M-V-NRET and SD-VNRET are the best discriminatory single parameters to distinguish between patients with B9B12 deficiency and reference subjects M-V-NRETAUC=0823 sensitivity 78 and specificity 86
AUC=0852 sensitivity 55 and specificity 60
Conclusions The CPD parameters of Volume and Light Scatter (M and SD of LALS angle) that inform about size and intracellular structure of RBCs provided very useful information for the detection of B9B12 deficiency
Congreso Nacional Laboratorio Cliacutenico
2018
Cell Population Data
bull Paraacutemetros poblacionales de los leucocitos
bull Describen la morfologiacutea tamantildeo
estructuras citoplasmaacuteticas
nuacutecleo aacutecidos nucleacuteicos
bull Son datos numeacutericos con los que se construyen los ejes de lo diagramas de dispersioacuten de los leucocitos
bull Dependen de la tecnologiacutea
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
High Sensitivity New Parameters for the Detection of Vitamin B12 and Folate Deficiencies Blood 2008 1125379
B12 def vs
Normals
Mann
Withney T-Test
ROC
AUC Sens Specif Cutoff signifROC
MCV p=03156 p=09533 0577
MPV p=00001 0802 792 806 lt83 p=00001
NE Mean
Volume plt00001 0862 833 778 gt1403 p=00001
MO Mean
Volume plt00001 0829 625 889 gt1723 p=00001
MRV p=00113 0705 50 964 gt1133 p=00051
Folate def vs
Normals
Mann
Withney T-Test
ROC
AUC Sens Specif Cut-off signifROC
MCV p=00798 p=06461 0665
MPV plt00001 0832 81 806 lt83 p=00001
NE Mean
Volume p=00008 087 952 694 gt1402 p=00001
MO Mean
Volume p=00002 0801 667 833 gt1696 p=00001
MRV p=00054 0731 476 964 gt1133 p=00019
The Mean Neutrophil Volume (MNE V) and Mean Monocyte Volume (MMOV) may be used for the detection of megaloblastic neutrophils and monocytes MNEV and MMOV have significantly higher sensitivity than the previous information from the red cells (MCV) detecting B12 or folate deficiency because they are not affected by the presence at the same time of Iron deficiency or other reasons of anemia
Congreso Nacional Laboratorio Cliacutenico
2018
POSTER 733
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
CPD Sysmex XN
NE SSC complejidad
NE SFL aacutecidos nucleacuteicos
NE FSC tamantildeo
NE WX
NE WY
NE WZ
MO X
MO Y
MO Z
MO WX
MO WY
MO WZ
LY X
LY Y
LY Z
LY WX
LY WY
LY WZCongreso Nacio
nal Laboratorio Cliacutenico 2018
As MCV is the mean which is calculated it is insensitive to the presence of a small number of macrocytes
Further macrocytosis can be obscured by concomitant disorders that can cause microcytosis resulting inmasked megaloblastic anaemia (MA) for example iron deficiency hereditary elliptocytosis alpha and betathalassemia
This study was undertaken to evaluate the role of NEUT-X and NEUT-Y in detecting MA on peripheral blood andalso see whether other forms of macrocytic anaemia can be differentiated from MA
In MA the peripheral blood smear shows cytopenia with macroovalocytes and hypersegmented
neutrophils (gt5 lobes in 5 neutrophils six lobes nuclei or lobe average of gt35)
In conclusion our study shows that higher values of NEUT-X and NEUT-Y in MA patients in spite of low ornormal MCV high RDW may be used to not only reveal the masked cases of MA with concomitant irondeficiency but also separate them from the broader macrocytic anaemia group
Peripheral smear remains diagnostic however making smear for all the suspicious cases is a cumbersomeand tedious procedure Thus these parameters emerge as more reliable and stable parameters in themodern laboratories which in future may replace the older screening tools
Congreso Nacional Laboratorio Cliacutenico
2018
A favor Eficiencia Operativa
Mejora el proceso del Laboratorio
Mejor informacioacuten al Cliacutenico al mismo coste
Mejora la informacioacuten
Informa sobre la eritropoyesis deteccioacuten precoz de estados carenciales
Ayuda al cliacutenico
Estado real del paciente
En contraParaacutemetros de investigacioacuten
Dificultad de standarizar dependencia teacutecnica
Control de calidadCongreso Nacional Laboratorio Cliacutenico
2018
Angulo alto
Dispersioacuten lateral Hb
Angulo bajo
Dispersioacuten frontal VOLUMEN
LASER Absorbancia Fluorescencia
RNA contenido
Citometriacutea
Congreso Nacional Laboratorio Cliacutenico
2018
RETICULOCITOS
Compantildeiacutea Instrumento Meacutetodo Colorante Paraacutemetros
Abbott CELLDYN Ruby
CELLDYN
Sapphire
Absorbancia
Fluorescencia
Nuevo azul
metileno
Sybr II
IRF
IRF MCHr MCVr
Beckman
Coulter
UniCell DxH
LH series
Impedancia
citometriacutea de flujo
VCS
Nuevo azul
metileno
Nuevo azul
metileno
IRF MRVHLRRSf
IRF MRV
MSCVHLR
Horiba ABX Pentra
DX120
Impedancia
citometriacutea de flujo
fluorescencia
Naranja de tiazol IRF MRV RETH
RHbC
Siemens ADVIA 120 Absorbancia
Scatter
Oxazine 750 IRF MCVr CHr
Sysmex XE5000 XN Fluorescencia Polimetina IRF RetHe ΔHeCongreso Nacional Laboratorio Cliacutenico
2018
Los reticulocitos precursores de los eritrocitos madurangeneralmente a lo largo de unos dos diacuteas El recuento dereticulocitos es por lo tanto una medida de la cantidad dela eritropoyesis en la meacutedulaParaacutemetros derivados de los reticulocitos los describenmorfoloacutegicamente tamantildeo contenido en Hemoglobinacantidad de material geneacuteticoDe esta forma al referirse a caracteriacutesticas de losreticulocitos es la calidad de la eritropoyesis la que puedeser evaluada
La Hb reticulocitaria se relaciona con la cantidad de hierro disponible efectivamente para laeritropoyesis un valor bajo indica que el aporte es deficitario respecto a la demanda en el momentoactual 28-30 pg
Congreso Nacional Laboratorio Cliacutenico
2018
MCV MCH son los valores medios de volumen y Hb en toda la poblacioacuten RBC
No informan acerca de las ceacutelulas individuales
Ni de la variedad de eacutestas anisocitosis policromasia
Congreso Nacional Laboratorio Cliacutenico
2018
Se cuentan el nuacutemero de pulsos de 36-360fL y el nuacutemero de partiacuteculas que tienen el mismo tamantildeo y se trasladan los resultados a una graacutefica de Volumen Nuacutemero de ceacutelulasSe obtiene el histograma de RBC que proporciona
bull Nuacutemero de RBC el nuacutemero de pulsos dentro de este rango de tamantildeos
bull MCV se corresponde con la media del histograma de RBC
bull RDW o ADE Ancho de Distribucioacuten del histograma de RBC se corresponde con el coeficiente de variacioacuten de la curva
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
Abbott Sapphire lo calcula en el 50 de la altura del pico del histogramaSysmex y Mindray al 20 desde la base del histogramaSiemens calcula la anchura del pico comprendido entre 60 y 120 fL
Aunque RDW ADE generalmente se entiendecomo coeficiente de variacioacuten de ladistribucioacuten de los voluacutemenes de loseritrocitos algunos analizadoreshematoloacutegicos lo calculan desde la medicioacutendirecta de la anchura de la distribucioacuten
Congreso Nacional Laboratorio Cliacutenico
2018
G Lippi amp M Plebani
Recent developments and innovations in red blood cells diagnostics
Journal of Laboratory and Precision Medicine 2018
DOI 1021037jlpm20180709 AOPCongreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
copy 2012 Mindray Confidential 26
HDWHYPERHYPO
HDW HGB Distribution Width
HDW is the distribution width of Hgb histogram
Congreso Nacional Laboratorio Cliacutenico
2018
copy 2012 Mindray Confidential 27
MCHrHDWHYPERHYPOMCHr Mean RET HGB Concentration
Congreso Nacional Laboratorio Cliacutenico
2018
Histograma RBC el mapa de Mie
28 41
Congreso Nacional Laboratorio Cliacutenico
2018
Abbott Mindray Siemens
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
Severe Iron Deficiency Anemia Female 34 years
19 th March 18 th April
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
SysmexRBCHe erythrocyte Hb equivalentRetHe reticulocyte Hb equivalent(content)
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
MIC
MAC
HPO HPR
Congreso Nacional Laboratorio Cliacutenico
2018
copy 2012 Mindray Confidential 36
MINDRAY MCHrHDWHYPERHYPO
MCHr Mean RET HGB Concentration
HDW HGB Distribution Width
HYPER The percentage of hyperchromicred blood cells
HYPO The percentage of hypochromic red blood cells
Thalassemia screeningIDA treatment monitoringIDA screening
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
Hipocromo
Hipercroacutemico onormocroacutemico
iquestConcentracioacuten o contenido de Hemoglobina
Hipocroacutemiconormocroacutemico
Abbott Mindray Siemens Hypo CONCENTRACIOacuteN Hblt280gL
Sysmex Hypo CONTENIDO Hblt 17 pg
Congreso Nacional Laboratorio Cliacutenico
2018
Low Hb Density
Microcytic Factor Maf = (HbMCV)100
Nuevo moacutedulo transductor muacuteltiple con laacuteser de diodo y dos sensores oacutepticos
Anaacutelisis de hasta 50000 ceacutelulas con 7 paraacutemetros tecnoloacutegicos (leucocitos reticulocitos eritroblastos)
1 Volumen digital
2 Conductividad digital
3 5 aacutengulos de dispersioacuten de luz laacuteser digital
bull MALS (Median Angle Light Scatter)
bull UMALS (Upper Median Angle Light Scatter) 20deg a 43deg
bull LMALS (Lower Median Angle Light Scatter) 09deg a 19deg
bull LALS (Low Angle Light Scatter) asymp 51deg
bull AL2 (Axial Light Loss) 0deg a 05deg
Congreso Nacional Laboratorio Cliacutenico
2018
Hierro es un elemento criacutetico para elfuncionamiento oacuteptimo y supervivenciade las ceacutelulas
Disfuncioacuten mitocondrialActividad enzimaacutetica afectadaProteiacutenas de transporte y estructuralesproteins
Capacidad fiacutesica mermadaCapacidad de trabajo reducidaCapacidades cognitivas afectadasMorbilidad y mortalidad
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
It is generally assumed that worldwide ldquoat least half the anemia is due tonutritional iron deficiencyrdquo and that ldquoup to a prevalence of iron deficiency anemiaof 40 the prevalence of iron deficiency will be about 25 times that of anemiardquoHowever it is evident from the foregoing discussion that there are considerablevariations in both of these ratios depending on the age and sex of the peoplebeing studied the region of the world in which they live and the prevalence ratesof other causes of anemia
WHO Department of Nutrition for Health and DevelopmentAssessing the iron status of populations including literature reviews report of a Joint World Health OrganizationCenters for DiseaseControl and Prevention Technical Consultation on the Assessment of Iron Status at the Population Level Geneva Switzerland 6ndash8 April2004 ndash 2nd ed
Congreso Nacional Laboratorio Cliacutenico
2018
Estaacute bien establecido que la anemia produce una miriacuteada de secuelas tanto fiacutesicas comopsicoloacutegicas
Pero los efecto deleteacutereos se deben al deficit de hierro que es un evento previo a que seestablezca la anemia
El deacuteficit de hierrro auacuten sin anemia tiene efectos negativos en el desarrollo cognitivo y fiacutesico
Rattehalli D et al Iron deficiency without anemia do not wait for the Hemoglobin to drop
Health Policy and Technology 2013 2 45-48Congreso Nacio
nal Laboratorio Cliacutenico 2018
SuominenP et al Serum transferrin receptor and transferrin receptor-ferritin index identify healthy subjects with subclinical iron deficits Blood 1998 92 2934ndash9Halwachs-Baumann G Diagnosis of anaemia old things rearranged Wien Med Wochenschr 2012 162478ndash88
Congreso Nacional Laboratorio Cliacutenico
2018
Hemoglobina de reticulocito y su importancia en el diagnoacutestico temprano de anemiaferropeacutenica
Y Maacuterquez-Beniacutetez et al Universidad de BocayaAugust
2018 DOI 1022267rus182003133 aop
El contenido de hemoglobina de reticulocitos (CHr) es un paraacutemetro en la biometriacuteahematoloacutegica automatizada utilizado como un marcador de la biodisponibilidad delhierro en la eritropoyesis
Objetivo Exponer la aplicabilidad de la CHr como un paraacutemetro en el diagnoacutesticoprecoz de la anemia por deficiencia de hierro asiacute como su medicioacuten e interpretacioacuten
Materiales y meacutetodos Se realizoacute la revisioacuten de artiacuteculos cientiacuteficos en ingleacutes y espantildeolen las bases de datos PubMed ScienceDirect LILACS y Medline usando descriptoresvalidados en Medical Subject Headings (MeSH) considerando periodo depublicabilidad del 80 inferior a 5 antildeos
Conclusiones La CHr es un paraacutemetro de gran utilidad en el diagnoacutestico temprano deanemia ferropeacutenica y otras patologiacuteas como deficiencia funcional de hierro estadosde inflamacioacuten croacutenica y enfermedad renal croacutenica
Biomarcador temprano en el diagnoacutestico de deficiencia de hierro antes de presentarsecambios morfoloacutegicos eritrociacuteticosCongreso Nacio
nal Laboratorio Cliacutenico 2018
bull A total of 1105 NES participants (639 men 466 women)bull CHr becomes affected in a relatively early stage in the development of iron deficiency before iron
deficiency anemia and clinical symptoms become apparentbull Therefore this parameter might be useful to identify persons healthy and diseased at risk of
developing iron deficiency anemia and subsequently to apply interventions in order to prevent further development of iron deficiency anemiaCongreso Nacio
nal Laboratorio Cliacutenico 2018
Hb reticulocitaria sensible para detectar la fase inicial del deacuteficit de hierro cuando laeritropoyesis requiere maacutes cantidad que la que recibe ANTES de que la anemia seestablezca
Congreso Nacional Laboratorio Cliacutenico
2018
No ID LID P
RBC 1012L 48 (08) 437 (05) lt00001
Hb gL 135 (6) 131 (12) 0006
MCV fL 922 (21) 902 (38) 0006
MCH pg 324 (07) 306 (22) lt00001
MCHC gL 339 (6) 319 (23) 0001
RDW
Ret He pg
Hypo He
LHD
Ferritin microgL
131 (06)
338 (21)
03 (015)
28 (20)
86 (3)
145 (21)
278 (24)
69 (55)
56 (25)
16 (76)
lt00001
lt00001
lt00001
lt00001
lt00001
AUC 95 CI Cutoff Sensitivity Specificity
LHD 0898 0819-0978 50 859 841
Ret He 0914 0824-1000 299pg 868 857
Hypo He 0934 0856-1000 16 857 921
Clinical value of markers of hypochromia in the detection of latent iron deficiency in non-anemic premenopausal women
No ID Hb gt 120 gL s-ferritin was within reference intervalLatent Iron Defiency Hb gt 120 gL s-ferritin lt 30 μgL
Urrechaga E et al Journal Clin Lab Analysis 2016 30 (5) 623-627
97 women (388) in 250 apparently healthy women had latent IDCongreso Nacional Laboratorio Cliacutenico
2018
Schorer G et al Abstract Jahreskongress der Deutschen Gesellschaft fuumlr Transfusionsmedizin und Immunhaumlmatologie Rostock 15 - 18 September 2009
Congreso Nacional Laboratorio Cliacutenico
2018
Caring for Those Who Share Mitigating Iron Deficiency in Regular Blood DonorsMast Alan E
bull Iron deficiency caused by regular blood donation is a problem facing blood centers Each blood donation removes 200 to 250 mg of iron from the donor Consequently many donors become iron deficient with repeated donation
bull This presents a challenge to blood centers that has become more acute in recent years with the realization that iron deficiency even in the absence of anemia is associated with adverse effects including fatigue and decreased exercise tolerance as well as neurological symptoms such as decreased cognitive function pica and restless leg syndrome
bull REDS-II investigators performed a longitudinal study investigating the iron status of blood donors over a two year period called the REDS-II Donor Iron Status Evaluation (RISE)
bull Results from the baseline analysis of regular donors (e 2 donations per year (females) or e 3 donations per year (males) revealed that over two-thirds of female donors and over one-half of male donors have iron deficiency
Congreso Nacional Laboratorio Cliacutenico
2018
Transfusion 2013 532766-2775
bull We evaluated the diagnostic sensitivity and specificity of red blood cell (RBC) hematology analyzer indices to assess iron status as a part of donor management iron deficient erythropoiesis (IDE) and absence of iron stores (AIS)
bull STUDY DESIGN AND METHODS A total of 1659 male and female donors from the Retrovirus Epidemiology Donor Study-II (REDS-II) Donor Iron Status Evaluation (RISE) study who were either first-timereactivated (FT RA no donations for 2 years) or frequent donors were recruited into a longitudinal study of regular donation of RBCs Of these 1002 donors returned 15 to 24 months later for a final assessment
Absent iron stores (AIS) was defined as plasma ferritin level of less than 12 mgL Logarithm of the ratio of soluble transferrin receptor to ferritin of at least 207 was used to define iron-deficient erythropoiesis (IDE)
bull RESULTS HYPOm and CHr detected IDE with comparable sensitivity 72 versus 69 but differed in specificity HYPOm 68 and CHr 53
For detecting AIS sensitivity was improved to 85 for HYPOm and 81 for CHr but specificity was reduced
Venous Hb had high specificity but poor sensitivity for IDE and AIS A plasma ferritin level of less than 267 mgL was a good surrogate for assessing IDE Congreso Nacio
nal Laboratorio Cliacutenico 2018
Microcytic RBC and reticulocyte mean cell hemoglobin content predicted iron depletion with
sensitivities 70 and 64
specificities of 72 and 78 respectively
When both combined
increased the sensitivity to 82
Congreso Nacional Laboratorio Cliacutenico
2018
Depending on the number of donations during the preceding12 months
Absent iron stores were detected in up to 214 of male and278 of female donors respectively
impaired hemoglobinisation IH was present in up to 64 maleand 167 female donors with 2 and 4 preceding donationsrespectively
The defined CHr cut-off value was 280 pg to detect IH infrequent whole blood donors with AIS leading to a testspecificity of 982 (positive predictive value PPV 577) inmale and of 978 (PPV 829) in female donors
It may help to prevent the development of anemia in frequentblood donors and also can help to decide whether donordeferral or even iron substitution need to be recommended
Congreso Nacional Laboratorio Cliacutenico
2018
Of the 501 blood donors sTfR and Ret-He detected Latent Iron Deficiency in 148 and 135 donors respectively
In comparison to sTfR Ret-He had sensitivity of 927 specificity of 9716 PPV of 931 and NPV of 963
Serum Ferritin TIBC and serum Iron had comparatively lower sensitivity of 8716 797 and 777 respectively
Conclusion Ret-He can be used as a routine screening test to detect LID in blood donors
This could provide an opportunity to make appropriate and timely interventions like dietary changes or drug supplementation
Congreso Nacional Laboratorio Cliacutenico
2018
Singh A Chaudhary R Pandey HC Sonker A Identification of iron status of blood donors by using low hemoglobin density and microcytic anemia factor Asian J Transfus Sci 20181246-50
The main objective of this study was to assess ifLHD and Maf could be used for assessment ofiron status in blood donors and also to establisha cut-off for these two parameters at which atentative iron deficiency could be reportedconclusively
Results LHD and Maf were able to differentiatebetween iron deficient and iron-depleteddonors from normal donorsA cutoff of 918 for LHD was able todifferentiate iron deficient and depleted statefrom normal iron statessensitivity 919 and specificity 71respectivelya cutoff of 1016 for Mafsensitivity 946 and specificity 968
MAf = (MVC Hb) 100
Congreso Nacional Laboratorio Cliacutenico
2018
Hb reticulocitaria sensible para detectar la fase inicial del deacuteficitde hierro cuando la eritropoyesis requiere maacutes cantidad que laque recibe ANTES de que la anemia se establezca
La deteccioacuten precoz del deacuteficit de hierro en la fase del balance negativo demanda aporte contribuye a reducir sus manifestaciones cliacutenicas en los pacientes afectados mejorando la salud puacuteblica
Un tratamiento menos prolongado con suplementos y menor consumo de los recursos sanitaros Contribuye a la eficiencia y sostenibilidad de los servicios sanitarios
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
Buttarello MLaboratory diagnosis of anemia are the old and new red cell parameters useful in classification and treatment howInt Jnl Lab Hem 2016 38 (Suppl 1) 123ndash132
Congreso Nacional Laboratorio Cliacutenico
2018
Buttarello MLaboratory diagnosis of anemia are the old and new red cell parameters useful in classification and treatment howInt Jnl Lab Hem 2016 38 (Suppl 1) 123ndash132
Congreso Nacional Laboratorio Cliacutenico
2018
Ralph Green amp Ananya Datta Mitra Megaloblastic Anemias Nutritional and Other CausesMed Clin N Am 2017 101 297ndash317
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
ANEMIA CARENCIAL CAUSAS
Factores alimentariosConsumir una dieta vegetariana mal planeadaAlimentacioacuten deficiente en los bebeacutesDesnutricioacuten durante el embarazo
Deacuteficit de absorcioacutenAlcoholismo croacutenicoEnfermedad de Crohn celiaquiacutea infeccioacuten otros problemas que le dificulten al cuerpo la digestioacuten de los alimentosAnemia perniciosa (factor intriacutenseco)Cirugiacuteas para extirpar ciertas partes del estoacutemago o el intestino delgado
MedicamentosB12 omeprazol metformina colchicina aminosalicilatos neomicinaFOLATO fenitoiacutena metotrexato sulfasalacina triamtereno pirimetamina trimetoprim con sulfametoxazol barbituacutericos
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
Reacciones metaboacutelicas en las que participan la vitamina B12 y el folato bull la conversioacuten de metilmalonil-CoA a succinil-CoA donde la adenosil-cobalamina actuacutea de
cofactor Por ello un deacuteficit de B12 conlleva un aumento de metilmalonil-CoA y de su producto de hidroacutelisis el aacutecido metilmaloacutenico
bull la siacutentesis de metionina a partir de homocisteina gracias a la metionina sintetasa y a la metil-cobalamina como cofactor En esta misma reaccioacuten el metiltetrahidrofolato es transformado a tetrahidrofolato que es necesario para la siacutentesis de DNA
Congreso Nacional Laboratorio Cliacutenico
2018
Anemia macrociacutetica secundaria a deficiencia de aacutecido foacutelico y de vitamina B12(cobalamina)
La deficiencia de B12 yo aacutecido foacutelico es la causa maacutes frecuente de megaloblastosis
Dentro de distintas funciones generales del metabolismo la vitamina B12 es uncofactor esencial en la siacutentesis de ADN y ARN compromete a todas las ceacutelulas delorganismo
Su deficiencia se manifiesta en oacuterganos con alto recambio celular como la meacutedulaosea y en el sistema nervioso central (SNC) a traveacutes de la siacutentesis de mielina y lareparacioacuten axonal
La deficiencia de cobalamina es responsable de alteraciones hematoloacutegicasneuroloacutegicas neurocognitivas y neuropsiquiaacutetricas
La siacutentesis defectuosa de ADN conduce a la apoptosis y a la hemoacutelisis (intra yextramedular) causantes de la hemopoyesis inefectiva
En meacutedula la siacutentesis ineficiente de DNA causa cambios megaloblaacutesticos comoconsecuencIa anemia y citopenias
Congreso Nacional Laboratorio Cliacutenico
2018
Limitaciones de los meacutetodos diagnoacutesticos claacutesicos
Volumen Corpuscular Medio (VCM) y morfologiacutea de sangre perifeacuterica En una serie de pacientes con deacuteficit de cobalamina soacutelo un 29 teniacutean anemia y soacutelo un 36 teniacutean un VCM gt 100 fL
Un VCM normal no puede ser empleado para rechazar una determinacioacuten de nivel de cobalamina ya que hasta un 25 de casos con manifestaciones neuroloacutegicas cursan con un VCM normal
Cobalamina seacuterica (nivel de B12) Es el test diagnoacutestico rutinario inicial estaacutendar Es un test ampliamente disponible de bajo coste y automatizado Sin embargo presenta algunas limitaciones
-- Existencia de varias teacutecnicas y ausencia de un gold standard por lo que hay diferentes liacutemites de referencia
-- Variacioacuten intraindividual muy alta
La OMS publicoacute en 2008 las conclusiones de un grupo teacutecnico consultado sobre el deacuteficit de cobalamina y folato
El grupo reconocioacute que no existen unos umbrales universalmente reconocidos para definir el deacuteficit de ambas vitaminas y expresaron la necesidad de un consenso
Devalia V Hamilton MS and Molloy AM on behalf of the British Committee for standards in haematology Guidelines for the diagnosis and treatment of cobalamin and folate disorders Br J Haematol 2014 166(4) 496-513
Schrier SL Diagnosis and treatment of vitamin B12 and folate deficiency UpToDate Last updated Jun 25 2014
de Benoist B Conclusions of a WHO Technical Consultation on folate and vitamin B12 deficiencies Food Nutr Bull 200829(2 Suppl)S238ndash44Congreso Nacional Laboratorio Cliacutenico
2018
Tomado de Tefferi A Li C En Atlas of Clinical Hematology Publicado por JO Armitage Philadelphia Current Medicine 2004
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
Int Jnl Lab Hem 2007 29 327ndash334
Clin Lab 201662343-347
In ourstudy mean MCVrMCV ratio of healthy controls is130 as microcytic anemia irondeficiency anemia is121 as also macrocytic anemia vitamin B12 deficiencyanemia is 115
Congreso Nacional Laboratorio Cliacutenico
2018
Sualeh Muslim Khan Muhammad Akbar Agha
Mean cell volume of reticulocytemdashA new parameter for diagnosing sub-clinical cobalamin deficiency in blood donors Int J Lab Hem 20181ndash4
The Abbott CELL-DYN Sapphire Hematology System uses multi-angle polarized scatter separation (MAPSS) and focused flow impedance technologies
Congreso Nacional Laboratorio Cliacutenico
2018
MCVr at 985 fL yielded the highest Youdenrsquos index at sensitivity of 82 specificity of 828 AUC 0847 ( 95 CI 803-891)
Khan SM Agha MA Mean cell volume of reticulocyte-A new parameter for diagnosing sub-clinical cobalamin deficiency in blood donors
Int J Lab Hem 20181ndash4 2018 Jul 13 doi 101111ijlh12899
Congreso Nacional Laboratorio Cliacutenico
2018
Role of Cell Population Data in the detection of folate and cobalamin deficiency
J Nieto et al
XXXI st International Symposium on Technological Innovations in Laboratory Hematology ISLH 2018 10-12 May 2018 Brussels Belgium
M-V-NRET and SD-VNRET are the best discriminatory single parameters to distinguish between patients with B9B12 deficiency and reference subjects M-V-NRETAUC=0823 sensitivity 78 and specificity 86
AUC=0852 sensitivity 55 and specificity 60
Conclusions The CPD parameters of Volume and Light Scatter (M and SD of LALS angle) that inform about size and intracellular structure of RBCs provided very useful information for the detection of B9B12 deficiency
Congreso Nacional Laboratorio Cliacutenico
2018
Cell Population Data
bull Paraacutemetros poblacionales de los leucocitos
bull Describen la morfologiacutea tamantildeo
estructuras citoplasmaacuteticas
nuacutecleo aacutecidos nucleacuteicos
bull Son datos numeacutericos con los que se construyen los ejes de lo diagramas de dispersioacuten de los leucocitos
bull Dependen de la tecnologiacutea
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
High Sensitivity New Parameters for the Detection of Vitamin B12 and Folate Deficiencies Blood 2008 1125379
B12 def vs
Normals
Mann
Withney T-Test
ROC
AUC Sens Specif Cutoff signifROC
MCV p=03156 p=09533 0577
MPV p=00001 0802 792 806 lt83 p=00001
NE Mean
Volume plt00001 0862 833 778 gt1403 p=00001
MO Mean
Volume plt00001 0829 625 889 gt1723 p=00001
MRV p=00113 0705 50 964 gt1133 p=00051
Folate def vs
Normals
Mann
Withney T-Test
ROC
AUC Sens Specif Cut-off signifROC
MCV p=00798 p=06461 0665
MPV plt00001 0832 81 806 lt83 p=00001
NE Mean
Volume p=00008 087 952 694 gt1402 p=00001
MO Mean
Volume p=00002 0801 667 833 gt1696 p=00001
MRV p=00054 0731 476 964 gt1133 p=00019
The Mean Neutrophil Volume (MNE V) and Mean Monocyte Volume (MMOV) may be used for the detection of megaloblastic neutrophils and monocytes MNEV and MMOV have significantly higher sensitivity than the previous information from the red cells (MCV) detecting B12 or folate deficiency because they are not affected by the presence at the same time of Iron deficiency or other reasons of anemia
Congreso Nacional Laboratorio Cliacutenico
2018
POSTER 733
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
CPD Sysmex XN
NE SSC complejidad
NE SFL aacutecidos nucleacuteicos
NE FSC tamantildeo
NE WX
NE WY
NE WZ
MO X
MO Y
MO Z
MO WX
MO WY
MO WZ
LY X
LY Y
LY Z
LY WX
LY WY
LY WZCongreso Nacio
nal Laboratorio Cliacutenico 2018
As MCV is the mean which is calculated it is insensitive to the presence of a small number of macrocytes
Further macrocytosis can be obscured by concomitant disorders that can cause microcytosis resulting inmasked megaloblastic anaemia (MA) for example iron deficiency hereditary elliptocytosis alpha and betathalassemia
This study was undertaken to evaluate the role of NEUT-X and NEUT-Y in detecting MA on peripheral blood andalso see whether other forms of macrocytic anaemia can be differentiated from MA
In MA the peripheral blood smear shows cytopenia with macroovalocytes and hypersegmented
neutrophils (gt5 lobes in 5 neutrophils six lobes nuclei or lobe average of gt35)
In conclusion our study shows that higher values of NEUT-X and NEUT-Y in MA patients in spite of low ornormal MCV high RDW may be used to not only reveal the masked cases of MA with concomitant irondeficiency but also separate them from the broader macrocytic anaemia group
Peripheral smear remains diagnostic however making smear for all the suspicious cases is a cumbersomeand tedious procedure Thus these parameters emerge as more reliable and stable parameters in themodern laboratories which in future may replace the older screening tools
Congreso Nacional Laboratorio Cliacutenico
2018
A favor Eficiencia Operativa
Mejora el proceso del Laboratorio
Mejor informacioacuten al Cliacutenico al mismo coste
Mejora la informacioacuten
Informa sobre la eritropoyesis deteccioacuten precoz de estados carenciales
Ayuda al cliacutenico
Estado real del paciente
En contraParaacutemetros de investigacioacuten
Dificultad de standarizar dependencia teacutecnica
Control de calidadCongreso Nacional Laboratorio Cliacutenico
2018
RETICULOCITOS
Compantildeiacutea Instrumento Meacutetodo Colorante Paraacutemetros
Abbott CELLDYN Ruby
CELLDYN
Sapphire
Absorbancia
Fluorescencia
Nuevo azul
metileno
Sybr II
IRF
IRF MCHr MCVr
Beckman
Coulter
UniCell DxH
LH series
Impedancia
citometriacutea de flujo
VCS
Nuevo azul
metileno
Nuevo azul
metileno
IRF MRVHLRRSf
IRF MRV
MSCVHLR
Horiba ABX Pentra
DX120
Impedancia
citometriacutea de flujo
fluorescencia
Naranja de tiazol IRF MRV RETH
RHbC
Siemens ADVIA 120 Absorbancia
Scatter
Oxazine 750 IRF MCVr CHr
Sysmex XE5000 XN Fluorescencia Polimetina IRF RetHe ΔHeCongreso Nacional Laboratorio Cliacutenico
2018
Los reticulocitos precursores de los eritrocitos madurangeneralmente a lo largo de unos dos diacuteas El recuento dereticulocitos es por lo tanto una medida de la cantidad dela eritropoyesis en la meacutedulaParaacutemetros derivados de los reticulocitos los describenmorfoloacutegicamente tamantildeo contenido en Hemoglobinacantidad de material geneacuteticoDe esta forma al referirse a caracteriacutesticas de losreticulocitos es la calidad de la eritropoyesis la que puedeser evaluada
La Hb reticulocitaria se relaciona con la cantidad de hierro disponible efectivamente para laeritropoyesis un valor bajo indica que el aporte es deficitario respecto a la demanda en el momentoactual 28-30 pg
Congreso Nacional Laboratorio Cliacutenico
2018
MCV MCH son los valores medios de volumen y Hb en toda la poblacioacuten RBC
No informan acerca de las ceacutelulas individuales
Ni de la variedad de eacutestas anisocitosis policromasia
Congreso Nacional Laboratorio Cliacutenico
2018
Se cuentan el nuacutemero de pulsos de 36-360fL y el nuacutemero de partiacuteculas que tienen el mismo tamantildeo y se trasladan los resultados a una graacutefica de Volumen Nuacutemero de ceacutelulasSe obtiene el histograma de RBC que proporciona
bull Nuacutemero de RBC el nuacutemero de pulsos dentro de este rango de tamantildeos
bull MCV se corresponde con la media del histograma de RBC
bull RDW o ADE Ancho de Distribucioacuten del histograma de RBC se corresponde con el coeficiente de variacioacuten de la curva
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
Abbott Sapphire lo calcula en el 50 de la altura del pico del histogramaSysmex y Mindray al 20 desde la base del histogramaSiemens calcula la anchura del pico comprendido entre 60 y 120 fL
Aunque RDW ADE generalmente se entiendecomo coeficiente de variacioacuten de ladistribucioacuten de los voluacutemenes de loseritrocitos algunos analizadoreshematoloacutegicos lo calculan desde la medicioacutendirecta de la anchura de la distribucioacuten
Congreso Nacional Laboratorio Cliacutenico
2018
G Lippi amp M Plebani
Recent developments and innovations in red blood cells diagnostics
Journal of Laboratory and Precision Medicine 2018
DOI 1021037jlpm20180709 AOPCongreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
copy 2012 Mindray Confidential 26
HDWHYPERHYPO
HDW HGB Distribution Width
HDW is the distribution width of Hgb histogram
Congreso Nacional Laboratorio Cliacutenico
2018
copy 2012 Mindray Confidential 27
MCHrHDWHYPERHYPOMCHr Mean RET HGB Concentration
Congreso Nacional Laboratorio Cliacutenico
2018
Histograma RBC el mapa de Mie
28 41
Congreso Nacional Laboratorio Cliacutenico
2018
Abbott Mindray Siemens
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
Severe Iron Deficiency Anemia Female 34 years
19 th March 18 th April
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
SysmexRBCHe erythrocyte Hb equivalentRetHe reticulocyte Hb equivalent(content)
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
MIC
MAC
HPO HPR
Congreso Nacional Laboratorio Cliacutenico
2018
copy 2012 Mindray Confidential 36
MINDRAY MCHrHDWHYPERHYPO
MCHr Mean RET HGB Concentration
HDW HGB Distribution Width
HYPER The percentage of hyperchromicred blood cells
HYPO The percentage of hypochromic red blood cells
Thalassemia screeningIDA treatment monitoringIDA screening
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
Hipocromo
Hipercroacutemico onormocroacutemico
iquestConcentracioacuten o contenido de Hemoglobina
Hipocroacutemiconormocroacutemico
Abbott Mindray Siemens Hypo CONCENTRACIOacuteN Hblt280gL
Sysmex Hypo CONTENIDO Hblt 17 pg
Congreso Nacional Laboratorio Cliacutenico
2018
Low Hb Density
Microcytic Factor Maf = (HbMCV)100
Nuevo moacutedulo transductor muacuteltiple con laacuteser de diodo y dos sensores oacutepticos
Anaacutelisis de hasta 50000 ceacutelulas con 7 paraacutemetros tecnoloacutegicos (leucocitos reticulocitos eritroblastos)
1 Volumen digital
2 Conductividad digital
3 5 aacutengulos de dispersioacuten de luz laacuteser digital
bull MALS (Median Angle Light Scatter)
bull UMALS (Upper Median Angle Light Scatter) 20deg a 43deg
bull LMALS (Lower Median Angle Light Scatter) 09deg a 19deg
bull LALS (Low Angle Light Scatter) asymp 51deg
bull AL2 (Axial Light Loss) 0deg a 05deg
Congreso Nacional Laboratorio Cliacutenico
2018
Hierro es un elemento criacutetico para elfuncionamiento oacuteptimo y supervivenciade las ceacutelulas
Disfuncioacuten mitocondrialActividad enzimaacutetica afectadaProteiacutenas de transporte y estructuralesproteins
Capacidad fiacutesica mermadaCapacidad de trabajo reducidaCapacidades cognitivas afectadasMorbilidad y mortalidad
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
It is generally assumed that worldwide ldquoat least half the anemia is due tonutritional iron deficiencyrdquo and that ldquoup to a prevalence of iron deficiency anemiaof 40 the prevalence of iron deficiency will be about 25 times that of anemiardquoHowever it is evident from the foregoing discussion that there are considerablevariations in both of these ratios depending on the age and sex of the peoplebeing studied the region of the world in which they live and the prevalence ratesof other causes of anemia
WHO Department of Nutrition for Health and DevelopmentAssessing the iron status of populations including literature reviews report of a Joint World Health OrganizationCenters for DiseaseControl and Prevention Technical Consultation on the Assessment of Iron Status at the Population Level Geneva Switzerland 6ndash8 April2004 ndash 2nd ed
Congreso Nacional Laboratorio Cliacutenico
2018
Estaacute bien establecido que la anemia produce una miriacuteada de secuelas tanto fiacutesicas comopsicoloacutegicas
Pero los efecto deleteacutereos se deben al deficit de hierro que es un evento previo a que seestablezca la anemia
El deacuteficit de hierrro auacuten sin anemia tiene efectos negativos en el desarrollo cognitivo y fiacutesico
Rattehalli D et al Iron deficiency without anemia do not wait for the Hemoglobin to drop
Health Policy and Technology 2013 2 45-48Congreso Nacio
nal Laboratorio Cliacutenico 2018
SuominenP et al Serum transferrin receptor and transferrin receptor-ferritin index identify healthy subjects with subclinical iron deficits Blood 1998 92 2934ndash9Halwachs-Baumann G Diagnosis of anaemia old things rearranged Wien Med Wochenschr 2012 162478ndash88
Congreso Nacional Laboratorio Cliacutenico
2018
Hemoglobina de reticulocito y su importancia en el diagnoacutestico temprano de anemiaferropeacutenica
Y Maacuterquez-Beniacutetez et al Universidad de BocayaAugust
2018 DOI 1022267rus182003133 aop
El contenido de hemoglobina de reticulocitos (CHr) es un paraacutemetro en la biometriacuteahematoloacutegica automatizada utilizado como un marcador de la biodisponibilidad delhierro en la eritropoyesis
Objetivo Exponer la aplicabilidad de la CHr como un paraacutemetro en el diagnoacutesticoprecoz de la anemia por deficiencia de hierro asiacute como su medicioacuten e interpretacioacuten
Materiales y meacutetodos Se realizoacute la revisioacuten de artiacuteculos cientiacuteficos en ingleacutes y espantildeolen las bases de datos PubMed ScienceDirect LILACS y Medline usando descriptoresvalidados en Medical Subject Headings (MeSH) considerando periodo depublicabilidad del 80 inferior a 5 antildeos
Conclusiones La CHr es un paraacutemetro de gran utilidad en el diagnoacutestico temprano deanemia ferropeacutenica y otras patologiacuteas como deficiencia funcional de hierro estadosde inflamacioacuten croacutenica y enfermedad renal croacutenica
Biomarcador temprano en el diagnoacutestico de deficiencia de hierro antes de presentarsecambios morfoloacutegicos eritrociacuteticosCongreso Nacio
nal Laboratorio Cliacutenico 2018
bull A total of 1105 NES participants (639 men 466 women)bull CHr becomes affected in a relatively early stage in the development of iron deficiency before iron
deficiency anemia and clinical symptoms become apparentbull Therefore this parameter might be useful to identify persons healthy and diseased at risk of
developing iron deficiency anemia and subsequently to apply interventions in order to prevent further development of iron deficiency anemiaCongreso Nacio
nal Laboratorio Cliacutenico 2018
Hb reticulocitaria sensible para detectar la fase inicial del deacuteficit de hierro cuando laeritropoyesis requiere maacutes cantidad que la que recibe ANTES de que la anemia seestablezca
Congreso Nacional Laboratorio Cliacutenico
2018
No ID LID P
RBC 1012L 48 (08) 437 (05) lt00001
Hb gL 135 (6) 131 (12) 0006
MCV fL 922 (21) 902 (38) 0006
MCH pg 324 (07) 306 (22) lt00001
MCHC gL 339 (6) 319 (23) 0001
RDW
Ret He pg
Hypo He
LHD
Ferritin microgL
131 (06)
338 (21)
03 (015)
28 (20)
86 (3)
145 (21)
278 (24)
69 (55)
56 (25)
16 (76)
lt00001
lt00001
lt00001
lt00001
lt00001
AUC 95 CI Cutoff Sensitivity Specificity
LHD 0898 0819-0978 50 859 841
Ret He 0914 0824-1000 299pg 868 857
Hypo He 0934 0856-1000 16 857 921
Clinical value of markers of hypochromia in the detection of latent iron deficiency in non-anemic premenopausal women
No ID Hb gt 120 gL s-ferritin was within reference intervalLatent Iron Defiency Hb gt 120 gL s-ferritin lt 30 μgL
Urrechaga E et al Journal Clin Lab Analysis 2016 30 (5) 623-627
97 women (388) in 250 apparently healthy women had latent IDCongreso Nacional Laboratorio Cliacutenico
2018
Schorer G et al Abstract Jahreskongress der Deutschen Gesellschaft fuumlr Transfusionsmedizin und Immunhaumlmatologie Rostock 15 - 18 September 2009
Congreso Nacional Laboratorio Cliacutenico
2018
Caring for Those Who Share Mitigating Iron Deficiency in Regular Blood DonorsMast Alan E
bull Iron deficiency caused by regular blood donation is a problem facing blood centers Each blood donation removes 200 to 250 mg of iron from the donor Consequently many donors become iron deficient with repeated donation
bull This presents a challenge to blood centers that has become more acute in recent years with the realization that iron deficiency even in the absence of anemia is associated with adverse effects including fatigue and decreased exercise tolerance as well as neurological symptoms such as decreased cognitive function pica and restless leg syndrome
bull REDS-II investigators performed a longitudinal study investigating the iron status of blood donors over a two year period called the REDS-II Donor Iron Status Evaluation (RISE)
bull Results from the baseline analysis of regular donors (e 2 donations per year (females) or e 3 donations per year (males) revealed that over two-thirds of female donors and over one-half of male donors have iron deficiency
Congreso Nacional Laboratorio Cliacutenico
2018
Transfusion 2013 532766-2775
bull We evaluated the diagnostic sensitivity and specificity of red blood cell (RBC) hematology analyzer indices to assess iron status as a part of donor management iron deficient erythropoiesis (IDE) and absence of iron stores (AIS)
bull STUDY DESIGN AND METHODS A total of 1659 male and female donors from the Retrovirus Epidemiology Donor Study-II (REDS-II) Donor Iron Status Evaluation (RISE) study who were either first-timereactivated (FT RA no donations for 2 years) or frequent donors were recruited into a longitudinal study of regular donation of RBCs Of these 1002 donors returned 15 to 24 months later for a final assessment
Absent iron stores (AIS) was defined as plasma ferritin level of less than 12 mgL Logarithm of the ratio of soluble transferrin receptor to ferritin of at least 207 was used to define iron-deficient erythropoiesis (IDE)
bull RESULTS HYPOm and CHr detected IDE with comparable sensitivity 72 versus 69 but differed in specificity HYPOm 68 and CHr 53
For detecting AIS sensitivity was improved to 85 for HYPOm and 81 for CHr but specificity was reduced
Venous Hb had high specificity but poor sensitivity for IDE and AIS A plasma ferritin level of less than 267 mgL was a good surrogate for assessing IDE Congreso Nacio
nal Laboratorio Cliacutenico 2018
Microcytic RBC and reticulocyte mean cell hemoglobin content predicted iron depletion with
sensitivities 70 and 64
specificities of 72 and 78 respectively
When both combined
increased the sensitivity to 82
Congreso Nacional Laboratorio Cliacutenico
2018
Depending on the number of donations during the preceding12 months
Absent iron stores were detected in up to 214 of male and278 of female donors respectively
impaired hemoglobinisation IH was present in up to 64 maleand 167 female donors with 2 and 4 preceding donationsrespectively
The defined CHr cut-off value was 280 pg to detect IH infrequent whole blood donors with AIS leading to a testspecificity of 982 (positive predictive value PPV 577) inmale and of 978 (PPV 829) in female donors
It may help to prevent the development of anemia in frequentblood donors and also can help to decide whether donordeferral or even iron substitution need to be recommended
Congreso Nacional Laboratorio Cliacutenico
2018
Of the 501 blood donors sTfR and Ret-He detected Latent Iron Deficiency in 148 and 135 donors respectively
In comparison to sTfR Ret-He had sensitivity of 927 specificity of 9716 PPV of 931 and NPV of 963
Serum Ferritin TIBC and serum Iron had comparatively lower sensitivity of 8716 797 and 777 respectively
Conclusion Ret-He can be used as a routine screening test to detect LID in blood donors
This could provide an opportunity to make appropriate and timely interventions like dietary changes or drug supplementation
Congreso Nacional Laboratorio Cliacutenico
2018
Singh A Chaudhary R Pandey HC Sonker A Identification of iron status of blood donors by using low hemoglobin density and microcytic anemia factor Asian J Transfus Sci 20181246-50
The main objective of this study was to assess ifLHD and Maf could be used for assessment ofiron status in blood donors and also to establisha cut-off for these two parameters at which atentative iron deficiency could be reportedconclusively
Results LHD and Maf were able to differentiatebetween iron deficient and iron-depleteddonors from normal donorsA cutoff of 918 for LHD was able todifferentiate iron deficient and depleted statefrom normal iron statessensitivity 919 and specificity 71respectivelya cutoff of 1016 for Mafsensitivity 946 and specificity 968
MAf = (MVC Hb) 100
Congreso Nacional Laboratorio Cliacutenico
2018
Hb reticulocitaria sensible para detectar la fase inicial del deacuteficitde hierro cuando la eritropoyesis requiere maacutes cantidad que laque recibe ANTES de que la anemia se establezca
La deteccioacuten precoz del deacuteficit de hierro en la fase del balance negativo demanda aporte contribuye a reducir sus manifestaciones cliacutenicas en los pacientes afectados mejorando la salud puacuteblica
Un tratamiento menos prolongado con suplementos y menor consumo de los recursos sanitaros Contribuye a la eficiencia y sostenibilidad de los servicios sanitarios
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
Buttarello MLaboratory diagnosis of anemia are the old and new red cell parameters useful in classification and treatment howInt Jnl Lab Hem 2016 38 (Suppl 1) 123ndash132
Congreso Nacional Laboratorio Cliacutenico
2018
Buttarello MLaboratory diagnosis of anemia are the old and new red cell parameters useful in classification and treatment howInt Jnl Lab Hem 2016 38 (Suppl 1) 123ndash132
Congreso Nacional Laboratorio Cliacutenico
2018
Ralph Green amp Ananya Datta Mitra Megaloblastic Anemias Nutritional and Other CausesMed Clin N Am 2017 101 297ndash317
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
ANEMIA CARENCIAL CAUSAS
Factores alimentariosConsumir una dieta vegetariana mal planeadaAlimentacioacuten deficiente en los bebeacutesDesnutricioacuten durante el embarazo
Deacuteficit de absorcioacutenAlcoholismo croacutenicoEnfermedad de Crohn celiaquiacutea infeccioacuten otros problemas que le dificulten al cuerpo la digestioacuten de los alimentosAnemia perniciosa (factor intriacutenseco)Cirugiacuteas para extirpar ciertas partes del estoacutemago o el intestino delgado
MedicamentosB12 omeprazol metformina colchicina aminosalicilatos neomicinaFOLATO fenitoiacutena metotrexato sulfasalacina triamtereno pirimetamina trimetoprim con sulfametoxazol barbituacutericos
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
Reacciones metaboacutelicas en las que participan la vitamina B12 y el folato bull la conversioacuten de metilmalonil-CoA a succinil-CoA donde la adenosil-cobalamina actuacutea de
cofactor Por ello un deacuteficit de B12 conlleva un aumento de metilmalonil-CoA y de su producto de hidroacutelisis el aacutecido metilmaloacutenico
bull la siacutentesis de metionina a partir de homocisteina gracias a la metionina sintetasa y a la metil-cobalamina como cofactor En esta misma reaccioacuten el metiltetrahidrofolato es transformado a tetrahidrofolato que es necesario para la siacutentesis de DNA
Congreso Nacional Laboratorio Cliacutenico
2018
Anemia macrociacutetica secundaria a deficiencia de aacutecido foacutelico y de vitamina B12(cobalamina)
La deficiencia de B12 yo aacutecido foacutelico es la causa maacutes frecuente de megaloblastosis
Dentro de distintas funciones generales del metabolismo la vitamina B12 es uncofactor esencial en la siacutentesis de ADN y ARN compromete a todas las ceacutelulas delorganismo
Su deficiencia se manifiesta en oacuterganos con alto recambio celular como la meacutedulaosea y en el sistema nervioso central (SNC) a traveacutes de la siacutentesis de mielina y lareparacioacuten axonal
La deficiencia de cobalamina es responsable de alteraciones hematoloacutegicasneuroloacutegicas neurocognitivas y neuropsiquiaacutetricas
La siacutentesis defectuosa de ADN conduce a la apoptosis y a la hemoacutelisis (intra yextramedular) causantes de la hemopoyesis inefectiva
En meacutedula la siacutentesis ineficiente de DNA causa cambios megaloblaacutesticos comoconsecuencIa anemia y citopenias
Congreso Nacional Laboratorio Cliacutenico
2018
Limitaciones de los meacutetodos diagnoacutesticos claacutesicos
Volumen Corpuscular Medio (VCM) y morfologiacutea de sangre perifeacuterica En una serie de pacientes con deacuteficit de cobalamina soacutelo un 29 teniacutean anemia y soacutelo un 36 teniacutean un VCM gt 100 fL
Un VCM normal no puede ser empleado para rechazar una determinacioacuten de nivel de cobalamina ya que hasta un 25 de casos con manifestaciones neuroloacutegicas cursan con un VCM normal
Cobalamina seacuterica (nivel de B12) Es el test diagnoacutestico rutinario inicial estaacutendar Es un test ampliamente disponible de bajo coste y automatizado Sin embargo presenta algunas limitaciones
-- Existencia de varias teacutecnicas y ausencia de un gold standard por lo que hay diferentes liacutemites de referencia
-- Variacioacuten intraindividual muy alta
La OMS publicoacute en 2008 las conclusiones de un grupo teacutecnico consultado sobre el deacuteficit de cobalamina y folato
El grupo reconocioacute que no existen unos umbrales universalmente reconocidos para definir el deacuteficit de ambas vitaminas y expresaron la necesidad de un consenso
Devalia V Hamilton MS and Molloy AM on behalf of the British Committee for standards in haematology Guidelines for the diagnosis and treatment of cobalamin and folate disorders Br J Haematol 2014 166(4) 496-513
Schrier SL Diagnosis and treatment of vitamin B12 and folate deficiency UpToDate Last updated Jun 25 2014
de Benoist B Conclusions of a WHO Technical Consultation on folate and vitamin B12 deficiencies Food Nutr Bull 200829(2 Suppl)S238ndash44Congreso Nacional Laboratorio Cliacutenico
2018
Tomado de Tefferi A Li C En Atlas of Clinical Hematology Publicado por JO Armitage Philadelphia Current Medicine 2004
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
Int Jnl Lab Hem 2007 29 327ndash334
Clin Lab 201662343-347
In ourstudy mean MCVrMCV ratio of healthy controls is130 as microcytic anemia irondeficiency anemia is121 as also macrocytic anemia vitamin B12 deficiencyanemia is 115
Congreso Nacional Laboratorio Cliacutenico
2018
Sualeh Muslim Khan Muhammad Akbar Agha
Mean cell volume of reticulocytemdashA new parameter for diagnosing sub-clinical cobalamin deficiency in blood donors Int J Lab Hem 20181ndash4
The Abbott CELL-DYN Sapphire Hematology System uses multi-angle polarized scatter separation (MAPSS) and focused flow impedance technologies
Congreso Nacional Laboratorio Cliacutenico
2018
MCVr at 985 fL yielded the highest Youdenrsquos index at sensitivity of 82 specificity of 828 AUC 0847 ( 95 CI 803-891)
Khan SM Agha MA Mean cell volume of reticulocyte-A new parameter for diagnosing sub-clinical cobalamin deficiency in blood donors
Int J Lab Hem 20181ndash4 2018 Jul 13 doi 101111ijlh12899
Congreso Nacional Laboratorio Cliacutenico
2018
Role of Cell Population Data in the detection of folate and cobalamin deficiency
J Nieto et al
XXXI st International Symposium on Technological Innovations in Laboratory Hematology ISLH 2018 10-12 May 2018 Brussels Belgium
M-V-NRET and SD-VNRET are the best discriminatory single parameters to distinguish between patients with B9B12 deficiency and reference subjects M-V-NRETAUC=0823 sensitivity 78 and specificity 86
AUC=0852 sensitivity 55 and specificity 60
Conclusions The CPD parameters of Volume and Light Scatter (M and SD of LALS angle) that inform about size and intracellular structure of RBCs provided very useful information for the detection of B9B12 deficiency
Congreso Nacional Laboratorio Cliacutenico
2018
Cell Population Data
bull Paraacutemetros poblacionales de los leucocitos
bull Describen la morfologiacutea tamantildeo
estructuras citoplasmaacuteticas
nuacutecleo aacutecidos nucleacuteicos
bull Son datos numeacutericos con los que se construyen los ejes de lo diagramas de dispersioacuten de los leucocitos
bull Dependen de la tecnologiacutea
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
High Sensitivity New Parameters for the Detection of Vitamin B12 and Folate Deficiencies Blood 2008 1125379
B12 def vs
Normals
Mann
Withney T-Test
ROC
AUC Sens Specif Cutoff signifROC
MCV p=03156 p=09533 0577
MPV p=00001 0802 792 806 lt83 p=00001
NE Mean
Volume plt00001 0862 833 778 gt1403 p=00001
MO Mean
Volume plt00001 0829 625 889 gt1723 p=00001
MRV p=00113 0705 50 964 gt1133 p=00051
Folate def vs
Normals
Mann
Withney T-Test
ROC
AUC Sens Specif Cut-off signifROC
MCV p=00798 p=06461 0665
MPV plt00001 0832 81 806 lt83 p=00001
NE Mean
Volume p=00008 087 952 694 gt1402 p=00001
MO Mean
Volume p=00002 0801 667 833 gt1696 p=00001
MRV p=00054 0731 476 964 gt1133 p=00019
The Mean Neutrophil Volume (MNE V) and Mean Monocyte Volume (MMOV) may be used for the detection of megaloblastic neutrophils and monocytes MNEV and MMOV have significantly higher sensitivity than the previous information from the red cells (MCV) detecting B12 or folate deficiency because they are not affected by the presence at the same time of Iron deficiency or other reasons of anemia
Congreso Nacional Laboratorio Cliacutenico
2018
POSTER 733
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
CPD Sysmex XN
NE SSC complejidad
NE SFL aacutecidos nucleacuteicos
NE FSC tamantildeo
NE WX
NE WY
NE WZ
MO X
MO Y
MO Z
MO WX
MO WY
MO WZ
LY X
LY Y
LY Z
LY WX
LY WY
LY WZCongreso Nacio
nal Laboratorio Cliacutenico 2018
As MCV is the mean which is calculated it is insensitive to the presence of a small number of macrocytes
Further macrocytosis can be obscured by concomitant disorders that can cause microcytosis resulting inmasked megaloblastic anaemia (MA) for example iron deficiency hereditary elliptocytosis alpha and betathalassemia
This study was undertaken to evaluate the role of NEUT-X and NEUT-Y in detecting MA on peripheral blood andalso see whether other forms of macrocytic anaemia can be differentiated from MA
In MA the peripheral blood smear shows cytopenia with macroovalocytes and hypersegmented
neutrophils (gt5 lobes in 5 neutrophils six lobes nuclei or lobe average of gt35)
In conclusion our study shows that higher values of NEUT-X and NEUT-Y in MA patients in spite of low ornormal MCV high RDW may be used to not only reveal the masked cases of MA with concomitant irondeficiency but also separate them from the broader macrocytic anaemia group
Peripheral smear remains diagnostic however making smear for all the suspicious cases is a cumbersomeand tedious procedure Thus these parameters emerge as more reliable and stable parameters in themodern laboratories which in future may replace the older screening tools
Congreso Nacional Laboratorio Cliacutenico
2018
A favor Eficiencia Operativa
Mejora el proceso del Laboratorio
Mejor informacioacuten al Cliacutenico al mismo coste
Mejora la informacioacuten
Informa sobre la eritropoyesis deteccioacuten precoz de estados carenciales
Ayuda al cliacutenico
Estado real del paciente
En contraParaacutemetros de investigacioacuten
Dificultad de standarizar dependencia teacutecnica
Control de calidadCongreso Nacional Laboratorio Cliacutenico
2018
Los reticulocitos precursores de los eritrocitos madurangeneralmente a lo largo de unos dos diacuteas El recuento dereticulocitos es por lo tanto una medida de la cantidad dela eritropoyesis en la meacutedulaParaacutemetros derivados de los reticulocitos los describenmorfoloacutegicamente tamantildeo contenido en Hemoglobinacantidad de material geneacuteticoDe esta forma al referirse a caracteriacutesticas de losreticulocitos es la calidad de la eritropoyesis la que puedeser evaluada
La Hb reticulocitaria se relaciona con la cantidad de hierro disponible efectivamente para laeritropoyesis un valor bajo indica que el aporte es deficitario respecto a la demanda en el momentoactual 28-30 pg
Congreso Nacional Laboratorio Cliacutenico
2018
MCV MCH son los valores medios de volumen y Hb en toda la poblacioacuten RBC
No informan acerca de las ceacutelulas individuales
Ni de la variedad de eacutestas anisocitosis policromasia
Congreso Nacional Laboratorio Cliacutenico
2018
Se cuentan el nuacutemero de pulsos de 36-360fL y el nuacutemero de partiacuteculas que tienen el mismo tamantildeo y se trasladan los resultados a una graacutefica de Volumen Nuacutemero de ceacutelulasSe obtiene el histograma de RBC que proporciona
bull Nuacutemero de RBC el nuacutemero de pulsos dentro de este rango de tamantildeos
bull MCV se corresponde con la media del histograma de RBC
bull RDW o ADE Ancho de Distribucioacuten del histograma de RBC se corresponde con el coeficiente de variacioacuten de la curva
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
Abbott Sapphire lo calcula en el 50 de la altura del pico del histogramaSysmex y Mindray al 20 desde la base del histogramaSiemens calcula la anchura del pico comprendido entre 60 y 120 fL
Aunque RDW ADE generalmente se entiendecomo coeficiente de variacioacuten de ladistribucioacuten de los voluacutemenes de loseritrocitos algunos analizadoreshematoloacutegicos lo calculan desde la medicioacutendirecta de la anchura de la distribucioacuten
Congreso Nacional Laboratorio Cliacutenico
2018
G Lippi amp M Plebani
Recent developments and innovations in red blood cells diagnostics
Journal of Laboratory and Precision Medicine 2018
DOI 1021037jlpm20180709 AOPCongreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
copy 2012 Mindray Confidential 26
HDWHYPERHYPO
HDW HGB Distribution Width
HDW is the distribution width of Hgb histogram
Congreso Nacional Laboratorio Cliacutenico
2018
copy 2012 Mindray Confidential 27
MCHrHDWHYPERHYPOMCHr Mean RET HGB Concentration
Congreso Nacional Laboratorio Cliacutenico
2018
Histograma RBC el mapa de Mie
28 41
Congreso Nacional Laboratorio Cliacutenico
2018
Abbott Mindray Siemens
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
Severe Iron Deficiency Anemia Female 34 years
19 th March 18 th April
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
SysmexRBCHe erythrocyte Hb equivalentRetHe reticulocyte Hb equivalent(content)
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
MIC
MAC
HPO HPR
Congreso Nacional Laboratorio Cliacutenico
2018
copy 2012 Mindray Confidential 36
MINDRAY MCHrHDWHYPERHYPO
MCHr Mean RET HGB Concentration
HDW HGB Distribution Width
HYPER The percentage of hyperchromicred blood cells
HYPO The percentage of hypochromic red blood cells
Thalassemia screeningIDA treatment monitoringIDA screening
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
Hipocromo
Hipercroacutemico onormocroacutemico
iquestConcentracioacuten o contenido de Hemoglobina
Hipocroacutemiconormocroacutemico
Abbott Mindray Siemens Hypo CONCENTRACIOacuteN Hblt280gL
Sysmex Hypo CONTENIDO Hblt 17 pg
Congreso Nacional Laboratorio Cliacutenico
2018
Low Hb Density
Microcytic Factor Maf = (HbMCV)100
Nuevo moacutedulo transductor muacuteltiple con laacuteser de diodo y dos sensores oacutepticos
Anaacutelisis de hasta 50000 ceacutelulas con 7 paraacutemetros tecnoloacutegicos (leucocitos reticulocitos eritroblastos)
1 Volumen digital
2 Conductividad digital
3 5 aacutengulos de dispersioacuten de luz laacuteser digital
bull MALS (Median Angle Light Scatter)
bull UMALS (Upper Median Angle Light Scatter) 20deg a 43deg
bull LMALS (Lower Median Angle Light Scatter) 09deg a 19deg
bull LALS (Low Angle Light Scatter) asymp 51deg
bull AL2 (Axial Light Loss) 0deg a 05deg
Congreso Nacional Laboratorio Cliacutenico
2018
Hierro es un elemento criacutetico para elfuncionamiento oacuteptimo y supervivenciade las ceacutelulas
Disfuncioacuten mitocondrialActividad enzimaacutetica afectadaProteiacutenas de transporte y estructuralesproteins
Capacidad fiacutesica mermadaCapacidad de trabajo reducidaCapacidades cognitivas afectadasMorbilidad y mortalidad
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
It is generally assumed that worldwide ldquoat least half the anemia is due tonutritional iron deficiencyrdquo and that ldquoup to a prevalence of iron deficiency anemiaof 40 the prevalence of iron deficiency will be about 25 times that of anemiardquoHowever it is evident from the foregoing discussion that there are considerablevariations in both of these ratios depending on the age and sex of the peoplebeing studied the region of the world in which they live and the prevalence ratesof other causes of anemia
WHO Department of Nutrition for Health and DevelopmentAssessing the iron status of populations including literature reviews report of a Joint World Health OrganizationCenters for DiseaseControl and Prevention Technical Consultation on the Assessment of Iron Status at the Population Level Geneva Switzerland 6ndash8 April2004 ndash 2nd ed
Congreso Nacional Laboratorio Cliacutenico
2018
Estaacute bien establecido que la anemia produce una miriacuteada de secuelas tanto fiacutesicas comopsicoloacutegicas
Pero los efecto deleteacutereos se deben al deficit de hierro que es un evento previo a que seestablezca la anemia
El deacuteficit de hierrro auacuten sin anemia tiene efectos negativos en el desarrollo cognitivo y fiacutesico
Rattehalli D et al Iron deficiency without anemia do not wait for the Hemoglobin to drop
Health Policy and Technology 2013 2 45-48Congreso Nacio
nal Laboratorio Cliacutenico 2018
SuominenP et al Serum transferrin receptor and transferrin receptor-ferritin index identify healthy subjects with subclinical iron deficits Blood 1998 92 2934ndash9Halwachs-Baumann G Diagnosis of anaemia old things rearranged Wien Med Wochenschr 2012 162478ndash88
Congreso Nacional Laboratorio Cliacutenico
2018
Hemoglobina de reticulocito y su importancia en el diagnoacutestico temprano de anemiaferropeacutenica
Y Maacuterquez-Beniacutetez et al Universidad de BocayaAugust
2018 DOI 1022267rus182003133 aop
El contenido de hemoglobina de reticulocitos (CHr) es un paraacutemetro en la biometriacuteahematoloacutegica automatizada utilizado como un marcador de la biodisponibilidad delhierro en la eritropoyesis
Objetivo Exponer la aplicabilidad de la CHr como un paraacutemetro en el diagnoacutesticoprecoz de la anemia por deficiencia de hierro asiacute como su medicioacuten e interpretacioacuten
Materiales y meacutetodos Se realizoacute la revisioacuten de artiacuteculos cientiacuteficos en ingleacutes y espantildeolen las bases de datos PubMed ScienceDirect LILACS y Medline usando descriptoresvalidados en Medical Subject Headings (MeSH) considerando periodo depublicabilidad del 80 inferior a 5 antildeos
Conclusiones La CHr es un paraacutemetro de gran utilidad en el diagnoacutestico temprano deanemia ferropeacutenica y otras patologiacuteas como deficiencia funcional de hierro estadosde inflamacioacuten croacutenica y enfermedad renal croacutenica
Biomarcador temprano en el diagnoacutestico de deficiencia de hierro antes de presentarsecambios morfoloacutegicos eritrociacuteticosCongreso Nacio
nal Laboratorio Cliacutenico 2018
bull A total of 1105 NES participants (639 men 466 women)bull CHr becomes affected in a relatively early stage in the development of iron deficiency before iron
deficiency anemia and clinical symptoms become apparentbull Therefore this parameter might be useful to identify persons healthy and diseased at risk of
developing iron deficiency anemia and subsequently to apply interventions in order to prevent further development of iron deficiency anemiaCongreso Nacio
nal Laboratorio Cliacutenico 2018
Hb reticulocitaria sensible para detectar la fase inicial del deacuteficit de hierro cuando laeritropoyesis requiere maacutes cantidad que la que recibe ANTES de que la anemia seestablezca
Congreso Nacional Laboratorio Cliacutenico
2018
No ID LID P
RBC 1012L 48 (08) 437 (05) lt00001
Hb gL 135 (6) 131 (12) 0006
MCV fL 922 (21) 902 (38) 0006
MCH pg 324 (07) 306 (22) lt00001
MCHC gL 339 (6) 319 (23) 0001
RDW
Ret He pg
Hypo He
LHD
Ferritin microgL
131 (06)
338 (21)
03 (015)
28 (20)
86 (3)
145 (21)
278 (24)
69 (55)
56 (25)
16 (76)
lt00001
lt00001
lt00001
lt00001
lt00001
AUC 95 CI Cutoff Sensitivity Specificity
LHD 0898 0819-0978 50 859 841
Ret He 0914 0824-1000 299pg 868 857
Hypo He 0934 0856-1000 16 857 921
Clinical value of markers of hypochromia in the detection of latent iron deficiency in non-anemic premenopausal women
No ID Hb gt 120 gL s-ferritin was within reference intervalLatent Iron Defiency Hb gt 120 gL s-ferritin lt 30 μgL
Urrechaga E et al Journal Clin Lab Analysis 2016 30 (5) 623-627
97 women (388) in 250 apparently healthy women had latent IDCongreso Nacional Laboratorio Cliacutenico
2018
Schorer G et al Abstract Jahreskongress der Deutschen Gesellschaft fuumlr Transfusionsmedizin und Immunhaumlmatologie Rostock 15 - 18 September 2009
Congreso Nacional Laboratorio Cliacutenico
2018
Caring for Those Who Share Mitigating Iron Deficiency in Regular Blood DonorsMast Alan E
bull Iron deficiency caused by regular blood donation is a problem facing blood centers Each blood donation removes 200 to 250 mg of iron from the donor Consequently many donors become iron deficient with repeated donation
bull This presents a challenge to blood centers that has become more acute in recent years with the realization that iron deficiency even in the absence of anemia is associated with adverse effects including fatigue and decreased exercise tolerance as well as neurological symptoms such as decreased cognitive function pica and restless leg syndrome
bull REDS-II investigators performed a longitudinal study investigating the iron status of blood donors over a two year period called the REDS-II Donor Iron Status Evaluation (RISE)
bull Results from the baseline analysis of regular donors (e 2 donations per year (females) or e 3 donations per year (males) revealed that over two-thirds of female donors and over one-half of male donors have iron deficiency
Congreso Nacional Laboratorio Cliacutenico
2018
Transfusion 2013 532766-2775
bull We evaluated the diagnostic sensitivity and specificity of red blood cell (RBC) hematology analyzer indices to assess iron status as a part of donor management iron deficient erythropoiesis (IDE) and absence of iron stores (AIS)
bull STUDY DESIGN AND METHODS A total of 1659 male and female donors from the Retrovirus Epidemiology Donor Study-II (REDS-II) Donor Iron Status Evaluation (RISE) study who were either first-timereactivated (FT RA no donations for 2 years) or frequent donors were recruited into a longitudinal study of regular donation of RBCs Of these 1002 donors returned 15 to 24 months later for a final assessment
Absent iron stores (AIS) was defined as plasma ferritin level of less than 12 mgL Logarithm of the ratio of soluble transferrin receptor to ferritin of at least 207 was used to define iron-deficient erythropoiesis (IDE)
bull RESULTS HYPOm and CHr detected IDE with comparable sensitivity 72 versus 69 but differed in specificity HYPOm 68 and CHr 53
For detecting AIS sensitivity was improved to 85 for HYPOm and 81 for CHr but specificity was reduced
Venous Hb had high specificity but poor sensitivity for IDE and AIS A plasma ferritin level of less than 267 mgL was a good surrogate for assessing IDE Congreso Nacio
nal Laboratorio Cliacutenico 2018
Microcytic RBC and reticulocyte mean cell hemoglobin content predicted iron depletion with
sensitivities 70 and 64
specificities of 72 and 78 respectively
When both combined
increased the sensitivity to 82
Congreso Nacional Laboratorio Cliacutenico
2018
Depending on the number of donations during the preceding12 months
Absent iron stores were detected in up to 214 of male and278 of female donors respectively
impaired hemoglobinisation IH was present in up to 64 maleand 167 female donors with 2 and 4 preceding donationsrespectively
The defined CHr cut-off value was 280 pg to detect IH infrequent whole blood donors with AIS leading to a testspecificity of 982 (positive predictive value PPV 577) inmale and of 978 (PPV 829) in female donors
It may help to prevent the development of anemia in frequentblood donors and also can help to decide whether donordeferral or even iron substitution need to be recommended
Congreso Nacional Laboratorio Cliacutenico
2018
Of the 501 blood donors sTfR and Ret-He detected Latent Iron Deficiency in 148 and 135 donors respectively
In comparison to sTfR Ret-He had sensitivity of 927 specificity of 9716 PPV of 931 and NPV of 963
Serum Ferritin TIBC and serum Iron had comparatively lower sensitivity of 8716 797 and 777 respectively
Conclusion Ret-He can be used as a routine screening test to detect LID in blood donors
This could provide an opportunity to make appropriate and timely interventions like dietary changes or drug supplementation
Congreso Nacional Laboratorio Cliacutenico
2018
Singh A Chaudhary R Pandey HC Sonker A Identification of iron status of blood donors by using low hemoglobin density and microcytic anemia factor Asian J Transfus Sci 20181246-50
The main objective of this study was to assess ifLHD and Maf could be used for assessment ofiron status in blood donors and also to establisha cut-off for these two parameters at which atentative iron deficiency could be reportedconclusively
Results LHD and Maf were able to differentiatebetween iron deficient and iron-depleteddonors from normal donorsA cutoff of 918 for LHD was able todifferentiate iron deficient and depleted statefrom normal iron statessensitivity 919 and specificity 71respectivelya cutoff of 1016 for Mafsensitivity 946 and specificity 968
MAf = (MVC Hb) 100
Congreso Nacional Laboratorio Cliacutenico
2018
Hb reticulocitaria sensible para detectar la fase inicial del deacuteficitde hierro cuando la eritropoyesis requiere maacutes cantidad que laque recibe ANTES de que la anemia se establezca
La deteccioacuten precoz del deacuteficit de hierro en la fase del balance negativo demanda aporte contribuye a reducir sus manifestaciones cliacutenicas en los pacientes afectados mejorando la salud puacuteblica
Un tratamiento menos prolongado con suplementos y menor consumo de los recursos sanitaros Contribuye a la eficiencia y sostenibilidad de los servicios sanitarios
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
Buttarello MLaboratory diagnosis of anemia are the old and new red cell parameters useful in classification and treatment howInt Jnl Lab Hem 2016 38 (Suppl 1) 123ndash132
Congreso Nacional Laboratorio Cliacutenico
2018
Buttarello MLaboratory diagnosis of anemia are the old and new red cell parameters useful in classification and treatment howInt Jnl Lab Hem 2016 38 (Suppl 1) 123ndash132
Congreso Nacional Laboratorio Cliacutenico
2018
Ralph Green amp Ananya Datta Mitra Megaloblastic Anemias Nutritional and Other CausesMed Clin N Am 2017 101 297ndash317
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
ANEMIA CARENCIAL CAUSAS
Factores alimentariosConsumir una dieta vegetariana mal planeadaAlimentacioacuten deficiente en los bebeacutesDesnutricioacuten durante el embarazo
Deacuteficit de absorcioacutenAlcoholismo croacutenicoEnfermedad de Crohn celiaquiacutea infeccioacuten otros problemas que le dificulten al cuerpo la digestioacuten de los alimentosAnemia perniciosa (factor intriacutenseco)Cirugiacuteas para extirpar ciertas partes del estoacutemago o el intestino delgado
MedicamentosB12 omeprazol metformina colchicina aminosalicilatos neomicinaFOLATO fenitoiacutena metotrexato sulfasalacina triamtereno pirimetamina trimetoprim con sulfametoxazol barbituacutericos
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
Reacciones metaboacutelicas en las que participan la vitamina B12 y el folato bull la conversioacuten de metilmalonil-CoA a succinil-CoA donde la adenosil-cobalamina actuacutea de
cofactor Por ello un deacuteficit de B12 conlleva un aumento de metilmalonil-CoA y de su producto de hidroacutelisis el aacutecido metilmaloacutenico
bull la siacutentesis de metionina a partir de homocisteina gracias a la metionina sintetasa y a la metil-cobalamina como cofactor En esta misma reaccioacuten el metiltetrahidrofolato es transformado a tetrahidrofolato que es necesario para la siacutentesis de DNA
Congreso Nacional Laboratorio Cliacutenico
2018
Anemia macrociacutetica secundaria a deficiencia de aacutecido foacutelico y de vitamina B12(cobalamina)
La deficiencia de B12 yo aacutecido foacutelico es la causa maacutes frecuente de megaloblastosis
Dentro de distintas funciones generales del metabolismo la vitamina B12 es uncofactor esencial en la siacutentesis de ADN y ARN compromete a todas las ceacutelulas delorganismo
Su deficiencia se manifiesta en oacuterganos con alto recambio celular como la meacutedulaosea y en el sistema nervioso central (SNC) a traveacutes de la siacutentesis de mielina y lareparacioacuten axonal
La deficiencia de cobalamina es responsable de alteraciones hematoloacutegicasneuroloacutegicas neurocognitivas y neuropsiquiaacutetricas
La siacutentesis defectuosa de ADN conduce a la apoptosis y a la hemoacutelisis (intra yextramedular) causantes de la hemopoyesis inefectiva
En meacutedula la siacutentesis ineficiente de DNA causa cambios megaloblaacutesticos comoconsecuencIa anemia y citopenias
Congreso Nacional Laboratorio Cliacutenico
2018
Limitaciones de los meacutetodos diagnoacutesticos claacutesicos
Volumen Corpuscular Medio (VCM) y morfologiacutea de sangre perifeacuterica En una serie de pacientes con deacuteficit de cobalamina soacutelo un 29 teniacutean anemia y soacutelo un 36 teniacutean un VCM gt 100 fL
Un VCM normal no puede ser empleado para rechazar una determinacioacuten de nivel de cobalamina ya que hasta un 25 de casos con manifestaciones neuroloacutegicas cursan con un VCM normal
Cobalamina seacuterica (nivel de B12) Es el test diagnoacutestico rutinario inicial estaacutendar Es un test ampliamente disponible de bajo coste y automatizado Sin embargo presenta algunas limitaciones
-- Existencia de varias teacutecnicas y ausencia de un gold standard por lo que hay diferentes liacutemites de referencia
-- Variacioacuten intraindividual muy alta
La OMS publicoacute en 2008 las conclusiones de un grupo teacutecnico consultado sobre el deacuteficit de cobalamina y folato
El grupo reconocioacute que no existen unos umbrales universalmente reconocidos para definir el deacuteficit de ambas vitaminas y expresaron la necesidad de un consenso
Devalia V Hamilton MS and Molloy AM on behalf of the British Committee for standards in haematology Guidelines for the diagnosis and treatment of cobalamin and folate disorders Br J Haematol 2014 166(4) 496-513
Schrier SL Diagnosis and treatment of vitamin B12 and folate deficiency UpToDate Last updated Jun 25 2014
de Benoist B Conclusions of a WHO Technical Consultation on folate and vitamin B12 deficiencies Food Nutr Bull 200829(2 Suppl)S238ndash44Congreso Nacional Laboratorio Cliacutenico
2018
Tomado de Tefferi A Li C En Atlas of Clinical Hematology Publicado por JO Armitage Philadelphia Current Medicine 2004
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
Int Jnl Lab Hem 2007 29 327ndash334
Clin Lab 201662343-347
In ourstudy mean MCVrMCV ratio of healthy controls is130 as microcytic anemia irondeficiency anemia is121 as also macrocytic anemia vitamin B12 deficiencyanemia is 115
Congreso Nacional Laboratorio Cliacutenico
2018
Sualeh Muslim Khan Muhammad Akbar Agha
Mean cell volume of reticulocytemdashA new parameter for diagnosing sub-clinical cobalamin deficiency in blood donors Int J Lab Hem 20181ndash4
The Abbott CELL-DYN Sapphire Hematology System uses multi-angle polarized scatter separation (MAPSS) and focused flow impedance technologies
Congreso Nacional Laboratorio Cliacutenico
2018
MCVr at 985 fL yielded the highest Youdenrsquos index at sensitivity of 82 specificity of 828 AUC 0847 ( 95 CI 803-891)
Khan SM Agha MA Mean cell volume of reticulocyte-A new parameter for diagnosing sub-clinical cobalamin deficiency in blood donors
Int J Lab Hem 20181ndash4 2018 Jul 13 doi 101111ijlh12899
Congreso Nacional Laboratorio Cliacutenico
2018
Role of Cell Population Data in the detection of folate and cobalamin deficiency
J Nieto et al
XXXI st International Symposium on Technological Innovations in Laboratory Hematology ISLH 2018 10-12 May 2018 Brussels Belgium
M-V-NRET and SD-VNRET are the best discriminatory single parameters to distinguish between patients with B9B12 deficiency and reference subjects M-V-NRETAUC=0823 sensitivity 78 and specificity 86
AUC=0852 sensitivity 55 and specificity 60
Conclusions The CPD parameters of Volume and Light Scatter (M and SD of LALS angle) that inform about size and intracellular structure of RBCs provided very useful information for the detection of B9B12 deficiency
Congreso Nacional Laboratorio Cliacutenico
2018
Cell Population Data
bull Paraacutemetros poblacionales de los leucocitos
bull Describen la morfologiacutea tamantildeo
estructuras citoplasmaacuteticas
nuacutecleo aacutecidos nucleacuteicos
bull Son datos numeacutericos con los que se construyen los ejes de lo diagramas de dispersioacuten de los leucocitos
bull Dependen de la tecnologiacutea
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
High Sensitivity New Parameters for the Detection of Vitamin B12 and Folate Deficiencies Blood 2008 1125379
B12 def vs
Normals
Mann
Withney T-Test
ROC
AUC Sens Specif Cutoff signifROC
MCV p=03156 p=09533 0577
MPV p=00001 0802 792 806 lt83 p=00001
NE Mean
Volume plt00001 0862 833 778 gt1403 p=00001
MO Mean
Volume plt00001 0829 625 889 gt1723 p=00001
MRV p=00113 0705 50 964 gt1133 p=00051
Folate def vs
Normals
Mann
Withney T-Test
ROC
AUC Sens Specif Cut-off signifROC
MCV p=00798 p=06461 0665
MPV plt00001 0832 81 806 lt83 p=00001
NE Mean
Volume p=00008 087 952 694 gt1402 p=00001
MO Mean
Volume p=00002 0801 667 833 gt1696 p=00001
MRV p=00054 0731 476 964 gt1133 p=00019
The Mean Neutrophil Volume (MNE V) and Mean Monocyte Volume (MMOV) may be used for the detection of megaloblastic neutrophils and monocytes MNEV and MMOV have significantly higher sensitivity than the previous information from the red cells (MCV) detecting B12 or folate deficiency because they are not affected by the presence at the same time of Iron deficiency or other reasons of anemia
Congreso Nacional Laboratorio Cliacutenico
2018
POSTER 733
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
CPD Sysmex XN
NE SSC complejidad
NE SFL aacutecidos nucleacuteicos
NE FSC tamantildeo
NE WX
NE WY
NE WZ
MO X
MO Y
MO Z
MO WX
MO WY
MO WZ
LY X
LY Y
LY Z
LY WX
LY WY
LY WZCongreso Nacio
nal Laboratorio Cliacutenico 2018
As MCV is the mean which is calculated it is insensitive to the presence of a small number of macrocytes
Further macrocytosis can be obscured by concomitant disorders that can cause microcytosis resulting inmasked megaloblastic anaemia (MA) for example iron deficiency hereditary elliptocytosis alpha and betathalassemia
This study was undertaken to evaluate the role of NEUT-X and NEUT-Y in detecting MA on peripheral blood andalso see whether other forms of macrocytic anaemia can be differentiated from MA
In MA the peripheral blood smear shows cytopenia with macroovalocytes and hypersegmented
neutrophils (gt5 lobes in 5 neutrophils six lobes nuclei or lobe average of gt35)
In conclusion our study shows that higher values of NEUT-X and NEUT-Y in MA patients in spite of low ornormal MCV high RDW may be used to not only reveal the masked cases of MA with concomitant irondeficiency but also separate them from the broader macrocytic anaemia group
Peripheral smear remains diagnostic however making smear for all the suspicious cases is a cumbersomeand tedious procedure Thus these parameters emerge as more reliable and stable parameters in themodern laboratories which in future may replace the older screening tools
Congreso Nacional Laboratorio Cliacutenico
2018
A favor Eficiencia Operativa
Mejora el proceso del Laboratorio
Mejor informacioacuten al Cliacutenico al mismo coste
Mejora la informacioacuten
Informa sobre la eritropoyesis deteccioacuten precoz de estados carenciales
Ayuda al cliacutenico
Estado real del paciente
En contraParaacutemetros de investigacioacuten
Dificultad de standarizar dependencia teacutecnica
Control de calidadCongreso Nacional Laboratorio Cliacutenico
2018
MCV MCH son los valores medios de volumen y Hb en toda la poblacioacuten RBC
No informan acerca de las ceacutelulas individuales
Ni de la variedad de eacutestas anisocitosis policromasia
Congreso Nacional Laboratorio Cliacutenico
2018
Se cuentan el nuacutemero de pulsos de 36-360fL y el nuacutemero de partiacuteculas que tienen el mismo tamantildeo y se trasladan los resultados a una graacutefica de Volumen Nuacutemero de ceacutelulasSe obtiene el histograma de RBC que proporciona
bull Nuacutemero de RBC el nuacutemero de pulsos dentro de este rango de tamantildeos
bull MCV se corresponde con la media del histograma de RBC
bull RDW o ADE Ancho de Distribucioacuten del histograma de RBC se corresponde con el coeficiente de variacioacuten de la curva
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
Abbott Sapphire lo calcula en el 50 de la altura del pico del histogramaSysmex y Mindray al 20 desde la base del histogramaSiemens calcula la anchura del pico comprendido entre 60 y 120 fL
Aunque RDW ADE generalmente se entiendecomo coeficiente de variacioacuten de ladistribucioacuten de los voluacutemenes de loseritrocitos algunos analizadoreshematoloacutegicos lo calculan desde la medicioacutendirecta de la anchura de la distribucioacuten
Congreso Nacional Laboratorio Cliacutenico
2018
G Lippi amp M Plebani
Recent developments and innovations in red blood cells diagnostics
Journal of Laboratory and Precision Medicine 2018
DOI 1021037jlpm20180709 AOPCongreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
copy 2012 Mindray Confidential 26
HDWHYPERHYPO
HDW HGB Distribution Width
HDW is the distribution width of Hgb histogram
Congreso Nacional Laboratorio Cliacutenico
2018
copy 2012 Mindray Confidential 27
MCHrHDWHYPERHYPOMCHr Mean RET HGB Concentration
Congreso Nacional Laboratorio Cliacutenico
2018
Histograma RBC el mapa de Mie
28 41
Congreso Nacional Laboratorio Cliacutenico
2018
Abbott Mindray Siemens
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
Severe Iron Deficiency Anemia Female 34 years
19 th March 18 th April
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
SysmexRBCHe erythrocyte Hb equivalentRetHe reticulocyte Hb equivalent(content)
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
MIC
MAC
HPO HPR
Congreso Nacional Laboratorio Cliacutenico
2018
copy 2012 Mindray Confidential 36
MINDRAY MCHrHDWHYPERHYPO
MCHr Mean RET HGB Concentration
HDW HGB Distribution Width
HYPER The percentage of hyperchromicred blood cells
HYPO The percentage of hypochromic red blood cells
Thalassemia screeningIDA treatment monitoringIDA screening
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
Hipocromo
Hipercroacutemico onormocroacutemico
iquestConcentracioacuten o contenido de Hemoglobina
Hipocroacutemiconormocroacutemico
Abbott Mindray Siemens Hypo CONCENTRACIOacuteN Hblt280gL
Sysmex Hypo CONTENIDO Hblt 17 pg
Congreso Nacional Laboratorio Cliacutenico
2018
Low Hb Density
Microcytic Factor Maf = (HbMCV)100
Nuevo moacutedulo transductor muacuteltiple con laacuteser de diodo y dos sensores oacutepticos
Anaacutelisis de hasta 50000 ceacutelulas con 7 paraacutemetros tecnoloacutegicos (leucocitos reticulocitos eritroblastos)
1 Volumen digital
2 Conductividad digital
3 5 aacutengulos de dispersioacuten de luz laacuteser digital
bull MALS (Median Angle Light Scatter)
bull UMALS (Upper Median Angle Light Scatter) 20deg a 43deg
bull LMALS (Lower Median Angle Light Scatter) 09deg a 19deg
bull LALS (Low Angle Light Scatter) asymp 51deg
bull AL2 (Axial Light Loss) 0deg a 05deg
Congreso Nacional Laboratorio Cliacutenico
2018
Hierro es un elemento criacutetico para elfuncionamiento oacuteptimo y supervivenciade las ceacutelulas
Disfuncioacuten mitocondrialActividad enzimaacutetica afectadaProteiacutenas de transporte y estructuralesproteins
Capacidad fiacutesica mermadaCapacidad de trabajo reducidaCapacidades cognitivas afectadasMorbilidad y mortalidad
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
It is generally assumed that worldwide ldquoat least half the anemia is due tonutritional iron deficiencyrdquo and that ldquoup to a prevalence of iron deficiency anemiaof 40 the prevalence of iron deficiency will be about 25 times that of anemiardquoHowever it is evident from the foregoing discussion that there are considerablevariations in both of these ratios depending on the age and sex of the peoplebeing studied the region of the world in which they live and the prevalence ratesof other causes of anemia
WHO Department of Nutrition for Health and DevelopmentAssessing the iron status of populations including literature reviews report of a Joint World Health OrganizationCenters for DiseaseControl and Prevention Technical Consultation on the Assessment of Iron Status at the Population Level Geneva Switzerland 6ndash8 April2004 ndash 2nd ed
Congreso Nacional Laboratorio Cliacutenico
2018
Estaacute bien establecido que la anemia produce una miriacuteada de secuelas tanto fiacutesicas comopsicoloacutegicas
Pero los efecto deleteacutereos se deben al deficit de hierro que es un evento previo a que seestablezca la anemia
El deacuteficit de hierrro auacuten sin anemia tiene efectos negativos en el desarrollo cognitivo y fiacutesico
Rattehalli D et al Iron deficiency without anemia do not wait for the Hemoglobin to drop
Health Policy and Technology 2013 2 45-48Congreso Nacio
nal Laboratorio Cliacutenico 2018
SuominenP et al Serum transferrin receptor and transferrin receptor-ferritin index identify healthy subjects with subclinical iron deficits Blood 1998 92 2934ndash9Halwachs-Baumann G Diagnosis of anaemia old things rearranged Wien Med Wochenschr 2012 162478ndash88
Congreso Nacional Laboratorio Cliacutenico
2018
Hemoglobina de reticulocito y su importancia en el diagnoacutestico temprano de anemiaferropeacutenica
Y Maacuterquez-Beniacutetez et al Universidad de BocayaAugust
2018 DOI 1022267rus182003133 aop
El contenido de hemoglobina de reticulocitos (CHr) es un paraacutemetro en la biometriacuteahematoloacutegica automatizada utilizado como un marcador de la biodisponibilidad delhierro en la eritropoyesis
Objetivo Exponer la aplicabilidad de la CHr como un paraacutemetro en el diagnoacutesticoprecoz de la anemia por deficiencia de hierro asiacute como su medicioacuten e interpretacioacuten
Materiales y meacutetodos Se realizoacute la revisioacuten de artiacuteculos cientiacuteficos en ingleacutes y espantildeolen las bases de datos PubMed ScienceDirect LILACS y Medline usando descriptoresvalidados en Medical Subject Headings (MeSH) considerando periodo depublicabilidad del 80 inferior a 5 antildeos
Conclusiones La CHr es un paraacutemetro de gran utilidad en el diagnoacutestico temprano deanemia ferropeacutenica y otras patologiacuteas como deficiencia funcional de hierro estadosde inflamacioacuten croacutenica y enfermedad renal croacutenica
Biomarcador temprano en el diagnoacutestico de deficiencia de hierro antes de presentarsecambios morfoloacutegicos eritrociacuteticosCongreso Nacio
nal Laboratorio Cliacutenico 2018
bull A total of 1105 NES participants (639 men 466 women)bull CHr becomes affected in a relatively early stage in the development of iron deficiency before iron
deficiency anemia and clinical symptoms become apparentbull Therefore this parameter might be useful to identify persons healthy and diseased at risk of
developing iron deficiency anemia and subsequently to apply interventions in order to prevent further development of iron deficiency anemiaCongreso Nacio
nal Laboratorio Cliacutenico 2018
Hb reticulocitaria sensible para detectar la fase inicial del deacuteficit de hierro cuando laeritropoyesis requiere maacutes cantidad que la que recibe ANTES de que la anemia seestablezca
Congreso Nacional Laboratorio Cliacutenico
2018
No ID LID P
RBC 1012L 48 (08) 437 (05) lt00001
Hb gL 135 (6) 131 (12) 0006
MCV fL 922 (21) 902 (38) 0006
MCH pg 324 (07) 306 (22) lt00001
MCHC gL 339 (6) 319 (23) 0001
RDW
Ret He pg
Hypo He
LHD
Ferritin microgL
131 (06)
338 (21)
03 (015)
28 (20)
86 (3)
145 (21)
278 (24)
69 (55)
56 (25)
16 (76)
lt00001
lt00001
lt00001
lt00001
lt00001
AUC 95 CI Cutoff Sensitivity Specificity
LHD 0898 0819-0978 50 859 841
Ret He 0914 0824-1000 299pg 868 857
Hypo He 0934 0856-1000 16 857 921
Clinical value of markers of hypochromia in the detection of latent iron deficiency in non-anemic premenopausal women
No ID Hb gt 120 gL s-ferritin was within reference intervalLatent Iron Defiency Hb gt 120 gL s-ferritin lt 30 μgL
Urrechaga E et al Journal Clin Lab Analysis 2016 30 (5) 623-627
97 women (388) in 250 apparently healthy women had latent IDCongreso Nacional Laboratorio Cliacutenico
2018
Schorer G et al Abstract Jahreskongress der Deutschen Gesellschaft fuumlr Transfusionsmedizin und Immunhaumlmatologie Rostock 15 - 18 September 2009
Congreso Nacional Laboratorio Cliacutenico
2018
Caring for Those Who Share Mitigating Iron Deficiency in Regular Blood DonorsMast Alan E
bull Iron deficiency caused by regular blood donation is a problem facing blood centers Each blood donation removes 200 to 250 mg of iron from the donor Consequently many donors become iron deficient with repeated donation
bull This presents a challenge to blood centers that has become more acute in recent years with the realization that iron deficiency even in the absence of anemia is associated with adverse effects including fatigue and decreased exercise tolerance as well as neurological symptoms such as decreased cognitive function pica and restless leg syndrome
bull REDS-II investigators performed a longitudinal study investigating the iron status of blood donors over a two year period called the REDS-II Donor Iron Status Evaluation (RISE)
bull Results from the baseline analysis of regular donors (e 2 donations per year (females) or e 3 donations per year (males) revealed that over two-thirds of female donors and over one-half of male donors have iron deficiency
Congreso Nacional Laboratorio Cliacutenico
2018
Transfusion 2013 532766-2775
bull We evaluated the diagnostic sensitivity and specificity of red blood cell (RBC) hematology analyzer indices to assess iron status as a part of donor management iron deficient erythropoiesis (IDE) and absence of iron stores (AIS)
bull STUDY DESIGN AND METHODS A total of 1659 male and female donors from the Retrovirus Epidemiology Donor Study-II (REDS-II) Donor Iron Status Evaluation (RISE) study who were either first-timereactivated (FT RA no donations for 2 years) or frequent donors were recruited into a longitudinal study of regular donation of RBCs Of these 1002 donors returned 15 to 24 months later for a final assessment
Absent iron stores (AIS) was defined as plasma ferritin level of less than 12 mgL Logarithm of the ratio of soluble transferrin receptor to ferritin of at least 207 was used to define iron-deficient erythropoiesis (IDE)
bull RESULTS HYPOm and CHr detected IDE with comparable sensitivity 72 versus 69 but differed in specificity HYPOm 68 and CHr 53
For detecting AIS sensitivity was improved to 85 for HYPOm and 81 for CHr but specificity was reduced
Venous Hb had high specificity but poor sensitivity for IDE and AIS A plasma ferritin level of less than 267 mgL was a good surrogate for assessing IDE Congreso Nacio
nal Laboratorio Cliacutenico 2018
Microcytic RBC and reticulocyte mean cell hemoglobin content predicted iron depletion with
sensitivities 70 and 64
specificities of 72 and 78 respectively
When both combined
increased the sensitivity to 82
Congreso Nacional Laboratorio Cliacutenico
2018
Depending on the number of donations during the preceding12 months
Absent iron stores were detected in up to 214 of male and278 of female donors respectively
impaired hemoglobinisation IH was present in up to 64 maleand 167 female donors with 2 and 4 preceding donationsrespectively
The defined CHr cut-off value was 280 pg to detect IH infrequent whole blood donors with AIS leading to a testspecificity of 982 (positive predictive value PPV 577) inmale and of 978 (PPV 829) in female donors
It may help to prevent the development of anemia in frequentblood donors and also can help to decide whether donordeferral or even iron substitution need to be recommended
Congreso Nacional Laboratorio Cliacutenico
2018
Of the 501 blood donors sTfR and Ret-He detected Latent Iron Deficiency in 148 and 135 donors respectively
In comparison to sTfR Ret-He had sensitivity of 927 specificity of 9716 PPV of 931 and NPV of 963
Serum Ferritin TIBC and serum Iron had comparatively lower sensitivity of 8716 797 and 777 respectively
Conclusion Ret-He can be used as a routine screening test to detect LID in blood donors
This could provide an opportunity to make appropriate and timely interventions like dietary changes or drug supplementation
Congreso Nacional Laboratorio Cliacutenico
2018
Singh A Chaudhary R Pandey HC Sonker A Identification of iron status of blood donors by using low hemoglobin density and microcytic anemia factor Asian J Transfus Sci 20181246-50
The main objective of this study was to assess ifLHD and Maf could be used for assessment ofiron status in blood donors and also to establisha cut-off for these two parameters at which atentative iron deficiency could be reportedconclusively
Results LHD and Maf were able to differentiatebetween iron deficient and iron-depleteddonors from normal donorsA cutoff of 918 for LHD was able todifferentiate iron deficient and depleted statefrom normal iron statessensitivity 919 and specificity 71respectivelya cutoff of 1016 for Mafsensitivity 946 and specificity 968
MAf = (MVC Hb) 100
Congreso Nacional Laboratorio Cliacutenico
2018
Hb reticulocitaria sensible para detectar la fase inicial del deacuteficitde hierro cuando la eritropoyesis requiere maacutes cantidad que laque recibe ANTES de que la anemia se establezca
La deteccioacuten precoz del deacuteficit de hierro en la fase del balance negativo demanda aporte contribuye a reducir sus manifestaciones cliacutenicas en los pacientes afectados mejorando la salud puacuteblica
Un tratamiento menos prolongado con suplementos y menor consumo de los recursos sanitaros Contribuye a la eficiencia y sostenibilidad de los servicios sanitarios
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
Buttarello MLaboratory diagnosis of anemia are the old and new red cell parameters useful in classification and treatment howInt Jnl Lab Hem 2016 38 (Suppl 1) 123ndash132
Congreso Nacional Laboratorio Cliacutenico
2018
Buttarello MLaboratory diagnosis of anemia are the old and new red cell parameters useful in classification and treatment howInt Jnl Lab Hem 2016 38 (Suppl 1) 123ndash132
Congreso Nacional Laboratorio Cliacutenico
2018
Ralph Green amp Ananya Datta Mitra Megaloblastic Anemias Nutritional and Other CausesMed Clin N Am 2017 101 297ndash317
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
ANEMIA CARENCIAL CAUSAS
Factores alimentariosConsumir una dieta vegetariana mal planeadaAlimentacioacuten deficiente en los bebeacutesDesnutricioacuten durante el embarazo
Deacuteficit de absorcioacutenAlcoholismo croacutenicoEnfermedad de Crohn celiaquiacutea infeccioacuten otros problemas que le dificulten al cuerpo la digestioacuten de los alimentosAnemia perniciosa (factor intriacutenseco)Cirugiacuteas para extirpar ciertas partes del estoacutemago o el intestino delgado
MedicamentosB12 omeprazol metformina colchicina aminosalicilatos neomicinaFOLATO fenitoiacutena metotrexato sulfasalacina triamtereno pirimetamina trimetoprim con sulfametoxazol barbituacutericos
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
Reacciones metaboacutelicas en las que participan la vitamina B12 y el folato bull la conversioacuten de metilmalonil-CoA a succinil-CoA donde la adenosil-cobalamina actuacutea de
cofactor Por ello un deacuteficit de B12 conlleva un aumento de metilmalonil-CoA y de su producto de hidroacutelisis el aacutecido metilmaloacutenico
bull la siacutentesis de metionina a partir de homocisteina gracias a la metionina sintetasa y a la metil-cobalamina como cofactor En esta misma reaccioacuten el metiltetrahidrofolato es transformado a tetrahidrofolato que es necesario para la siacutentesis de DNA
Congreso Nacional Laboratorio Cliacutenico
2018
Anemia macrociacutetica secundaria a deficiencia de aacutecido foacutelico y de vitamina B12(cobalamina)
La deficiencia de B12 yo aacutecido foacutelico es la causa maacutes frecuente de megaloblastosis
Dentro de distintas funciones generales del metabolismo la vitamina B12 es uncofactor esencial en la siacutentesis de ADN y ARN compromete a todas las ceacutelulas delorganismo
Su deficiencia se manifiesta en oacuterganos con alto recambio celular como la meacutedulaosea y en el sistema nervioso central (SNC) a traveacutes de la siacutentesis de mielina y lareparacioacuten axonal
La deficiencia de cobalamina es responsable de alteraciones hematoloacutegicasneuroloacutegicas neurocognitivas y neuropsiquiaacutetricas
La siacutentesis defectuosa de ADN conduce a la apoptosis y a la hemoacutelisis (intra yextramedular) causantes de la hemopoyesis inefectiva
En meacutedula la siacutentesis ineficiente de DNA causa cambios megaloblaacutesticos comoconsecuencIa anemia y citopenias
Congreso Nacional Laboratorio Cliacutenico
2018
Limitaciones de los meacutetodos diagnoacutesticos claacutesicos
Volumen Corpuscular Medio (VCM) y morfologiacutea de sangre perifeacuterica En una serie de pacientes con deacuteficit de cobalamina soacutelo un 29 teniacutean anemia y soacutelo un 36 teniacutean un VCM gt 100 fL
Un VCM normal no puede ser empleado para rechazar una determinacioacuten de nivel de cobalamina ya que hasta un 25 de casos con manifestaciones neuroloacutegicas cursan con un VCM normal
Cobalamina seacuterica (nivel de B12) Es el test diagnoacutestico rutinario inicial estaacutendar Es un test ampliamente disponible de bajo coste y automatizado Sin embargo presenta algunas limitaciones
-- Existencia de varias teacutecnicas y ausencia de un gold standard por lo que hay diferentes liacutemites de referencia
-- Variacioacuten intraindividual muy alta
La OMS publicoacute en 2008 las conclusiones de un grupo teacutecnico consultado sobre el deacuteficit de cobalamina y folato
El grupo reconocioacute que no existen unos umbrales universalmente reconocidos para definir el deacuteficit de ambas vitaminas y expresaron la necesidad de un consenso
Devalia V Hamilton MS and Molloy AM on behalf of the British Committee for standards in haematology Guidelines for the diagnosis and treatment of cobalamin and folate disorders Br J Haematol 2014 166(4) 496-513
Schrier SL Diagnosis and treatment of vitamin B12 and folate deficiency UpToDate Last updated Jun 25 2014
de Benoist B Conclusions of a WHO Technical Consultation on folate and vitamin B12 deficiencies Food Nutr Bull 200829(2 Suppl)S238ndash44Congreso Nacional Laboratorio Cliacutenico
2018
Tomado de Tefferi A Li C En Atlas of Clinical Hematology Publicado por JO Armitage Philadelphia Current Medicine 2004
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
Int Jnl Lab Hem 2007 29 327ndash334
Clin Lab 201662343-347
In ourstudy mean MCVrMCV ratio of healthy controls is130 as microcytic anemia irondeficiency anemia is121 as also macrocytic anemia vitamin B12 deficiencyanemia is 115
Congreso Nacional Laboratorio Cliacutenico
2018
Sualeh Muslim Khan Muhammad Akbar Agha
Mean cell volume of reticulocytemdashA new parameter for diagnosing sub-clinical cobalamin deficiency in blood donors Int J Lab Hem 20181ndash4
The Abbott CELL-DYN Sapphire Hematology System uses multi-angle polarized scatter separation (MAPSS) and focused flow impedance technologies
Congreso Nacional Laboratorio Cliacutenico
2018
MCVr at 985 fL yielded the highest Youdenrsquos index at sensitivity of 82 specificity of 828 AUC 0847 ( 95 CI 803-891)
Khan SM Agha MA Mean cell volume of reticulocyte-A new parameter for diagnosing sub-clinical cobalamin deficiency in blood donors
Int J Lab Hem 20181ndash4 2018 Jul 13 doi 101111ijlh12899
Congreso Nacional Laboratorio Cliacutenico
2018
Role of Cell Population Data in the detection of folate and cobalamin deficiency
J Nieto et al
XXXI st International Symposium on Technological Innovations in Laboratory Hematology ISLH 2018 10-12 May 2018 Brussels Belgium
M-V-NRET and SD-VNRET are the best discriminatory single parameters to distinguish between patients with B9B12 deficiency and reference subjects M-V-NRETAUC=0823 sensitivity 78 and specificity 86
AUC=0852 sensitivity 55 and specificity 60
Conclusions The CPD parameters of Volume and Light Scatter (M and SD of LALS angle) that inform about size and intracellular structure of RBCs provided very useful information for the detection of B9B12 deficiency
Congreso Nacional Laboratorio Cliacutenico
2018
Cell Population Data
bull Paraacutemetros poblacionales de los leucocitos
bull Describen la morfologiacutea tamantildeo
estructuras citoplasmaacuteticas
nuacutecleo aacutecidos nucleacuteicos
bull Son datos numeacutericos con los que se construyen los ejes de lo diagramas de dispersioacuten de los leucocitos
bull Dependen de la tecnologiacutea
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
High Sensitivity New Parameters for the Detection of Vitamin B12 and Folate Deficiencies Blood 2008 1125379
B12 def vs
Normals
Mann
Withney T-Test
ROC
AUC Sens Specif Cutoff signifROC
MCV p=03156 p=09533 0577
MPV p=00001 0802 792 806 lt83 p=00001
NE Mean
Volume plt00001 0862 833 778 gt1403 p=00001
MO Mean
Volume plt00001 0829 625 889 gt1723 p=00001
MRV p=00113 0705 50 964 gt1133 p=00051
Folate def vs
Normals
Mann
Withney T-Test
ROC
AUC Sens Specif Cut-off signifROC
MCV p=00798 p=06461 0665
MPV plt00001 0832 81 806 lt83 p=00001
NE Mean
Volume p=00008 087 952 694 gt1402 p=00001
MO Mean
Volume p=00002 0801 667 833 gt1696 p=00001
MRV p=00054 0731 476 964 gt1133 p=00019
The Mean Neutrophil Volume (MNE V) and Mean Monocyte Volume (MMOV) may be used for the detection of megaloblastic neutrophils and monocytes MNEV and MMOV have significantly higher sensitivity than the previous information from the red cells (MCV) detecting B12 or folate deficiency because they are not affected by the presence at the same time of Iron deficiency or other reasons of anemia
Congreso Nacional Laboratorio Cliacutenico
2018
POSTER 733
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
CPD Sysmex XN
NE SSC complejidad
NE SFL aacutecidos nucleacuteicos
NE FSC tamantildeo
NE WX
NE WY
NE WZ
MO X
MO Y
MO Z
MO WX
MO WY
MO WZ
LY X
LY Y
LY Z
LY WX
LY WY
LY WZCongreso Nacio
nal Laboratorio Cliacutenico 2018
As MCV is the mean which is calculated it is insensitive to the presence of a small number of macrocytes
Further macrocytosis can be obscured by concomitant disorders that can cause microcytosis resulting inmasked megaloblastic anaemia (MA) for example iron deficiency hereditary elliptocytosis alpha and betathalassemia
This study was undertaken to evaluate the role of NEUT-X and NEUT-Y in detecting MA on peripheral blood andalso see whether other forms of macrocytic anaemia can be differentiated from MA
In MA the peripheral blood smear shows cytopenia with macroovalocytes and hypersegmented
neutrophils (gt5 lobes in 5 neutrophils six lobes nuclei or lobe average of gt35)
In conclusion our study shows that higher values of NEUT-X and NEUT-Y in MA patients in spite of low ornormal MCV high RDW may be used to not only reveal the masked cases of MA with concomitant irondeficiency but also separate them from the broader macrocytic anaemia group
Peripheral smear remains diagnostic however making smear for all the suspicious cases is a cumbersomeand tedious procedure Thus these parameters emerge as more reliable and stable parameters in themodern laboratories which in future may replace the older screening tools
Congreso Nacional Laboratorio Cliacutenico
2018
A favor Eficiencia Operativa
Mejora el proceso del Laboratorio
Mejor informacioacuten al Cliacutenico al mismo coste
Mejora la informacioacuten
Informa sobre la eritropoyesis deteccioacuten precoz de estados carenciales
Ayuda al cliacutenico
Estado real del paciente
En contraParaacutemetros de investigacioacuten
Dificultad de standarizar dependencia teacutecnica
Control de calidadCongreso Nacional Laboratorio Cliacutenico
2018
Se cuentan el nuacutemero de pulsos de 36-360fL y el nuacutemero de partiacuteculas que tienen el mismo tamantildeo y se trasladan los resultados a una graacutefica de Volumen Nuacutemero de ceacutelulasSe obtiene el histograma de RBC que proporciona
bull Nuacutemero de RBC el nuacutemero de pulsos dentro de este rango de tamantildeos
bull MCV se corresponde con la media del histograma de RBC
bull RDW o ADE Ancho de Distribucioacuten del histograma de RBC se corresponde con el coeficiente de variacioacuten de la curva
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
Abbott Sapphire lo calcula en el 50 de la altura del pico del histogramaSysmex y Mindray al 20 desde la base del histogramaSiemens calcula la anchura del pico comprendido entre 60 y 120 fL
Aunque RDW ADE generalmente se entiendecomo coeficiente de variacioacuten de ladistribucioacuten de los voluacutemenes de loseritrocitos algunos analizadoreshematoloacutegicos lo calculan desde la medicioacutendirecta de la anchura de la distribucioacuten
Congreso Nacional Laboratorio Cliacutenico
2018
G Lippi amp M Plebani
Recent developments and innovations in red blood cells diagnostics
Journal of Laboratory and Precision Medicine 2018
DOI 1021037jlpm20180709 AOPCongreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
copy 2012 Mindray Confidential 26
HDWHYPERHYPO
HDW HGB Distribution Width
HDW is the distribution width of Hgb histogram
Congreso Nacional Laboratorio Cliacutenico
2018
copy 2012 Mindray Confidential 27
MCHrHDWHYPERHYPOMCHr Mean RET HGB Concentration
Congreso Nacional Laboratorio Cliacutenico
2018
Histograma RBC el mapa de Mie
28 41
Congreso Nacional Laboratorio Cliacutenico
2018
Abbott Mindray Siemens
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
Severe Iron Deficiency Anemia Female 34 years
19 th March 18 th April
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
SysmexRBCHe erythrocyte Hb equivalentRetHe reticulocyte Hb equivalent(content)
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
MIC
MAC
HPO HPR
Congreso Nacional Laboratorio Cliacutenico
2018
copy 2012 Mindray Confidential 36
MINDRAY MCHrHDWHYPERHYPO
MCHr Mean RET HGB Concentration
HDW HGB Distribution Width
HYPER The percentage of hyperchromicred blood cells
HYPO The percentage of hypochromic red blood cells
Thalassemia screeningIDA treatment monitoringIDA screening
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
Hipocromo
Hipercroacutemico onormocroacutemico
iquestConcentracioacuten o contenido de Hemoglobina
Hipocroacutemiconormocroacutemico
Abbott Mindray Siemens Hypo CONCENTRACIOacuteN Hblt280gL
Sysmex Hypo CONTENIDO Hblt 17 pg
Congreso Nacional Laboratorio Cliacutenico
2018
Low Hb Density
Microcytic Factor Maf = (HbMCV)100
Nuevo moacutedulo transductor muacuteltiple con laacuteser de diodo y dos sensores oacutepticos
Anaacutelisis de hasta 50000 ceacutelulas con 7 paraacutemetros tecnoloacutegicos (leucocitos reticulocitos eritroblastos)
1 Volumen digital
2 Conductividad digital
3 5 aacutengulos de dispersioacuten de luz laacuteser digital
bull MALS (Median Angle Light Scatter)
bull UMALS (Upper Median Angle Light Scatter) 20deg a 43deg
bull LMALS (Lower Median Angle Light Scatter) 09deg a 19deg
bull LALS (Low Angle Light Scatter) asymp 51deg
bull AL2 (Axial Light Loss) 0deg a 05deg
Congreso Nacional Laboratorio Cliacutenico
2018
Hierro es un elemento criacutetico para elfuncionamiento oacuteptimo y supervivenciade las ceacutelulas
Disfuncioacuten mitocondrialActividad enzimaacutetica afectadaProteiacutenas de transporte y estructuralesproteins
Capacidad fiacutesica mermadaCapacidad de trabajo reducidaCapacidades cognitivas afectadasMorbilidad y mortalidad
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
It is generally assumed that worldwide ldquoat least half the anemia is due tonutritional iron deficiencyrdquo and that ldquoup to a prevalence of iron deficiency anemiaof 40 the prevalence of iron deficiency will be about 25 times that of anemiardquoHowever it is evident from the foregoing discussion that there are considerablevariations in both of these ratios depending on the age and sex of the peoplebeing studied the region of the world in which they live and the prevalence ratesof other causes of anemia
WHO Department of Nutrition for Health and DevelopmentAssessing the iron status of populations including literature reviews report of a Joint World Health OrganizationCenters for DiseaseControl and Prevention Technical Consultation on the Assessment of Iron Status at the Population Level Geneva Switzerland 6ndash8 April2004 ndash 2nd ed
Congreso Nacional Laboratorio Cliacutenico
2018
Estaacute bien establecido que la anemia produce una miriacuteada de secuelas tanto fiacutesicas comopsicoloacutegicas
Pero los efecto deleteacutereos se deben al deficit de hierro que es un evento previo a que seestablezca la anemia
El deacuteficit de hierrro auacuten sin anemia tiene efectos negativos en el desarrollo cognitivo y fiacutesico
Rattehalli D et al Iron deficiency without anemia do not wait for the Hemoglobin to drop
Health Policy and Technology 2013 2 45-48Congreso Nacio
nal Laboratorio Cliacutenico 2018
SuominenP et al Serum transferrin receptor and transferrin receptor-ferritin index identify healthy subjects with subclinical iron deficits Blood 1998 92 2934ndash9Halwachs-Baumann G Diagnosis of anaemia old things rearranged Wien Med Wochenschr 2012 162478ndash88
Congreso Nacional Laboratorio Cliacutenico
2018
Hemoglobina de reticulocito y su importancia en el diagnoacutestico temprano de anemiaferropeacutenica
Y Maacuterquez-Beniacutetez et al Universidad de BocayaAugust
2018 DOI 1022267rus182003133 aop
El contenido de hemoglobina de reticulocitos (CHr) es un paraacutemetro en la biometriacuteahematoloacutegica automatizada utilizado como un marcador de la biodisponibilidad delhierro en la eritropoyesis
Objetivo Exponer la aplicabilidad de la CHr como un paraacutemetro en el diagnoacutesticoprecoz de la anemia por deficiencia de hierro asiacute como su medicioacuten e interpretacioacuten
Materiales y meacutetodos Se realizoacute la revisioacuten de artiacuteculos cientiacuteficos en ingleacutes y espantildeolen las bases de datos PubMed ScienceDirect LILACS y Medline usando descriptoresvalidados en Medical Subject Headings (MeSH) considerando periodo depublicabilidad del 80 inferior a 5 antildeos
Conclusiones La CHr es un paraacutemetro de gran utilidad en el diagnoacutestico temprano deanemia ferropeacutenica y otras patologiacuteas como deficiencia funcional de hierro estadosde inflamacioacuten croacutenica y enfermedad renal croacutenica
Biomarcador temprano en el diagnoacutestico de deficiencia de hierro antes de presentarsecambios morfoloacutegicos eritrociacuteticosCongreso Nacio
nal Laboratorio Cliacutenico 2018
bull A total of 1105 NES participants (639 men 466 women)bull CHr becomes affected in a relatively early stage in the development of iron deficiency before iron
deficiency anemia and clinical symptoms become apparentbull Therefore this parameter might be useful to identify persons healthy and diseased at risk of
developing iron deficiency anemia and subsequently to apply interventions in order to prevent further development of iron deficiency anemiaCongreso Nacio
nal Laboratorio Cliacutenico 2018
Hb reticulocitaria sensible para detectar la fase inicial del deacuteficit de hierro cuando laeritropoyesis requiere maacutes cantidad que la que recibe ANTES de que la anemia seestablezca
Congreso Nacional Laboratorio Cliacutenico
2018
No ID LID P
RBC 1012L 48 (08) 437 (05) lt00001
Hb gL 135 (6) 131 (12) 0006
MCV fL 922 (21) 902 (38) 0006
MCH pg 324 (07) 306 (22) lt00001
MCHC gL 339 (6) 319 (23) 0001
RDW
Ret He pg
Hypo He
LHD
Ferritin microgL
131 (06)
338 (21)
03 (015)
28 (20)
86 (3)
145 (21)
278 (24)
69 (55)
56 (25)
16 (76)
lt00001
lt00001
lt00001
lt00001
lt00001
AUC 95 CI Cutoff Sensitivity Specificity
LHD 0898 0819-0978 50 859 841
Ret He 0914 0824-1000 299pg 868 857
Hypo He 0934 0856-1000 16 857 921
Clinical value of markers of hypochromia in the detection of latent iron deficiency in non-anemic premenopausal women
No ID Hb gt 120 gL s-ferritin was within reference intervalLatent Iron Defiency Hb gt 120 gL s-ferritin lt 30 μgL
Urrechaga E et al Journal Clin Lab Analysis 2016 30 (5) 623-627
97 women (388) in 250 apparently healthy women had latent IDCongreso Nacional Laboratorio Cliacutenico
2018
Schorer G et al Abstract Jahreskongress der Deutschen Gesellschaft fuumlr Transfusionsmedizin und Immunhaumlmatologie Rostock 15 - 18 September 2009
Congreso Nacional Laboratorio Cliacutenico
2018
Caring for Those Who Share Mitigating Iron Deficiency in Regular Blood DonorsMast Alan E
bull Iron deficiency caused by regular blood donation is a problem facing blood centers Each blood donation removes 200 to 250 mg of iron from the donor Consequently many donors become iron deficient with repeated donation
bull This presents a challenge to blood centers that has become more acute in recent years with the realization that iron deficiency even in the absence of anemia is associated with adverse effects including fatigue and decreased exercise tolerance as well as neurological symptoms such as decreased cognitive function pica and restless leg syndrome
bull REDS-II investigators performed a longitudinal study investigating the iron status of blood donors over a two year period called the REDS-II Donor Iron Status Evaluation (RISE)
bull Results from the baseline analysis of regular donors (e 2 donations per year (females) or e 3 donations per year (males) revealed that over two-thirds of female donors and over one-half of male donors have iron deficiency
Congreso Nacional Laboratorio Cliacutenico
2018
Transfusion 2013 532766-2775
bull We evaluated the diagnostic sensitivity and specificity of red blood cell (RBC) hematology analyzer indices to assess iron status as a part of donor management iron deficient erythropoiesis (IDE) and absence of iron stores (AIS)
bull STUDY DESIGN AND METHODS A total of 1659 male and female donors from the Retrovirus Epidemiology Donor Study-II (REDS-II) Donor Iron Status Evaluation (RISE) study who were either first-timereactivated (FT RA no donations for 2 years) or frequent donors were recruited into a longitudinal study of regular donation of RBCs Of these 1002 donors returned 15 to 24 months later for a final assessment
Absent iron stores (AIS) was defined as plasma ferritin level of less than 12 mgL Logarithm of the ratio of soluble transferrin receptor to ferritin of at least 207 was used to define iron-deficient erythropoiesis (IDE)
bull RESULTS HYPOm and CHr detected IDE with comparable sensitivity 72 versus 69 but differed in specificity HYPOm 68 and CHr 53
For detecting AIS sensitivity was improved to 85 for HYPOm and 81 for CHr but specificity was reduced
Venous Hb had high specificity but poor sensitivity for IDE and AIS A plasma ferritin level of less than 267 mgL was a good surrogate for assessing IDE Congreso Nacio
nal Laboratorio Cliacutenico 2018
Microcytic RBC and reticulocyte mean cell hemoglobin content predicted iron depletion with
sensitivities 70 and 64
specificities of 72 and 78 respectively
When both combined
increased the sensitivity to 82
Congreso Nacional Laboratorio Cliacutenico
2018
Depending on the number of donations during the preceding12 months
Absent iron stores were detected in up to 214 of male and278 of female donors respectively
impaired hemoglobinisation IH was present in up to 64 maleand 167 female donors with 2 and 4 preceding donationsrespectively
The defined CHr cut-off value was 280 pg to detect IH infrequent whole blood donors with AIS leading to a testspecificity of 982 (positive predictive value PPV 577) inmale and of 978 (PPV 829) in female donors
It may help to prevent the development of anemia in frequentblood donors and also can help to decide whether donordeferral or even iron substitution need to be recommended
Congreso Nacional Laboratorio Cliacutenico
2018
Of the 501 blood donors sTfR and Ret-He detected Latent Iron Deficiency in 148 and 135 donors respectively
In comparison to sTfR Ret-He had sensitivity of 927 specificity of 9716 PPV of 931 and NPV of 963
Serum Ferritin TIBC and serum Iron had comparatively lower sensitivity of 8716 797 and 777 respectively
Conclusion Ret-He can be used as a routine screening test to detect LID in blood donors
This could provide an opportunity to make appropriate and timely interventions like dietary changes or drug supplementation
Congreso Nacional Laboratorio Cliacutenico
2018
Singh A Chaudhary R Pandey HC Sonker A Identification of iron status of blood donors by using low hemoglobin density and microcytic anemia factor Asian J Transfus Sci 20181246-50
The main objective of this study was to assess ifLHD and Maf could be used for assessment ofiron status in blood donors and also to establisha cut-off for these two parameters at which atentative iron deficiency could be reportedconclusively
Results LHD and Maf were able to differentiatebetween iron deficient and iron-depleteddonors from normal donorsA cutoff of 918 for LHD was able todifferentiate iron deficient and depleted statefrom normal iron statessensitivity 919 and specificity 71respectivelya cutoff of 1016 for Mafsensitivity 946 and specificity 968
MAf = (MVC Hb) 100
Congreso Nacional Laboratorio Cliacutenico
2018
Hb reticulocitaria sensible para detectar la fase inicial del deacuteficitde hierro cuando la eritropoyesis requiere maacutes cantidad que laque recibe ANTES de que la anemia se establezca
La deteccioacuten precoz del deacuteficit de hierro en la fase del balance negativo demanda aporte contribuye a reducir sus manifestaciones cliacutenicas en los pacientes afectados mejorando la salud puacuteblica
Un tratamiento menos prolongado con suplementos y menor consumo de los recursos sanitaros Contribuye a la eficiencia y sostenibilidad de los servicios sanitarios
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
Buttarello MLaboratory diagnosis of anemia are the old and new red cell parameters useful in classification and treatment howInt Jnl Lab Hem 2016 38 (Suppl 1) 123ndash132
Congreso Nacional Laboratorio Cliacutenico
2018
Buttarello MLaboratory diagnosis of anemia are the old and new red cell parameters useful in classification and treatment howInt Jnl Lab Hem 2016 38 (Suppl 1) 123ndash132
Congreso Nacional Laboratorio Cliacutenico
2018
Ralph Green amp Ananya Datta Mitra Megaloblastic Anemias Nutritional and Other CausesMed Clin N Am 2017 101 297ndash317
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
ANEMIA CARENCIAL CAUSAS
Factores alimentariosConsumir una dieta vegetariana mal planeadaAlimentacioacuten deficiente en los bebeacutesDesnutricioacuten durante el embarazo
Deacuteficit de absorcioacutenAlcoholismo croacutenicoEnfermedad de Crohn celiaquiacutea infeccioacuten otros problemas que le dificulten al cuerpo la digestioacuten de los alimentosAnemia perniciosa (factor intriacutenseco)Cirugiacuteas para extirpar ciertas partes del estoacutemago o el intestino delgado
MedicamentosB12 omeprazol metformina colchicina aminosalicilatos neomicinaFOLATO fenitoiacutena metotrexato sulfasalacina triamtereno pirimetamina trimetoprim con sulfametoxazol barbituacutericos
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
Reacciones metaboacutelicas en las que participan la vitamina B12 y el folato bull la conversioacuten de metilmalonil-CoA a succinil-CoA donde la adenosil-cobalamina actuacutea de
cofactor Por ello un deacuteficit de B12 conlleva un aumento de metilmalonil-CoA y de su producto de hidroacutelisis el aacutecido metilmaloacutenico
bull la siacutentesis de metionina a partir de homocisteina gracias a la metionina sintetasa y a la metil-cobalamina como cofactor En esta misma reaccioacuten el metiltetrahidrofolato es transformado a tetrahidrofolato que es necesario para la siacutentesis de DNA
Congreso Nacional Laboratorio Cliacutenico
2018
Anemia macrociacutetica secundaria a deficiencia de aacutecido foacutelico y de vitamina B12(cobalamina)
La deficiencia de B12 yo aacutecido foacutelico es la causa maacutes frecuente de megaloblastosis
Dentro de distintas funciones generales del metabolismo la vitamina B12 es uncofactor esencial en la siacutentesis de ADN y ARN compromete a todas las ceacutelulas delorganismo
Su deficiencia se manifiesta en oacuterganos con alto recambio celular como la meacutedulaosea y en el sistema nervioso central (SNC) a traveacutes de la siacutentesis de mielina y lareparacioacuten axonal
La deficiencia de cobalamina es responsable de alteraciones hematoloacutegicasneuroloacutegicas neurocognitivas y neuropsiquiaacutetricas
La siacutentesis defectuosa de ADN conduce a la apoptosis y a la hemoacutelisis (intra yextramedular) causantes de la hemopoyesis inefectiva
En meacutedula la siacutentesis ineficiente de DNA causa cambios megaloblaacutesticos comoconsecuencIa anemia y citopenias
Congreso Nacional Laboratorio Cliacutenico
2018
Limitaciones de los meacutetodos diagnoacutesticos claacutesicos
Volumen Corpuscular Medio (VCM) y morfologiacutea de sangre perifeacuterica En una serie de pacientes con deacuteficit de cobalamina soacutelo un 29 teniacutean anemia y soacutelo un 36 teniacutean un VCM gt 100 fL
Un VCM normal no puede ser empleado para rechazar una determinacioacuten de nivel de cobalamina ya que hasta un 25 de casos con manifestaciones neuroloacutegicas cursan con un VCM normal
Cobalamina seacuterica (nivel de B12) Es el test diagnoacutestico rutinario inicial estaacutendar Es un test ampliamente disponible de bajo coste y automatizado Sin embargo presenta algunas limitaciones
-- Existencia de varias teacutecnicas y ausencia de un gold standard por lo que hay diferentes liacutemites de referencia
-- Variacioacuten intraindividual muy alta
La OMS publicoacute en 2008 las conclusiones de un grupo teacutecnico consultado sobre el deacuteficit de cobalamina y folato
El grupo reconocioacute que no existen unos umbrales universalmente reconocidos para definir el deacuteficit de ambas vitaminas y expresaron la necesidad de un consenso
Devalia V Hamilton MS and Molloy AM on behalf of the British Committee for standards in haematology Guidelines for the diagnosis and treatment of cobalamin and folate disorders Br J Haematol 2014 166(4) 496-513
Schrier SL Diagnosis and treatment of vitamin B12 and folate deficiency UpToDate Last updated Jun 25 2014
de Benoist B Conclusions of a WHO Technical Consultation on folate and vitamin B12 deficiencies Food Nutr Bull 200829(2 Suppl)S238ndash44Congreso Nacional Laboratorio Cliacutenico
2018
Tomado de Tefferi A Li C En Atlas of Clinical Hematology Publicado por JO Armitage Philadelphia Current Medicine 2004
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
Int Jnl Lab Hem 2007 29 327ndash334
Clin Lab 201662343-347
In ourstudy mean MCVrMCV ratio of healthy controls is130 as microcytic anemia irondeficiency anemia is121 as also macrocytic anemia vitamin B12 deficiencyanemia is 115
Congreso Nacional Laboratorio Cliacutenico
2018
Sualeh Muslim Khan Muhammad Akbar Agha
Mean cell volume of reticulocytemdashA new parameter for diagnosing sub-clinical cobalamin deficiency in blood donors Int J Lab Hem 20181ndash4
The Abbott CELL-DYN Sapphire Hematology System uses multi-angle polarized scatter separation (MAPSS) and focused flow impedance technologies
Congreso Nacional Laboratorio Cliacutenico
2018
MCVr at 985 fL yielded the highest Youdenrsquos index at sensitivity of 82 specificity of 828 AUC 0847 ( 95 CI 803-891)
Khan SM Agha MA Mean cell volume of reticulocyte-A new parameter for diagnosing sub-clinical cobalamin deficiency in blood donors
Int J Lab Hem 20181ndash4 2018 Jul 13 doi 101111ijlh12899
Congreso Nacional Laboratorio Cliacutenico
2018
Role of Cell Population Data in the detection of folate and cobalamin deficiency
J Nieto et al
XXXI st International Symposium on Technological Innovations in Laboratory Hematology ISLH 2018 10-12 May 2018 Brussels Belgium
M-V-NRET and SD-VNRET are the best discriminatory single parameters to distinguish between patients with B9B12 deficiency and reference subjects M-V-NRETAUC=0823 sensitivity 78 and specificity 86
AUC=0852 sensitivity 55 and specificity 60
Conclusions The CPD parameters of Volume and Light Scatter (M and SD of LALS angle) that inform about size and intracellular structure of RBCs provided very useful information for the detection of B9B12 deficiency
Congreso Nacional Laboratorio Cliacutenico
2018
Cell Population Data
bull Paraacutemetros poblacionales de los leucocitos
bull Describen la morfologiacutea tamantildeo
estructuras citoplasmaacuteticas
nuacutecleo aacutecidos nucleacuteicos
bull Son datos numeacutericos con los que se construyen los ejes de lo diagramas de dispersioacuten de los leucocitos
bull Dependen de la tecnologiacutea
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
High Sensitivity New Parameters for the Detection of Vitamin B12 and Folate Deficiencies Blood 2008 1125379
B12 def vs
Normals
Mann
Withney T-Test
ROC
AUC Sens Specif Cutoff signifROC
MCV p=03156 p=09533 0577
MPV p=00001 0802 792 806 lt83 p=00001
NE Mean
Volume plt00001 0862 833 778 gt1403 p=00001
MO Mean
Volume plt00001 0829 625 889 gt1723 p=00001
MRV p=00113 0705 50 964 gt1133 p=00051
Folate def vs
Normals
Mann
Withney T-Test
ROC
AUC Sens Specif Cut-off signifROC
MCV p=00798 p=06461 0665
MPV plt00001 0832 81 806 lt83 p=00001
NE Mean
Volume p=00008 087 952 694 gt1402 p=00001
MO Mean
Volume p=00002 0801 667 833 gt1696 p=00001
MRV p=00054 0731 476 964 gt1133 p=00019
The Mean Neutrophil Volume (MNE V) and Mean Monocyte Volume (MMOV) may be used for the detection of megaloblastic neutrophils and monocytes MNEV and MMOV have significantly higher sensitivity than the previous information from the red cells (MCV) detecting B12 or folate deficiency because they are not affected by the presence at the same time of Iron deficiency or other reasons of anemia
Congreso Nacional Laboratorio Cliacutenico
2018
POSTER 733
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
CPD Sysmex XN
NE SSC complejidad
NE SFL aacutecidos nucleacuteicos
NE FSC tamantildeo
NE WX
NE WY
NE WZ
MO X
MO Y
MO Z
MO WX
MO WY
MO WZ
LY X
LY Y
LY Z
LY WX
LY WY
LY WZCongreso Nacio
nal Laboratorio Cliacutenico 2018
As MCV is the mean which is calculated it is insensitive to the presence of a small number of macrocytes
Further macrocytosis can be obscured by concomitant disorders that can cause microcytosis resulting inmasked megaloblastic anaemia (MA) for example iron deficiency hereditary elliptocytosis alpha and betathalassemia
This study was undertaken to evaluate the role of NEUT-X and NEUT-Y in detecting MA on peripheral blood andalso see whether other forms of macrocytic anaemia can be differentiated from MA
In MA the peripheral blood smear shows cytopenia with macroovalocytes and hypersegmented
neutrophils (gt5 lobes in 5 neutrophils six lobes nuclei or lobe average of gt35)
In conclusion our study shows that higher values of NEUT-X and NEUT-Y in MA patients in spite of low ornormal MCV high RDW may be used to not only reveal the masked cases of MA with concomitant irondeficiency but also separate them from the broader macrocytic anaemia group
Peripheral smear remains diagnostic however making smear for all the suspicious cases is a cumbersomeand tedious procedure Thus these parameters emerge as more reliable and stable parameters in themodern laboratories which in future may replace the older screening tools
Congreso Nacional Laboratorio Cliacutenico
2018
A favor Eficiencia Operativa
Mejora el proceso del Laboratorio
Mejor informacioacuten al Cliacutenico al mismo coste
Mejora la informacioacuten
Informa sobre la eritropoyesis deteccioacuten precoz de estados carenciales
Ayuda al cliacutenico
Estado real del paciente
En contraParaacutemetros de investigacioacuten
Dificultad de standarizar dependencia teacutecnica
Control de calidadCongreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
Abbott Sapphire lo calcula en el 50 de la altura del pico del histogramaSysmex y Mindray al 20 desde la base del histogramaSiemens calcula la anchura del pico comprendido entre 60 y 120 fL
Aunque RDW ADE generalmente se entiendecomo coeficiente de variacioacuten de ladistribucioacuten de los voluacutemenes de loseritrocitos algunos analizadoreshematoloacutegicos lo calculan desde la medicioacutendirecta de la anchura de la distribucioacuten
Congreso Nacional Laboratorio Cliacutenico
2018
G Lippi amp M Plebani
Recent developments and innovations in red blood cells diagnostics
Journal of Laboratory and Precision Medicine 2018
DOI 1021037jlpm20180709 AOPCongreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
copy 2012 Mindray Confidential 26
HDWHYPERHYPO
HDW HGB Distribution Width
HDW is the distribution width of Hgb histogram
Congreso Nacional Laboratorio Cliacutenico
2018
copy 2012 Mindray Confidential 27
MCHrHDWHYPERHYPOMCHr Mean RET HGB Concentration
Congreso Nacional Laboratorio Cliacutenico
2018
Histograma RBC el mapa de Mie
28 41
Congreso Nacional Laboratorio Cliacutenico
2018
Abbott Mindray Siemens
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
Severe Iron Deficiency Anemia Female 34 years
19 th March 18 th April
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
SysmexRBCHe erythrocyte Hb equivalentRetHe reticulocyte Hb equivalent(content)
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
MIC
MAC
HPO HPR
Congreso Nacional Laboratorio Cliacutenico
2018
copy 2012 Mindray Confidential 36
MINDRAY MCHrHDWHYPERHYPO
MCHr Mean RET HGB Concentration
HDW HGB Distribution Width
HYPER The percentage of hyperchromicred blood cells
HYPO The percentage of hypochromic red blood cells
Thalassemia screeningIDA treatment monitoringIDA screening
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
Hipocromo
Hipercroacutemico onormocroacutemico
iquestConcentracioacuten o contenido de Hemoglobina
Hipocroacutemiconormocroacutemico
Abbott Mindray Siemens Hypo CONCENTRACIOacuteN Hblt280gL
Sysmex Hypo CONTENIDO Hblt 17 pg
Congreso Nacional Laboratorio Cliacutenico
2018
Low Hb Density
Microcytic Factor Maf = (HbMCV)100
Nuevo moacutedulo transductor muacuteltiple con laacuteser de diodo y dos sensores oacutepticos
Anaacutelisis de hasta 50000 ceacutelulas con 7 paraacutemetros tecnoloacutegicos (leucocitos reticulocitos eritroblastos)
1 Volumen digital
2 Conductividad digital
3 5 aacutengulos de dispersioacuten de luz laacuteser digital
bull MALS (Median Angle Light Scatter)
bull UMALS (Upper Median Angle Light Scatter) 20deg a 43deg
bull LMALS (Lower Median Angle Light Scatter) 09deg a 19deg
bull LALS (Low Angle Light Scatter) asymp 51deg
bull AL2 (Axial Light Loss) 0deg a 05deg
Congreso Nacional Laboratorio Cliacutenico
2018
Hierro es un elemento criacutetico para elfuncionamiento oacuteptimo y supervivenciade las ceacutelulas
Disfuncioacuten mitocondrialActividad enzimaacutetica afectadaProteiacutenas de transporte y estructuralesproteins
Capacidad fiacutesica mermadaCapacidad de trabajo reducidaCapacidades cognitivas afectadasMorbilidad y mortalidad
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
It is generally assumed that worldwide ldquoat least half the anemia is due tonutritional iron deficiencyrdquo and that ldquoup to a prevalence of iron deficiency anemiaof 40 the prevalence of iron deficiency will be about 25 times that of anemiardquoHowever it is evident from the foregoing discussion that there are considerablevariations in both of these ratios depending on the age and sex of the peoplebeing studied the region of the world in which they live and the prevalence ratesof other causes of anemia
WHO Department of Nutrition for Health and DevelopmentAssessing the iron status of populations including literature reviews report of a Joint World Health OrganizationCenters for DiseaseControl and Prevention Technical Consultation on the Assessment of Iron Status at the Population Level Geneva Switzerland 6ndash8 April2004 ndash 2nd ed
Congreso Nacional Laboratorio Cliacutenico
2018
Estaacute bien establecido que la anemia produce una miriacuteada de secuelas tanto fiacutesicas comopsicoloacutegicas
Pero los efecto deleteacutereos se deben al deficit de hierro que es un evento previo a que seestablezca la anemia
El deacuteficit de hierrro auacuten sin anemia tiene efectos negativos en el desarrollo cognitivo y fiacutesico
Rattehalli D et al Iron deficiency without anemia do not wait for the Hemoglobin to drop
Health Policy and Technology 2013 2 45-48Congreso Nacio
nal Laboratorio Cliacutenico 2018
SuominenP et al Serum transferrin receptor and transferrin receptor-ferritin index identify healthy subjects with subclinical iron deficits Blood 1998 92 2934ndash9Halwachs-Baumann G Diagnosis of anaemia old things rearranged Wien Med Wochenschr 2012 162478ndash88
Congreso Nacional Laboratorio Cliacutenico
2018
Hemoglobina de reticulocito y su importancia en el diagnoacutestico temprano de anemiaferropeacutenica
Y Maacuterquez-Beniacutetez et al Universidad de BocayaAugust
2018 DOI 1022267rus182003133 aop
El contenido de hemoglobina de reticulocitos (CHr) es un paraacutemetro en la biometriacuteahematoloacutegica automatizada utilizado como un marcador de la biodisponibilidad delhierro en la eritropoyesis
Objetivo Exponer la aplicabilidad de la CHr como un paraacutemetro en el diagnoacutesticoprecoz de la anemia por deficiencia de hierro asiacute como su medicioacuten e interpretacioacuten
Materiales y meacutetodos Se realizoacute la revisioacuten de artiacuteculos cientiacuteficos en ingleacutes y espantildeolen las bases de datos PubMed ScienceDirect LILACS y Medline usando descriptoresvalidados en Medical Subject Headings (MeSH) considerando periodo depublicabilidad del 80 inferior a 5 antildeos
Conclusiones La CHr es un paraacutemetro de gran utilidad en el diagnoacutestico temprano deanemia ferropeacutenica y otras patologiacuteas como deficiencia funcional de hierro estadosde inflamacioacuten croacutenica y enfermedad renal croacutenica
Biomarcador temprano en el diagnoacutestico de deficiencia de hierro antes de presentarsecambios morfoloacutegicos eritrociacuteticosCongreso Nacio
nal Laboratorio Cliacutenico 2018
bull A total of 1105 NES participants (639 men 466 women)bull CHr becomes affected in a relatively early stage in the development of iron deficiency before iron
deficiency anemia and clinical symptoms become apparentbull Therefore this parameter might be useful to identify persons healthy and diseased at risk of
developing iron deficiency anemia and subsequently to apply interventions in order to prevent further development of iron deficiency anemiaCongreso Nacio
nal Laboratorio Cliacutenico 2018
Hb reticulocitaria sensible para detectar la fase inicial del deacuteficit de hierro cuando laeritropoyesis requiere maacutes cantidad que la que recibe ANTES de que la anemia seestablezca
Congreso Nacional Laboratorio Cliacutenico
2018
No ID LID P
RBC 1012L 48 (08) 437 (05) lt00001
Hb gL 135 (6) 131 (12) 0006
MCV fL 922 (21) 902 (38) 0006
MCH pg 324 (07) 306 (22) lt00001
MCHC gL 339 (6) 319 (23) 0001
RDW
Ret He pg
Hypo He
LHD
Ferritin microgL
131 (06)
338 (21)
03 (015)
28 (20)
86 (3)
145 (21)
278 (24)
69 (55)
56 (25)
16 (76)
lt00001
lt00001
lt00001
lt00001
lt00001
AUC 95 CI Cutoff Sensitivity Specificity
LHD 0898 0819-0978 50 859 841
Ret He 0914 0824-1000 299pg 868 857
Hypo He 0934 0856-1000 16 857 921
Clinical value of markers of hypochromia in the detection of latent iron deficiency in non-anemic premenopausal women
No ID Hb gt 120 gL s-ferritin was within reference intervalLatent Iron Defiency Hb gt 120 gL s-ferritin lt 30 μgL
Urrechaga E et al Journal Clin Lab Analysis 2016 30 (5) 623-627
97 women (388) in 250 apparently healthy women had latent IDCongreso Nacional Laboratorio Cliacutenico
2018
Schorer G et al Abstract Jahreskongress der Deutschen Gesellschaft fuumlr Transfusionsmedizin und Immunhaumlmatologie Rostock 15 - 18 September 2009
Congreso Nacional Laboratorio Cliacutenico
2018
Caring for Those Who Share Mitigating Iron Deficiency in Regular Blood DonorsMast Alan E
bull Iron deficiency caused by regular blood donation is a problem facing blood centers Each blood donation removes 200 to 250 mg of iron from the donor Consequently many donors become iron deficient with repeated donation
bull This presents a challenge to blood centers that has become more acute in recent years with the realization that iron deficiency even in the absence of anemia is associated with adverse effects including fatigue and decreased exercise tolerance as well as neurological symptoms such as decreased cognitive function pica and restless leg syndrome
bull REDS-II investigators performed a longitudinal study investigating the iron status of blood donors over a two year period called the REDS-II Donor Iron Status Evaluation (RISE)
bull Results from the baseline analysis of regular donors (e 2 donations per year (females) or e 3 donations per year (males) revealed that over two-thirds of female donors and over one-half of male donors have iron deficiency
Congreso Nacional Laboratorio Cliacutenico
2018
Transfusion 2013 532766-2775
bull We evaluated the diagnostic sensitivity and specificity of red blood cell (RBC) hematology analyzer indices to assess iron status as a part of donor management iron deficient erythropoiesis (IDE) and absence of iron stores (AIS)
bull STUDY DESIGN AND METHODS A total of 1659 male and female donors from the Retrovirus Epidemiology Donor Study-II (REDS-II) Donor Iron Status Evaluation (RISE) study who were either first-timereactivated (FT RA no donations for 2 years) or frequent donors were recruited into a longitudinal study of regular donation of RBCs Of these 1002 donors returned 15 to 24 months later for a final assessment
Absent iron stores (AIS) was defined as plasma ferritin level of less than 12 mgL Logarithm of the ratio of soluble transferrin receptor to ferritin of at least 207 was used to define iron-deficient erythropoiesis (IDE)
bull RESULTS HYPOm and CHr detected IDE with comparable sensitivity 72 versus 69 but differed in specificity HYPOm 68 and CHr 53
For detecting AIS sensitivity was improved to 85 for HYPOm and 81 for CHr but specificity was reduced
Venous Hb had high specificity but poor sensitivity for IDE and AIS A plasma ferritin level of less than 267 mgL was a good surrogate for assessing IDE Congreso Nacio
nal Laboratorio Cliacutenico 2018
Microcytic RBC and reticulocyte mean cell hemoglobin content predicted iron depletion with
sensitivities 70 and 64
specificities of 72 and 78 respectively
When both combined
increased the sensitivity to 82
Congreso Nacional Laboratorio Cliacutenico
2018
Depending on the number of donations during the preceding12 months
Absent iron stores were detected in up to 214 of male and278 of female donors respectively
impaired hemoglobinisation IH was present in up to 64 maleand 167 female donors with 2 and 4 preceding donationsrespectively
The defined CHr cut-off value was 280 pg to detect IH infrequent whole blood donors with AIS leading to a testspecificity of 982 (positive predictive value PPV 577) inmale and of 978 (PPV 829) in female donors
It may help to prevent the development of anemia in frequentblood donors and also can help to decide whether donordeferral or even iron substitution need to be recommended
Congreso Nacional Laboratorio Cliacutenico
2018
Of the 501 blood donors sTfR and Ret-He detected Latent Iron Deficiency in 148 and 135 donors respectively
In comparison to sTfR Ret-He had sensitivity of 927 specificity of 9716 PPV of 931 and NPV of 963
Serum Ferritin TIBC and serum Iron had comparatively lower sensitivity of 8716 797 and 777 respectively
Conclusion Ret-He can be used as a routine screening test to detect LID in blood donors
This could provide an opportunity to make appropriate and timely interventions like dietary changes or drug supplementation
Congreso Nacional Laboratorio Cliacutenico
2018
Singh A Chaudhary R Pandey HC Sonker A Identification of iron status of blood donors by using low hemoglobin density and microcytic anemia factor Asian J Transfus Sci 20181246-50
The main objective of this study was to assess ifLHD and Maf could be used for assessment ofiron status in blood donors and also to establisha cut-off for these two parameters at which atentative iron deficiency could be reportedconclusively
Results LHD and Maf were able to differentiatebetween iron deficient and iron-depleteddonors from normal donorsA cutoff of 918 for LHD was able todifferentiate iron deficient and depleted statefrom normal iron statessensitivity 919 and specificity 71respectivelya cutoff of 1016 for Mafsensitivity 946 and specificity 968
MAf = (MVC Hb) 100
Congreso Nacional Laboratorio Cliacutenico
2018
Hb reticulocitaria sensible para detectar la fase inicial del deacuteficitde hierro cuando la eritropoyesis requiere maacutes cantidad que laque recibe ANTES de que la anemia se establezca
La deteccioacuten precoz del deacuteficit de hierro en la fase del balance negativo demanda aporte contribuye a reducir sus manifestaciones cliacutenicas en los pacientes afectados mejorando la salud puacuteblica
Un tratamiento menos prolongado con suplementos y menor consumo de los recursos sanitaros Contribuye a la eficiencia y sostenibilidad de los servicios sanitarios
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
Buttarello MLaboratory diagnosis of anemia are the old and new red cell parameters useful in classification and treatment howInt Jnl Lab Hem 2016 38 (Suppl 1) 123ndash132
Congreso Nacional Laboratorio Cliacutenico
2018
Buttarello MLaboratory diagnosis of anemia are the old and new red cell parameters useful in classification and treatment howInt Jnl Lab Hem 2016 38 (Suppl 1) 123ndash132
Congreso Nacional Laboratorio Cliacutenico
2018
Ralph Green amp Ananya Datta Mitra Megaloblastic Anemias Nutritional and Other CausesMed Clin N Am 2017 101 297ndash317
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
ANEMIA CARENCIAL CAUSAS
Factores alimentariosConsumir una dieta vegetariana mal planeadaAlimentacioacuten deficiente en los bebeacutesDesnutricioacuten durante el embarazo
Deacuteficit de absorcioacutenAlcoholismo croacutenicoEnfermedad de Crohn celiaquiacutea infeccioacuten otros problemas que le dificulten al cuerpo la digestioacuten de los alimentosAnemia perniciosa (factor intriacutenseco)Cirugiacuteas para extirpar ciertas partes del estoacutemago o el intestino delgado
MedicamentosB12 omeprazol metformina colchicina aminosalicilatos neomicinaFOLATO fenitoiacutena metotrexato sulfasalacina triamtereno pirimetamina trimetoprim con sulfametoxazol barbituacutericos
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
Reacciones metaboacutelicas en las que participan la vitamina B12 y el folato bull la conversioacuten de metilmalonil-CoA a succinil-CoA donde la adenosil-cobalamina actuacutea de
cofactor Por ello un deacuteficit de B12 conlleva un aumento de metilmalonil-CoA y de su producto de hidroacutelisis el aacutecido metilmaloacutenico
bull la siacutentesis de metionina a partir de homocisteina gracias a la metionina sintetasa y a la metil-cobalamina como cofactor En esta misma reaccioacuten el metiltetrahidrofolato es transformado a tetrahidrofolato que es necesario para la siacutentesis de DNA
Congreso Nacional Laboratorio Cliacutenico
2018
Anemia macrociacutetica secundaria a deficiencia de aacutecido foacutelico y de vitamina B12(cobalamina)
La deficiencia de B12 yo aacutecido foacutelico es la causa maacutes frecuente de megaloblastosis
Dentro de distintas funciones generales del metabolismo la vitamina B12 es uncofactor esencial en la siacutentesis de ADN y ARN compromete a todas las ceacutelulas delorganismo
Su deficiencia se manifiesta en oacuterganos con alto recambio celular como la meacutedulaosea y en el sistema nervioso central (SNC) a traveacutes de la siacutentesis de mielina y lareparacioacuten axonal
La deficiencia de cobalamina es responsable de alteraciones hematoloacutegicasneuroloacutegicas neurocognitivas y neuropsiquiaacutetricas
La siacutentesis defectuosa de ADN conduce a la apoptosis y a la hemoacutelisis (intra yextramedular) causantes de la hemopoyesis inefectiva
En meacutedula la siacutentesis ineficiente de DNA causa cambios megaloblaacutesticos comoconsecuencIa anemia y citopenias
Congreso Nacional Laboratorio Cliacutenico
2018
Limitaciones de los meacutetodos diagnoacutesticos claacutesicos
Volumen Corpuscular Medio (VCM) y morfologiacutea de sangre perifeacuterica En una serie de pacientes con deacuteficit de cobalamina soacutelo un 29 teniacutean anemia y soacutelo un 36 teniacutean un VCM gt 100 fL
Un VCM normal no puede ser empleado para rechazar una determinacioacuten de nivel de cobalamina ya que hasta un 25 de casos con manifestaciones neuroloacutegicas cursan con un VCM normal
Cobalamina seacuterica (nivel de B12) Es el test diagnoacutestico rutinario inicial estaacutendar Es un test ampliamente disponible de bajo coste y automatizado Sin embargo presenta algunas limitaciones
-- Existencia de varias teacutecnicas y ausencia de un gold standard por lo que hay diferentes liacutemites de referencia
-- Variacioacuten intraindividual muy alta
La OMS publicoacute en 2008 las conclusiones de un grupo teacutecnico consultado sobre el deacuteficit de cobalamina y folato
El grupo reconocioacute que no existen unos umbrales universalmente reconocidos para definir el deacuteficit de ambas vitaminas y expresaron la necesidad de un consenso
Devalia V Hamilton MS and Molloy AM on behalf of the British Committee for standards in haematology Guidelines for the diagnosis and treatment of cobalamin and folate disorders Br J Haematol 2014 166(4) 496-513
Schrier SL Diagnosis and treatment of vitamin B12 and folate deficiency UpToDate Last updated Jun 25 2014
de Benoist B Conclusions of a WHO Technical Consultation on folate and vitamin B12 deficiencies Food Nutr Bull 200829(2 Suppl)S238ndash44Congreso Nacional Laboratorio Cliacutenico
2018
Tomado de Tefferi A Li C En Atlas of Clinical Hematology Publicado por JO Armitage Philadelphia Current Medicine 2004
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
Int Jnl Lab Hem 2007 29 327ndash334
Clin Lab 201662343-347
In ourstudy mean MCVrMCV ratio of healthy controls is130 as microcytic anemia irondeficiency anemia is121 as also macrocytic anemia vitamin B12 deficiencyanemia is 115
Congreso Nacional Laboratorio Cliacutenico
2018
Sualeh Muslim Khan Muhammad Akbar Agha
Mean cell volume of reticulocytemdashA new parameter for diagnosing sub-clinical cobalamin deficiency in blood donors Int J Lab Hem 20181ndash4
The Abbott CELL-DYN Sapphire Hematology System uses multi-angle polarized scatter separation (MAPSS) and focused flow impedance technologies
Congreso Nacional Laboratorio Cliacutenico
2018
MCVr at 985 fL yielded the highest Youdenrsquos index at sensitivity of 82 specificity of 828 AUC 0847 ( 95 CI 803-891)
Khan SM Agha MA Mean cell volume of reticulocyte-A new parameter for diagnosing sub-clinical cobalamin deficiency in blood donors
Int J Lab Hem 20181ndash4 2018 Jul 13 doi 101111ijlh12899
Congreso Nacional Laboratorio Cliacutenico
2018
Role of Cell Population Data in the detection of folate and cobalamin deficiency
J Nieto et al
XXXI st International Symposium on Technological Innovations in Laboratory Hematology ISLH 2018 10-12 May 2018 Brussels Belgium
M-V-NRET and SD-VNRET are the best discriminatory single parameters to distinguish between patients with B9B12 deficiency and reference subjects M-V-NRETAUC=0823 sensitivity 78 and specificity 86
AUC=0852 sensitivity 55 and specificity 60
Conclusions The CPD parameters of Volume and Light Scatter (M and SD of LALS angle) that inform about size and intracellular structure of RBCs provided very useful information for the detection of B9B12 deficiency
Congreso Nacional Laboratorio Cliacutenico
2018
Cell Population Data
bull Paraacutemetros poblacionales de los leucocitos
bull Describen la morfologiacutea tamantildeo
estructuras citoplasmaacuteticas
nuacutecleo aacutecidos nucleacuteicos
bull Son datos numeacutericos con los que se construyen los ejes de lo diagramas de dispersioacuten de los leucocitos
bull Dependen de la tecnologiacutea
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
High Sensitivity New Parameters for the Detection of Vitamin B12 and Folate Deficiencies Blood 2008 1125379
B12 def vs
Normals
Mann
Withney T-Test
ROC
AUC Sens Specif Cutoff signifROC
MCV p=03156 p=09533 0577
MPV p=00001 0802 792 806 lt83 p=00001
NE Mean
Volume plt00001 0862 833 778 gt1403 p=00001
MO Mean
Volume plt00001 0829 625 889 gt1723 p=00001
MRV p=00113 0705 50 964 gt1133 p=00051
Folate def vs
Normals
Mann
Withney T-Test
ROC
AUC Sens Specif Cut-off signifROC
MCV p=00798 p=06461 0665
MPV plt00001 0832 81 806 lt83 p=00001
NE Mean
Volume p=00008 087 952 694 gt1402 p=00001
MO Mean
Volume p=00002 0801 667 833 gt1696 p=00001
MRV p=00054 0731 476 964 gt1133 p=00019
The Mean Neutrophil Volume (MNE V) and Mean Monocyte Volume (MMOV) may be used for the detection of megaloblastic neutrophils and monocytes MNEV and MMOV have significantly higher sensitivity than the previous information from the red cells (MCV) detecting B12 or folate deficiency because they are not affected by the presence at the same time of Iron deficiency or other reasons of anemia
Congreso Nacional Laboratorio Cliacutenico
2018
POSTER 733
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
CPD Sysmex XN
NE SSC complejidad
NE SFL aacutecidos nucleacuteicos
NE FSC tamantildeo
NE WX
NE WY
NE WZ
MO X
MO Y
MO Z
MO WX
MO WY
MO WZ
LY X
LY Y
LY Z
LY WX
LY WY
LY WZCongreso Nacio
nal Laboratorio Cliacutenico 2018
As MCV is the mean which is calculated it is insensitive to the presence of a small number of macrocytes
Further macrocytosis can be obscured by concomitant disorders that can cause microcytosis resulting inmasked megaloblastic anaemia (MA) for example iron deficiency hereditary elliptocytosis alpha and betathalassemia
This study was undertaken to evaluate the role of NEUT-X and NEUT-Y in detecting MA on peripheral blood andalso see whether other forms of macrocytic anaemia can be differentiated from MA
In MA the peripheral blood smear shows cytopenia with macroovalocytes and hypersegmented
neutrophils (gt5 lobes in 5 neutrophils six lobes nuclei or lobe average of gt35)
In conclusion our study shows that higher values of NEUT-X and NEUT-Y in MA patients in spite of low ornormal MCV high RDW may be used to not only reveal the masked cases of MA with concomitant irondeficiency but also separate them from the broader macrocytic anaemia group
Peripheral smear remains diagnostic however making smear for all the suspicious cases is a cumbersomeand tedious procedure Thus these parameters emerge as more reliable and stable parameters in themodern laboratories which in future may replace the older screening tools
Congreso Nacional Laboratorio Cliacutenico
2018
A favor Eficiencia Operativa
Mejora el proceso del Laboratorio
Mejor informacioacuten al Cliacutenico al mismo coste
Mejora la informacioacuten
Informa sobre la eritropoyesis deteccioacuten precoz de estados carenciales
Ayuda al cliacutenico
Estado real del paciente
En contraParaacutemetros de investigacioacuten
Dificultad de standarizar dependencia teacutecnica
Control de calidadCongreso Nacional Laboratorio Cliacutenico
2018
Abbott Sapphire lo calcula en el 50 de la altura del pico del histogramaSysmex y Mindray al 20 desde la base del histogramaSiemens calcula la anchura del pico comprendido entre 60 y 120 fL
Aunque RDW ADE generalmente se entiendecomo coeficiente de variacioacuten de ladistribucioacuten de los voluacutemenes de loseritrocitos algunos analizadoreshematoloacutegicos lo calculan desde la medicioacutendirecta de la anchura de la distribucioacuten
Congreso Nacional Laboratorio Cliacutenico
2018
G Lippi amp M Plebani
Recent developments and innovations in red blood cells diagnostics
Journal of Laboratory and Precision Medicine 2018
DOI 1021037jlpm20180709 AOPCongreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
copy 2012 Mindray Confidential 26
HDWHYPERHYPO
HDW HGB Distribution Width
HDW is the distribution width of Hgb histogram
Congreso Nacional Laboratorio Cliacutenico
2018
copy 2012 Mindray Confidential 27
MCHrHDWHYPERHYPOMCHr Mean RET HGB Concentration
Congreso Nacional Laboratorio Cliacutenico
2018
Histograma RBC el mapa de Mie
28 41
Congreso Nacional Laboratorio Cliacutenico
2018
Abbott Mindray Siemens
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
Severe Iron Deficiency Anemia Female 34 years
19 th March 18 th April
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
SysmexRBCHe erythrocyte Hb equivalentRetHe reticulocyte Hb equivalent(content)
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
MIC
MAC
HPO HPR
Congreso Nacional Laboratorio Cliacutenico
2018
copy 2012 Mindray Confidential 36
MINDRAY MCHrHDWHYPERHYPO
MCHr Mean RET HGB Concentration
HDW HGB Distribution Width
HYPER The percentage of hyperchromicred blood cells
HYPO The percentage of hypochromic red blood cells
Thalassemia screeningIDA treatment monitoringIDA screening
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
Hipocromo
Hipercroacutemico onormocroacutemico
iquestConcentracioacuten o contenido de Hemoglobina
Hipocroacutemiconormocroacutemico
Abbott Mindray Siemens Hypo CONCENTRACIOacuteN Hblt280gL
Sysmex Hypo CONTENIDO Hblt 17 pg
Congreso Nacional Laboratorio Cliacutenico
2018
Low Hb Density
Microcytic Factor Maf = (HbMCV)100
Nuevo moacutedulo transductor muacuteltiple con laacuteser de diodo y dos sensores oacutepticos
Anaacutelisis de hasta 50000 ceacutelulas con 7 paraacutemetros tecnoloacutegicos (leucocitos reticulocitos eritroblastos)
1 Volumen digital
2 Conductividad digital
3 5 aacutengulos de dispersioacuten de luz laacuteser digital
bull MALS (Median Angle Light Scatter)
bull UMALS (Upper Median Angle Light Scatter) 20deg a 43deg
bull LMALS (Lower Median Angle Light Scatter) 09deg a 19deg
bull LALS (Low Angle Light Scatter) asymp 51deg
bull AL2 (Axial Light Loss) 0deg a 05deg
Congreso Nacional Laboratorio Cliacutenico
2018
Hierro es un elemento criacutetico para elfuncionamiento oacuteptimo y supervivenciade las ceacutelulas
Disfuncioacuten mitocondrialActividad enzimaacutetica afectadaProteiacutenas de transporte y estructuralesproteins
Capacidad fiacutesica mermadaCapacidad de trabajo reducidaCapacidades cognitivas afectadasMorbilidad y mortalidad
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
It is generally assumed that worldwide ldquoat least half the anemia is due tonutritional iron deficiencyrdquo and that ldquoup to a prevalence of iron deficiency anemiaof 40 the prevalence of iron deficiency will be about 25 times that of anemiardquoHowever it is evident from the foregoing discussion that there are considerablevariations in both of these ratios depending on the age and sex of the peoplebeing studied the region of the world in which they live and the prevalence ratesof other causes of anemia
WHO Department of Nutrition for Health and DevelopmentAssessing the iron status of populations including literature reviews report of a Joint World Health OrganizationCenters for DiseaseControl and Prevention Technical Consultation on the Assessment of Iron Status at the Population Level Geneva Switzerland 6ndash8 April2004 ndash 2nd ed
Congreso Nacional Laboratorio Cliacutenico
2018
Estaacute bien establecido que la anemia produce una miriacuteada de secuelas tanto fiacutesicas comopsicoloacutegicas
Pero los efecto deleteacutereos se deben al deficit de hierro que es un evento previo a que seestablezca la anemia
El deacuteficit de hierrro auacuten sin anemia tiene efectos negativos en el desarrollo cognitivo y fiacutesico
Rattehalli D et al Iron deficiency without anemia do not wait for the Hemoglobin to drop
Health Policy and Technology 2013 2 45-48Congreso Nacio
nal Laboratorio Cliacutenico 2018
SuominenP et al Serum transferrin receptor and transferrin receptor-ferritin index identify healthy subjects with subclinical iron deficits Blood 1998 92 2934ndash9Halwachs-Baumann G Diagnosis of anaemia old things rearranged Wien Med Wochenschr 2012 162478ndash88
Congreso Nacional Laboratorio Cliacutenico
2018
Hemoglobina de reticulocito y su importancia en el diagnoacutestico temprano de anemiaferropeacutenica
Y Maacuterquez-Beniacutetez et al Universidad de BocayaAugust
2018 DOI 1022267rus182003133 aop
El contenido de hemoglobina de reticulocitos (CHr) es un paraacutemetro en la biometriacuteahematoloacutegica automatizada utilizado como un marcador de la biodisponibilidad delhierro en la eritropoyesis
Objetivo Exponer la aplicabilidad de la CHr como un paraacutemetro en el diagnoacutesticoprecoz de la anemia por deficiencia de hierro asiacute como su medicioacuten e interpretacioacuten
Materiales y meacutetodos Se realizoacute la revisioacuten de artiacuteculos cientiacuteficos en ingleacutes y espantildeolen las bases de datos PubMed ScienceDirect LILACS y Medline usando descriptoresvalidados en Medical Subject Headings (MeSH) considerando periodo depublicabilidad del 80 inferior a 5 antildeos
Conclusiones La CHr es un paraacutemetro de gran utilidad en el diagnoacutestico temprano deanemia ferropeacutenica y otras patologiacuteas como deficiencia funcional de hierro estadosde inflamacioacuten croacutenica y enfermedad renal croacutenica
Biomarcador temprano en el diagnoacutestico de deficiencia de hierro antes de presentarsecambios morfoloacutegicos eritrociacuteticosCongreso Nacio
nal Laboratorio Cliacutenico 2018
bull A total of 1105 NES participants (639 men 466 women)bull CHr becomes affected in a relatively early stage in the development of iron deficiency before iron
deficiency anemia and clinical symptoms become apparentbull Therefore this parameter might be useful to identify persons healthy and diseased at risk of
developing iron deficiency anemia and subsequently to apply interventions in order to prevent further development of iron deficiency anemiaCongreso Nacio
nal Laboratorio Cliacutenico 2018
Hb reticulocitaria sensible para detectar la fase inicial del deacuteficit de hierro cuando laeritropoyesis requiere maacutes cantidad que la que recibe ANTES de que la anemia seestablezca
Congreso Nacional Laboratorio Cliacutenico
2018
No ID LID P
RBC 1012L 48 (08) 437 (05) lt00001
Hb gL 135 (6) 131 (12) 0006
MCV fL 922 (21) 902 (38) 0006
MCH pg 324 (07) 306 (22) lt00001
MCHC gL 339 (6) 319 (23) 0001
RDW
Ret He pg
Hypo He
LHD
Ferritin microgL
131 (06)
338 (21)
03 (015)
28 (20)
86 (3)
145 (21)
278 (24)
69 (55)
56 (25)
16 (76)
lt00001
lt00001
lt00001
lt00001
lt00001
AUC 95 CI Cutoff Sensitivity Specificity
LHD 0898 0819-0978 50 859 841
Ret He 0914 0824-1000 299pg 868 857
Hypo He 0934 0856-1000 16 857 921
Clinical value of markers of hypochromia in the detection of latent iron deficiency in non-anemic premenopausal women
No ID Hb gt 120 gL s-ferritin was within reference intervalLatent Iron Defiency Hb gt 120 gL s-ferritin lt 30 μgL
Urrechaga E et al Journal Clin Lab Analysis 2016 30 (5) 623-627
97 women (388) in 250 apparently healthy women had latent IDCongreso Nacional Laboratorio Cliacutenico
2018
Schorer G et al Abstract Jahreskongress der Deutschen Gesellschaft fuumlr Transfusionsmedizin und Immunhaumlmatologie Rostock 15 - 18 September 2009
Congreso Nacional Laboratorio Cliacutenico
2018
Caring for Those Who Share Mitigating Iron Deficiency in Regular Blood DonorsMast Alan E
bull Iron deficiency caused by regular blood donation is a problem facing blood centers Each blood donation removes 200 to 250 mg of iron from the donor Consequently many donors become iron deficient with repeated donation
bull This presents a challenge to blood centers that has become more acute in recent years with the realization that iron deficiency even in the absence of anemia is associated with adverse effects including fatigue and decreased exercise tolerance as well as neurological symptoms such as decreased cognitive function pica and restless leg syndrome
bull REDS-II investigators performed a longitudinal study investigating the iron status of blood donors over a two year period called the REDS-II Donor Iron Status Evaluation (RISE)
bull Results from the baseline analysis of regular donors (e 2 donations per year (females) or e 3 donations per year (males) revealed that over two-thirds of female donors and over one-half of male donors have iron deficiency
Congreso Nacional Laboratorio Cliacutenico
2018
Transfusion 2013 532766-2775
bull We evaluated the diagnostic sensitivity and specificity of red blood cell (RBC) hematology analyzer indices to assess iron status as a part of donor management iron deficient erythropoiesis (IDE) and absence of iron stores (AIS)
bull STUDY DESIGN AND METHODS A total of 1659 male and female donors from the Retrovirus Epidemiology Donor Study-II (REDS-II) Donor Iron Status Evaluation (RISE) study who were either first-timereactivated (FT RA no donations for 2 years) or frequent donors were recruited into a longitudinal study of regular donation of RBCs Of these 1002 donors returned 15 to 24 months later for a final assessment
Absent iron stores (AIS) was defined as plasma ferritin level of less than 12 mgL Logarithm of the ratio of soluble transferrin receptor to ferritin of at least 207 was used to define iron-deficient erythropoiesis (IDE)
bull RESULTS HYPOm and CHr detected IDE with comparable sensitivity 72 versus 69 but differed in specificity HYPOm 68 and CHr 53
For detecting AIS sensitivity was improved to 85 for HYPOm and 81 for CHr but specificity was reduced
Venous Hb had high specificity but poor sensitivity for IDE and AIS A plasma ferritin level of less than 267 mgL was a good surrogate for assessing IDE Congreso Nacio
nal Laboratorio Cliacutenico 2018
Microcytic RBC and reticulocyte mean cell hemoglobin content predicted iron depletion with
sensitivities 70 and 64
specificities of 72 and 78 respectively
When both combined
increased the sensitivity to 82
Congreso Nacional Laboratorio Cliacutenico
2018
Depending on the number of donations during the preceding12 months
Absent iron stores were detected in up to 214 of male and278 of female donors respectively
impaired hemoglobinisation IH was present in up to 64 maleand 167 female donors with 2 and 4 preceding donationsrespectively
The defined CHr cut-off value was 280 pg to detect IH infrequent whole blood donors with AIS leading to a testspecificity of 982 (positive predictive value PPV 577) inmale and of 978 (PPV 829) in female donors
It may help to prevent the development of anemia in frequentblood donors and also can help to decide whether donordeferral or even iron substitution need to be recommended
Congreso Nacional Laboratorio Cliacutenico
2018
Of the 501 blood donors sTfR and Ret-He detected Latent Iron Deficiency in 148 and 135 donors respectively
In comparison to sTfR Ret-He had sensitivity of 927 specificity of 9716 PPV of 931 and NPV of 963
Serum Ferritin TIBC and serum Iron had comparatively lower sensitivity of 8716 797 and 777 respectively
Conclusion Ret-He can be used as a routine screening test to detect LID in blood donors
This could provide an opportunity to make appropriate and timely interventions like dietary changes or drug supplementation
Congreso Nacional Laboratorio Cliacutenico
2018
Singh A Chaudhary R Pandey HC Sonker A Identification of iron status of blood donors by using low hemoglobin density and microcytic anemia factor Asian J Transfus Sci 20181246-50
The main objective of this study was to assess ifLHD and Maf could be used for assessment ofiron status in blood donors and also to establisha cut-off for these two parameters at which atentative iron deficiency could be reportedconclusively
Results LHD and Maf were able to differentiatebetween iron deficient and iron-depleteddonors from normal donorsA cutoff of 918 for LHD was able todifferentiate iron deficient and depleted statefrom normal iron statessensitivity 919 and specificity 71respectivelya cutoff of 1016 for Mafsensitivity 946 and specificity 968
MAf = (MVC Hb) 100
Congreso Nacional Laboratorio Cliacutenico
2018
Hb reticulocitaria sensible para detectar la fase inicial del deacuteficitde hierro cuando la eritropoyesis requiere maacutes cantidad que laque recibe ANTES de que la anemia se establezca
La deteccioacuten precoz del deacuteficit de hierro en la fase del balance negativo demanda aporte contribuye a reducir sus manifestaciones cliacutenicas en los pacientes afectados mejorando la salud puacuteblica
Un tratamiento menos prolongado con suplementos y menor consumo de los recursos sanitaros Contribuye a la eficiencia y sostenibilidad de los servicios sanitarios
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
Buttarello MLaboratory diagnosis of anemia are the old and new red cell parameters useful in classification and treatment howInt Jnl Lab Hem 2016 38 (Suppl 1) 123ndash132
Congreso Nacional Laboratorio Cliacutenico
2018
Buttarello MLaboratory diagnosis of anemia are the old and new red cell parameters useful in classification and treatment howInt Jnl Lab Hem 2016 38 (Suppl 1) 123ndash132
Congreso Nacional Laboratorio Cliacutenico
2018
Ralph Green amp Ananya Datta Mitra Megaloblastic Anemias Nutritional and Other CausesMed Clin N Am 2017 101 297ndash317
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
ANEMIA CARENCIAL CAUSAS
Factores alimentariosConsumir una dieta vegetariana mal planeadaAlimentacioacuten deficiente en los bebeacutesDesnutricioacuten durante el embarazo
Deacuteficit de absorcioacutenAlcoholismo croacutenicoEnfermedad de Crohn celiaquiacutea infeccioacuten otros problemas que le dificulten al cuerpo la digestioacuten de los alimentosAnemia perniciosa (factor intriacutenseco)Cirugiacuteas para extirpar ciertas partes del estoacutemago o el intestino delgado
MedicamentosB12 omeprazol metformina colchicina aminosalicilatos neomicinaFOLATO fenitoiacutena metotrexato sulfasalacina triamtereno pirimetamina trimetoprim con sulfametoxazol barbituacutericos
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
Reacciones metaboacutelicas en las que participan la vitamina B12 y el folato bull la conversioacuten de metilmalonil-CoA a succinil-CoA donde la adenosil-cobalamina actuacutea de
cofactor Por ello un deacuteficit de B12 conlleva un aumento de metilmalonil-CoA y de su producto de hidroacutelisis el aacutecido metilmaloacutenico
bull la siacutentesis de metionina a partir de homocisteina gracias a la metionina sintetasa y a la metil-cobalamina como cofactor En esta misma reaccioacuten el metiltetrahidrofolato es transformado a tetrahidrofolato que es necesario para la siacutentesis de DNA
Congreso Nacional Laboratorio Cliacutenico
2018
Anemia macrociacutetica secundaria a deficiencia de aacutecido foacutelico y de vitamina B12(cobalamina)
La deficiencia de B12 yo aacutecido foacutelico es la causa maacutes frecuente de megaloblastosis
Dentro de distintas funciones generales del metabolismo la vitamina B12 es uncofactor esencial en la siacutentesis de ADN y ARN compromete a todas las ceacutelulas delorganismo
Su deficiencia se manifiesta en oacuterganos con alto recambio celular como la meacutedulaosea y en el sistema nervioso central (SNC) a traveacutes de la siacutentesis de mielina y lareparacioacuten axonal
La deficiencia de cobalamina es responsable de alteraciones hematoloacutegicasneuroloacutegicas neurocognitivas y neuropsiquiaacutetricas
La siacutentesis defectuosa de ADN conduce a la apoptosis y a la hemoacutelisis (intra yextramedular) causantes de la hemopoyesis inefectiva
En meacutedula la siacutentesis ineficiente de DNA causa cambios megaloblaacutesticos comoconsecuencIa anemia y citopenias
Congreso Nacional Laboratorio Cliacutenico
2018
Limitaciones de los meacutetodos diagnoacutesticos claacutesicos
Volumen Corpuscular Medio (VCM) y morfologiacutea de sangre perifeacuterica En una serie de pacientes con deacuteficit de cobalamina soacutelo un 29 teniacutean anemia y soacutelo un 36 teniacutean un VCM gt 100 fL
Un VCM normal no puede ser empleado para rechazar una determinacioacuten de nivel de cobalamina ya que hasta un 25 de casos con manifestaciones neuroloacutegicas cursan con un VCM normal
Cobalamina seacuterica (nivel de B12) Es el test diagnoacutestico rutinario inicial estaacutendar Es un test ampliamente disponible de bajo coste y automatizado Sin embargo presenta algunas limitaciones
-- Existencia de varias teacutecnicas y ausencia de un gold standard por lo que hay diferentes liacutemites de referencia
-- Variacioacuten intraindividual muy alta
La OMS publicoacute en 2008 las conclusiones de un grupo teacutecnico consultado sobre el deacuteficit de cobalamina y folato
El grupo reconocioacute que no existen unos umbrales universalmente reconocidos para definir el deacuteficit de ambas vitaminas y expresaron la necesidad de un consenso
Devalia V Hamilton MS and Molloy AM on behalf of the British Committee for standards in haematology Guidelines for the diagnosis and treatment of cobalamin and folate disorders Br J Haematol 2014 166(4) 496-513
Schrier SL Diagnosis and treatment of vitamin B12 and folate deficiency UpToDate Last updated Jun 25 2014
de Benoist B Conclusions of a WHO Technical Consultation on folate and vitamin B12 deficiencies Food Nutr Bull 200829(2 Suppl)S238ndash44Congreso Nacional Laboratorio Cliacutenico
2018
Tomado de Tefferi A Li C En Atlas of Clinical Hematology Publicado por JO Armitage Philadelphia Current Medicine 2004
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
Int Jnl Lab Hem 2007 29 327ndash334
Clin Lab 201662343-347
In ourstudy mean MCVrMCV ratio of healthy controls is130 as microcytic anemia irondeficiency anemia is121 as also macrocytic anemia vitamin B12 deficiencyanemia is 115
Congreso Nacional Laboratorio Cliacutenico
2018
Sualeh Muslim Khan Muhammad Akbar Agha
Mean cell volume of reticulocytemdashA new parameter for diagnosing sub-clinical cobalamin deficiency in blood donors Int J Lab Hem 20181ndash4
The Abbott CELL-DYN Sapphire Hematology System uses multi-angle polarized scatter separation (MAPSS) and focused flow impedance technologies
Congreso Nacional Laboratorio Cliacutenico
2018
MCVr at 985 fL yielded the highest Youdenrsquos index at sensitivity of 82 specificity of 828 AUC 0847 ( 95 CI 803-891)
Khan SM Agha MA Mean cell volume of reticulocyte-A new parameter for diagnosing sub-clinical cobalamin deficiency in blood donors
Int J Lab Hem 20181ndash4 2018 Jul 13 doi 101111ijlh12899
Congreso Nacional Laboratorio Cliacutenico
2018
Role of Cell Population Data in the detection of folate and cobalamin deficiency
J Nieto et al
XXXI st International Symposium on Technological Innovations in Laboratory Hematology ISLH 2018 10-12 May 2018 Brussels Belgium
M-V-NRET and SD-VNRET are the best discriminatory single parameters to distinguish between patients with B9B12 deficiency and reference subjects M-V-NRETAUC=0823 sensitivity 78 and specificity 86
AUC=0852 sensitivity 55 and specificity 60
Conclusions The CPD parameters of Volume and Light Scatter (M and SD of LALS angle) that inform about size and intracellular structure of RBCs provided very useful information for the detection of B9B12 deficiency
Congreso Nacional Laboratorio Cliacutenico
2018
Cell Population Data
bull Paraacutemetros poblacionales de los leucocitos
bull Describen la morfologiacutea tamantildeo
estructuras citoplasmaacuteticas
nuacutecleo aacutecidos nucleacuteicos
bull Son datos numeacutericos con los que se construyen los ejes de lo diagramas de dispersioacuten de los leucocitos
bull Dependen de la tecnologiacutea
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
High Sensitivity New Parameters for the Detection of Vitamin B12 and Folate Deficiencies Blood 2008 1125379
B12 def vs
Normals
Mann
Withney T-Test
ROC
AUC Sens Specif Cutoff signifROC
MCV p=03156 p=09533 0577
MPV p=00001 0802 792 806 lt83 p=00001
NE Mean
Volume plt00001 0862 833 778 gt1403 p=00001
MO Mean
Volume plt00001 0829 625 889 gt1723 p=00001
MRV p=00113 0705 50 964 gt1133 p=00051
Folate def vs
Normals
Mann
Withney T-Test
ROC
AUC Sens Specif Cut-off signifROC
MCV p=00798 p=06461 0665
MPV plt00001 0832 81 806 lt83 p=00001
NE Mean
Volume p=00008 087 952 694 gt1402 p=00001
MO Mean
Volume p=00002 0801 667 833 gt1696 p=00001
MRV p=00054 0731 476 964 gt1133 p=00019
The Mean Neutrophil Volume (MNE V) and Mean Monocyte Volume (MMOV) may be used for the detection of megaloblastic neutrophils and monocytes MNEV and MMOV have significantly higher sensitivity than the previous information from the red cells (MCV) detecting B12 or folate deficiency because they are not affected by the presence at the same time of Iron deficiency or other reasons of anemia
Congreso Nacional Laboratorio Cliacutenico
2018
POSTER 733
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
CPD Sysmex XN
NE SSC complejidad
NE SFL aacutecidos nucleacuteicos
NE FSC tamantildeo
NE WX
NE WY
NE WZ
MO X
MO Y
MO Z
MO WX
MO WY
MO WZ
LY X
LY Y
LY Z
LY WX
LY WY
LY WZCongreso Nacio
nal Laboratorio Cliacutenico 2018
As MCV is the mean which is calculated it is insensitive to the presence of a small number of macrocytes
Further macrocytosis can be obscured by concomitant disorders that can cause microcytosis resulting inmasked megaloblastic anaemia (MA) for example iron deficiency hereditary elliptocytosis alpha and betathalassemia
This study was undertaken to evaluate the role of NEUT-X and NEUT-Y in detecting MA on peripheral blood andalso see whether other forms of macrocytic anaemia can be differentiated from MA
In MA the peripheral blood smear shows cytopenia with macroovalocytes and hypersegmented
neutrophils (gt5 lobes in 5 neutrophils six lobes nuclei or lobe average of gt35)
In conclusion our study shows that higher values of NEUT-X and NEUT-Y in MA patients in spite of low ornormal MCV high RDW may be used to not only reveal the masked cases of MA with concomitant irondeficiency but also separate them from the broader macrocytic anaemia group
Peripheral smear remains diagnostic however making smear for all the suspicious cases is a cumbersomeand tedious procedure Thus these parameters emerge as more reliable and stable parameters in themodern laboratories which in future may replace the older screening tools
Congreso Nacional Laboratorio Cliacutenico
2018
A favor Eficiencia Operativa
Mejora el proceso del Laboratorio
Mejor informacioacuten al Cliacutenico al mismo coste
Mejora la informacioacuten
Informa sobre la eritropoyesis deteccioacuten precoz de estados carenciales
Ayuda al cliacutenico
Estado real del paciente
En contraParaacutemetros de investigacioacuten
Dificultad de standarizar dependencia teacutecnica
Control de calidadCongreso Nacional Laboratorio Cliacutenico
2018
G Lippi amp M Plebani
Recent developments and innovations in red blood cells diagnostics
Journal of Laboratory and Precision Medicine 2018
DOI 1021037jlpm20180709 AOPCongreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
copy 2012 Mindray Confidential 26
HDWHYPERHYPO
HDW HGB Distribution Width
HDW is the distribution width of Hgb histogram
Congreso Nacional Laboratorio Cliacutenico
2018
copy 2012 Mindray Confidential 27
MCHrHDWHYPERHYPOMCHr Mean RET HGB Concentration
Congreso Nacional Laboratorio Cliacutenico
2018
Histograma RBC el mapa de Mie
28 41
Congreso Nacional Laboratorio Cliacutenico
2018
Abbott Mindray Siemens
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
Severe Iron Deficiency Anemia Female 34 years
19 th March 18 th April
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
SysmexRBCHe erythrocyte Hb equivalentRetHe reticulocyte Hb equivalent(content)
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
MIC
MAC
HPO HPR
Congreso Nacional Laboratorio Cliacutenico
2018
copy 2012 Mindray Confidential 36
MINDRAY MCHrHDWHYPERHYPO
MCHr Mean RET HGB Concentration
HDW HGB Distribution Width
HYPER The percentage of hyperchromicred blood cells
HYPO The percentage of hypochromic red blood cells
Thalassemia screeningIDA treatment monitoringIDA screening
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
Hipocromo
Hipercroacutemico onormocroacutemico
iquestConcentracioacuten o contenido de Hemoglobina
Hipocroacutemiconormocroacutemico
Abbott Mindray Siemens Hypo CONCENTRACIOacuteN Hblt280gL
Sysmex Hypo CONTENIDO Hblt 17 pg
Congreso Nacional Laboratorio Cliacutenico
2018
Low Hb Density
Microcytic Factor Maf = (HbMCV)100
Nuevo moacutedulo transductor muacuteltiple con laacuteser de diodo y dos sensores oacutepticos
Anaacutelisis de hasta 50000 ceacutelulas con 7 paraacutemetros tecnoloacutegicos (leucocitos reticulocitos eritroblastos)
1 Volumen digital
2 Conductividad digital
3 5 aacutengulos de dispersioacuten de luz laacuteser digital
bull MALS (Median Angle Light Scatter)
bull UMALS (Upper Median Angle Light Scatter) 20deg a 43deg
bull LMALS (Lower Median Angle Light Scatter) 09deg a 19deg
bull LALS (Low Angle Light Scatter) asymp 51deg
bull AL2 (Axial Light Loss) 0deg a 05deg
Congreso Nacional Laboratorio Cliacutenico
2018
Hierro es un elemento criacutetico para elfuncionamiento oacuteptimo y supervivenciade las ceacutelulas
Disfuncioacuten mitocondrialActividad enzimaacutetica afectadaProteiacutenas de transporte y estructuralesproteins
Capacidad fiacutesica mermadaCapacidad de trabajo reducidaCapacidades cognitivas afectadasMorbilidad y mortalidad
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
It is generally assumed that worldwide ldquoat least half the anemia is due tonutritional iron deficiencyrdquo and that ldquoup to a prevalence of iron deficiency anemiaof 40 the prevalence of iron deficiency will be about 25 times that of anemiardquoHowever it is evident from the foregoing discussion that there are considerablevariations in both of these ratios depending on the age and sex of the peoplebeing studied the region of the world in which they live and the prevalence ratesof other causes of anemia
WHO Department of Nutrition for Health and DevelopmentAssessing the iron status of populations including literature reviews report of a Joint World Health OrganizationCenters for DiseaseControl and Prevention Technical Consultation on the Assessment of Iron Status at the Population Level Geneva Switzerland 6ndash8 April2004 ndash 2nd ed
Congreso Nacional Laboratorio Cliacutenico
2018
Estaacute bien establecido que la anemia produce una miriacuteada de secuelas tanto fiacutesicas comopsicoloacutegicas
Pero los efecto deleteacutereos se deben al deficit de hierro que es un evento previo a que seestablezca la anemia
El deacuteficit de hierrro auacuten sin anemia tiene efectos negativos en el desarrollo cognitivo y fiacutesico
Rattehalli D et al Iron deficiency without anemia do not wait for the Hemoglobin to drop
Health Policy and Technology 2013 2 45-48Congreso Nacio
nal Laboratorio Cliacutenico 2018
SuominenP et al Serum transferrin receptor and transferrin receptor-ferritin index identify healthy subjects with subclinical iron deficits Blood 1998 92 2934ndash9Halwachs-Baumann G Diagnosis of anaemia old things rearranged Wien Med Wochenschr 2012 162478ndash88
Congreso Nacional Laboratorio Cliacutenico
2018
Hemoglobina de reticulocito y su importancia en el diagnoacutestico temprano de anemiaferropeacutenica
Y Maacuterquez-Beniacutetez et al Universidad de BocayaAugust
2018 DOI 1022267rus182003133 aop
El contenido de hemoglobina de reticulocitos (CHr) es un paraacutemetro en la biometriacuteahematoloacutegica automatizada utilizado como un marcador de la biodisponibilidad delhierro en la eritropoyesis
Objetivo Exponer la aplicabilidad de la CHr como un paraacutemetro en el diagnoacutesticoprecoz de la anemia por deficiencia de hierro asiacute como su medicioacuten e interpretacioacuten
Materiales y meacutetodos Se realizoacute la revisioacuten de artiacuteculos cientiacuteficos en ingleacutes y espantildeolen las bases de datos PubMed ScienceDirect LILACS y Medline usando descriptoresvalidados en Medical Subject Headings (MeSH) considerando periodo depublicabilidad del 80 inferior a 5 antildeos
Conclusiones La CHr es un paraacutemetro de gran utilidad en el diagnoacutestico temprano deanemia ferropeacutenica y otras patologiacuteas como deficiencia funcional de hierro estadosde inflamacioacuten croacutenica y enfermedad renal croacutenica
Biomarcador temprano en el diagnoacutestico de deficiencia de hierro antes de presentarsecambios morfoloacutegicos eritrociacuteticosCongreso Nacio
nal Laboratorio Cliacutenico 2018
bull A total of 1105 NES participants (639 men 466 women)bull CHr becomes affected in a relatively early stage in the development of iron deficiency before iron
deficiency anemia and clinical symptoms become apparentbull Therefore this parameter might be useful to identify persons healthy and diseased at risk of
developing iron deficiency anemia and subsequently to apply interventions in order to prevent further development of iron deficiency anemiaCongreso Nacio
nal Laboratorio Cliacutenico 2018
Hb reticulocitaria sensible para detectar la fase inicial del deacuteficit de hierro cuando laeritropoyesis requiere maacutes cantidad que la que recibe ANTES de que la anemia seestablezca
Congreso Nacional Laboratorio Cliacutenico
2018
No ID LID P
RBC 1012L 48 (08) 437 (05) lt00001
Hb gL 135 (6) 131 (12) 0006
MCV fL 922 (21) 902 (38) 0006
MCH pg 324 (07) 306 (22) lt00001
MCHC gL 339 (6) 319 (23) 0001
RDW
Ret He pg
Hypo He
LHD
Ferritin microgL
131 (06)
338 (21)
03 (015)
28 (20)
86 (3)
145 (21)
278 (24)
69 (55)
56 (25)
16 (76)
lt00001
lt00001
lt00001
lt00001
lt00001
AUC 95 CI Cutoff Sensitivity Specificity
LHD 0898 0819-0978 50 859 841
Ret He 0914 0824-1000 299pg 868 857
Hypo He 0934 0856-1000 16 857 921
Clinical value of markers of hypochromia in the detection of latent iron deficiency in non-anemic premenopausal women
No ID Hb gt 120 gL s-ferritin was within reference intervalLatent Iron Defiency Hb gt 120 gL s-ferritin lt 30 μgL
Urrechaga E et al Journal Clin Lab Analysis 2016 30 (5) 623-627
97 women (388) in 250 apparently healthy women had latent IDCongreso Nacional Laboratorio Cliacutenico
2018
Schorer G et al Abstract Jahreskongress der Deutschen Gesellschaft fuumlr Transfusionsmedizin und Immunhaumlmatologie Rostock 15 - 18 September 2009
Congreso Nacional Laboratorio Cliacutenico
2018
Caring for Those Who Share Mitigating Iron Deficiency in Regular Blood DonorsMast Alan E
bull Iron deficiency caused by regular blood donation is a problem facing blood centers Each blood donation removes 200 to 250 mg of iron from the donor Consequently many donors become iron deficient with repeated donation
bull This presents a challenge to blood centers that has become more acute in recent years with the realization that iron deficiency even in the absence of anemia is associated with adverse effects including fatigue and decreased exercise tolerance as well as neurological symptoms such as decreased cognitive function pica and restless leg syndrome
bull REDS-II investigators performed a longitudinal study investigating the iron status of blood donors over a two year period called the REDS-II Donor Iron Status Evaluation (RISE)
bull Results from the baseline analysis of regular donors (e 2 donations per year (females) or e 3 donations per year (males) revealed that over two-thirds of female donors and over one-half of male donors have iron deficiency
Congreso Nacional Laboratorio Cliacutenico
2018
Transfusion 2013 532766-2775
bull We evaluated the diagnostic sensitivity and specificity of red blood cell (RBC) hematology analyzer indices to assess iron status as a part of donor management iron deficient erythropoiesis (IDE) and absence of iron stores (AIS)
bull STUDY DESIGN AND METHODS A total of 1659 male and female donors from the Retrovirus Epidemiology Donor Study-II (REDS-II) Donor Iron Status Evaluation (RISE) study who were either first-timereactivated (FT RA no donations for 2 years) or frequent donors were recruited into a longitudinal study of regular donation of RBCs Of these 1002 donors returned 15 to 24 months later for a final assessment
Absent iron stores (AIS) was defined as plasma ferritin level of less than 12 mgL Logarithm of the ratio of soluble transferrin receptor to ferritin of at least 207 was used to define iron-deficient erythropoiesis (IDE)
bull RESULTS HYPOm and CHr detected IDE with comparable sensitivity 72 versus 69 but differed in specificity HYPOm 68 and CHr 53
For detecting AIS sensitivity was improved to 85 for HYPOm and 81 for CHr but specificity was reduced
Venous Hb had high specificity but poor sensitivity for IDE and AIS A plasma ferritin level of less than 267 mgL was a good surrogate for assessing IDE Congreso Nacio
nal Laboratorio Cliacutenico 2018
Microcytic RBC and reticulocyte mean cell hemoglobin content predicted iron depletion with
sensitivities 70 and 64
specificities of 72 and 78 respectively
When both combined
increased the sensitivity to 82
Congreso Nacional Laboratorio Cliacutenico
2018
Depending on the number of donations during the preceding12 months
Absent iron stores were detected in up to 214 of male and278 of female donors respectively
impaired hemoglobinisation IH was present in up to 64 maleand 167 female donors with 2 and 4 preceding donationsrespectively
The defined CHr cut-off value was 280 pg to detect IH infrequent whole blood donors with AIS leading to a testspecificity of 982 (positive predictive value PPV 577) inmale and of 978 (PPV 829) in female donors
It may help to prevent the development of anemia in frequentblood donors and also can help to decide whether donordeferral or even iron substitution need to be recommended
Congreso Nacional Laboratorio Cliacutenico
2018
Of the 501 blood donors sTfR and Ret-He detected Latent Iron Deficiency in 148 and 135 donors respectively
In comparison to sTfR Ret-He had sensitivity of 927 specificity of 9716 PPV of 931 and NPV of 963
Serum Ferritin TIBC and serum Iron had comparatively lower sensitivity of 8716 797 and 777 respectively
Conclusion Ret-He can be used as a routine screening test to detect LID in blood donors
This could provide an opportunity to make appropriate and timely interventions like dietary changes or drug supplementation
Congreso Nacional Laboratorio Cliacutenico
2018
Singh A Chaudhary R Pandey HC Sonker A Identification of iron status of blood donors by using low hemoglobin density and microcytic anemia factor Asian J Transfus Sci 20181246-50
The main objective of this study was to assess ifLHD and Maf could be used for assessment ofiron status in blood donors and also to establisha cut-off for these two parameters at which atentative iron deficiency could be reportedconclusively
Results LHD and Maf were able to differentiatebetween iron deficient and iron-depleteddonors from normal donorsA cutoff of 918 for LHD was able todifferentiate iron deficient and depleted statefrom normal iron statessensitivity 919 and specificity 71respectivelya cutoff of 1016 for Mafsensitivity 946 and specificity 968
MAf = (MVC Hb) 100
Congreso Nacional Laboratorio Cliacutenico
2018
Hb reticulocitaria sensible para detectar la fase inicial del deacuteficitde hierro cuando la eritropoyesis requiere maacutes cantidad que laque recibe ANTES de que la anemia se establezca
La deteccioacuten precoz del deacuteficit de hierro en la fase del balance negativo demanda aporte contribuye a reducir sus manifestaciones cliacutenicas en los pacientes afectados mejorando la salud puacuteblica
Un tratamiento menos prolongado con suplementos y menor consumo de los recursos sanitaros Contribuye a la eficiencia y sostenibilidad de los servicios sanitarios
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
Buttarello MLaboratory diagnosis of anemia are the old and new red cell parameters useful in classification and treatment howInt Jnl Lab Hem 2016 38 (Suppl 1) 123ndash132
Congreso Nacional Laboratorio Cliacutenico
2018
Buttarello MLaboratory diagnosis of anemia are the old and new red cell parameters useful in classification and treatment howInt Jnl Lab Hem 2016 38 (Suppl 1) 123ndash132
Congreso Nacional Laboratorio Cliacutenico
2018
Ralph Green amp Ananya Datta Mitra Megaloblastic Anemias Nutritional and Other CausesMed Clin N Am 2017 101 297ndash317
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
ANEMIA CARENCIAL CAUSAS
Factores alimentariosConsumir una dieta vegetariana mal planeadaAlimentacioacuten deficiente en los bebeacutesDesnutricioacuten durante el embarazo
Deacuteficit de absorcioacutenAlcoholismo croacutenicoEnfermedad de Crohn celiaquiacutea infeccioacuten otros problemas que le dificulten al cuerpo la digestioacuten de los alimentosAnemia perniciosa (factor intriacutenseco)Cirugiacuteas para extirpar ciertas partes del estoacutemago o el intestino delgado
MedicamentosB12 omeprazol metformina colchicina aminosalicilatos neomicinaFOLATO fenitoiacutena metotrexato sulfasalacina triamtereno pirimetamina trimetoprim con sulfametoxazol barbituacutericos
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
Reacciones metaboacutelicas en las que participan la vitamina B12 y el folato bull la conversioacuten de metilmalonil-CoA a succinil-CoA donde la adenosil-cobalamina actuacutea de
cofactor Por ello un deacuteficit de B12 conlleva un aumento de metilmalonil-CoA y de su producto de hidroacutelisis el aacutecido metilmaloacutenico
bull la siacutentesis de metionina a partir de homocisteina gracias a la metionina sintetasa y a la metil-cobalamina como cofactor En esta misma reaccioacuten el metiltetrahidrofolato es transformado a tetrahidrofolato que es necesario para la siacutentesis de DNA
Congreso Nacional Laboratorio Cliacutenico
2018
Anemia macrociacutetica secundaria a deficiencia de aacutecido foacutelico y de vitamina B12(cobalamina)
La deficiencia de B12 yo aacutecido foacutelico es la causa maacutes frecuente de megaloblastosis
Dentro de distintas funciones generales del metabolismo la vitamina B12 es uncofactor esencial en la siacutentesis de ADN y ARN compromete a todas las ceacutelulas delorganismo
Su deficiencia se manifiesta en oacuterganos con alto recambio celular como la meacutedulaosea y en el sistema nervioso central (SNC) a traveacutes de la siacutentesis de mielina y lareparacioacuten axonal
La deficiencia de cobalamina es responsable de alteraciones hematoloacutegicasneuroloacutegicas neurocognitivas y neuropsiquiaacutetricas
La siacutentesis defectuosa de ADN conduce a la apoptosis y a la hemoacutelisis (intra yextramedular) causantes de la hemopoyesis inefectiva
En meacutedula la siacutentesis ineficiente de DNA causa cambios megaloblaacutesticos comoconsecuencIa anemia y citopenias
Congreso Nacional Laboratorio Cliacutenico
2018
Limitaciones de los meacutetodos diagnoacutesticos claacutesicos
Volumen Corpuscular Medio (VCM) y morfologiacutea de sangre perifeacuterica En una serie de pacientes con deacuteficit de cobalamina soacutelo un 29 teniacutean anemia y soacutelo un 36 teniacutean un VCM gt 100 fL
Un VCM normal no puede ser empleado para rechazar una determinacioacuten de nivel de cobalamina ya que hasta un 25 de casos con manifestaciones neuroloacutegicas cursan con un VCM normal
Cobalamina seacuterica (nivel de B12) Es el test diagnoacutestico rutinario inicial estaacutendar Es un test ampliamente disponible de bajo coste y automatizado Sin embargo presenta algunas limitaciones
-- Existencia de varias teacutecnicas y ausencia de un gold standard por lo que hay diferentes liacutemites de referencia
-- Variacioacuten intraindividual muy alta
La OMS publicoacute en 2008 las conclusiones de un grupo teacutecnico consultado sobre el deacuteficit de cobalamina y folato
El grupo reconocioacute que no existen unos umbrales universalmente reconocidos para definir el deacuteficit de ambas vitaminas y expresaron la necesidad de un consenso
Devalia V Hamilton MS and Molloy AM on behalf of the British Committee for standards in haematology Guidelines for the diagnosis and treatment of cobalamin and folate disorders Br J Haematol 2014 166(4) 496-513
Schrier SL Diagnosis and treatment of vitamin B12 and folate deficiency UpToDate Last updated Jun 25 2014
de Benoist B Conclusions of a WHO Technical Consultation on folate and vitamin B12 deficiencies Food Nutr Bull 200829(2 Suppl)S238ndash44Congreso Nacional Laboratorio Cliacutenico
2018
Tomado de Tefferi A Li C En Atlas of Clinical Hematology Publicado por JO Armitage Philadelphia Current Medicine 2004
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
Int Jnl Lab Hem 2007 29 327ndash334
Clin Lab 201662343-347
In ourstudy mean MCVrMCV ratio of healthy controls is130 as microcytic anemia irondeficiency anemia is121 as also macrocytic anemia vitamin B12 deficiencyanemia is 115
Congreso Nacional Laboratorio Cliacutenico
2018
Sualeh Muslim Khan Muhammad Akbar Agha
Mean cell volume of reticulocytemdashA new parameter for diagnosing sub-clinical cobalamin deficiency in blood donors Int J Lab Hem 20181ndash4
The Abbott CELL-DYN Sapphire Hematology System uses multi-angle polarized scatter separation (MAPSS) and focused flow impedance technologies
Congreso Nacional Laboratorio Cliacutenico
2018
MCVr at 985 fL yielded the highest Youdenrsquos index at sensitivity of 82 specificity of 828 AUC 0847 ( 95 CI 803-891)
Khan SM Agha MA Mean cell volume of reticulocyte-A new parameter for diagnosing sub-clinical cobalamin deficiency in blood donors
Int J Lab Hem 20181ndash4 2018 Jul 13 doi 101111ijlh12899
Congreso Nacional Laboratorio Cliacutenico
2018
Role of Cell Population Data in the detection of folate and cobalamin deficiency
J Nieto et al
XXXI st International Symposium on Technological Innovations in Laboratory Hematology ISLH 2018 10-12 May 2018 Brussels Belgium
M-V-NRET and SD-VNRET are the best discriminatory single parameters to distinguish between patients with B9B12 deficiency and reference subjects M-V-NRETAUC=0823 sensitivity 78 and specificity 86
AUC=0852 sensitivity 55 and specificity 60
Conclusions The CPD parameters of Volume and Light Scatter (M and SD of LALS angle) that inform about size and intracellular structure of RBCs provided very useful information for the detection of B9B12 deficiency
Congreso Nacional Laboratorio Cliacutenico
2018
Cell Population Data
bull Paraacutemetros poblacionales de los leucocitos
bull Describen la morfologiacutea tamantildeo
estructuras citoplasmaacuteticas
nuacutecleo aacutecidos nucleacuteicos
bull Son datos numeacutericos con los que se construyen los ejes de lo diagramas de dispersioacuten de los leucocitos
bull Dependen de la tecnologiacutea
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
High Sensitivity New Parameters for the Detection of Vitamin B12 and Folate Deficiencies Blood 2008 1125379
B12 def vs
Normals
Mann
Withney T-Test
ROC
AUC Sens Specif Cutoff signifROC
MCV p=03156 p=09533 0577
MPV p=00001 0802 792 806 lt83 p=00001
NE Mean
Volume plt00001 0862 833 778 gt1403 p=00001
MO Mean
Volume plt00001 0829 625 889 gt1723 p=00001
MRV p=00113 0705 50 964 gt1133 p=00051
Folate def vs
Normals
Mann
Withney T-Test
ROC
AUC Sens Specif Cut-off signifROC
MCV p=00798 p=06461 0665
MPV plt00001 0832 81 806 lt83 p=00001
NE Mean
Volume p=00008 087 952 694 gt1402 p=00001
MO Mean
Volume p=00002 0801 667 833 gt1696 p=00001
MRV p=00054 0731 476 964 gt1133 p=00019
The Mean Neutrophil Volume (MNE V) and Mean Monocyte Volume (MMOV) may be used for the detection of megaloblastic neutrophils and monocytes MNEV and MMOV have significantly higher sensitivity than the previous information from the red cells (MCV) detecting B12 or folate deficiency because they are not affected by the presence at the same time of Iron deficiency or other reasons of anemia
Congreso Nacional Laboratorio Cliacutenico
2018
POSTER 733
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
CPD Sysmex XN
NE SSC complejidad
NE SFL aacutecidos nucleacuteicos
NE FSC tamantildeo
NE WX
NE WY
NE WZ
MO X
MO Y
MO Z
MO WX
MO WY
MO WZ
LY X
LY Y
LY Z
LY WX
LY WY
LY WZCongreso Nacio
nal Laboratorio Cliacutenico 2018
As MCV is the mean which is calculated it is insensitive to the presence of a small number of macrocytes
Further macrocytosis can be obscured by concomitant disorders that can cause microcytosis resulting inmasked megaloblastic anaemia (MA) for example iron deficiency hereditary elliptocytosis alpha and betathalassemia
This study was undertaken to evaluate the role of NEUT-X and NEUT-Y in detecting MA on peripheral blood andalso see whether other forms of macrocytic anaemia can be differentiated from MA
In MA the peripheral blood smear shows cytopenia with macroovalocytes and hypersegmented
neutrophils (gt5 lobes in 5 neutrophils six lobes nuclei or lobe average of gt35)
In conclusion our study shows that higher values of NEUT-X and NEUT-Y in MA patients in spite of low ornormal MCV high RDW may be used to not only reveal the masked cases of MA with concomitant irondeficiency but also separate them from the broader macrocytic anaemia group
Peripheral smear remains diagnostic however making smear for all the suspicious cases is a cumbersomeand tedious procedure Thus these parameters emerge as more reliable and stable parameters in themodern laboratories which in future may replace the older screening tools
Congreso Nacional Laboratorio Cliacutenico
2018
A favor Eficiencia Operativa
Mejora el proceso del Laboratorio
Mejor informacioacuten al Cliacutenico al mismo coste
Mejora la informacioacuten
Informa sobre la eritropoyesis deteccioacuten precoz de estados carenciales
Ayuda al cliacutenico
Estado real del paciente
En contraParaacutemetros de investigacioacuten
Dificultad de standarizar dependencia teacutecnica
Control de calidadCongreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
copy 2012 Mindray Confidential 26
HDWHYPERHYPO
HDW HGB Distribution Width
HDW is the distribution width of Hgb histogram
Congreso Nacional Laboratorio Cliacutenico
2018
copy 2012 Mindray Confidential 27
MCHrHDWHYPERHYPOMCHr Mean RET HGB Concentration
Congreso Nacional Laboratorio Cliacutenico
2018
Histograma RBC el mapa de Mie
28 41
Congreso Nacional Laboratorio Cliacutenico
2018
Abbott Mindray Siemens
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
Severe Iron Deficiency Anemia Female 34 years
19 th March 18 th April
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
SysmexRBCHe erythrocyte Hb equivalentRetHe reticulocyte Hb equivalent(content)
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
MIC
MAC
HPO HPR
Congreso Nacional Laboratorio Cliacutenico
2018
copy 2012 Mindray Confidential 36
MINDRAY MCHrHDWHYPERHYPO
MCHr Mean RET HGB Concentration
HDW HGB Distribution Width
HYPER The percentage of hyperchromicred blood cells
HYPO The percentage of hypochromic red blood cells
Thalassemia screeningIDA treatment monitoringIDA screening
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
Hipocromo
Hipercroacutemico onormocroacutemico
iquestConcentracioacuten o contenido de Hemoglobina
Hipocroacutemiconormocroacutemico
Abbott Mindray Siemens Hypo CONCENTRACIOacuteN Hblt280gL
Sysmex Hypo CONTENIDO Hblt 17 pg
Congreso Nacional Laboratorio Cliacutenico
2018
Low Hb Density
Microcytic Factor Maf = (HbMCV)100
Nuevo moacutedulo transductor muacuteltiple con laacuteser de diodo y dos sensores oacutepticos
Anaacutelisis de hasta 50000 ceacutelulas con 7 paraacutemetros tecnoloacutegicos (leucocitos reticulocitos eritroblastos)
1 Volumen digital
2 Conductividad digital
3 5 aacutengulos de dispersioacuten de luz laacuteser digital
bull MALS (Median Angle Light Scatter)
bull UMALS (Upper Median Angle Light Scatter) 20deg a 43deg
bull LMALS (Lower Median Angle Light Scatter) 09deg a 19deg
bull LALS (Low Angle Light Scatter) asymp 51deg
bull AL2 (Axial Light Loss) 0deg a 05deg
Congreso Nacional Laboratorio Cliacutenico
2018
Hierro es un elemento criacutetico para elfuncionamiento oacuteptimo y supervivenciade las ceacutelulas
Disfuncioacuten mitocondrialActividad enzimaacutetica afectadaProteiacutenas de transporte y estructuralesproteins
Capacidad fiacutesica mermadaCapacidad de trabajo reducidaCapacidades cognitivas afectadasMorbilidad y mortalidad
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
It is generally assumed that worldwide ldquoat least half the anemia is due tonutritional iron deficiencyrdquo and that ldquoup to a prevalence of iron deficiency anemiaof 40 the prevalence of iron deficiency will be about 25 times that of anemiardquoHowever it is evident from the foregoing discussion that there are considerablevariations in both of these ratios depending on the age and sex of the peoplebeing studied the region of the world in which they live and the prevalence ratesof other causes of anemia
WHO Department of Nutrition for Health and DevelopmentAssessing the iron status of populations including literature reviews report of a Joint World Health OrganizationCenters for DiseaseControl and Prevention Technical Consultation on the Assessment of Iron Status at the Population Level Geneva Switzerland 6ndash8 April2004 ndash 2nd ed
Congreso Nacional Laboratorio Cliacutenico
2018
Estaacute bien establecido que la anemia produce una miriacuteada de secuelas tanto fiacutesicas comopsicoloacutegicas
Pero los efecto deleteacutereos se deben al deficit de hierro que es un evento previo a que seestablezca la anemia
El deacuteficit de hierrro auacuten sin anemia tiene efectos negativos en el desarrollo cognitivo y fiacutesico
Rattehalli D et al Iron deficiency without anemia do not wait for the Hemoglobin to drop
Health Policy and Technology 2013 2 45-48Congreso Nacio
nal Laboratorio Cliacutenico 2018
SuominenP et al Serum transferrin receptor and transferrin receptor-ferritin index identify healthy subjects with subclinical iron deficits Blood 1998 92 2934ndash9Halwachs-Baumann G Diagnosis of anaemia old things rearranged Wien Med Wochenschr 2012 162478ndash88
Congreso Nacional Laboratorio Cliacutenico
2018
Hemoglobina de reticulocito y su importancia en el diagnoacutestico temprano de anemiaferropeacutenica
Y Maacuterquez-Beniacutetez et al Universidad de BocayaAugust
2018 DOI 1022267rus182003133 aop
El contenido de hemoglobina de reticulocitos (CHr) es un paraacutemetro en la biometriacuteahematoloacutegica automatizada utilizado como un marcador de la biodisponibilidad delhierro en la eritropoyesis
Objetivo Exponer la aplicabilidad de la CHr como un paraacutemetro en el diagnoacutesticoprecoz de la anemia por deficiencia de hierro asiacute como su medicioacuten e interpretacioacuten
Materiales y meacutetodos Se realizoacute la revisioacuten de artiacuteculos cientiacuteficos en ingleacutes y espantildeolen las bases de datos PubMed ScienceDirect LILACS y Medline usando descriptoresvalidados en Medical Subject Headings (MeSH) considerando periodo depublicabilidad del 80 inferior a 5 antildeos
Conclusiones La CHr es un paraacutemetro de gran utilidad en el diagnoacutestico temprano deanemia ferropeacutenica y otras patologiacuteas como deficiencia funcional de hierro estadosde inflamacioacuten croacutenica y enfermedad renal croacutenica
Biomarcador temprano en el diagnoacutestico de deficiencia de hierro antes de presentarsecambios morfoloacutegicos eritrociacuteticosCongreso Nacio
nal Laboratorio Cliacutenico 2018
bull A total of 1105 NES participants (639 men 466 women)bull CHr becomes affected in a relatively early stage in the development of iron deficiency before iron
deficiency anemia and clinical symptoms become apparentbull Therefore this parameter might be useful to identify persons healthy and diseased at risk of
developing iron deficiency anemia and subsequently to apply interventions in order to prevent further development of iron deficiency anemiaCongreso Nacio
nal Laboratorio Cliacutenico 2018
Hb reticulocitaria sensible para detectar la fase inicial del deacuteficit de hierro cuando laeritropoyesis requiere maacutes cantidad que la que recibe ANTES de que la anemia seestablezca
Congreso Nacional Laboratorio Cliacutenico
2018
No ID LID P
RBC 1012L 48 (08) 437 (05) lt00001
Hb gL 135 (6) 131 (12) 0006
MCV fL 922 (21) 902 (38) 0006
MCH pg 324 (07) 306 (22) lt00001
MCHC gL 339 (6) 319 (23) 0001
RDW
Ret He pg
Hypo He
LHD
Ferritin microgL
131 (06)
338 (21)
03 (015)
28 (20)
86 (3)
145 (21)
278 (24)
69 (55)
56 (25)
16 (76)
lt00001
lt00001
lt00001
lt00001
lt00001
AUC 95 CI Cutoff Sensitivity Specificity
LHD 0898 0819-0978 50 859 841
Ret He 0914 0824-1000 299pg 868 857
Hypo He 0934 0856-1000 16 857 921
Clinical value of markers of hypochromia in the detection of latent iron deficiency in non-anemic premenopausal women
No ID Hb gt 120 gL s-ferritin was within reference intervalLatent Iron Defiency Hb gt 120 gL s-ferritin lt 30 μgL
Urrechaga E et al Journal Clin Lab Analysis 2016 30 (5) 623-627
97 women (388) in 250 apparently healthy women had latent IDCongreso Nacional Laboratorio Cliacutenico
2018
Schorer G et al Abstract Jahreskongress der Deutschen Gesellschaft fuumlr Transfusionsmedizin und Immunhaumlmatologie Rostock 15 - 18 September 2009
Congreso Nacional Laboratorio Cliacutenico
2018
Caring for Those Who Share Mitigating Iron Deficiency in Regular Blood DonorsMast Alan E
bull Iron deficiency caused by regular blood donation is a problem facing blood centers Each blood donation removes 200 to 250 mg of iron from the donor Consequently many donors become iron deficient with repeated donation
bull This presents a challenge to blood centers that has become more acute in recent years with the realization that iron deficiency even in the absence of anemia is associated with adverse effects including fatigue and decreased exercise tolerance as well as neurological symptoms such as decreased cognitive function pica and restless leg syndrome
bull REDS-II investigators performed a longitudinal study investigating the iron status of blood donors over a two year period called the REDS-II Donor Iron Status Evaluation (RISE)
bull Results from the baseline analysis of regular donors (e 2 donations per year (females) or e 3 donations per year (males) revealed that over two-thirds of female donors and over one-half of male donors have iron deficiency
Congreso Nacional Laboratorio Cliacutenico
2018
Transfusion 2013 532766-2775
bull We evaluated the diagnostic sensitivity and specificity of red blood cell (RBC) hematology analyzer indices to assess iron status as a part of donor management iron deficient erythropoiesis (IDE) and absence of iron stores (AIS)
bull STUDY DESIGN AND METHODS A total of 1659 male and female donors from the Retrovirus Epidemiology Donor Study-II (REDS-II) Donor Iron Status Evaluation (RISE) study who were either first-timereactivated (FT RA no donations for 2 years) or frequent donors were recruited into a longitudinal study of regular donation of RBCs Of these 1002 donors returned 15 to 24 months later for a final assessment
Absent iron stores (AIS) was defined as plasma ferritin level of less than 12 mgL Logarithm of the ratio of soluble transferrin receptor to ferritin of at least 207 was used to define iron-deficient erythropoiesis (IDE)
bull RESULTS HYPOm and CHr detected IDE with comparable sensitivity 72 versus 69 but differed in specificity HYPOm 68 and CHr 53
For detecting AIS sensitivity was improved to 85 for HYPOm and 81 for CHr but specificity was reduced
Venous Hb had high specificity but poor sensitivity for IDE and AIS A plasma ferritin level of less than 267 mgL was a good surrogate for assessing IDE Congreso Nacio
nal Laboratorio Cliacutenico 2018
Microcytic RBC and reticulocyte mean cell hemoglobin content predicted iron depletion with
sensitivities 70 and 64
specificities of 72 and 78 respectively
When both combined
increased the sensitivity to 82
Congreso Nacional Laboratorio Cliacutenico
2018
Depending on the number of donations during the preceding12 months
Absent iron stores were detected in up to 214 of male and278 of female donors respectively
impaired hemoglobinisation IH was present in up to 64 maleand 167 female donors with 2 and 4 preceding donationsrespectively
The defined CHr cut-off value was 280 pg to detect IH infrequent whole blood donors with AIS leading to a testspecificity of 982 (positive predictive value PPV 577) inmale and of 978 (PPV 829) in female donors
It may help to prevent the development of anemia in frequentblood donors and also can help to decide whether donordeferral or even iron substitution need to be recommended
Congreso Nacional Laboratorio Cliacutenico
2018
Of the 501 blood donors sTfR and Ret-He detected Latent Iron Deficiency in 148 and 135 donors respectively
In comparison to sTfR Ret-He had sensitivity of 927 specificity of 9716 PPV of 931 and NPV of 963
Serum Ferritin TIBC and serum Iron had comparatively lower sensitivity of 8716 797 and 777 respectively
Conclusion Ret-He can be used as a routine screening test to detect LID in blood donors
This could provide an opportunity to make appropriate and timely interventions like dietary changes or drug supplementation
Congreso Nacional Laboratorio Cliacutenico
2018
Singh A Chaudhary R Pandey HC Sonker A Identification of iron status of blood donors by using low hemoglobin density and microcytic anemia factor Asian J Transfus Sci 20181246-50
The main objective of this study was to assess ifLHD and Maf could be used for assessment ofiron status in blood donors and also to establisha cut-off for these two parameters at which atentative iron deficiency could be reportedconclusively
Results LHD and Maf were able to differentiatebetween iron deficient and iron-depleteddonors from normal donorsA cutoff of 918 for LHD was able todifferentiate iron deficient and depleted statefrom normal iron statessensitivity 919 and specificity 71respectivelya cutoff of 1016 for Mafsensitivity 946 and specificity 968
MAf = (MVC Hb) 100
Congreso Nacional Laboratorio Cliacutenico
2018
Hb reticulocitaria sensible para detectar la fase inicial del deacuteficitde hierro cuando la eritropoyesis requiere maacutes cantidad que laque recibe ANTES de que la anemia se establezca
La deteccioacuten precoz del deacuteficit de hierro en la fase del balance negativo demanda aporte contribuye a reducir sus manifestaciones cliacutenicas en los pacientes afectados mejorando la salud puacuteblica
Un tratamiento menos prolongado con suplementos y menor consumo de los recursos sanitaros Contribuye a la eficiencia y sostenibilidad de los servicios sanitarios
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
Buttarello MLaboratory diagnosis of anemia are the old and new red cell parameters useful in classification and treatment howInt Jnl Lab Hem 2016 38 (Suppl 1) 123ndash132
Congreso Nacional Laboratorio Cliacutenico
2018
Buttarello MLaboratory diagnosis of anemia are the old and new red cell parameters useful in classification and treatment howInt Jnl Lab Hem 2016 38 (Suppl 1) 123ndash132
Congreso Nacional Laboratorio Cliacutenico
2018
Ralph Green amp Ananya Datta Mitra Megaloblastic Anemias Nutritional and Other CausesMed Clin N Am 2017 101 297ndash317
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
ANEMIA CARENCIAL CAUSAS
Factores alimentariosConsumir una dieta vegetariana mal planeadaAlimentacioacuten deficiente en los bebeacutesDesnutricioacuten durante el embarazo
Deacuteficit de absorcioacutenAlcoholismo croacutenicoEnfermedad de Crohn celiaquiacutea infeccioacuten otros problemas que le dificulten al cuerpo la digestioacuten de los alimentosAnemia perniciosa (factor intriacutenseco)Cirugiacuteas para extirpar ciertas partes del estoacutemago o el intestino delgado
MedicamentosB12 omeprazol metformina colchicina aminosalicilatos neomicinaFOLATO fenitoiacutena metotrexato sulfasalacina triamtereno pirimetamina trimetoprim con sulfametoxazol barbituacutericos
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
Reacciones metaboacutelicas en las que participan la vitamina B12 y el folato bull la conversioacuten de metilmalonil-CoA a succinil-CoA donde la adenosil-cobalamina actuacutea de
cofactor Por ello un deacuteficit de B12 conlleva un aumento de metilmalonil-CoA y de su producto de hidroacutelisis el aacutecido metilmaloacutenico
bull la siacutentesis de metionina a partir de homocisteina gracias a la metionina sintetasa y a la metil-cobalamina como cofactor En esta misma reaccioacuten el metiltetrahidrofolato es transformado a tetrahidrofolato que es necesario para la siacutentesis de DNA
Congreso Nacional Laboratorio Cliacutenico
2018
Anemia macrociacutetica secundaria a deficiencia de aacutecido foacutelico y de vitamina B12(cobalamina)
La deficiencia de B12 yo aacutecido foacutelico es la causa maacutes frecuente de megaloblastosis
Dentro de distintas funciones generales del metabolismo la vitamina B12 es uncofactor esencial en la siacutentesis de ADN y ARN compromete a todas las ceacutelulas delorganismo
Su deficiencia se manifiesta en oacuterganos con alto recambio celular como la meacutedulaosea y en el sistema nervioso central (SNC) a traveacutes de la siacutentesis de mielina y lareparacioacuten axonal
La deficiencia de cobalamina es responsable de alteraciones hematoloacutegicasneuroloacutegicas neurocognitivas y neuropsiquiaacutetricas
La siacutentesis defectuosa de ADN conduce a la apoptosis y a la hemoacutelisis (intra yextramedular) causantes de la hemopoyesis inefectiva
En meacutedula la siacutentesis ineficiente de DNA causa cambios megaloblaacutesticos comoconsecuencIa anemia y citopenias
Congreso Nacional Laboratorio Cliacutenico
2018
Limitaciones de los meacutetodos diagnoacutesticos claacutesicos
Volumen Corpuscular Medio (VCM) y morfologiacutea de sangre perifeacuterica En una serie de pacientes con deacuteficit de cobalamina soacutelo un 29 teniacutean anemia y soacutelo un 36 teniacutean un VCM gt 100 fL
Un VCM normal no puede ser empleado para rechazar una determinacioacuten de nivel de cobalamina ya que hasta un 25 de casos con manifestaciones neuroloacutegicas cursan con un VCM normal
Cobalamina seacuterica (nivel de B12) Es el test diagnoacutestico rutinario inicial estaacutendar Es un test ampliamente disponible de bajo coste y automatizado Sin embargo presenta algunas limitaciones
-- Existencia de varias teacutecnicas y ausencia de un gold standard por lo que hay diferentes liacutemites de referencia
-- Variacioacuten intraindividual muy alta
La OMS publicoacute en 2008 las conclusiones de un grupo teacutecnico consultado sobre el deacuteficit de cobalamina y folato
El grupo reconocioacute que no existen unos umbrales universalmente reconocidos para definir el deacuteficit de ambas vitaminas y expresaron la necesidad de un consenso
Devalia V Hamilton MS and Molloy AM on behalf of the British Committee for standards in haematology Guidelines for the diagnosis and treatment of cobalamin and folate disorders Br J Haematol 2014 166(4) 496-513
Schrier SL Diagnosis and treatment of vitamin B12 and folate deficiency UpToDate Last updated Jun 25 2014
de Benoist B Conclusions of a WHO Technical Consultation on folate and vitamin B12 deficiencies Food Nutr Bull 200829(2 Suppl)S238ndash44Congreso Nacional Laboratorio Cliacutenico
2018
Tomado de Tefferi A Li C En Atlas of Clinical Hematology Publicado por JO Armitage Philadelphia Current Medicine 2004
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
Int Jnl Lab Hem 2007 29 327ndash334
Clin Lab 201662343-347
In ourstudy mean MCVrMCV ratio of healthy controls is130 as microcytic anemia irondeficiency anemia is121 as also macrocytic anemia vitamin B12 deficiencyanemia is 115
Congreso Nacional Laboratorio Cliacutenico
2018
Sualeh Muslim Khan Muhammad Akbar Agha
Mean cell volume of reticulocytemdashA new parameter for diagnosing sub-clinical cobalamin deficiency in blood donors Int J Lab Hem 20181ndash4
The Abbott CELL-DYN Sapphire Hematology System uses multi-angle polarized scatter separation (MAPSS) and focused flow impedance technologies
Congreso Nacional Laboratorio Cliacutenico
2018
MCVr at 985 fL yielded the highest Youdenrsquos index at sensitivity of 82 specificity of 828 AUC 0847 ( 95 CI 803-891)
Khan SM Agha MA Mean cell volume of reticulocyte-A new parameter for diagnosing sub-clinical cobalamin deficiency in blood donors
Int J Lab Hem 20181ndash4 2018 Jul 13 doi 101111ijlh12899
Congreso Nacional Laboratorio Cliacutenico
2018
Role of Cell Population Data in the detection of folate and cobalamin deficiency
J Nieto et al
XXXI st International Symposium on Technological Innovations in Laboratory Hematology ISLH 2018 10-12 May 2018 Brussels Belgium
M-V-NRET and SD-VNRET are the best discriminatory single parameters to distinguish between patients with B9B12 deficiency and reference subjects M-V-NRETAUC=0823 sensitivity 78 and specificity 86
AUC=0852 sensitivity 55 and specificity 60
Conclusions The CPD parameters of Volume and Light Scatter (M and SD of LALS angle) that inform about size and intracellular structure of RBCs provided very useful information for the detection of B9B12 deficiency
Congreso Nacional Laboratorio Cliacutenico
2018
Cell Population Data
bull Paraacutemetros poblacionales de los leucocitos
bull Describen la morfologiacutea tamantildeo
estructuras citoplasmaacuteticas
nuacutecleo aacutecidos nucleacuteicos
bull Son datos numeacutericos con los que se construyen los ejes de lo diagramas de dispersioacuten de los leucocitos
bull Dependen de la tecnologiacutea
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
High Sensitivity New Parameters for the Detection of Vitamin B12 and Folate Deficiencies Blood 2008 1125379
B12 def vs
Normals
Mann
Withney T-Test
ROC
AUC Sens Specif Cutoff signifROC
MCV p=03156 p=09533 0577
MPV p=00001 0802 792 806 lt83 p=00001
NE Mean
Volume plt00001 0862 833 778 gt1403 p=00001
MO Mean
Volume plt00001 0829 625 889 gt1723 p=00001
MRV p=00113 0705 50 964 gt1133 p=00051
Folate def vs
Normals
Mann
Withney T-Test
ROC
AUC Sens Specif Cut-off signifROC
MCV p=00798 p=06461 0665
MPV plt00001 0832 81 806 lt83 p=00001
NE Mean
Volume p=00008 087 952 694 gt1402 p=00001
MO Mean
Volume p=00002 0801 667 833 gt1696 p=00001
MRV p=00054 0731 476 964 gt1133 p=00019
The Mean Neutrophil Volume (MNE V) and Mean Monocyte Volume (MMOV) may be used for the detection of megaloblastic neutrophils and monocytes MNEV and MMOV have significantly higher sensitivity than the previous information from the red cells (MCV) detecting B12 or folate deficiency because they are not affected by the presence at the same time of Iron deficiency or other reasons of anemia
Congreso Nacional Laboratorio Cliacutenico
2018
POSTER 733
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
CPD Sysmex XN
NE SSC complejidad
NE SFL aacutecidos nucleacuteicos
NE FSC tamantildeo
NE WX
NE WY
NE WZ
MO X
MO Y
MO Z
MO WX
MO WY
MO WZ
LY X
LY Y
LY Z
LY WX
LY WY
LY WZCongreso Nacio
nal Laboratorio Cliacutenico 2018
As MCV is the mean which is calculated it is insensitive to the presence of a small number of macrocytes
Further macrocytosis can be obscured by concomitant disorders that can cause microcytosis resulting inmasked megaloblastic anaemia (MA) for example iron deficiency hereditary elliptocytosis alpha and betathalassemia
This study was undertaken to evaluate the role of NEUT-X and NEUT-Y in detecting MA on peripheral blood andalso see whether other forms of macrocytic anaemia can be differentiated from MA
In MA the peripheral blood smear shows cytopenia with macroovalocytes and hypersegmented
neutrophils (gt5 lobes in 5 neutrophils six lobes nuclei or lobe average of gt35)
In conclusion our study shows that higher values of NEUT-X and NEUT-Y in MA patients in spite of low ornormal MCV high RDW may be used to not only reveal the masked cases of MA with concomitant irondeficiency but also separate them from the broader macrocytic anaemia group
Peripheral smear remains diagnostic however making smear for all the suspicious cases is a cumbersomeand tedious procedure Thus these parameters emerge as more reliable and stable parameters in themodern laboratories which in future may replace the older screening tools
Congreso Nacional Laboratorio Cliacutenico
2018
A favor Eficiencia Operativa
Mejora el proceso del Laboratorio
Mejor informacioacuten al Cliacutenico al mismo coste
Mejora la informacioacuten
Informa sobre la eritropoyesis deteccioacuten precoz de estados carenciales
Ayuda al cliacutenico
Estado real del paciente
En contraParaacutemetros de investigacioacuten
Dificultad de standarizar dependencia teacutecnica
Control de calidadCongreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
copy 2012 Mindray Confidential 26
HDWHYPERHYPO
HDW HGB Distribution Width
HDW is the distribution width of Hgb histogram
Congreso Nacional Laboratorio Cliacutenico
2018
copy 2012 Mindray Confidential 27
MCHrHDWHYPERHYPOMCHr Mean RET HGB Concentration
Congreso Nacional Laboratorio Cliacutenico
2018
Histograma RBC el mapa de Mie
28 41
Congreso Nacional Laboratorio Cliacutenico
2018
Abbott Mindray Siemens
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
Severe Iron Deficiency Anemia Female 34 years
19 th March 18 th April
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
SysmexRBCHe erythrocyte Hb equivalentRetHe reticulocyte Hb equivalent(content)
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
MIC
MAC
HPO HPR
Congreso Nacional Laboratorio Cliacutenico
2018
copy 2012 Mindray Confidential 36
MINDRAY MCHrHDWHYPERHYPO
MCHr Mean RET HGB Concentration
HDW HGB Distribution Width
HYPER The percentage of hyperchromicred blood cells
HYPO The percentage of hypochromic red blood cells
Thalassemia screeningIDA treatment monitoringIDA screening
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
Hipocromo
Hipercroacutemico onormocroacutemico
iquestConcentracioacuten o contenido de Hemoglobina
Hipocroacutemiconormocroacutemico
Abbott Mindray Siemens Hypo CONCENTRACIOacuteN Hblt280gL
Sysmex Hypo CONTENIDO Hblt 17 pg
Congreso Nacional Laboratorio Cliacutenico
2018
Low Hb Density
Microcytic Factor Maf = (HbMCV)100
Nuevo moacutedulo transductor muacuteltiple con laacuteser de diodo y dos sensores oacutepticos
Anaacutelisis de hasta 50000 ceacutelulas con 7 paraacutemetros tecnoloacutegicos (leucocitos reticulocitos eritroblastos)
1 Volumen digital
2 Conductividad digital
3 5 aacutengulos de dispersioacuten de luz laacuteser digital
bull MALS (Median Angle Light Scatter)
bull UMALS (Upper Median Angle Light Scatter) 20deg a 43deg
bull LMALS (Lower Median Angle Light Scatter) 09deg a 19deg
bull LALS (Low Angle Light Scatter) asymp 51deg
bull AL2 (Axial Light Loss) 0deg a 05deg
Congreso Nacional Laboratorio Cliacutenico
2018
Hierro es un elemento criacutetico para elfuncionamiento oacuteptimo y supervivenciade las ceacutelulas
Disfuncioacuten mitocondrialActividad enzimaacutetica afectadaProteiacutenas de transporte y estructuralesproteins
Capacidad fiacutesica mermadaCapacidad de trabajo reducidaCapacidades cognitivas afectadasMorbilidad y mortalidad
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
It is generally assumed that worldwide ldquoat least half the anemia is due tonutritional iron deficiencyrdquo and that ldquoup to a prevalence of iron deficiency anemiaof 40 the prevalence of iron deficiency will be about 25 times that of anemiardquoHowever it is evident from the foregoing discussion that there are considerablevariations in both of these ratios depending on the age and sex of the peoplebeing studied the region of the world in which they live and the prevalence ratesof other causes of anemia
WHO Department of Nutrition for Health and DevelopmentAssessing the iron status of populations including literature reviews report of a Joint World Health OrganizationCenters for DiseaseControl and Prevention Technical Consultation on the Assessment of Iron Status at the Population Level Geneva Switzerland 6ndash8 April2004 ndash 2nd ed
Congreso Nacional Laboratorio Cliacutenico
2018
Estaacute bien establecido que la anemia produce una miriacuteada de secuelas tanto fiacutesicas comopsicoloacutegicas
Pero los efecto deleteacutereos se deben al deficit de hierro que es un evento previo a que seestablezca la anemia
El deacuteficit de hierrro auacuten sin anemia tiene efectos negativos en el desarrollo cognitivo y fiacutesico
Rattehalli D et al Iron deficiency without anemia do not wait for the Hemoglobin to drop
Health Policy and Technology 2013 2 45-48Congreso Nacio
nal Laboratorio Cliacutenico 2018
SuominenP et al Serum transferrin receptor and transferrin receptor-ferritin index identify healthy subjects with subclinical iron deficits Blood 1998 92 2934ndash9Halwachs-Baumann G Diagnosis of anaemia old things rearranged Wien Med Wochenschr 2012 162478ndash88
Congreso Nacional Laboratorio Cliacutenico
2018
Hemoglobina de reticulocito y su importancia en el diagnoacutestico temprano de anemiaferropeacutenica
Y Maacuterquez-Beniacutetez et al Universidad de BocayaAugust
2018 DOI 1022267rus182003133 aop
El contenido de hemoglobina de reticulocitos (CHr) es un paraacutemetro en la biometriacuteahematoloacutegica automatizada utilizado como un marcador de la biodisponibilidad delhierro en la eritropoyesis
Objetivo Exponer la aplicabilidad de la CHr como un paraacutemetro en el diagnoacutesticoprecoz de la anemia por deficiencia de hierro asiacute como su medicioacuten e interpretacioacuten
Materiales y meacutetodos Se realizoacute la revisioacuten de artiacuteculos cientiacuteficos en ingleacutes y espantildeolen las bases de datos PubMed ScienceDirect LILACS y Medline usando descriptoresvalidados en Medical Subject Headings (MeSH) considerando periodo depublicabilidad del 80 inferior a 5 antildeos
Conclusiones La CHr es un paraacutemetro de gran utilidad en el diagnoacutestico temprano deanemia ferropeacutenica y otras patologiacuteas como deficiencia funcional de hierro estadosde inflamacioacuten croacutenica y enfermedad renal croacutenica
Biomarcador temprano en el diagnoacutestico de deficiencia de hierro antes de presentarsecambios morfoloacutegicos eritrociacuteticosCongreso Nacio
nal Laboratorio Cliacutenico 2018
bull A total of 1105 NES participants (639 men 466 women)bull CHr becomes affected in a relatively early stage in the development of iron deficiency before iron
deficiency anemia and clinical symptoms become apparentbull Therefore this parameter might be useful to identify persons healthy and diseased at risk of
developing iron deficiency anemia and subsequently to apply interventions in order to prevent further development of iron deficiency anemiaCongreso Nacio
nal Laboratorio Cliacutenico 2018
Hb reticulocitaria sensible para detectar la fase inicial del deacuteficit de hierro cuando laeritropoyesis requiere maacutes cantidad que la que recibe ANTES de que la anemia seestablezca
Congreso Nacional Laboratorio Cliacutenico
2018
No ID LID P
RBC 1012L 48 (08) 437 (05) lt00001
Hb gL 135 (6) 131 (12) 0006
MCV fL 922 (21) 902 (38) 0006
MCH pg 324 (07) 306 (22) lt00001
MCHC gL 339 (6) 319 (23) 0001
RDW
Ret He pg
Hypo He
LHD
Ferritin microgL
131 (06)
338 (21)
03 (015)
28 (20)
86 (3)
145 (21)
278 (24)
69 (55)
56 (25)
16 (76)
lt00001
lt00001
lt00001
lt00001
lt00001
AUC 95 CI Cutoff Sensitivity Specificity
LHD 0898 0819-0978 50 859 841
Ret He 0914 0824-1000 299pg 868 857
Hypo He 0934 0856-1000 16 857 921
Clinical value of markers of hypochromia in the detection of latent iron deficiency in non-anemic premenopausal women
No ID Hb gt 120 gL s-ferritin was within reference intervalLatent Iron Defiency Hb gt 120 gL s-ferritin lt 30 μgL
Urrechaga E et al Journal Clin Lab Analysis 2016 30 (5) 623-627
97 women (388) in 250 apparently healthy women had latent IDCongreso Nacional Laboratorio Cliacutenico
2018
Schorer G et al Abstract Jahreskongress der Deutschen Gesellschaft fuumlr Transfusionsmedizin und Immunhaumlmatologie Rostock 15 - 18 September 2009
Congreso Nacional Laboratorio Cliacutenico
2018
Caring for Those Who Share Mitigating Iron Deficiency in Regular Blood DonorsMast Alan E
bull Iron deficiency caused by regular blood donation is a problem facing blood centers Each blood donation removes 200 to 250 mg of iron from the donor Consequently many donors become iron deficient with repeated donation
bull This presents a challenge to blood centers that has become more acute in recent years with the realization that iron deficiency even in the absence of anemia is associated with adverse effects including fatigue and decreased exercise tolerance as well as neurological symptoms such as decreased cognitive function pica and restless leg syndrome
bull REDS-II investigators performed a longitudinal study investigating the iron status of blood donors over a two year period called the REDS-II Donor Iron Status Evaluation (RISE)
bull Results from the baseline analysis of regular donors (e 2 donations per year (females) or e 3 donations per year (males) revealed that over two-thirds of female donors and over one-half of male donors have iron deficiency
Congreso Nacional Laboratorio Cliacutenico
2018
Transfusion 2013 532766-2775
bull We evaluated the diagnostic sensitivity and specificity of red blood cell (RBC) hematology analyzer indices to assess iron status as a part of donor management iron deficient erythropoiesis (IDE) and absence of iron stores (AIS)
bull STUDY DESIGN AND METHODS A total of 1659 male and female donors from the Retrovirus Epidemiology Donor Study-II (REDS-II) Donor Iron Status Evaluation (RISE) study who were either first-timereactivated (FT RA no donations for 2 years) or frequent donors were recruited into a longitudinal study of regular donation of RBCs Of these 1002 donors returned 15 to 24 months later for a final assessment
Absent iron stores (AIS) was defined as plasma ferritin level of less than 12 mgL Logarithm of the ratio of soluble transferrin receptor to ferritin of at least 207 was used to define iron-deficient erythropoiesis (IDE)
bull RESULTS HYPOm and CHr detected IDE with comparable sensitivity 72 versus 69 but differed in specificity HYPOm 68 and CHr 53
For detecting AIS sensitivity was improved to 85 for HYPOm and 81 for CHr but specificity was reduced
Venous Hb had high specificity but poor sensitivity for IDE and AIS A plasma ferritin level of less than 267 mgL was a good surrogate for assessing IDE Congreso Nacio
nal Laboratorio Cliacutenico 2018
Microcytic RBC and reticulocyte mean cell hemoglobin content predicted iron depletion with
sensitivities 70 and 64
specificities of 72 and 78 respectively
When both combined
increased the sensitivity to 82
Congreso Nacional Laboratorio Cliacutenico
2018
Depending on the number of donations during the preceding12 months
Absent iron stores were detected in up to 214 of male and278 of female donors respectively
impaired hemoglobinisation IH was present in up to 64 maleand 167 female donors with 2 and 4 preceding donationsrespectively
The defined CHr cut-off value was 280 pg to detect IH infrequent whole blood donors with AIS leading to a testspecificity of 982 (positive predictive value PPV 577) inmale and of 978 (PPV 829) in female donors
It may help to prevent the development of anemia in frequentblood donors and also can help to decide whether donordeferral or even iron substitution need to be recommended
Congreso Nacional Laboratorio Cliacutenico
2018
Of the 501 blood donors sTfR and Ret-He detected Latent Iron Deficiency in 148 and 135 donors respectively
In comparison to sTfR Ret-He had sensitivity of 927 specificity of 9716 PPV of 931 and NPV of 963
Serum Ferritin TIBC and serum Iron had comparatively lower sensitivity of 8716 797 and 777 respectively
Conclusion Ret-He can be used as a routine screening test to detect LID in blood donors
This could provide an opportunity to make appropriate and timely interventions like dietary changes or drug supplementation
Congreso Nacional Laboratorio Cliacutenico
2018
Singh A Chaudhary R Pandey HC Sonker A Identification of iron status of blood donors by using low hemoglobin density and microcytic anemia factor Asian J Transfus Sci 20181246-50
The main objective of this study was to assess ifLHD and Maf could be used for assessment ofiron status in blood donors and also to establisha cut-off for these two parameters at which atentative iron deficiency could be reportedconclusively
Results LHD and Maf were able to differentiatebetween iron deficient and iron-depleteddonors from normal donorsA cutoff of 918 for LHD was able todifferentiate iron deficient and depleted statefrom normal iron statessensitivity 919 and specificity 71respectivelya cutoff of 1016 for Mafsensitivity 946 and specificity 968
MAf = (MVC Hb) 100
Congreso Nacional Laboratorio Cliacutenico
2018
Hb reticulocitaria sensible para detectar la fase inicial del deacuteficitde hierro cuando la eritropoyesis requiere maacutes cantidad que laque recibe ANTES de que la anemia se establezca
La deteccioacuten precoz del deacuteficit de hierro en la fase del balance negativo demanda aporte contribuye a reducir sus manifestaciones cliacutenicas en los pacientes afectados mejorando la salud puacuteblica
Un tratamiento menos prolongado con suplementos y menor consumo de los recursos sanitaros Contribuye a la eficiencia y sostenibilidad de los servicios sanitarios
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
Buttarello MLaboratory diagnosis of anemia are the old and new red cell parameters useful in classification and treatment howInt Jnl Lab Hem 2016 38 (Suppl 1) 123ndash132
Congreso Nacional Laboratorio Cliacutenico
2018
Buttarello MLaboratory diagnosis of anemia are the old and new red cell parameters useful in classification and treatment howInt Jnl Lab Hem 2016 38 (Suppl 1) 123ndash132
Congreso Nacional Laboratorio Cliacutenico
2018
Ralph Green amp Ananya Datta Mitra Megaloblastic Anemias Nutritional and Other CausesMed Clin N Am 2017 101 297ndash317
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
ANEMIA CARENCIAL CAUSAS
Factores alimentariosConsumir una dieta vegetariana mal planeadaAlimentacioacuten deficiente en los bebeacutesDesnutricioacuten durante el embarazo
Deacuteficit de absorcioacutenAlcoholismo croacutenicoEnfermedad de Crohn celiaquiacutea infeccioacuten otros problemas que le dificulten al cuerpo la digestioacuten de los alimentosAnemia perniciosa (factor intriacutenseco)Cirugiacuteas para extirpar ciertas partes del estoacutemago o el intestino delgado
MedicamentosB12 omeprazol metformina colchicina aminosalicilatos neomicinaFOLATO fenitoiacutena metotrexato sulfasalacina triamtereno pirimetamina trimetoprim con sulfametoxazol barbituacutericos
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
Reacciones metaboacutelicas en las que participan la vitamina B12 y el folato bull la conversioacuten de metilmalonil-CoA a succinil-CoA donde la adenosil-cobalamina actuacutea de
cofactor Por ello un deacuteficit de B12 conlleva un aumento de metilmalonil-CoA y de su producto de hidroacutelisis el aacutecido metilmaloacutenico
bull la siacutentesis de metionina a partir de homocisteina gracias a la metionina sintetasa y a la metil-cobalamina como cofactor En esta misma reaccioacuten el metiltetrahidrofolato es transformado a tetrahidrofolato que es necesario para la siacutentesis de DNA
Congreso Nacional Laboratorio Cliacutenico
2018
Anemia macrociacutetica secundaria a deficiencia de aacutecido foacutelico y de vitamina B12(cobalamina)
La deficiencia de B12 yo aacutecido foacutelico es la causa maacutes frecuente de megaloblastosis
Dentro de distintas funciones generales del metabolismo la vitamina B12 es uncofactor esencial en la siacutentesis de ADN y ARN compromete a todas las ceacutelulas delorganismo
Su deficiencia se manifiesta en oacuterganos con alto recambio celular como la meacutedulaosea y en el sistema nervioso central (SNC) a traveacutes de la siacutentesis de mielina y lareparacioacuten axonal
La deficiencia de cobalamina es responsable de alteraciones hematoloacutegicasneuroloacutegicas neurocognitivas y neuropsiquiaacutetricas
La siacutentesis defectuosa de ADN conduce a la apoptosis y a la hemoacutelisis (intra yextramedular) causantes de la hemopoyesis inefectiva
En meacutedula la siacutentesis ineficiente de DNA causa cambios megaloblaacutesticos comoconsecuencIa anemia y citopenias
Congreso Nacional Laboratorio Cliacutenico
2018
Limitaciones de los meacutetodos diagnoacutesticos claacutesicos
Volumen Corpuscular Medio (VCM) y morfologiacutea de sangre perifeacuterica En una serie de pacientes con deacuteficit de cobalamina soacutelo un 29 teniacutean anemia y soacutelo un 36 teniacutean un VCM gt 100 fL
Un VCM normal no puede ser empleado para rechazar una determinacioacuten de nivel de cobalamina ya que hasta un 25 de casos con manifestaciones neuroloacutegicas cursan con un VCM normal
Cobalamina seacuterica (nivel de B12) Es el test diagnoacutestico rutinario inicial estaacutendar Es un test ampliamente disponible de bajo coste y automatizado Sin embargo presenta algunas limitaciones
-- Existencia de varias teacutecnicas y ausencia de un gold standard por lo que hay diferentes liacutemites de referencia
-- Variacioacuten intraindividual muy alta
La OMS publicoacute en 2008 las conclusiones de un grupo teacutecnico consultado sobre el deacuteficit de cobalamina y folato
El grupo reconocioacute que no existen unos umbrales universalmente reconocidos para definir el deacuteficit de ambas vitaminas y expresaron la necesidad de un consenso
Devalia V Hamilton MS and Molloy AM on behalf of the British Committee for standards in haematology Guidelines for the diagnosis and treatment of cobalamin and folate disorders Br J Haematol 2014 166(4) 496-513
Schrier SL Diagnosis and treatment of vitamin B12 and folate deficiency UpToDate Last updated Jun 25 2014
de Benoist B Conclusions of a WHO Technical Consultation on folate and vitamin B12 deficiencies Food Nutr Bull 200829(2 Suppl)S238ndash44Congreso Nacional Laboratorio Cliacutenico
2018
Tomado de Tefferi A Li C En Atlas of Clinical Hematology Publicado por JO Armitage Philadelphia Current Medicine 2004
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
Int Jnl Lab Hem 2007 29 327ndash334
Clin Lab 201662343-347
In ourstudy mean MCVrMCV ratio of healthy controls is130 as microcytic anemia irondeficiency anemia is121 as also macrocytic anemia vitamin B12 deficiencyanemia is 115
Congreso Nacional Laboratorio Cliacutenico
2018
Sualeh Muslim Khan Muhammad Akbar Agha
Mean cell volume of reticulocytemdashA new parameter for diagnosing sub-clinical cobalamin deficiency in blood donors Int J Lab Hem 20181ndash4
The Abbott CELL-DYN Sapphire Hematology System uses multi-angle polarized scatter separation (MAPSS) and focused flow impedance technologies
Congreso Nacional Laboratorio Cliacutenico
2018
MCVr at 985 fL yielded the highest Youdenrsquos index at sensitivity of 82 specificity of 828 AUC 0847 ( 95 CI 803-891)
Khan SM Agha MA Mean cell volume of reticulocyte-A new parameter for diagnosing sub-clinical cobalamin deficiency in blood donors
Int J Lab Hem 20181ndash4 2018 Jul 13 doi 101111ijlh12899
Congreso Nacional Laboratorio Cliacutenico
2018
Role of Cell Population Data in the detection of folate and cobalamin deficiency
J Nieto et al
XXXI st International Symposium on Technological Innovations in Laboratory Hematology ISLH 2018 10-12 May 2018 Brussels Belgium
M-V-NRET and SD-VNRET are the best discriminatory single parameters to distinguish between patients with B9B12 deficiency and reference subjects M-V-NRETAUC=0823 sensitivity 78 and specificity 86
AUC=0852 sensitivity 55 and specificity 60
Conclusions The CPD parameters of Volume and Light Scatter (M and SD of LALS angle) that inform about size and intracellular structure of RBCs provided very useful information for the detection of B9B12 deficiency
Congreso Nacional Laboratorio Cliacutenico
2018
Cell Population Data
bull Paraacutemetros poblacionales de los leucocitos
bull Describen la morfologiacutea tamantildeo
estructuras citoplasmaacuteticas
nuacutecleo aacutecidos nucleacuteicos
bull Son datos numeacutericos con los que se construyen los ejes de lo diagramas de dispersioacuten de los leucocitos
bull Dependen de la tecnologiacutea
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
High Sensitivity New Parameters for the Detection of Vitamin B12 and Folate Deficiencies Blood 2008 1125379
B12 def vs
Normals
Mann
Withney T-Test
ROC
AUC Sens Specif Cutoff signifROC
MCV p=03156 p=09533 0577
MPV p=00001 0802 792 806 lt83 p=00001
NE Mean
Volume plt00001 0862 833 778 gt1403 p=00001
MO Mean
Volume plt00001 0829 625 889 gt1723 p=00001
MRV p=00113 0705 50 964 gt1133 p=00051
Folate def vs
Normals
Mann
Withney T-Test
ROC
AUC Sens Specif Cut-off signifROC
MCV p=00798 p=06461 0665
MPV plt00001 0832 81 806 lt83 p=00001
NE Mean
Volume p=00008 087 952 694 gt1402 p=00001
MO Mean
Volume p=00002 0801 667 833 gt1696 p=00001
MRV p=00054 0731 476 964 gt1133 p=00019
The Mean Neutrophil Volume (MNE V) and Mean Monocyte Volume (MMOV) may be used for the detection of megaloblastic neutrophils and monocytes MNEV and MMOV have significantly higher sensitivity than the previous information from the red cells (MCV) detecting B12 or folate deficiency because they are not affected by the presence at the same time of Iron deficiency or other reasons of anemia
Congreso Nacional Laboratorio Cliacutenico
2018
POSTER 733
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
CPD Sysmex XN
NE SSC complejidad
NE SFL aacutecidos nucleacuteicos
NE FSC tamantildeo
NE WX
NE WY
NE WZ
MO X
MO Y
MO Z
MO WX
MO WY
MO WZ
LY X
LY Y
LY Z
LY WX
LY WY
LY WZCongreso Nacio
nal Laboratorio Cliacutenico 2018
As MCV is the mean which is calculated it is insensitive to the presence of a small number of macrocytes
Further macrocytosis can be obscured by concomitant disorders that can cause microcytosis resulting inmasked megaloblastic anaemia (MA) for example iron deficiency hereditary elliptocytosis alpha and betathalassemia
This study was undertaken to evaluate the role of NEUT-X and NEUT-Y in detecting MA on peripheral blood andalso see whether other forms of macrocytic anaemia can be differentiated from MA
In MA the peripheral blood smear shows cytopenia with macroovalocytes and hypersegmented
neutrophils (gt5 lobes in 5 neutrophils six lobes nuclei or lobe average of gt35)
In conclusion our study shows that higher values of NEUT-X and NEUT-Y in MA patients in spite of low ornormal MCV high RDW may be used to not only reveal the masked cases of MA with concomitant irondeficiency but also separate them from the broader macrocytic anaemia group
Peripheral smear remains diagnostic however making smear for all the suspicious cases is a cumbersomeand tedious procedure Thus these parameters emerge as more reliable and stable parameters in themodern laboratories which in future may replace the older screening tools
Congreso Nacional Laboratorio Cliacutenico
2018
A favor Eficiencia Operativa
Mejora el proceso del Laboratorio
Mejor informacioacuten al Cliacutenico al mismo coste
Mejora la informacioacuten
Informa sobre la eritropoyesis deteccioacuten precoz de estados carenciales
Ayuda al cliacutenico
Estado real del paciente
En contraParaacutemetros de investigacioacuten
Dificultad de standarizar dependencia teacutecnica
Control de calidadCongreso Nacional Laboratorio Cliacutenico
2018
copy 2012 Mindray Confidential 26
HDWHYPERHYPO
HDW HGB Distribution Width
HDW is the distribution width of Hgb histogram
Congreso Nacional Laboratorio Cliacutenico
2018
copy 2012 Mindray Confidential 27
MCHrHDWHYPERHYPOMCHr Mean RET HGB Concentration
Congreso Nacional Laboratorio Cliacutenico
2018
Histograma RBC el mapa de Mie
28 41
Congreso Nacional Laboratorio Cliacutenico
2018
Abbott Mindray Siemens
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
Severe Iron Deficiency Anemia Female 34 years
19 th March 18 th April
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
SysmexRBCHe erythrocyte Hb equivalentRetHe reticulocyte Hb equivalent(content)
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
MIC
MAC
HPO HPR
Congreso Nacional Laboratorio Cliacutenico
2018
copy 2012 Mindray Confidential 36
MINDRAY MCHrHDWHYPERHYPO
MCHr Mean RET HGB Concentration
HDW HGB Distribution Width
HYPER The percentage of hyperchromicred blood cells
HYPO The percentage of hypochromic red blood cells
Thalassemia screeningIDA treatment monitoringIDA screening
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
Hipocromo
Hipercroacutemico onormocroacutemico
iquestConcentracioacuten o contenido de Hemoglobina
Hipocroacutemiconormocroacutemico
Abbott Mindray Siemens Hypo CONCENTRACIOacuteN Hblt280gL
Sysmex Hypo CONTENIDO Hblt 17 pg
Congreso Nacional Laboratorio Cliacutenico
2018
Low Hb Density
Microcytic Factor Maf = (HbMCV)100
Nuevo moacutedulo transductor muacuteltiple con laacuteser de diodo y dos sensores oacutepticos
Anaacutelisis de hasta 50000 ceacutelulas con 7 paraacutemetros tecnoloacutegicos (leucocitos reticulocitos eritroblastos)
1 Volumen digital
2 Conductividad digital
3 5 aacutengulos de dispersioacuten de luz laacuteser digital
bull MALS (Median Angle Light Scatter)
bull UMALS (Upper Median Angle Light Scatter) 20deg a 43deg
bull LMALS (Lower Median Angle Light Scatter) 09deg a 19deg
bull LALS (Low Angle Light Scatter) asymp 51deg
bull AL2 (Axial Light Loss) 0deg a 05deg
Congreso Nacional Laboratorio Cliacutenico
2018
Hierro es un elemento criacutetico para elfuncionamiento oacuteptimo y supervivenciade las ceacutelulas
Disfuncioacuten mitocondrialActividad enzimaacutetica afectadaProteiacutenas de transporte y estructuralesproteins
Capacidad fiacutesica mermadaCapacidad de trabajo reducidaCapacidades cognitivas afectadasMorbilidad y mortalidad
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
It is generally assumed that worldwide ldquoat least half the anemia is due tonutritional iron deficiencyrdquo and that ldquoup to a prevalence of iron deficiency anemiaof 40 the prevalence of iron deficiency will be about 25 times that of anemiardquoHowever it is evident from the foregoing discussion that there are considerablevariations in both of these ratios depending on the age and sex of the peoplebeing studied the region of the world in which they live and the prevalence ratesof other causes of anemia
WHO Department of Nutrition for Health and DevelopmentAssessing the iron status of populations including literature reviews report of a Joint World Health OrganizationCenters for DiseaseControl and Prevention Technical Consultation on the Assessment of Iron Status at the Population Level Geneva Switzerland 6ndash8 April2004 ndash 2nd ed
Congreso Nacional Laboratorio Cliacutenico
2018
Estaacute bien establecido que la anemia produce una miriacuteada de secuelas tanto fiacutesicas comopsicoloacutegicas
Pero los efecto deleteacutereos se deben al deficit de hierro que es un evento previo a que seestablezca la anemia
El deacuteficit de hierrro auacuten sin anemia tiene efectos negativos en el desarrollo cognitivo y fiacutesico
Rattehalli D et al Iron deficiency without anemia do not wait for the Hemoglobin to drop
Health Policy and Technology 2013 2 45-48Congreso Nacio
nal Laboratorio Cliacutenico 2018
SuominenP et al Serum transferrin receptor and transferrin receptor-ferritin index identify healthy subjects with subclinical iron deficits Blood 1998 92 2934ndash9Halwachs-Baumann G Diagnosis of anaemia old things rearranged Wien Med Wochenschr 2012 162478ndash88
Congreso Nacional Laboratorio Cliacutenico
2018
Hemoglobina de reticulocito y su importancia en el diagnoacutestico temprano de anemiaferropeacutenica
Y Maacuterquez-Beniacutetez et al Universidad de BocayaAugust
2018 DOI 1022267rus182003133 aop
El contenido de hemoglobina de reticulocitos (CHr) es un paraacutemetro en la biometriacuteahematoloacutegica automatizada utilizado como un marcador de la biodisponibilidad delhierro en la eritropoyesis
Objetivo Exponer la aplicabilidad de la CHr como un paraacutemetro en el diagnoacutesticoprecoz de la anemia por deficiencia de hierro asiacute como su medicioacuten e interpretacioacuten
Materiales y meacutetodos Se realizoacute la revisioacuten de artiacuteculos cientiacuteficos en ingleacutes y espantildeolen las bases de datos PubMed ScienceDirect LILACS y Medline usando descriptoresvalidados en Medical Subject Headings (MeSH) considerando periodo depublicabilidad del 80 inferior a 5 antildeos
Conclusiones La CHr es un paraacutemetro de gran utilidad en el diagnoacutestico temprano deanemia ferropeacutenica y otras patologiacuteas como deficiencia funcional de hierro estadosde inflamacioacuten croacutenica y enfermedad renal croacutenica
Biomarcador temprano en el diagnoacutestico de deficiencia de hierro antes de presentarsecambios morfoloacutegicos eritrociacuteticosCongreso Nacio
nal Laboratorio Cliacutenico 2018
bull A total of 1105 NES participants (639 men 466 women)bull CHr becomes affected in a relatively early stage in the development of iron deficiency before iron
deficiency anemia and clinical symptoms become apparentbull Therefore this parameter might be useful to identify persons healthy and diseased at risk of
developing iron deficiency anemia and subsequently to apply interventions in order to prevent further development of iron deficiency anemiaCongreso Nacio
nal Laboratorio Cliacutenico 2018
Hb reticulocitaria sensible para detectar la fase inicial del deacuteficit de hierro cuando laeritropoyesis requiere maacutes cantidad que la que recibe ANTES de que la anemia seestablezca
Congreso Nacional Laboratorio Cliacutenico
2018
No ID LID P
RBC 1012L 48 (08) 437 (05) lt00001
Hb gL 135 (6) 131 (12) 0006
MCV fL 922 (21) 902 (38) 0006
MCH pg 324 (07) 306 (22) lt00001
MCHC gL 339 (6) 319 (23) 0001
RDW
Ret He pg
Hypo He
LHD
Ferritin microgL
131 (06)
338 (21)
03 (015)
28 (20)
86 (3)
145 (21)
278 (24)
69 (55)
56 (25)
16 (76)
lt00001
lt00001
lt00001
lt00001
lt00001
AUC 95 CI Cutoff Sensitivity Specificity
LHD 0898 0819-0978 50 859 841
Ret He 0914 0824-1000 299pg 868 857
Hypo He 0934 0856-1000 16 857 921
Clinical value of markers of hypochromia in the detection of latent iron deficiency in non-anemic premenopausal women
No ID Hb gt 120 gL s-ferritin was within reference intervalLatent Iron Defiency Hb gt 120 gL s-ferritin lt 30 μgL
Urrechaga E et al Journal Clin Lab Analysis 2016 30 (5) 623-627
97 women (388) in 250 apparently healthy women had latent IDCongreso Nacional Laboratorio Cliacutenico
2018
Schorer G et al Abstract Jahreskongress der Deutschen Gesellschaft fuumlr Transfusionsmedizin und Immunhaumlmatologie Rostock 15 - 18 September 2009
Congreso Nacional Laboratorio Cliacutenico
2018
Caring for Those Who Share Mitigating Iron Deficiency in Regular Blood DonorsMast Alan E
bull Iron deficiency caused by regular blood donation is a problem facing blood centers Each blood donation removes 200 to 250 mg of iron from the donor Consequently many donors become iron deficient with repeated donation
bull This presents a challenge to blood centers that has become more acute in recent years with the realization that iron deficiency even in the absence of anemia is associated with adverse effects including fatigue and decreased exercise tolerance as well as neurological symptoms such as decreased cognitive function pica and restless leg syndrome
bull REDS-II investigators performed a longitudinal study investigating the iron status of blood donors over a two year period called the REDS-II Donor Iron Status Evaluation (RISE)
bull Results from the baseline analysis of regular donors (e 2 donations per year (females) or e 3 donations per year (males) revealed that over two-thirds of female donors and over one-half of male donors have iron deficiency
Congreso Nacional Laboratorio Cliacutenico
2018
Transfusion 2013 532766-2775
bull We evaluated the diagnostic sensitivity and specificity of red blood cell (RBC) hematology analyzer indices to assess iron status as a part of donor management iron deficient erythropoiesis (IDE) and absence of iron stores (AIS)
bull STUDY DESIGN AND METHODS A total of 1659 male and female donors from the Retrovirus Epidemiology Donor Study-II (REDS-II) Donor Iron Status Evaluation (RISE) study who were either first-timereactivated (FT RA no donations for 2 years) or frequent donors were recruited into a longitudinal study of regular donation of RBCs Of these 1002 donors returned 15 to 24 months later for a final assessment
Absent iron stores (AIS) was defined as plasma ferritin level of less than 12 mgL Logarithm of the ratio of soluble transferrin receptor to ferritin of at least 207 was used to define iron-deficient erythropoiesis (IDE)
bull RESULTS HYPOm and CHr detected IDE with comparable sensitivity 72 versus 69 but differed in specificity HYPOm 68 and CHr 53
For detecting AIS sensitivity was improved to 85 for HYPOm and 81 for CHr but specificity was reduced
Venous Hb had high specificity but poor sensitivity for IDE and AIS A plasma ferritin level of less than 267 mgL was a good surrogate for assessing IDE Congreso Nacio
nal Laboratorio Cliacutenico 2018
Microcytic RBC and reticulocyte mean cell hemoglobin content predicted iron depletion with
sensitivities 70 and 64
specificities of 72 and 78 respectively
When both combined
increased the sensitivity to 82
Congreso Nacional Laboratorio Cliacutenico
2018
Depending on the number of donations during the preceding12 months
Absent iron stores were detected in up to 214 of male and278 of female donors respectively
impaired hemoglobinisation IH was present in up to 64 maleand 167 female donors with 2 and 4 preceding donationsrespectively
The defined CHr cut-off value was 280 pg to detect IH infrequent whole blood donors with AIS leading to a testspecificity of 982 (positive predictive value PPV 577) inmale and of 978 (PPV 829) in female donors
It may help to prevent the development of anemia in frequentblood donors and also can help to decide whether donordeferral or even iron substitution need to be recommended
Congreso Nacional Laboratorio Cliacutenico
2018
Of the 501 blood donors sTfR and Ret-He detected Latent Iron Deficiency in 148 and 135 donors respectively
In comparison to sTfR Ret-He had sensitivity of 927 specificity of 9716 PPV of 931 and NPV of 963
Serum Ferritin TIBC and serum Iron had comparatively lower sensitivity of 8716 797 and 777 respectively
Conclusion Ret-He can be used as a routine screening test to detect LID in blood donors
This could provide an opportunity to make appropriate and timely interventions like dietary changes or drug supplementation
Congreso Nacional Laboratorio Cliacutenico
2018
Singh A Chaudhary R Pandey HC Sonker A Identification of iron status of blood donors by using low hemoglobin density and microcytic anemia factor Asian J Transfus Sci 20181246-50
The main objective of this study was to assess ifLHD and Maf could be used for assessment ofiron status in blood donors and also to establisha cut-off for these two parameters at which atentative iron deficiency could be reportedconclusively
Results LHD and Maf were able to differentiatebetween iron deficient and iron-depleteddonors from normal donorsA cutoff of 918 for LHD was able todifferentiate iron deficient and depleted statefrom normal iron statessensitivity 919 and specificity 71respectivelya cutoff of 1016 for Mafsensitivity 946 and specificity 968
MAf = (MVC Hb) 100
Congreso Nacional Laboratorio Cliacutenico
2018
Hb reticulocitaria sensible para detectar la fase inicial del deacuteficitde hierro cuando la eritropoyesis requiere maacutes cantidad que laque recibe ANTES de que la anemia se establezca
La deteccioacuten precoz del deacuteficit de hierro en la fase del balance negativo demanda aporte contribuye a reducir sus manifestaciones cliacutenicas en los pacientes afectados mejorando la salud puacuteblica
Un tratamiento menos prolongado con suplementos y menor consumo de los recursos sanitaros Contribuye a la eficiencia y sostenibilidad de los servicios sanitarios
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
Buttarello MLaboratory diagnosis of anemia are the old and new red cell parameters useful in classification and treatment howInt Jnl Lab Hem 2016 38 (Suppl 1) 123ndash132
Congreso Nacional Laboratorio Cliacutenico
2018
Buttarello MLaboratory diagnosis of anemia are the old and new red cell parameters useful in classification and treatment howInt Jnl Lab Hem 2016 38 (Suppl 1) 123ndash132
Congreso Nacional Laboratorio Cliacutenico
2018
Ralph Green amp Ananya Datta Mitra Megaloblastic Anemias Nutritional and Other CausesMed Clin N Am 2017 101 297ndash317
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
ANEMIA CARENCIAL CAUSAS
Factores alimentariosConsumir una dieta vegetariana mal planeadaAlimentacioacuten deficiente en los bebeacutesDesnutricioacuten durante el embarazo
Deacuteficit de absorcioacutenAlcoholismo croacutenicoEnfermedad de Crohn celiaquiacutea infeccioacuten otros problemas que le dificulten al cuerpo la digestioacuten de los alimentosAnemia perniciosa (factor intriacutenseco)Cirugiacuteas para extirpar ciertas partes del estoacutemago o el intestino delgado
MedicamentosB12 omeprazol metformina colchicina aminosalicilatos neomicinaFOLATO fenitoiacutena metotrexato sulfasalacina triamtereno pirimetamina trimetoprim con sulfametoxazol barbituacutericos
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
Reacciones metaboacutelicas en las que participan la vitamina B12 y el folato bull la conversioacuten de metilmalonil-CoA a succinil-CoA donde la adenosil-cobalamina actuacutea de
cofactor Por ello un deacuteficit de B12 conlleva un aumento de metilmalonil-CoA y de su producto de hidroacutelisis el aacutecido metilmaloacutenico
bull la siacutentesis de metionina a partir de homocisteina gracias a la metionina sintetasa y a la metil-cobalamina como cofactor En esta misma reaccioacuten el metiltetrahidrofolato es transformado a tetrahidrofolato que es necesario para la siacutentesis de DNA
Congreso Nacional Laboratorio Cliacutenico
2018
Anemia macrociacutetica secundaria a deficiencia de aacutecido foacutelico y de vitamina B12(cobalamina)
La deficiencia de B12 yo aacutecido foacutelico es la causa maacutes frecuente de megaloblastosis
Dentro de distintas funciones generales del metabolismo la vitamina B12 es uncofactor esencial en la siacutentesis de ADN y ARN compromete a todas las ceacutelulas delorganismo
Su deficiencia se manifiesta en oacuterganos con alto recambio celular como la meacutedulaosea y en el sistema nervioso central (SNC) a traveacutes de la siacutentesis de mielina y lareparacioacuten axonal
La deficiencia de cobalamina es responsable de alteraciones hematoloacutegicasneuroloacutegicas neurocognitivas y neuropsiquiaacutetricas
La siacutentesis defectuosa de ADN conduce a la apoptosis y a la hemoacutelisis (intra yextramedular) causantes de la hemopoyesis inefectiva
En meacutedula la siacutentesis ineficiente de DNA causa cambios megaloblaacutesticos comoconsecuencIa anemia y citopenias
Congreso Nacional Laboratorio Cliacutenico
2018
Limitaciones de los meacutetodos diagnoacutesticos claacutesicos
Volumen Corpuscular Medio (VCM) y morfologiacutea de sangre perifeacuterica En una serie de pacientes con deacuteficit de cobalamina soacutelo un 29 teniacutean anemia y soacutelo un 36 teniacutean un VCM gt 100 fL
Un VCM normal no puede ser empleado para rechazar una determinacioacuten de nivel de cobalamina ya que hasta un 25 de casos con manifestaciones neuroloacutegicas cursan con un VCM normal
Cobalamina seacuterica (nivel de B12) Es el test diagnoacutestico rutinario inicial estaacutendar Es un test ampliamente disponible de bajo coste y automatizado Sin embargo presenta algunas limitaciones
-- Existencia de varias teacutecnicas y ausencia de un gold standard por lo que hay diferentes liacutemites de referencia
-- Variacioacuten intraindividual muy alta
La OMS publicoacute en 2008 las conclusiones de un grupo teacutecnico consultado sobre el deacuteficit de cobalamina y folato
El grupo reconocioacute que no existen unos umbrales universalmente reconocidos para definir el deacuteficit de ambas vitaminas y expresaron la necesidad de un consenso
Devalia V Hamilton MS and Molloy AM on behalf of the British Committee for standards in haematology Guidelines for the diagnosis and treatment of cobalamin and folate disorders Br J Haematol 2014 166(4) 496-513
Schrier SL Diagnosis and treatment of vitamin B12 and folate deficiency UpToDate Last updated Jun 25 2014
de Benoist B Conclusions of a WHO Technical Consultation on folate and vitamin B12 deficiencies Food Nutr Bull 200829(2 Suppl)S238ndash44Congreso Nacional Laboratorio Cliacutenico
2018
Tomado de Tefferi A Li C En Atlas of Clinical Hematology Publicado por JO Armitage Philadelphia Current Medicine 2004
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
Int Jnl Lab Hem 2007 29 327ndash334
Clin Lab 201662343-347
In ourstudy mean MCVrMCV ratio of healthy controls is130 as microcytic anemia irondeficiency anemia is121 as also macrocytic anemia vitamin B12 deficiencyanemia is 115
Congreso Nacional Laboratorio Cliacutenico
2018
Sualeh Muslim Khan Muhammad Akbar Agha
Mean cell volume of reticulocytemdashA new parameter for diagnosing sub-clinical cobalamin deficiency in blood donors Int J Lab Hem 20181ndash4
The Abbott CELL-DYN Sapphire Hematology System uses multi-angle polarized scatter separation (MAPSS) and focused flow impedance technologies
Congreso Nacional Laboratorio Cliacutenico
2018
MCVr at 985 fL yielded the highest Youdenrsquos index at sensitivity of 82 specificity of 828 AUC 0847 ( 95 CI 803-891)
Khan SM Agha MA Mean cell volume of reticulocyte-A new parameter for diagnosing sub-clinical cobalamin deficiency in blood donors
Int J Lab Hem 20181ndash4 2018 Jul 13 doi 101111ijlh12899
Congreso Nacional Laboratorio Cliacutenico
2018
Role of Cell Population Data in the detection of folate and cobalamin deficiency
J Nieto et al
XXXI st International Symposium on Technological Innovations in Laboratory Hematology ISLH 2018 10-12 May 2018 Brussels Belgium
M-V-NRET and SD-VNRET are the best discriminatory single parameters to distinguish between patients with B9B12 deficiency and reference subjects M-V-NRETAUC=0823 sensitivity 78 and specificity 86
AUC=0852 sensitivity 55 and specificity 60
Conclusions The CPD parameters of Volume and Light Scatter (M and SD of LALS angle) that inform about size and intracellular structure of RBCs provided very useful information for the detection of B9B12 deficiency
Congreso Nacional Laboratorio Cliacutenico
2018
Cell Population Data
bull Paraacutemetros poblacionales de los leucocitos
bull Describen la morfologiacutea tamantildeo
estructuras citoplasmaacuteticas
nuacutecleo aacutecidos nucleacuteicos
bull Son datos numeacutericos con los que se construyen los ejes de lo diagramas de dispersioacuten de los leucocitos
bull Dependen de la tecnologiacutea
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
High Sensitivity New Parameters for the Detection of Vitamin B12 and Folate Deficiencies Blood 2008 1125379
B12 def vs
Normals
Mann
Withney T-Test
ROC
AUC Sens Specif Cutoff signifROC
MCV p=03156 p=09533 0577
MPV p=00001 0802 792 806 lt83 p=00001
NE Mean
Volume plt00001 0862 833 778 gt1403 p=00001
MO Mean
Volume plt00001 0829 625 889 gt1723 p=00001
MRV p=00113 0705 50 964 gt1133 p=00051
Folate def vs
Normals
Mann
Withney T-Test
ROC
AUC Sens Specif Cut-off signifROC
MCV p=00798 p=06461 0665
MPV plt00001 0832 81 806 lt83 p=00001
NE Mean
Volume p=00008 087 952 694 gt1402 p=00001
MO Mean
Volume p=00002 0801 667 833 gt1696 p=00001
MRV p=00054 0731 476 964 gt1133 p=00019
The Mean Neutrophil Volume (MNE V) and Mean Monocyte Volume (MMOV) may be used for the detection of megaloblastic neutrophils and monocytes MNEV and MMOV have significantly higher sensitivity than the previous information from the red cells (MCV) detecting B12 or folate deficiency because they are not affected by the presence at the same time of Iron deficiency or other reasons of anemia
Congreso Nacional Laboratorio Cliacutenico
2018
POSTER 733
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
CPD Sysmex XN
NE SSC complejidad
NE SFL aacutecidos nucleacuteicos
NE FSC tamantildeo
NE WX
NE WY
NE WZ
MO X
MO Y
MO Z
MO WX
MO WY
MO WZ
LY X
LY Y
LY Z
LY WX
LY WY
LY WZCongreso Nacio
nal Laboratorio Cliacutenico 2018
As MCV is the mean which is calculated it is insensitive to the presence of a small number of macrocytes
Further macrocytosis can be obscured by concomitant disorders that can cause microcytosis resulting inmasked megaloblastic anaemia (MA) for example iron deficiency hereditary elliptocytosis alpha and betathalassemia
This study was undertaken to evaluate the role of NEUT-X and NEUT-Y in detecting MA on peripheral blood andalso see whether other forms of macrocytic anaemia can be differentiated from MA
In MA the peripheral blood smear shows cytopenia with macroovalocytes and hypersegmented
neutrophils (gt5 lobes in 5 neutrophils six lobes nuclei or lobe average of gt35)
In conclusion our study shows that higher values of NEUT-X and NEUT-Y in MA patients in spite of low ornormal MCV high RDW may be used to not only reveal the masked cases of MA with concomitant irondeficiency but also separate them from the broader macrocytic anaemia group
Peripheral smear remains diagnostic however making smear for all the suspicious cases is a cumbersomeand tedious procedure Thus these parameters emerge as more reliable and stable parameters in themodern laboratories which in future may replace the older screening tools
Congreso Nacional Laboratorio Cliacutenico
2018
A favor Eficiencia Operativa
Mejora el proceso del Laboratorio
Mejor informacioacuten al Cliacutenico al mismo coste
Mejora la informacioacuten
Informa sobre la eritropoyesis deteccioacuten precoz de estados carenciales
Ayuda al cliacutenico
Estado real del paciente
En contraParaacutemetros de investigacioacuten
Dificultad de standarizar dependencia teacutecnica
Control de calidadCongreso Nacional Laboratorio Cliacutenico
2018
copy 2012 Mindray Confidential 27
MCHrHDWHYPERHYPOMCHr Mean RET HGB Concentration
Congreso Nacional Laboratorio Cliacutenico
2018
Histograma RBC el mapa de Mie
28 41
Congreso Nacional Laboratorio Cliacutenico
2018
Abbott Mindray Siemens
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
Severe Iron Deficiency Anemia Female 34 years
19 th March 18 th April
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
SysmexRBCHe erythrocyte Hb equivalentRetHe reticulocyte Hb equivalent(content)
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
MIC
MAC
HPO HPR
Congreso Nacional Laboratorio Cliacutenico
2018
copy 2012 Mindray Confidential 36
MINDRAY MCHrHDWHYPERHYPO
MCHr Mean RET HGB Concentration
HDW HGB Distribution Width
HYPER The percentage of hyperchromicred blood cells
HYPO The percentage of hypochromic red blood cells
Thalassemia screeningIDA treatment monitoringIDA screening
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
Hipocromo
Hipercroacutemico onormocroacutemico
iquestConcentracioacuten o contenido de Hemoglobina
Hipocroacutemiconormocroacutemico
Abbott Mindray Siemens Hypo CONCENTRACIOacuteN Hblt280gL
Sysmex Hypo CONTENIDO Hblt 17 pg
Congreso Nacional Laboratorio Cliacutenico
2018
Low Hb Density
Microcytic Factor Maf = (HbMCV)100
Nuevo moacutedulo transductor muacuteltiple con laacuteser de diodo y dos sensores oacutepticos
Anaacutelisis de hasta 50000 ceacutelulas con 7 paraacutemetros tecnoloacutegicos (leucocitos reticulocitos eritroblastos)
1 Volumen digital
2 Conductividad digital
3 5 aacutengulos de dispersioacuten de luz laacuteser digital
bull MALS (Median Angle Light Scatter)
bull UMALS (Upper Median Angle Light Scatter) 20deg a 43deg
bull LMALS (Lower Median Angle Light Scatter) 09deg a 19deg
bull LALS (Low Angle Light Scatter) asymp 51deg
bull AL2 (Axial Light Loss) 0deg a 05deg
Congreso Nacional Laboratorio Cliacutenico
2018
Hierro es un elemento criacutetico para elfuncionamiento oacuteptimo y supervivenciade las ceacutelulas
Disfuncioacuten mitocondrialActividad enzimaacutetica afectadaProteiacutenas de transporte y estructuralesproteins
Capacidad fiacutesica mermadaCapacidad de trabajo reducidaCapacidades cognitivas afectadasMorbilidad y mortalidad
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
It is generally assumed that worldwide ldquoat least half the anemia is due tonutritional iron deficiencyrdquo and that ldquoup to a prevalence of iron deficiency anemiaof 40 the prevalence of iron deficiency will be about 25 times that of anemiardquoHowever it is evident from the foregoing discussion that there are considerablevariations in both of these ratios depending on the age and sex of the peoplebeing studied the region of the world in which they live and the prevalence ratesof other causes of anemia
WHO Department of Nutrition for Health and DevelopmentAssessing the iron status of populations including literature reviews report of a Joint World Health OrganizationCenters for DiseaseControl and Prevention Technical Consultation on the Assessment of Iron Status at the Population Level Geneva Switzerland 6ndash8 April2004 ndash 2nd ed
Congreso Nacional Laboratorio Cliacutenico
2018
Estaacute bien establecido que la anemia produce una miriacuteada de secuelas tanto fiacutesicas comopsicoloacutegicas
Pero los efecto deleteacutereos se deben al deficit de hierro que es un evento previo a que seestablezca la anemia
El deacuteficit de hierrro auacuten sin anemia tiene efectos negativos en el desarrollo cognitivo y fiacutesico
Rattehalli D et al Iron deficiency without anemia do not wait for the Hemoglobin to drop
Health Policy and Technology 2013 2 45-48Congreso Nacio
nal Laboratorio Cliacutenico 2018
SuominenP et al Serum transferrin receptor and transferrin receptor-ferritin index identify healthy subjects with subclinical iron deficits Blood 1998 92 2934ndash9Halwachs-Baumann G Diagnosis of anaemia old things rearranged Wien Med Wochenschr 2012 162478ndash88
Congreso Nacional Laboratorio Cliacutenico
2018
Hemoglobina de reticulocito y su importancia en el diagnoacutestico temprano de anemiaferropeacutenica
Y Maacuterquez-Beniacutetez et al Universidad de BocayaAugust
2018 DOI 1022267rus182003133 aop
El contenido de hemoglobina de reticulocitos (CHr) es un paraacutemetro en la biometriacuteahematoloacutegica automatizada utilizado como un marcador de la biodisponibilidad delhierro en la eritropoyesis
Objetivo Exponer la aplicabilidad de la CHr como un paraacutemetro en el diagnoacutesticoprecoz de la anemia por deficiencia de hierro asiacute como su medicioacuten e interpretacioacuten
Materiales y meacutetodos Se realizoacute la revisioacuten de artiacuteculos cientiacuteficos en ingleacutes y espantildeolen las bases de datos PubMed ScienceDirect LILACS y Medline usando descriptoresvalidados en Medical Subject Headings (MeSH) considerando periodo depublicabilidad del 80 inferior a 5 antildeos
Conclusiones La CHr es un paraacutemetro de gran utilidad en el diagnoacutestico temprano deanemia ferropeacutenica y otras patologiacuteas como deficiencia funcional de hierro estadosde inflamacioacuten croacutenica y enfermedad renal croacutenica
Biomarcador temprano en el diagnoacutestico de deficiencia de hierro antes de presentarsecambios morfoloacutegicos eritrociacuteticosCongreso Nacio
nal Laboratorio Cliacutenico 2018
bull A total of 1105 NES participants (639 men 466 women)bull CHr becomes affected in a relatively early stage in the development of iron deficiency before iron
deficiency anemia and clinical symptoms become apparentbull Therefore this parameter might be useful to identify persons healthy and diseased at risk of
developing iron deficiency anemia and subsequently to apply interventions in order to prevent further development of iron deficiency anemiaCongreso Nacio
nal Laboratorio Cliacutenico 2018
Hb reticulocitaria sensible para detectar la fase inicial del deacuteficit de hierro cuando laeritropoyesis requiere maacutes cantidad que la que recibe ANTES de que la anemia seestablezca
Congreso Nacional Laboratorio Cliacutenico
2018
No ID LID P
RBC 1012L 48 (08) 437 (05) lt00001
Hb gL 135 (6) 131 (12) 0006
MCV fL 922 (21) 902 (38) 0006
MCH pg 324 (07) 306 (22) lt00001
MCHC gL 339 (6) 319 (23) 0001
RDW
Ret He pg
Hypo He
LHD
Ferritin microgL
131 (06)
338 (21)
03 (015)
28 (20)
86 (3)
145 (21)
278 (24)
69 (55)
56 (25)
16 (76)
lt00001
lt00001
lt00001
lt00001
lt00001
AUC 95 CI Cutoff Sensitivity Specificity
LHD 0898 0819-0978 50 859 841
Ret He 0914 0824-1000 299pg 868 857
Hypo He 0934 0856-1000 16 857 921
Clinical value of markers of hypochromia in the detection of latent iron deficiency in non-anemic premenopausal women
No ID Hb gt 120 gL s-ferritin was within reference intervalLatent Iron Defiency Hb gt 120 gL s-ferritin lt 30 μgL
Urrechaga E et al Journal Clin Lab Analysis 2016 30 (5) 623-627
97 women (388) in 250 apparently healthy women had latent IDCongreso Nacional Laboratorio Cliacutenico
2018
Schorer G et al Abstract Jahreskongress der Deutschen Gesellschaft fuumlr Transfusionsmedizin und Immunhaumlmatologie Rostock 15 - 18 September 2009
Congreso Nacional Laboratorio Cliacutenico
2018
Caring for Those Who Share Mitigating Iron Deficiency in Regular Blood DonorsMast Alan E
bull Iron deficiency caused by regular blood donation is a problem facing blood centers Each blood donation removes 200 to 250 mg of iron from the donor Consequently many donors become iron deficient with repeated donation
bull This presents a challenge to blood centers that has become more acute in recent years with the realization that iron deficiency even in the absence of anemia is associated with adverse effects including fatigue and decreased exercise tolerance as well as neurological symptoms such as decreased cognitive function pica and restless leg syndrome
bull REDS-II investigators performed a longitudinal study investigating the iron status of blood donors over a two year period called the REDS-II Donor Iron Status Evaluation (RISE)
bull Results from the baseline analysis of regular donors (e 2 donations per year (females) or e 3 donations per year (males) revealed that over two-thirds of female donors and over one-half of male donors have iron deficiency
Congreso Nacional Laboratorio Cliacutenico
2018
Transfusion 2013 532766-2775
bull We evaluated the diagnostic sensitivity and specificity of red blood cell (RBC) hematology analyzer indices to assess iron status as a part of donor management iron deficient erythropoiesis (IDE) and absence of iron stores (AIS)
bull STUDY DESIGN AND METHODS A total of 1659 male and female donors from the Retrovirus Epidemiology Donor Study-II (REDS-II) Donor Iron Status Evaluation (RISE) study who were either first-timereactivated (FT RA no donations for 2 years) or frequent donors were recruited into a longitudinal study of regular donation of RBCs Of these 1002 donors returned 15 to 24 months later for a final assessment
Absent iron stores (AIS) was defined as plasma ferritin level of less than 12 mgL Logarithm of the ratio of soluble transferrin receptor to ferritin of at least 207 was used to define iron-deficient erythropoiesis (IDE)
bull RESULTS HYPOm and CHr detected IDE with comparable sensitivity 72 versus 69 but differed in specificity HYPOm 68 and CHr 53
For detecting AIS sensitivity was improved to 85 for HYPOm and 81 for CHr but specificity was reduced
Venous Hb had high specificity but poor sensitivity for IDE and AIS A plasma ferritin level of less than 267 mgL was a good surrogate for assessing IDE Congreso Nacio
nal Laboratorio Cliacutenico 2018
Microcytic RBC and reticulocyte mean cell hemoglobin content predicted iron depletion with
sensitivities 70 and 64
specificities of 72 and 78 respectively
When both combined
increased the sensitivity to 82
Congreso Nacional Laboratorio Cliacutenico
2018
Depending on the number of donations during the preceding12 months
Absent iron stores were detected in up to 214 of male and278 of female donors respectively
impaired hemoglobinisation IH was present in up to 64 maleand 167 female donors with 2 and 4 preceding donationsrespectively
The defined CHr cut-off value was 280 pg to detect IH infrequent whole blood donors with AIS leading to a testspecificity of 982 (positive predictive value PPV 577) inmale and of 978 (PPV 829) in female donors
It may help to prevent the development of anemia in frequentblood donors and also can help to decide whether donordeferral or even iron substitution need to be recommended
Congreso Nacional Laboratorio Cliacutenico
2018
Of the 501 blood donors sTfR and Ret-He detected Latent Iron Deficiency in 148 and 135 donors respectively
In comparison to sTfR Ret-He had sensitivity of 927 specificity of 9716 PPV of 931 and NPV of 963
Serum Ferritin TIBC and serum Iron had comparatively lower sensitivity of 8716 797 and 777 respectively
Conclusion Ret-He can be used as a routine screening test to detect LID in blood donors
This could provide an opportunity to make appropriate and timely interventions like dietary changes or drug supplementation
Congreso Nacional Laboratorio Cliacutenico
2018
Singh A Chaudhary R Pandey HC Sonker A Identification of iron status of blood donors by using low hemoglobin density and microcytic anemia factor Asian J Transfus Sci 20181246-50
The main objective of this study was to assess ifLHD and Maf could be used for assessment ofiron status in blood donors and also to establisha cut-off for these two parameters at which atentative iron deficiency could be reportedconclusively
Results LHD and Maf were able to differentiatebetween iron deficient and iron-depleteddonors from normal donorsA cutoff of 918 for LHD was able todifferentiate iron deficient and depleted statefrom normal iron statessensitivity 919 and specificity 71respectivelya cutoff of 1016 for Mafsensitivity 946 and specificity 968
MAf = (MVC Hb) 100
Congreso Nacional Laboratorio Cliacutenico
2018
Hb reticulocitaria sensible para detectar la fase inicial del deacuteficitde hierro cuando la eritropoyesis requiere maacutes cantidad que laque recibe ANTES de que la anemia se establezca
La deteccioacuten precoz del deacuteficit de hierro en la fase del balance negativo demanda aporte contribuye a reducir sus manifestaciones cliacutenicas en los pacientes afectados mejorando la salud puacuteblica
Un tratamiento menos prolongado con suplementos y menor consumo de los recursos sanitaros Contribuye a la eficiencia y sostenibilidad de los servicios sanitarios
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
Buttarello MLaboratory diagnosis of anemia are the old and new red cell parameters useful in classification and treatment howInt Jnl Lab Hem 2016 38 (Suppl 1) 123ndash132
Congreso Nacional Laboratorio Cliacutenico
2018
Buttarello MLaboratory diagnosis of anemia are the old and new red cell parameters useful in classification and treatment howInt Jnl Lab Hem 2016 38 (Suppl 1) 123ndash132
Congreso Nacional Laboratorio Cliacutenico
2018
Ralph Green amp Ananya Datta Mitra Megaloblastic Anemias Nutritional and Other CausesMed Clin N Am 2017 101 297ndash317
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
ANEMIA CARENCIAL CAUSAS
Factores alimentariosConsumir una dieta vegetariana mal planeadaAlimentacioacuten deficiente en los bebeacutesDesnutricioacuten durante el embarazo
Deacuteficit de absorcioacutenAlcoholismo croacutenicoEnfermedad de Crohn celiaquiacutea infeccioacuten otros problemas que le dificulten al cuerpo la digestioacuten de los alimentosAnemia perniciosa (factor intriacutenseco)Cirugiacuteas para extirpar ciertas partes del estoacutemago o el intestino delgado
MedicamentosB12 omeprazol metformina colchicina aminosalicilatos neomicinaFOLATO fenitoiacutena metotrexato sulfasalacina triamtereno pirimetamina trimetoprim con sulfametoxazol barbituacutericos
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
Reacciones metaboacutelicas en las que participan la vitamina B12 y el folato bull la conversioacuten de metilmalonil-CoA a succinil-CoA donde la adenosil-cobalamina actuacutea de
cofactor Por ello un deacuteficit de B12 conlleva un aumento de metilmalonil-CoA y de su producto de hidroacutelisis el aacutecido metilmaloacutenico
bull la siacutentesis de metionina a partir de homocisteina gracias a la metionina sintetasa y a la metil-cobalamina como cofactor En esta misma reaccioacuten el metiltetrahidrofolato es transformado a tetrahidrofolato que es necesario para la siacutentesis de DNA
Congreso Nacional Laboratorio Cliacutenico
2018
Anemia macrociacutetica secundaria a deficiencia de aacutecido foacutelico y de vitamina B12(cobalamina)
La deficiencia de B12 yo aacutecido foacutelico es la causa maacutes frecuente de megaloblastosis
Dentro de distintas funciones generales del metabolismo la vitamina B12 es uncofactor esencial en la siacutentesis de ADN y ARN compromete a todas las ceacutelulas delorganismo
Su deficiencia se manifiesta en oacuterganos con alto recambio celular como la meacutedulaosea y en el sistema nervioso central (SNC) a traveacutes de la siacutentesis de mielina y lareparacioacuten axonal
La deficiencia de cobalamina es responsable de alteraciones hematoloacutegicasneuroloacutegicas neurocognitivas y neuropsiquiaacutetricas
La siacutentesis defectuosa de ADN conduce a la apoptosis y a la hemoacutelisis (intra yextramedular) causantes de la hemopoyesis inefectiva
En meacutedula la siacutentesis ineficiente de DNA causa cambios megaloblaacutesticos comoconsecuencIa anemia y citopenias
Congreso Nacional Laboratorio Cliacutenico
2018
Limitaciones de los meacutetodos diagnoacutesticos claacutesicos
Volumen Corpuscular Medio (VCM) y morfologiacutea de sangre perifeacuterica En una serie de pacientes con deacuteficit de cobalamina soacutelo un 29 teniacutean anemia y soacutelo un 36 teniacutean un VCM gt 100 fL
Un VCM normal no puede ser empleado para rechazar una determinacioacuten de nivel de cobalamina ya que hasta un 25 de casos con manifestaciones neuroloacutegicas cursan con un VCM normal
Cobalamina seacuterica (nivel de B12) Es el test diagnoacutestico rutinario inicial estaacutendar Es un test ampliamente disponible de bajo coste y automatizado Sin embargo presenta algunas limitaciones
-- Existencia de varias teacutecnicas y ausencia de un gold standard por lo que hay diferentes liacutemites de referencia
-- Variacioacuten intraindividual muy alta
La OMS publicoacute en 2008 las conclusiones de un grupo teacutecnico consultado sobre el deacuteficit de cobalamina y folato
El grupo reconocioacute que no existen unos umbrales universalmente reconocidos para definir el deacuteficit de ambas vitaminas y expresaron la necesidad de un consenso
Devalia V Hamilton MS and Molloy AM on behalf of the British Committee for standards in haematology Guidelines for the diagnosis and treatment of cobalamin and folate disorders Br J Haematol 2014 166(4) 496-513
Schrier SL Diagnosis and treatment of vitamin B12 and folate deficiency UpToDate Last updated Jun 25 2014
de Benoist B Conclusions of a WHO Technical Consultation on folate and vitamin B12 deficiencies Food Nutr Bull 200829(2 Suppl)S238ndash44Congreso Nacional Laboratorio Cliacutenico
2018
Tomado de Tefferi A Li C En Atlas of Clinical Hematology Publicado por JO Armitage Philadelphia Current Medicine 2004
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
Int Jnl Lab Hem 2007 29 327ndash334
Clin Lab 201662343-347
In ourstudy mean MCVrMCV ratio of healthy controls is130 as microcytic anemia irondeficiency anemia is121 as also macrocytic anemia vitamin B12 deficiencyanemia is 115
Congreso Nacional Laboratorio Cliacutenico
2018
Sualeh Muslim Khan Muhammad Akbar Agha
Mean cell volume of reticulocytemdashA new parameter for diagnosing sub-clinical cobalamin deficiency in blood donors Int J Lab Hem 20181ndash4
The Abbott CELL-DYN Sapphire Hematology System uses multi-angle polarized scatter separation (MAPSS) and focused flow impedance technologies
Congreso Nacional Laboratorio Cliacutenico
2018
MCVr at 985 fL yielded the highest Youdenrsquos index at sensitivity of 82 specificity of 828 AUC 0847 ( 95 CI 803-891)
Khan SM Agha MA Mean cell volume of reticulocyte-A new parameter for diagnosing sub-clinical cobalamin deficiency in blood donors
Int J Lab Hem 20181ndash4 2018 Jul 13 doi 101111ijlh12899
Congreso Nacional Laboratorio Cliacutenico
2018
Role of Cell Population Data in the detection of folate and cobalamin deficiency
J Nieto et al
XXXI st International Symposium on Technological Innovations in Laboratory Hematology ISLH 2018 10-12 May 2018 Brussels Belgium
M-V-NRET and SD-VNRET are the best discriminatory single parameters to distinguish between patients with B9B12 deficiency and reference subjects M-V-NRETAUC=0823 sensitivity 78 and specificity 86
AUC=0852 sensitivity 55 and specificity 60
Conclusions The CPD parameters of Volume and Light Scatter (M and SD of LALS angle) that inform about size and intracellular structure of RBCs provided very useful information for the detection of B9B12 deficiency
Congreso Nacional Laboratorio Cliacutenico
2018
Cell Population Data
bull Paraacutemetros poblacionales de los leucocitos
bull Describen la morfologiacutea tamantildeo
estructuras citoplasmaacuteticas
nuacutecleo aacutecidos nucleacuteicos
bull Son datos numeacutericos con los que se construyen los ejes de lo diagramas de dispersioacuten de los leucocitos
bull Dependen de la tecnologiacutea
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
High Sensitivity New Parameters for the Detection of Vitamin B12 and Folate Deficiencies Blood 2008 1125379
B12 def vs
Normals
Mann
Withney T-Test
ROC
AUC Sens Specif Cutoff signifROC
MCV p=03156 p=09533 0577
MPV p=00001 0802 792 806 lt83 p=00001
NE Mean
Volume plt00001 0862 833 778 gt1403 p=00001
MO Mean
Volume plt00001 0829 625 889 gt1723 p=00001
MRV p=00113 0705 50 964 gt1133 p=00051
Folate def vs
Normals
Mann
Withney T-Test
ROC
AUC Sens Specif Cut-off signifROC
MCV p=00798 p=06461 0665
MPV plt00001 0832 81 806 lt83 p=00001
NE Mean
Volume p=00008 087 952 694 gt1402 p=00001
MO Mean
Volume p=00002 0801 667 833 gt1696 p=00001
MRV p=00054 0731 476 964 gt1133 p=00019
The Mean Neutrophil Volume (MNE V) and Mean Monocyte Volume (MMOV) may be used for the detection of megaloblastic neutrophils and monocytes MNEV and MMOV have significantly higher sensitivity than the previous information from the red cells (MCV) detecting B12 or folate deficiency because they are not affected by the presence at the same time of Iron deficiency or other reasons of anemia
Congreso Nacional Laboratorio Cliacutenico
2018
POSTER 733
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
CPD Sysmex XN
NE SSC complejidad
NE SFL aacutecidos nucleacuteicos
NE FSC tamantildeo
NE WX
NE WY
NE WZ
MO X
MO Y
MO Z
MO WX
MO WY
MO WZ
LY X
LY Y
LY Z
LY WX
LY WY
LY WZCongreso Nacio
nal Laboratorio Cliacutenico 2018
As MCV is the mean which is calculated it is insensitive to the presence of a small number of macrocytes
Further macrocytosis can be obscured by concomitant disorders that can cause microcytosis resulting inmasked megaloblastic anaemia (MA) for example iron deficiency hereditary elliptocytosis alpha and betathalassemia
This study was undertaken to evaluate the role of NEUT-X and NEUT-Y in detecting MA on peripheral blood andalso see whether other forms of macrocytic anaemia can be differentiated from MA
In MA the peripheral blood smear shows cytopenia with macroovalocytes and hypersegmented
neutrophils (gt5 lobes in 5 neutrophils six lobes nuclei or lobe average of gt35)
In conclusion our study shows that higher values of NEUT-X and NEUT-Y in MA patients in spite of low ornormal MCV high RDW may be used to not only reveal the masked cases of MA with concomitant irondeficiency but also separate them from the broader macrocytic anaemia group
Peripheral smear remains diagnostic however making smear for all the suspicious cases is a cumbersomeand tedious procedure Thus these parameters emerge as more reliable and stable parameters in themodern laboratories which in future may replace the older screening tools
Congreso Nacional Laboratorio Cliacutenico
2018
A favor Eficiencia Operativa
Mejora el proceso del Laboratorio
Mejor informacioacuten al Cliacutenico al mismo coste
Mejora la informacioacuten
Informa sobre la eritropoyesis deteccioacuten precoz de estados carenciales
Ayuda al cliacutenico
Estado real del paciente
En contraParaacutemetros de investigacioacuten
Dificultad de standarizar dependencia teacutecnica
Control de calidadCongreso Nacional Laboratorio Cliacutenico
2018
Histograma RBC el mapa de Mie
28 41
Congreso Nacional Laboratorio Cliacutenico
2018
Abbott Mindray Siemens
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
Severe Iron Deficiency Anemia Female 34 years
19 th March 18 th April
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
SysmexRBCHe erythrocyte Hb equivalentRetHe reticulocyte Hb equivalent(content)
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
MIC
MAC
HPO HPR
Congreso Nacional Laboratorio Cliacutenico
2018
copy 2012 Mindray Confidential 36
MINDRAY MCHrHDWHYPERHYPO
MCHr Mean RET HGB Concentration
HDW HGB Distribution Width
HYPER The percentage of hyperchromicred blood cells
HYPO The percentage of hypochromic red blood cells
Thalassemia screeningIDA treatment monitoringIDA screening
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
Hipocromo
Hipercroacutemico onormocroacutemico
iquestConcentracioacuten o contenido de Hemoglobina
Hipocroacutemiconormocroacutemico
Abbott Mindray Siemens Hypo CONCENTRACIOacuteN Hblt280gL
Sysmex Hypo CONTENIDO Hblt 17 pg
Congreso Nacional Laboratorio Cliacutenico
2018
Low Hb Density
Microcytic Factor Maf = (HbMCV)100
Nuevo moacutedulo transductor muacuteltiple con laacuteser de diodo y dos sensores oacutepticos
Anaacutelisis de hasta 50000 ceacutelulas con 7 paraacutemetros tecnoloacutegicos (leucocitos reticulocitos eritroblastos)
1 Volumen digital
2 Conductividad digital
3 5 aacutengulos de dispersioacuten de luz laacuteser digital
bull MALS (Median Angle Light Scatter)
bull UMALS (Upper Median Angle Light Scatter) 20deg a 43deg
bull LMALS (Lower Median Angle Light Scatter) 09deg a 19deg
bull LALS (Low Angle Light Scatter) asymp 51deg
bull AL2 (Axial Light Loss) 0deg a 05deg
Congreso Nacional Laboratorio Cliacutenico
2018
Hierro es un elemento criacutetico para elfuncionamiento oacuteptimo y supervivenciade las ceacutelulas
Disfuncioacuten mitocondrialActividad enzimaacutetica afectadaProteiacutenas de transporte y estructuralesproteins
Capacidad fiacutesica mermadaCapacidad de trabajo reducidaCapacidades cognitivas afectadasMorbilidad y mortalidad
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
It is generally assumed that worldwide ldquoat least half the anemia is due tonutritional iron deficiencyrdquo and that ldquoup to a prevalence of iron deficiency anemiaof 40 the prevalence of iron deficiency will be about 25 times that of anemiardquoHowever it is evident from the foregoing discussion that there are considerablevariations in both of these ratios depending on the age and sex of the peoplebeing studied the region of the world in which they live and the prevalence ratesof other causes of anemia
WHO Department of Nutrition for Health and DevelopmentAssessing the iron status of populations including literature reviews report of a Joint World Health OrganizationCenters for DiseaseControl and Prevention Technical Consultation on the Assessment of Iron Status at the Population Level Geneva Switzerland 6ndash8 April2004 ndash 2nd ed
Congreso Nacional Laboratorio Cliacutenico
2018
Estaacute bien establecido que la anemia produce una miriacuteada de secuelas tanto fiacutesicas comopsicoloacutegicas
Pero los efecto deleteacutereos se deben al deficit de hierro que es un evento previo a que seestablezca la anemia
El deacuteficit de hierrro auacuten sin anemia tiene efectos negativos en el desarrollo cognitivo y fiacutesico
Rattehalli D et al Iron deficiency without anemia do not wait for the Hemoglobin to drop
Health Policy and Technology 2013 2 45-48Congreso Nacio
nal Laboratorio Cliacutenico 2018
SuominenP et al Serum transferrin receptor and transferrin receptor-ferritin index identify healthy subjects with subclinical iron deficits Blood 1998 92 2934ndash9Halwachs-Baumann G Diagnosis of anaemia old things rearranged Wien Med Wochenschr 2012 162478ndash88
Congreso Nacional Laboratorio Cliacutenico
2018
Hemoglobina de reticulocito y su importancia en el diagnoacutestico temprano de anemiaferropeacutenica
Y Maacuterquez-Beniacutetez et al Universidad de BocayaAugust
2018 DOI 1022267rus182003133 aop
El contenido de hemoglobina de reticulocitos (CHr) es un paraacutemetro en la biometriacuteahematoloacutegica automatizada utilizado como un marcador de la biodisponibilidad delhierro en la eritropoyesis
Objetivo Exponer la aplicabilidad de la CHr como un paraacutemetro en el diagnoacutesticoprecoz de la anemia por deficiencia de hierro asiacute como su medicioacuten e interpretacioacuten
Materiales y meacutetodos Se realizoacute la revisioacuten de artiacuteculos cientiacuteficos en ingleacutes y espantildeolen las bases de datos PubMed ScienceDirect LILACS y Medline usando descriptoresvalidados en Medical Subject Headings (MeSH) considerando periodo depublicabilidad del 80 inferior a 5 antildeos
Conclusiones La CHr es un paraacutemetro de gran utilidad en el diagnoacutestico temprano deanemia ferropeacutenica y otras patologiacuteas como deficiencia funcional de hierro estadosde inflamacioacuten croacutenica y enfermedad renal croacutenica
Biomarcador temprano en el diagnoacutestico de deficiencia de hierro antes de presentarsecambios morfoloacutegicos eritrociacuteticosCongreso Nacio
nal Laboratorio Cliacutenico 2018
bull A total of 1105 NES participants (639 men 466 women)bull CHr becomes affected in a relatively early stage in the development of iron deficiency before iron
deficiency anemia and clinical symptoms become apparentbull Therefore this parameter might be useful to identify persons healthy and diseased at risk of
developing iron deficiency anemia and subsequently to apply interventions in order to prevent further development of iron deficiency anemiaCongreso Nacio
nal Laboratorio Cliacutenico 2018
Hb reticulocitaria sensible para detectar la fase inicial del deacuteficit de hierro cuando laeritropoyesis requiere maacutes cantidad que la que recibe ANTES de que la anemia seestablezca
Congreso Nacional Laboratorio Cliacutenico
2018
No ID LID P
RBC 1012L 48 (08) 437 (05) lt00001
Hb gL 135 (6) 131 (12) 0006
MCV fL 922 (21) 902 (38) 0006
MCH pg 324 (07) 306 (22) lt00001
MCHC gL 339 (6) 319 (23) 0001
RDW
Ret He pg
Hypo He
LHD
Ferritin microgL
131 (06)
338 (21)
03 (015)
28 (20)
86 (3)
145 (21)
278 (24)
69 (55)
56 (25)
16 (76)
lt00001
lt00001
lt00001
lt00001
lt00001
AUC 95 CI Cutoff Sensitivity Specificity
LHD 0898 0819-0978 50 859 841
Ret He 0914 0824-1000 299pg 868 857
Hypo He 0934 0856-1000 16 857 921
Clinical value of markers of hypochromia in the detection of latent iron deficiency in non-anemic premenopausal women
No ID Hb gt 120 gL s-ferritin was within reference intervalLatent Iron Defiency Hb gt 120 gL s-ferritin lt 30 μgL
Urrechaga E et al Journal Clin Lab Analysis 2016 30 (5) 623-627
97 women (388) in 250 apparently healthy women had latent IDCongreso Nacional Laboratorio Cliacutenico
2018
Schorer G et al Abstract Jahreskongress der Deutschen Gesellschaft fuumlr Transfusionsmedizin und Immunhaumlmatologie Rostock 15 - 18 September 2009
Congreso Nacional Laboratorio Cliacutenico
2018
Caring for Those Who Share Mitigating Iron Deficiency in Regular Blood DonorsMast Alan E
bull Iron deficiency caused by regular blood donation is a problem facing blood centers Each blood donation removes 200 to 250 mg of iron from the donor Consequently many donors become iron deficient with repeated donation
bull This presents a challenge to blood centers that has become more acute in recent years with the realization that iron deficiency even in the absence of anemia is associated with adverse effects including fatigue and decreased exercise tolerance as well as neurological symptoms such as decreased cognitive function pica and restless leg syndrome
bull REDS-II investigators performed a longitudinal study investigating the iron status of blood donors over a two year period called the REDS-II Donor Iron Status Evaluation (RISE)
bull Results from the baseline analysis of regular donors (e 2 donations per year (females) or e 3 donations per year (males) revealed that over two-thirds of female donors and over one-half of male donors have iron deficiency
Congreso Nacional Laboratorio Cliacutenico
2018
Transfusion 2013 532766-2775
bull We evaluated the diagnostic sensitivity and specificity of red blood cell (RBC) hematology analyzer indices to assess iron status as a part of donor management iron deficient erythropoiesis (IDE) and absence of iron stores (AIS)
bull STUDY DESIGN AND METHODS A total of 1659 male and female donors from the Retrovirus Epidemiology Donor Study-II (REDS-II) Donor Iron Status Evaluation (RISE) study who were either first-timereactivated (FT RA no donations for 2 years) or frequent donors were recruited into a longitudinal study of regular donation of RBCs Of these 1002 donors returned 15 to 24 months later for a final assessment
Absent iron stores (AIS) was defined as plasma ferritin level of less than 12 mgL Logarithm of the ratio of soluble transferrin receptor to ferritin of at least 207 was used to define iron-deficient erythropoiesis (IDE)
bull RESULTS HYPOm and CHr detected IDE with comparable sensitivity 72 versus 69 but differed in specificity HYPOm 68 and CHr 53
For detecting AIS sensitivity was improved to 85 for HYPOm and 81 for CHr but specificity was reduced
Venous Hb had high specificity but poor sensitivity for IDE and AIS A plasma ferritin level of less than 267 mgL was a good surrogate for assessing IDE Congreso Nacio
nal Laboratorio Cliacutenico 2018
Microcytic RBC and reticulocyte mean cell hemoglobin content predicted iron depletion with
sensitivities 70 and 64
specificities of 72 and 78 respectively
When both combined
increased the sensitivity to 82
Congreso Nacional Laboratorio Cliacutenico
2018
Depending on the number of donations during the preceding12 months
Absent iron stores were detected in up to 214 of male and278 of female donors respectively
impaired hemoglobinisation IH was present in up to 64 maleand 167 female donors with 2 and 4 preceding donationsrespectively
The defined CHr cut-off value was 280 pg to detect IH infrequent whole blood donors with AIS leading to a testspecificity of 982 (positive predictive value PPV 577) inmale and of 978 (PPV 829) in female donors
It may help to prevent the development of anemia in frequentblood donors and also can help to decide whether donordeferral or even iron substitution need to be recommended
Congreso Nacional Laboratorio Cliacutenico
2018
Of the 501 blood donors sTfR and Ret-He detected Latent Iron Deficiency in 148 and 135 donors respectively
In comparison to sTfR Ret-He had sensitivity of 927 specificity of 9716 PPV of 931 and NPV of 963
Serum Ferritin TIBC and serum Iron had comparatively lower sensitivity of 8716 797 and 777 respectively
Conclusion Ret-He can be used as a routine screening test to detect LID in blood donors
This could provide an opportunity to make appropriate and timely interventions like dietary changes or drug supplementation
Congreso Nacional Laboratorio Cliacutenico
2018
Singh A Chaudhary R Pandey HC Sonker A Identification of iron status of blood donors by using low hemoglobin density and microcytic anemia factor Asian J Transfus Sci 20181246-50
The main objective of this study was to assess ifLHD and Maf could be used for assessment ofiron status in blood donors and also to establisha cut-off for these two parameters at which atentative iron deficiency could be reportedconclusively
Results LHD and Maf were able to differentiatebetween iron deficient and iron-depleteddonors from normal donorsA cutoff of 918 for LHD was able todifferentiate iron deficient and depleted statefrom normal iron statessensitivity 919 and specificity 71respectivelya cutoff of 1016 for Mafsensitivity 946 and specificity 968
MAf = (MVC Hb) 100
Congreso Nacional Laboratorio Cliacutenico
2018
Hb reticulocitaria sensible para detectar la fase inicial del deacuteficitde hierro cuando la eritropoyesis requiere maacutes cantidad que laque recibe ANTES de que la anemia se establezca
La deteccioacuten precoz del deacuteficit de hierro en la fase del balance negativo demanda aporte contribuye a reducir sus manifestaciones cliacutenicas en los pacientes afectados mejorando la salud puacuteblica
Un tratamiento menos prolongado con suplementos y menor consumo de los recursos sanitaros Contribuye a la eficiencia y sostenibilidad de los servicios sanitarios
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
Buttarello MLaboratory diagnosis of anemia are the old and new red cell parameters useful in classification and treatment howInt Jnl Lab Hem 2016 38 (Suppl 1) 123ndash132
Congreso Nacional Laboratorio Cliacutenico
2018
Buttarello MLaboratory diagnosis of anemia are the old and new red cell parameters useful in classification and treatment howInt Jnl Lab Hem 2016 38 (Suppl 1) 123ndash132
Congreso Nacional Laboratorio Cliacutenico
2018
Ralph Green amp Ananya Datta Mitra Megaloblastic Anemias Nutritional and Other CausesMed Clin N Am 2017 101 297ndash317
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
ANEMIA CARENCIAL CAUSAS
Factores alimentariosConsumir una dieta vegetariana mal planeadaAlimentacioacuten deficiente en los bebeacutesDesnutricioacuten durante el embarazo
Deacuteficit de absorcioacutenAlcoholismo croacutenicoEnfermedad de Crohn celiaquiacutea infeccioacuten otros problemas que le dificulten al cuerpo la digestioacuten de los alimentosAnemia perniciosa (factor intriacutenseco)Cirugiacuteas para extirpar ciertas partes del estoacutemago o el intestino delgado
MedicamentosB12 omeprazol metformina colchicina aminosalicilatos neomicinaFOLATO fenitoiacutena metotrexato sulfasalacina triamtereno pirimetamina trimetoprim con sulfametoxazol barbituacutericos
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
Reacciones metaboacutelicas en las que participan la vitamina B12 y el folato bull la conversioacuten de metilmalonil-CoA a succinil-CoA donde la adenosil-cobalamina actuacutea de
cofactor Por ello un deacuteficit de B12 conlleva un aumento de metilmalonil-CoA y de su producto de hidroacutelisis el aacutecido metilmaloacutenico
bull la siacutentesis de metionina a partir de homocisteina gracias a la metionina sintetasa y a la metil-cobalamina como cofactor En esta misma reaccioacuten el metiltetrahidrofolato es transformado a tetrahidrofolato que es necesario para la siacutentesis de DNA
Congreso Nacional Laboratorio Cliacutenico
2018
Anemia macrociacutetica secundaria a deficiencia de aacutecido foacutelico y de vitamina B12(cobalamina)
La deficiencia de B12 yo aacutecido foacutelico es la causa maacutes frecuente de megaloblastosis
Dentro de distintas funciones generales del metabolismo la vitamina B12 es uncofactor esencial en la siacutentesis de ADN y ARN compromete a todas las ceacutelulas delorganismo
Su deficiencia se manifiesta en oacuterganos con alto recambio celular como la meacutedulaosea y en el sistema nervioso central (SNC) a traveacutes de la siacutentesis de mielina y lareparacioacuten axonal
La deficiencia de cobalamina es responsable de alteraciones hematoloacutegicasneuroloacutegicas neurocognitivas y neuropsiquiaacutetricas
La siacutentesis defectuosa de ADN conduce a la apoptosis y a la hemoacutelisis (intra yextramedular) causantes de la hemopoyesis inefectiva
En meacutedula la siacutentesis ineficiente de DNA causa cambios megaloblaacutesticos comoconsecuencIa anemia y citopenias
Congreso Nacional Laboratorio Cliacutenico
2018
Limitaciones de los meacutetodos diagnoacutesticos claacutesicos
Volumen Corpuscular Medio (VCM) y morfologiacutea de sangre perifeacuterica En una serie de pacientes con deacuteficit de cobalamina soacutelo un 29 teniacutean anemia y soacutelo un 36 teniacutean un VCM gt 100 fL
Un VCM normal no puede ser empleado para rechazar una determinacioacuten de nivel de cobalamina ya que hasta un 25 de casos con manifestaciones neuroloacutegicas cursan con un VCM normal
Cobalamina seacuterica (nivel de B12) Es el test diagnoacutestico rutinario inicial estaacutendar Es un test ampliamente disponible de bajo coste y automatizado Sin embargo presenta algunas limitaciones
-- Existencia de varias teacutecnicas y ausencia de un gold standard por lo que hay diferentes liacutemites de referencia
-- Variacioacuten intraindividual muy alta
La OMS publicoacute en 2008 las conclusiones de un grupo teacutecnico consultado sobre el deacuteficit de cobalamina y folato
El grupo reconocioacute que no existen unos umbrales universalmente reconocidos para definir el deacuteficit de ambas vitaminas y expresaron la necesidad de un consenso
Devalia V Hamilton MS and Molloy AM on behalf of the British Committee for standards in haematology Guidelines for the diagnosis and treatment of cobalamin and folate disorders Br J Haematol 2014 166(4) 496-513
Schrier SL Diagnosis and treatment of vitamin B12 and folate deficiency UpToDate Last updated Jun 25 2014
de Benoist B Conclusions of a WHO Technical Consultation on folate and vitamin B12 deficiencies Food Nutr Bull 200829(2 Suppl)S238ndash44Congreso Nacional Laboratorio Cliacutenico
2018
Tomado de Tefferi A Li C En Atlas of Clinical Hematology Publicado por JO Armitage Philadelphia Current Medicine 2004
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
Int Jnl Lab Hem 2007 29 327ndash334
Clin Lab 201662343-347
In ourstudy mean MCVrMCV ratio of healthy controls is130 as microcytic anemia irondeficiency anemia is121 as also macrocytic anemia vitamin B12 deficiencyanemia is 115
Congreso Nacional Laboratorio Cliacutenico
2018
Sualeh Muslim Khan Muhammad Akbar Agha
Mean cell volume of reticulocytemdashA new parameter for diagnosing sub-clinical cobalamin deficiency in blood donors Int J Lab Hem 20181ndash4
The Abbott CELL-DYN Sapphire Hematology System uses multi-angle polarized scatter separation (MAPSS) and focused flow impedance technologies
Congreso Nacional Laboratorio Cliacutenico
2018
MCVr at 985 fL yielded the highest Youdenrsquos index at sensitivity of 82 specificity of 828 AUC 0847 ( 95 CI 803-891)
Khan SM Agha MA Mean cell volume of reticulocyte-A new parameter for diagnosing sub-clinical cobalamin deficiency in blood donors
Int J Lab Hem 20181ndash4 2018 Jul 13 doi 101111ijlh12899
Congreso Nacional Laboratorio Cliacutenico
2018
Role of Cell Population Data in the detection of folate and cobalamin deficiency
J Nieto et al
XXXI st International Symposium on Technological Innovations in Laboratory Hematology ISLH 2018 10-12 May 2018 Brussels Belgium
M-V-NRET and SD-VNRET are the best discriminatory single parameters to distinguish between patients with B9B12 deficiency and reference subjects M-V-NRETAUC=0823 sensitivity 78 and specificity 86
AUC=0852 sensitivity 55 and specificity 60
Conclusions The CPD parameters of Volume and Light Scatter (M and SD of LALS angle) that inform about size and intracellular structure of RBCs provided very useful information for the detection of B9B12 deficiency
Congreso Nacional Laboratorio Cliacutenico
2018
Cell Population Data
bull Paraacutemetros poblacionales de los leucocitos
bull Describen la morfologiacutea tamantildeo
estructuras citoplasmaacuteticas
nuacutecleo aacutecidos nucleacuteicos
bull Son datos numeacutericos con los que se construyen los ejes de lo diagramas de dispersioacuten de los leucocitos
bull Dependen de la tecnologiacutea
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
High Sensitivity New Parameters for the Detection of Vitamin B12 and Folate Deficiencies Blood 2008 1125379
B12 def vs
Normals
Mann
Withney T-Test
ROC
AUC Sens Specif Cutoff signifROC
MCV p=03156 p=09533 0577
MPV p=00001 0802 792 806 lt83 p=00001
NE Mean
Volume plt00001 0862 833 778 gt1403 p=00001
MO Mean
Volume plt00001 0829 625 889 gt1723 p=00001
MRV p=00113 0705 50 964 gt1133 p=00051
Folate def vs
Normals
Mann
Withney T-Test
ROC
AUC Sens Specif Cut-off signifROC
MCV p=00798 p=06461 0665
MPV plt00001 0832 81 806 lt83 p=00001
NE Mean
Volume p=00008 087 952 694 gt1402 p=00001
MO Mean
Volume p=00002 0801 667 833 gt1696 p=00001
MRV p=00054 0731 476 964 gt1133 p=00019
The Mean Neutrophil Volume (MNE V) and Mean Monocyte Volume (MMOV) may be used for the detection of megaloblastic neutrophils and monocytes MNEV and MMOV have significantly higher sensitivity than the previous information from the red cells (MCV) detecting B12 or folate deficiency because they are not affected by the presence at the same time of Iron deficiency or other reasons of anemia
Congreso Nacional Laboratorio Cliacutenico
2018
POSTER 733
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
CPD Sysmex XN
NE SSC complejidad
NE SFL aacutecidos nucleacuteicos
NE FSC tamantildeo
NE WX
NE WY
NE WZ
MO X
MO Y
MO Z
MO WX
MO WY
MO WZ
LY X
LY Y
LY Z
LY WX
LY WY
LY WZCongreso Nacio
nal Laboratorio Cliacutenico 2018
As MCV is the mean which is calculated it is insensitive to the presence of a small number of macrocytes
Further macrocytosis can be obscured by concomitant disorders that can cause microcytosis resulting inmasked megaloblastic anaemia (MA) for example iron deficiency hereditary elliptocytosis alpha and betathalassemia
This study was undertaken to evaluate the role of NEUT-X and NEUT-Y in detecting MA on peripheral blood andalso see whether other forms of macrocytic anaemia can be differentiated from MA
In MA the peripheral blood smear shows cytopenia with macroovalocytes and hypersegmented
neutrophils (gt5 lobes in 5 neutrophils six lobes nuclei or lobe average of gt35)
In conclusion our study shows that higher values of NEUT-X and NEUT-Y in MA patients in spite of low ornormal MCV high RDW may be used to not only reveal the masked cases of MA with concomitant irondeficiency but also separate them from the broader macrocytic anaemia group
Peripheral smear remains diagnostic however making smear for all the suspicious cases is a cumbersomeand tedious procedure Thus these parameters emerge as more reliable and stable parameters in themodern laboratories which in future may replace the older screening tools
Congreso Nacional Laboratorio Cliacutenico
2018
A favor Eficiencia Operativa
Mejora el proceso del Laboratorio
Mejor informacioacuten al Cliacutenico al mismo coste
Mejora la informacioacuten
Informa sobre la eritropoyesis deteccioacuten precoz de estados carenciales
Ayuda al cliacutenico
Estado real del paciente
En contraParaacutemetros de investigacioacuten
Dificultad de standarizar dependencia teacutecnica
Control de calidadCongreso Nacional Laboratorio Cliacutenico
2018
Abbott Mindray Siemens
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
Severe Iron Deficiency Anemia Female 34 years
19 th March 18 th April
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
SysmexRBCHe erythrocyte Hb equivalentRetHe reticulocyte Hb equivalent(content)
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
MIC
MAC
HPO HPR
Congreso Nacional Laboratorio Cliacutenico
2018
copy 2012 Mindray Confidential 36
MINDRAY MCHrHDWHYPERHYPO
MCHr Mean RET HGB Concentration
HDW HGB Distribution Width
HYPER The percentage of hyperchromicred blood cells
HYPO The percentage of hypochromic red blood cells
Thalassemia screeningIDA treatment monitoringIDA screening
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
Hipocromo
Hipercroacutemico onormocroacutemico
iquestConcentracioacuten o contenido de Hemoglobina
Hipocroacutemiconormocroacutemico
Abbott Mindray Siemens Hypo CONCENTRACIOacuteN Hblt280gL
Sysmex Hypo CONTENIDO Hblt 17 pg
Congreso Nacional Laboratorio Cliacutenico
2018
Low Hb Density
Microcytic Factor Maf = (HbMCV)100
Nuevo moacutedulo transductor muacuteltiple con laacuteser de diodo y dos sensores oacutepticos
Anaacutelisis de hasta 50000 ceacutelulas con 7 paraacutemetros tecnoloacutegicos (leucocitos reticulocitos eritroblastos)
1 Volumen digital
2 Conductividad digital
3 5 aacutengulos de dispersioacuten de luz laacuteser digital
bull MALS (Median Angle Light Scatter)
bull UMALS (Upper Median Angle Light Scatter) 20deg a 43deg
bull LMALS (Lower Median Angle Light Scatter) 09deg a 19deg
bull LALS (Low Angle Light Scatter) asymp 51deg
bull AL2 (Axial Light Loss) 0deg a 05deg
Congreso Nacional Laboratorio Cliacutenico
2018
Hierro es un elemento criacutetico para elfuncionamiento oacuteptimo y supervivenciade las ceacutelulas
Disfuncioacuten mitocondrialActividad enzimaacutetica afectadaProteiacutenas de transporte y estructuralesproteins
Capacidad fiacutesica mermadaCapacidad de trabajo reducidaCapacidades cognitivas afectadasMorbilidad y mortalidad
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
It is generally assumed that worldwide ldquoat least half the anemia is due tonutritional iron deficiencyrdquo and that ldquoup to a prevalence of iron deficiency anemiaof 40 the prevalence of iron deficiency will be about 25 times that of anemiardquoHowever it is evident from the foregoing discussion that there are considerablevariations in both of these ratios depending on the age and sex of the peoplebeing studied the region of the world in which they live and the prevalence ratesof other causes of anemia
WHO Department of Nutrition for Health and DevelopmentAssessing the iron status of populations including literature reviews report of a Joint World Health OrganizationCenters for DiseaseControl and Prevention Technical Consultation on the Assessment of Iron Status at the Population Level Geneva Switzerland 6ndash8 April2004 ndash 2nd ed
Congreso Nacional Laboratorio Cliacutenico
2018
Estaacute bien establecido que la anemia produce una miriacuteada de secuelas tanto fiacutesicas comopsicoloacutegicas
Pero los efecto deleteacutereos se deben al deficit de hierro que es un evento previo a que seestablezca la anemia
El deacuteficit de hierrro auacuten sin anemia tiene efectos negativos en el desarrollo cognitivo y fiacutesico
Rattehalli D et al Iron deficiency without anemia do not wait for the Hemoglobin to drop
Health Policy and Technology 2013 2 45-48Congreso Nacio
nal Laboratorio Cliacutenico 2018
SuominenP et al Serum transferrin receptor and transferrin receptor-ferritin index identify healthy subjects with subclinical iron deficits Blood 1998 92 2934ndash9Halwachs-Baumann G Diagnosis of anaemia old things rearranged Wien Med Wochenschr 2012 162478ndash88
Congreso Nacional Laboratorio Cliacutenico
2018
Hemoglobina de reticulocito y su importancia en el diagnoacutestico temprano de anemiaferropeacutenica
Y Maacuterquez-Beniacutetez et al Universidad de BocayaAugust
2018 DOI 1022267rus182003133 aop
El contenido de hemoglobina de reticulocitos (CHr) es un paraacutemetro en la biometriacuteahematoloacutegica automatizada utilizado como un marcador de la biodisponibilidad delhierro en la eritropoyesis
Objetivo Exponer la aplicabilidad de la CHr como un paraacutemetro en el diagnoacutesticoprecoz de la anemia por deficiencia de hierro asiacute como su medicioacuten e interpretacioacuten
Materiales y meacutetodos Se realizoacute la revisioacuten de artiacuteculos cientiacuteficos en ingleacutes y espantildeolen las bases de datos PubMed ScienceDirect LILACS y Medline usando descriptoresvalidados en Medical Subject Headings (MeSH) considerando periodo depublicabilidad del 80 inferior a 5 antildeos
Conclusiones La CHr es un paraacutemetro de gran utilidad en el diagnoacutestico temprano deanemia ferropeacutenica y otras patologiacuteas como deficiencia funcional de hierro estadosde inflamacioacuten croacutenica y enfermedad renal croacutenica
Biomarcador temprano en el diagnoacutestico de deficiencia de hierro antes de presentarsecambios morfoloacutegicos eritrociacuteticosCongreso Nacio
nal Laboratorio Cliacutenico 2018
bull A total of 1105 NES participants (639 men 466 women)bull CHr becomes affected in a relatively early stage in the development of iron deficiency before iron
deficiency anemia and clinical symptoms become apparentbull Therefore this parameter might be useful to identify persons healthy and diseased at risk of
developing iron deficiency anemia and subsequently to apply interventions in order to prevent further development of iron deficiency anemiaCongreso Nacio
nal Laboratorio Cliacutenico 2018
Hb reticulocitaria sensible para detectar la fase inicial del deacuteficit de hierro cuando laeritropoyesis requiere maacutes cantidad que la que recibe ANTES de que la anemia seestablezca
Congreso Nacional Laboratorio Cliacutenico
2018
No ID LID P
RBC 1012L 48 (08) 437 (05) lt00001
Hb gL 135 (6) 131 (12) 0006
MCV fL 922 (21) 902 (38) 0006
MCH pg 324 (07) 306 (22) lt00001
MCHC gL 339 (6) 319 (23) 0001
RDW
Ret He pg
Hypo He
LHD
Ferritin microgL
131 (06)
338 (21)
03 (015)
28 (20)
86 (3)
145 (21)
278 (24)
69 (55)
56 (25)
16 (76)
lt00001
lt00001
lt00001
lt00001
lt00001
AUC 95 CI Cutoff Sensitivity Specificity
LHD 0898 0819-0978 50 859 841
Ret He 0914 0824-1000 299pg 868 857
Hypo He 0934 0856-1000 16 857 921
Clinical value of markers of hypochromia in the detection of latent iron deficiency in non-anemic premenopausal women
No ID Hb gt 120 gL s-ferritin was within reference intervalLatent Iron Defiency Hb gt 120 gL s-ferritin lt 30 μgL
Urrechaga E et al Journal Clin Lab Analysis 2016 30 (5) 623-627
97 women (388) in 250 apparently healthy women had latent IDCongreso Nacional Laboratorio Cliacutenico
2018
Schorer G et al Abstract Jahreskongress der Deutschen Gesellschaft fuumlr Transfusionsmedizin und Immunhaumlmatologie Rostock 15 - 18 September 2009
Congreso Nacional Laboratorio Cliacutenico
2018
Caring for Those Who Share Mitigating Iron Deficiency in Regular Blood DonorsMast Alan E
bull Iron deficiency caused by regular blood donation is a problem facing blood centers Each blood donation removes 200 to 250 mg of iron from the donor Consequently many donors become iron deficient with repeated donation
bull This presents a challenge to blood centers that has become more acute in recent years with the realization that iron deficiency even in the absence of anemia is associated with adverse effects including fatigue and decreased exercise tolerance as well as neurological symptoms such as decreased cognitive function pica and restless leg syndrome
bull REDS-II investigators performed a longitudinal study investigating the iron status of blood donors over a two year period called the REDS-II Donor Iron Status Evaluation (RISE)
bull Results from the baseline analysis of regular donors (e 2 donations per year (females) or e 3 donations per year (males) revealed that over two-thirds of female donors and over one-half of male donors have iron deficiency
Congreso Nacional Laboratorio Cliacutenico
2018
Transfusion 2013 532766-2775
bull We evaluated the diagnostic sensitivity and specificity of red blood cell (RBC) hematology analyzer indices to assess iron status as a part of donor management iron deficient erythropoiesis (IDE) and absence of iron stores (AIS)
bull STUDY DESIGN AND METHODS A total of 1659 male and female donors from the Retrovirus Epidemiology Donor Study-II (REDS-II) Donor Iron Status Evaluation (RISE) study who were either first-timereactivated (FT RA no donations for 2 years) or frequent donors were recruited into a longitudinal study of regular donation of RBCs Of these 1002 donors returned 15 to 24 months later for a final assessment
Absent iron stores (AIS) was defined as plasma ferritin level of less than 12 mgL Logarithm of the ratio of soluble transferrin receptor to ferritin of at least 207 was used to define iron-deficient erythropoiesis (IDE)
bull RESULTS HYPOm and CHr detected IDE with comparable sensitivity 72 versus 69 but differed in specificity HYPOm 68 and CHr 53
For detecting AIS sensitivity was improved to 85 for HYPOm and 81 for CHr but specificity was reduced
Venous Hb had high specificity but poor sensitivity for IDE and AIS A plasma ferritin level of less than 267 mgL was a good surrogate for assessing IDE Congreso Nacio
nal Laboratorio Cliacutenico 2018
Microcytic RBC and reticulocyte mean cell hemoglobin content predicted iron depletion with
sensitivities 70 and 64
specificities of 72 and 78 respectively
When both combined
increased the sensitivity to 82
Congreso Nacional Laboratorio Cliacutenico
2018
Depending on the number of donations during the preceding12 months
Absent iron stores were detected in up to 214 of male and278 of female donors respectively
impaired hemoglobinisation IH was present in up to 64 maleand 167 female donors with 2 and 4 preceding donationsrespectively
The defined CHr cut-off value was 280 pg to detect IH infrequent whole blood donors with AIS leading to a testspecificity of 982 (positive predictive value PPV 577) inmale and of 978 (PPV 829) in female donors
It may help to prevent the development of anemia in frequentblood donors and also can help to decide whether donordeferral or even iron substitution need to be recommended
Congreso Nacional Laboratorio Cliacutenico
2018
Of the 501 blood donors sTfR and Ret-He detected Latent Iron Deficiency in 148 and 135 donors respectively
In comparison to sTfR Ret-He had sensitivity of 927 specificity of 9716 PPV of 931 and NPV of 963
Serum Ferritin TIBC and serum Iron had comparatively lower sensitivity of 8716 797 and 777 respectively
Conclusion Ret-He can be used as a routine screening test to detect LID in blood donors
This could provide an opportunity to make appropriate and timely interventions like dietary changes or drug supplementation
Congreso Nacional Laboratorio Cliacutenico
2018
Singh A Chaudhary R Pandey HC Sonker A Identification of iron status of blood donors by using low hemoglobin density and microcytic anemia factor Asian J Transfus Sci 20181246-50
The main objective of this study was to assess ifLHD and Maf could be used for assessment ofiron status in blood donors and also to establisha cut-off for these two parameters at which atentative iron deficiency could be reportedconclusively
Results LHD and Maf were able to differentiatebetween iron deficient and iron-depleteddonors from normal donorsA cutoff of 918 for LHD was able todifferentiate iron deficient and depleted statefrom normal iron statessensitivity 919 and specificity 71respectivelya cutoff of 1016 for Mafsensitivity 946 and specificity 968
MAf = (MVC Hb) 100
Congreso Nacional Laboratorio Cliacutenico
2018
Hb reticulocitaria sensible para detectar la fase inicial del deacuteficitde hierro cuando la eritropoyesis requiere maacutes cantidad que laque recibe ANTES de que la anemia se establezca
La deteccioacuten precoz del deacuteficit de hierro en la fase del balance negativo demanda aporte contribuye a reducir sus manifestaciones cliacutenicas en los pacientes afectados mejorando la salud puacuteblica
Un tratamiento menos prolongado con suplementos y menor consumo de los recursos sanitaros Contribuye a la eficiencia y sostenibilidad de los servicios sanitarios
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
Buttarello MLaboratory diagnosis of anemia are the old and new red cell parameters useful in classification and treatment howInt Jnl Lab Hem 2016 38 (Suppl 1) 123ndash132
Congreso Nacional Laboratorio Cliacutenico
2018
Buttarello MLaboratory diagnosis of anemia are the old and new red cell parameters useful in classification and treatment howInt Jnl Lab Hem 2016 38 (Suppl 1) 123ndash132
Congreso Nacional Laboratorio Cliacutenico
2018
Ralph Green amp Ananya Datta Mitra Megaloblastic Anemias Nutritional and Other CausesMed Clin N Am 2017 101 297ndash317
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
ANEMIA CARENCIAL CAUSAS
Factores alimentariosConsumir una dieta vegetariana mal planeadaAlimentacioacuten deficiente en los bebeacutesDesnutricioacuten durante el embarazo
Deacuteficit de absorcioacutenAlcoholismo croacutenicoEnfermedad de Crohn celiaquiacutea infeccioacuten otros problemas que le dificulten al cuerpo la digestioacuten de los alimentosAnemia perniciosa (factor intriacutenseco)Cirugiacuteas para extirpar ciertas partes del estoacutemago o el intestino delgado
MedicamentosB12 omeprazol metformina colchicina aminosalicilatos neomicinaFOLATO fenitoiacutena metotrexato sulfasalacina triamtereno pirimetamina trimetoprim con sulfametoxazol barbituacutericos
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
Reacciones metaboacutelicas en las que participan la vitamina B12 y el folato bull la conversioacuten de metilmalonil-CoA a succinil-CoA donde la adenosil-cobalamina actuacutea de
cofactor Por ello un deacuteficit de B12 conlleva un aumento de metilmalonil-CoA y de su producto de hidroacutelisis el aacutecido metilmaloacutenico
bull la siacutentesis de metionina a partir de homocisteina gracias a la metionina sintetasa y a la metil-cobalamina como cofactor En esta misma reaccioacuten el metiltetrahidrofolato es transformado a tetrahidrofolato que es necesario para la siacutentesis de DNA
Congreso Nacional Laboratorio Cliacutenico
2018
Anemia macrociacutetica secundaria a deficiencia de aacutecido foacutelico y de vitamina B12(cobalamina)
La deficiencia de B12 yo aacutecido foacutelico es la causa maacutes frecuente de megaloblastosis
Dentro de distintas funciones generales del metabolismo la vitamina B12 es uncofactor esencial en la siacutentesis de ADN y ARN compromete a todas las ceacutelulas delorganismo
Su deficiencia se manifiesta en oacuterganos con alto recambio celular como la meacutedulaosea y en el sistema nervioso central (SNC) a traveacutes de la siacutentesis de mielina y lareparacioacuten axonal
La deficiencia de cobalamina es responsable de alteraciones hematoloacutegicasneuroloacutegicas neurocognitivas y neuropsiquiaacutetricas
La siacutentesis defectuosa de ADN conduce a la apoptosis y a la hemoacutelisis (intra yextramedular) causantes de la hemopoyesis inefectiva
En meacutedula la siacutentesis ineficiente de DNA causa cambios megaloblaacutesticos comoconsecuencIa anemia y citopenias
Congreso Nacional Laboratorio Cliacutenico
2018
Limitaciones de los meacutetodos diagnoacutesticos claacutesicos
Volumen Corpuscular Medio (VCM) y morfologiacutea de sangre perifeacuterica En una serie de pacientes con deacuteficit de cobalamina soacutelo un 29 teniacutean anemia y soacutelo un 36 teniacutean un VCM gt 100 fL
Un VCM normal no puede ser empleado para rechazar una determinacioacuten de nivel de cobalamina ya que hasta un 25 de casos con manifestaciones neuroloacutegicas cursan con un VCM normal
Cobalamina seacuterica (nivel de B12) Es el test diagnoacutestico rutinario inicial estaacutendar Es un test ampliamente disponible de bajo coste y automatizado Sin embargo presenta algunas limitaciones
-- Existencia de varias teacutecnicas y ausencia de un gold standard por lo que hay diferentes liacutemites de referencia
-- Variacioacuten intraindividual muy alta
La OMS publicoacute en 2008 las conclusiones de un grupo teacutecnico consultado sobre el deacuteficit de cobalamina y folato
El grupo reconocioacute que no existen unos umbrales universalmente reconocidos para definir el deacuteficit de ambas vitaminas y expresaron la necesidad de un consenso
Devalia V Hamilton MS and Molloy AM on behalf of the British Committee for standards in haematology Guidelines for the diagnosis and treatment of cobalamin and folate disorders Br J Haematol 2014 166(4) 496-513
Schrier SL Diagnosis and treatment of vitamin B12 and folate deficiency UpToDate Last updated Jun 25 2014
de Benoist B Conclusions of a WHO Technical Consultation on folate and vitamin B12 deficiencies Food Nutr Bull 200829(2 Suppl)S238ndash44Congreso Nacional Laboratorio Cliacutenico
2018
Tomado de Tefferi A Li C En Atlas of Clinical Hematology Publicado por JO Armitage Philadelphia Current Medicine 2004
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
Int Jnl Lab Hem 2007 29 327ndash334
Clin Lab 201662343-347
In ourstudy mean MCVrMCV ratio of healthy controls is130 as microcytic anemia irondeficiency anemia is121 as also macrocytic anemia vitamin B12 deficiencyanemia is 115
Congreso Nacional Laboratorio Cliacutenico
2018
Sualeh Muslim Khan Muhammad Akbar Agha
Mean cell volume of reticulocytemdashA new parameter for diagnosing sub-clinical cobalamin deficiency in blood donors Int J Lab Hem 20181ndash4
The Abbott CELL-DYN Sapphire Hematology System uses multi-angle polarized scatter separation (MAPSS) and focused flow impedance technologies
Congreso Nacional Laboratorio Cliacutenico
2018
MCVr at 985 fL yielded the highest Youdenrsquos index at sensitivity of 82 specificity of 828 AUC 0847 ( 95 CI 803-891)
Khan SM Agha MA Mean cell volume of reticulocyte-A new parameter for diagnosing sub-clinical cobalamin deficiency in blood donors
Int J Lab Hem 20181ndash4 2018 Jul 13 doi 101111ijlh12899
Congreso Nacional Laboratorio Cliacutenico
2018
Role of Cell Population Data in the detection of folate and cobalamin deficiency
J Nieto et al
XXXI st International Symposium on Technological Innovations in Laboratory Hematology ISLH 2018 10-12 May 2018 Brussels Belgium
M-V-NRET and SD-VNRET are the best discriminatory single parameters to distinguish between patients with B9B12 deficiency and reference subjects M-V-NRETAUC=0823 sensitivity 78 and specificity 86
AUC=0852 sensitivity 55 and specificity 60
Conclusions The CPD parameters of Volume and Light Scatter (M and SD of LALS angle) that inform about size and intracellular structure of RBCs provided very useful information for the detection of B9B12 deficiency
Congreso Nacional Laboratorio Cliacutenico
2018
Cell Population Data
bull Paraacutemetros poblacionales de los leucocitos
bull Describen la morfologiacutea tamantildeo
estructuras citoplasmaacuteticas
nuacutecleo aacutecidos nucleacuteicos
bull Son datos numeacutericos con los que se construyen los ejes de lo diagramas de dispersioacuten de los leucocitos
bull Dependen de la tecnologiacutea
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
High Sensitivity New Parameters for the Detection of Vitamin B12 and Folate Deficiencies Blood 2008 1125379
B12 def vs
Normals
Mann
Withney T-Test
ROC
AUC Sens Specif Cutoff signifROC
MCV p=03156 p=09533 0577
MPV p=00001 0802 792 806 lt83 p=00001
NE Mean
Volume plt00001 0862 833 778 gt1403 p=00001
MO Mean
Volume plt00001 0829 625 889 gt1723 p=00001
MRV p=00113 0705 50 964 gt1133 p=00051
Folate def vs
Normals
Mann
Withney T-Test
ROC
AUC Sens Specif Cut-off signifROC
MCV p=00798 p=06461 0665
MPV plt00001 0832 81 806 lt83 p=00001
NE Mean
Volume p=00008 087 952 694 gt1402 p=00001
MO Mean
Volume p=00002 0801 667 833 gt1696 p=00001
MRV p=00054 0731 476 964 gt1133 p=00019
The Mean Neutrophil Volume (MNE V) and Mean Monocyte Volume (MMOV) may be used for the detection of megaloblastic neutrophils and monocytes MNEV and MMOV have significantly higher sensitivity than the previous information from the red cells (MCV) detecting B12 or folate deficiency because they are not affected by the presence at the same time of Iron deficiency or other reasons of anemia
Congreso Nacional Laboratorio Cliacutenico
2018
POSTER 733
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
CPD Sysmex XN
NE SSC complejidad
NE SFL aacutecidos nucleacuteicos
NE FSC tamantildeo
NE WX
NE WY
NE WZ
MO X
MO Y
MO Z
MO WX
MO WY
MO WZ
LY X
LY Y
LY Z
LY WX
LY WY
LY WZCongreso Nacio
nal Laboratorio Cliacutenico 2018
As MCV is the mean which is calculated it is insensitive to the presence of a small number of macrocytes
Further macrocytosis can be obscured by concomitant disorders that can cause microcytosis resulting inmasked megaloblastic anaemia (MA) for example iron deficiency hereditary elliptocytosis alpha and betathalassemia
This study was undertaken to evaluate the role of NEUT-X and NEUT-Y in detecting MA on peripheral blood andalso see whether other forms of macrocytic anaemia can be differentiated from MA
In MA the peripheral blood smear shows cytopenia with macroovalocytes and hypersegmented
neutrophils (gt5 lobes in 5 neutrophils six lobes nuclei or lobe average of gt35)
In conclusion our study shows that higher values of NEUT-X and NEUT-Y in MA patients in spite of low ornormal MCV high RDW may be used to not only reveal the masked cases of MA with concomitant irondeficiency but also separate them from the broader macrocytic anaemia group
Peripheral smear remains diagnostic however making smear for all the suspicious cases is a cumbersomeand tedious procedure Thus these parameters emerge as more reliable and stable parameters in themodern laboratories which in future may replace the older screening tools
Congreso Nacional Laboratorio Cliacutenico
2018
A favor Eficiencia Operativa
Mejora el proceso del Laboratorio
Mejor informacioacuten al Cliacutenico al mismo coste
Mejora la informacioacuten
Informa sobre la eritropoyesis deteccioacuten precoz de estados carenciales
Ayuda al cliacutenico
Estado real del paciente
En contraParaacutemetros de investigacioacuten
Dificultad de standarizar dependencia teacutecnica
Control de calidadCongreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
Severe Iron Deficiency Anemia Female 34 years
19 th March 18 th April
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
SysmexRBCHe erythrocyte Hb equivalentRetHe reticulocyte Hb equivalent(content)
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
MIC
MAC
HPO HPR
Congreso Nacional Laboratorio Cliacutenico
2018
copy 2012 Mindray Confidential 36
MINDRAY MCHrHDWHYPERHYPO
MCHr Mean RET HGB Concentration
HDW HGB Distribution Width
HYPER The percentage of hyperchromicred blood cells
HYPO The percentage of hypochromic red blood cells
Thalassemia screeningIDA treatment monitoringIDA screening
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
Hipocromo
Hipercroacutemico onormocroacutemico
iquestConcentracioacuten o contenido de Hemoglobina
Hipocroacutemiconormocroacutemico
Abbott Mindray Siemens Hypo CONCENTRACIOacuteN Hblt280gL
Sysmex Hypo CONTENIDO Hblt 17 pg
Congreso Nacional Laboratorio Cliacutenico
2018
Low Hb Density
Microcytic Factor Maf = (HbMCV)100
Nuevo moacutedulo transductor muacuteltiple con laacuteser de diodo y dos sensores oacutepticos
Anaacutelisis de hasta 50000 ceacutelulas con 7 paraacutemetros tecnoloacutegicos (leucocitos reticulocitos eritroblastos)
1 Volumen digital
2 Conductividad digital
3 5 aacutengulos de dispersioacuten de luz laacuteser digital
bull MALS (Median Angle Light Scatter)
bull UMALS (Upper Median Angle Light Scatter) 20deg a 43deg
bull LMALS (Lower Median Angle Light Scatter) 09deg a 19deg
bull LALS (Low Angle Light Scatter) asymp 51deg
bull AL2 (Axial Light Loss) 0deg a 05deg
Congreso Nacional Laboratorio Cliacutenico
2018
Hierro es un elemento criacutetico para elfuncionamiento oacuteptimo y supervivenciade las ceacutelulas
Disfuncioacuten mitocondrialActividad enzimaacutetica afectadaProteiacutenas de transporte y estructuralesproteins
Capacidad fiacutesica mermadaCapacidad de trabajo reducidaCapacidades cognitivas afectadasMorbilidad y mortalidad
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
It is generally assumed that worldwide ldquoat least half the anemia is due tonutritional iron deficiencyrdquo and that ldquoup to a prevalence of iron deficiency anemiaof 40 the prevalence of iron deficiency will be about 25 times that of anemiardquoHowever it is evident from the foregoing discussion that there are considerablevariations in both of these ratios depending on the age and sex of the peoplebeing studied the region of the world in which they live and the prevalence ratesof other causes of anemia
WHO Department of Nutrition for Health and DevelopmentAssessing the iron status of populations including literature reviews report of a Joint World Health OrganizationCenters for DiseaseControl and Prevention Technical Consultation on the Assessment of Iron Status at the Population Level Geneva Switzerland 6ndash8 April2004 ndash 2nd ed
Congreso Nacional Laboratorio Cliacutenico
2018
Estaacute bien establecido que la anemia produce una miriacuteada de secuelas tanto fiacutesicas comopsicoloacutegicas
Pero los efecto deleteacutereos se deben al deficit de hierro que es un evento previo a que seestablezca la anemia
El deacuteficit de hierrro auacuten sin anemia tiene efectos negativos en el desarrollo cognitivo y fiacutesico
Rattehalli D et al Iron deficiency without anemia do not wait for the Hemoglobin to drop
Health Policy and Technology 2013 2 45-48Congreso Nacio
nal Laboratorio Cliacutenico 2018
SuominenP et al Serum transferrin receptor and transferrin receptor-ferritin index identify healthy subjects with subclinical iron deficits Blood 1998 92 2934ndash9Halwachs-Baumann G Diagnosis of anaemia old things rearranged Wien Med Wochenschr 2012 162478ndash88
Congreso Nacional Laboratorio Cliacutenico
2018
Hemoglobina de reticulocito y su importancia en el diagnoacutestico temprano de anemiaferropeacutenica
Y Maacuterquez-Beniacutetez et al Universidad de BocayaAugust
2018 DOI 1022267rus182003133 aop
El contenido de hemoglobina de reticulocitos (CHr) es un paraacutemetro en la biometriacuteahematoloacutegica automatizada utilizado como un marcador de la biodisponibilidad delhierro en la eritropoyesis
Objetivo Exponer la aplicabilidad de la CHr como un paraacutemetro en el diagnoacutesticoprecoz de la anemia por deficiencia de hierro asiacute como su medicioacuten e interpretacioacuten
Materiales y meacutetodos Se realizoacute la revisioacuten de artiacuteculos cientiacuteficos en ingleacutes y espantildeolen las bases de datos PubMed ScienceDirect LILACS y Medline usando descriptoresvalidados en Medical Subject Headings (MeSH) considerando periodo depublicabilidad del 80 inferior a 5 antildeos
Conclusiones La CHr es un paraacutemetro de gran utilidad en el diagnoacutestico temprano deanemia ferropeacutenica y otras patologiacuteas como deficiencia funcional de hierro estadosde inflamacioacuten croacutenica y enfermedad renal croacutenica
Biomarcador temprano en el diagnoacutestico de deficiencia de hierro antes de presentarsecambios morfoloacutegicos eritrociacuteticosCongreso Nacio
nal Laboratorio Cliacutenico 2018
bull A total of 1105 NES participants (639 men 466 women)bull CHr becomes affected in a relatively early stage in the development of iron deficiency before iron
deficiency anemia and clinical symptoms become apparentbull Therefore this parameter might be useful to identify persons healthy and diseased at risk of
developing iron deficiency anemia and subsequently to apply interventions in order to prevent further development of iron deficiency anemiaCongreso Nacio
nal Laboratorio Cliacutenico 2018
Hb reticulocitaria sensible para detectar la fase inicial del deacuteficit de hierro cuando laeritropoyesis requiere maacutes cantidad que la que recibe ANTES de que la anemia seestablezca
Congreso Nacional Laboratorio Cliacutenico
2018
No ID LID P
RBC 1012L 48 (08) 437 (05) lt00001
Hb gL 135 (6) 131 (12) 0006
MCV fL 922 (21) 902 (38) 0006
MCH pg 324 (07) 306 (22) lt00001
MCHC gL 339 (6) 319 (23) 0001
RDW
Ret He pg
Hypo He
LHD
Ferritin microgL
131 (06)
338 (21)
03 (015)
28 (20)
86 (3)
145 (21)
278 (24)
69 (55)
56 (25)
16 (76)
lt00001
lt00001
lt00001
lt00001
lt00001
AUC 95 CI Cutoff Sensitivity Specificity
LHD 0898 0819-0978 50 859 841
Ret He 0914 0824-1000 299pg 868 857
Hypo He 0934 0856-1000 16 857 921
Clinical value of markers of hypochromia in the detection of latent iron deficiency in non-anemic premenopausal women
No ID Hb gt 120 gL s-ferritin was within reference intervalLatent Iron Defiency Hb gt 120 gL s-ferritin lt 30 μgL
Urrechaga E et al Journal Clin Lab Analysis 2016 30 (5) 623-627
97 women (388) in 250 apparently healthy women had latent IDCongreso Nacional Laboratorio Cliacutenico
2018
Schorer G et al Abstract Jahreskongress der Deutschen Gesellschaft fuumlr Transfusionsmedizin und Immunhaumlmatologie Rostock 15 - 18 September 2009
Congreso Nacional Laboratorio Cliacutenico
2018
Caring for Those Who Share Mitigating Iron Deficiency in Regular Blood DonorsMast Alan E
bull Iron deficiency caused by regular blood donation is a problem facing blood centers Each blood donation removes 200 to 250 mg of iron from the donor Consequently many donors become iron deficient with repeated donation
bull This presents a challenge to blood centers that has become more acute in recent years with the realization that iron deficiency even in the absence of anemia is associated with adverse effects including fatigue and decreased exercise tolerance as well as neurological symptoms such as decreased cognitive function pica and restless leg syndrome
bull REDS-II investigators performed a longitudinal study investigating the iron status of blood donors over a two year period called the REDS-II Donor Iron Status Evaluation (RISE)
bull Results from the baseline analysis of regular donors (e 2 donations per year (females) or e 3 donations per year (males) revealed that over two-thirds of female donors and over one-half of male donors have iron deficiency
Congreso Nacional Laboratorio Cliacutenico
2018
Transfusion 2013 532766-2775
bull We evaluated the diagnostic sensitivity and specificity of red blood cell (RBC) hematology analyzer indices to assess iron status as a part of donor management iron deficient erythropoiesis (IDE) and absence of iron stores (AIS)
bull STUDY DESIGN AND METHODS A total of 1659 male and female donors from the Retrovirus Epidemiology Donor Study-II (REDS-II) Donor Iron Status Evaluation (RISE) study who were either first-timereactivated (FT RA no donations for 2 years) or frequent donors were recruited into a longitudinal study of regular donation of RBCs Of these 1002 donors returned 15 to 24 months later for a final assessment
Absent iron stores (AIS) was defined as plasma ferritin level of less than 12 mgL Logarithm of the ratio of soluble transferrin receptor to ferritin of at least 207 was used to define iron-deficient erythropoiesis (IDE)
bull RESULTS HYPOm and CHr detected IDE with comparable sensitivity 72 versus 69 but differed in specificity HYPOm 68 and CHr 53
For detecting AIS sensitivity was improved to 85 for HYPOm and 81 for CHr but specificity was reduced
Venous Hb had high specificity but poor sensitivity for IDE and AIS A plasma ferritin level of less than 267 mgL was a good surrogate for assessing IDE Congreso Nacio
nal Laboratorio Cliacutenico 2018
Microcytic RBC and reticulocyte mean cell hemoglobin content predicted iron depletion with
sensitivities 70 and 64
specificities of 72 and 78 respectively
When both combined
increased the sensitivity to 82
Congreso Nacional Laboratorio Cliacutenico
2018
Depending on the number of donations during the preceding12 months
Absent iron stores were detected in up to 214 of male and278 of female donors respectively
impaired hemoglobinisation IH was present in up to 64 maleand 167 female donors with 2 and 4 preceding donationsrespectively
The defined CHr cut-off value was 280 pg to detect IH infrequent whole blood donors with AIS leading to a testspecificity of 982 (positive predictive value PPV 577) inmale and of 978 (PPV 829) in female donors
It may help to prevent the development of anemia in frequentblood donors and also can help to decide whether donordeferral or even iron substitution need to be recommended
Congreso Nacional Laboratorio Cliacutenico
2018
Of the 501 blood donors sTfR and Ret-He detected Latent Iron Deficiency in 148 and 135 donors respectively
In comparison to sTfR Ret-He had sensitivity of 927 specificity of 9716 PPV of 931 and NPV of 963
Serum Ferritin TIBC and serum Iron had comparatively lower sensitivity of 8716 797 and 777 respectively
Conclusion Ret-He can be used as a routine screening test to detect LID in blood donors
This could provide an opportunity to make appropriate and timely interventions like dietary changes or drug supplementation
Congreso Nacional Laboratorio Cliacutenico
2018
Singh A Chaudhary R Pandey HC Sonker A Identification of iron status of blood donors by using low hemoglobin density and microcytic anemia factor Asian J Transfus Sci 20181246-50
The main objective of this study was to assess ifLHD and Maf could be used for assessment ofiron status in blood donors and also to establisha cut-off for these two parameters at which atentative iron deficiency could be reportedconclusively
Results LHD and Maf were able to differentiatebetween iron deficient and iron-depleteddonors from normal donorsA cutoff of 918 for LHD was able todifferentiate iron deficient and depleted statefrom normal iron statessensitivity 919 and specificity 71respectivelya cutoff of 1016 for Mafsensitivity 946 and specificity 968
MAf = (MVC Hb) 100
Congreso Nacional Laboratorio Cliacutenico
2018
Hb reticulocitaria sensible para detectar la fase inicial del deacuteficitde hierro cuando la eritropoyesis requiere maacutes cantidad que laque recibe ANTES de que la anemia se establezca
La deteccioacuten precoz del deacuteficit de hierro en la fase del balance negativo demanda aporte contribuye a reducir sus manifestaciones cliacutenicas en los pacientes afectados mejorando la salud puacuteblica
Un tratamiento menos prolongado con suplementos y menor consumo de los recursos sanitaros Contribuye a la eficiencia y sostenibilidad de los servicios sanitarios
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
Buttarello MLaboratory diagnosis of anemia are the old and new red cell parameters useful in classification and treatment howInt Jnl Lab Hem 2016 38 (Suppl 1) 123ndash132
Congreso Nacional Laboratorio Cliacutenico
2018
Buttarello MLaboratory diagnosis of anemia are the old and new red cell parameters useful in classification and treatment howInt Jnl Lab Hem 2016 38 (Suppl 1) 123ndash132
Congreso Nacional Laboratorio Cliacutenico
2018
Ralph Green amp Ananya Datta Mitra Megaloblastic Anemias Nutritional and Other CausesMed Clin N Am 2017 101 297ndash317
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
ANEMIA CARENCIAL CAUSAS
Factores alimentariosConsumir una dieta vegetariana mal planeadaAlimentacioacuten deficiente en los bebeacutesDesnutricioacuten durante el embarazo
Deacuteficit de absorcioacutenAlcoholismo croacutenicoEnfermedad de Crohn celiaquiacutea infeccioacuten otros problemas que le dificulten al cuerpo la digestioacuten de los alimentosAnemia perniciosa (factor intriacutenseco)Cirugiacuteas para extirpar ciertas partes del estoacutemago o el intestino delgado
MedicamentosB12 omeprazol metformina colchicina aminosalicilatos neomicinaFOLATO fenitoiacutena metotrexato sulfasalacina triamtereno pirimetamina trimetoprim con sulfametoxazol barbituacutericos
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
Reacciones metaboacutelicas en las que participan la vitamina B12 y el folato bull la conversioacuten de metilmalonil-CoA a succinil-CoA donde la adenosil-cobalamina actuacutea de
cofactor Por ello un deacuteficit de B12 conlleva un aumento de metilmalonil-CoA y de su producto de hidroacutelisis el aacutecido metilmaloacutenico
bull la siacutentesis de metionina a partir de homocisteina gracias a la metionina sintetasa y a la metil-cobalamina como cofactor En esta misma reaccioacuten el metiltetrahidrofolato es transformado a tetrahidrofolato que es necesario para la siacutentesis de DNA
Congreso Nacional Laboratorio Cliacutenico
2018
Anemia macrociacutetica secundaria a deficiencia de aacutecido foacutelico y de vitamina B12(cobalamina)
La deficiencia de B12 yo aacutecido foacutelico es la causa maacutes frecuente de megaloblastosis
Dentro de distintas funciones generales del metabolismo la vitamina B12 es uncofactor esencial en la siacutentesis de ADN y ARN compromete a todas las ceacutelulas delorganismo
Su deficiencia se manifiesta en oacuterganos con alto recambio celular como la meacutedulaosea y en el sistema nervioso central (SNC) a traveacutes de la siacutentesis de mielina y lareparacioacuten axonal
La deficiencia de cobalamina es responsable de alteraciones hematoloacutegicasneuroloacutegicas neurocognitivas y neuropsiquiaacutetricas
La siacutentesis defectuosa de ADN conduce a la apoptosis y a la hemoacutelisis (intra yextramedular) causantes de la hemopoyesis inefectiva
En meacutedula la siacutentesis ineficiente de DNA causa cambios megaloblaacutesticos comoconsecuencIa anemia y citopenias
Congreso Nacional Laboratorio Cliacutenico
2018
Limitaciones de los meacutetodos diagnoacutesticos claacutesicos
Volumen Corpuscular Medio (VCM) y morfologiacutea de sangre perifeacuterica En una serie de pacientes con deacuteficit de cobalamina soacutelo un 29 teniacutean anemia y soacutelo un 36 teniacutean un VCM gt 100 fL
Un VCM normal no puede ser empleado para rechazar una determinacioacuten de nivel de cobalamina ya que hasta un 25 de casos con manifestaciones neuroloacutegicas cursan con un VCM normal
Cobalamina seacuterica (nivel de B12) Es el test diagnoacutestico rutinario inicial estaacutendar Es un test ampliamente disponible de bajo coste y automatizado Sin embargo presenta algunas limitaciones
-- Existencia de varias teacutecnicas y ausencia de un gold standard por lo que hay diferentes liacutemites de referencia
-- Variacioacuten intraindividual muy alta
La OMS publicoacute en 2008 las conclusiones de un grupo teacutecnico consultado sobre el deacuteficit de cobalamina y folato
El grupo reconocioacute que no existen unos umbrales universalmente reconocidos para definir el deacuteficit de ambas vitaminas y expresaron la necesidad de un consenso
Devalia V Hamilton MS and Molloy AM on behalf of the British Committee for standards in haematology Guidelines for the diagnosis and treatment of cobalamin and folate disorders Br J Haematol 2014 166(4) 496-513
Schrier SL Diagnosis and treatment of vitamin B12 and folate deficiency UpToDate Last updated Jun 25 2014
de Benoist B Conclusions of a WHO Technical Consultation on folate and vitamin B12 deficiencies Food Nutr Bull 200829(2 Suppl)S238ndash44Congreso Nacional Laboratorio Cliacutenico
2018
Tomado de Tefferi A Li C En Atlas of Clinical Hematology Publicado por JO Armitage Philadelphia Current Medicine 2004
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
Int Jnl Lab Hem 2007 29 327ndash334
Clin Lab 201662343-347
In ourstudy mean MCVrMCV ratio of healthy controls is130 as microcytic anemia irondeficiency anemia is121 as also macrocytic anemia vitamin B12 deficiencyanemia is 115
Congreso Nacional Laboratorio Cliacutenico
2018
Sualeh Muslim Khan Muhammad Akbar Agha
Mean cell volume of reticulocytemdashA new parameter for diagnosing sub-clinical cobalamin deficiency in blood donors Int J Lab Hem 20181ndash4
The Abbott CELL-DYN Sapphire Hematology System uses multi-angle polarized scatter separation (MAPSS) and focused flow impedance technologies
Congreso Nacional Laboratorio Cliacutenico
2018
MCVr at 985 fL yielded the highest Youdenrsquos index at sensitivity of 82 specificity of 828 AUC 0847 ( 95 CI 803-891)
Khan SM Agha MA Mean cell volume of reticulocyte-A new parameter for diagnosing sub-clinical cobalamin deficiency in blood donors
Int J Lab Hem 20181ndash4 2018 Jul 13 doi 101111ijlh12899
Congreso Nacional Laboratorio Cliacutenico
2018
Role of Cell Population Data in the detection of folate and cobalamin deficiency
J Nieto et al
XXXI st International Symposium on Technological Innovations in Laboratory Hematology ISLH 2018 10-12 May 2018 Brussels Belgium
M-V-NRET and SD-VNRET are the best discriminatory single parameters to distinguish between patients with B9B12 deficiency and reference subjects M-V-NRETAUC=0823 sensitivity 78 and specificity 86
AUC=0852 sensitivity 55 and specificity 60
Conclusions The CPD parameters of Volume and Light Scatter (M and SD of LALS angle) that inform about size and intracellular structure of RBCs provided very useful information for the detection of B9B12 deficiency
Congreso Nacional Laboratorio Cliacutenico
2018
Cell Population Data
bull Paraacutemetros poblacionales de los leucocitos
bull Describen la morfologiacutea tamantildeo
estructuras citoplasmaacuteticas
nuacutecleo aacutecidos nucleacuteicos
bull Son datos numeacutericos con los que se construyen los ejes de lo diagramas de dispersioacuten de los leucocitos
bull Dependen de la tecnologiacutea
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
High Sensitivity New Parameters for the Detection of Vitamin B12 and Folate Deficiencies Blood 2008 1125379
B12 def vs
Normals
Mann
Withney T-Test
ROC
AUC Sens Specif Cutoff signifROC
MCV p=03156 p=09533 0577
MPV p=00001 0802 792 806 lt83 p=00001
NE Mean
Volume plt00001 0862 833 778 gt1403 p=00001
MO Mean
Volume plt00001 0829 625 889 gt1723 p=00001
MRV p=00113 0705 50 964 gt1133 p=00051
Folate def vs
Normals
Mann
Withney T-Test
ROC
AUC Sens Specif Cut-off signifROC
MCV p=00798 p=06461 0665
MPV plt00001 0832 81 806 lt83 p=00001
NE Mean
Volume p=00008 087 952 694 gt1402 p=00001
MO Mean
Volume p=00002 0801 667 833 gt1696 p=00001
MRV p=00054 0731 476 964 gt1133 p=00019
The Mean Neutrophil Volume (MNE V) and Mean Monocyte Volume (MMOV) may be used for the detection of megaloblastic neutrophils and monocytes MNEV and MMOV have significantly higher sensitivity than the previous information from the red cells (MCV) detecting B12 or folate deficiency because they are not affected by the presence at the same time of Iron deficiency or other reasons of anemia
Congreso Nacional Laboratorio Cliacutenico
2018
POSTER 733
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
CPD Sysmex XN
NE SSC complejidad
NE SFL aacutecidos nucleacuteicos
NE FSC tamantildeo
NE WX
NE WY
NE WZ
MO X
MO Y
MO Z
MO WX
MO WY
MO WZ
LY X
LY Y
LY Z
LY WX
LY WY
LY WZCongreso Nacio
nal Laboratorio Cliacutenico 2018
As MCV is the mean which is calculated it is insensitive to the presence of a small number of macrocytes
Further macrocytosis can be obscured by concomitant disorders that can cause microcytosis resulting inmasked megaloblastic anaemia (MA) for example iron deficiency hereditary elliptocytosis alpha and betathalassemia
This study was undertaken to evaluate the role of NEUT-X and NEUT-Y in detecting MA on peripheral blood andalso see whether other forms of macrocytic anaemia can be differentiated from MA
In MA the peripheral blood smear shows cytopenia with macroovalocytes and hypersegmented
neutrophils (gt5 lobes in 5 neutrophils six lobes nuclei or lobe average of gt35)
In conclusion our study shows that higher values of NEUT-X and NEUT-Y in MA patients in spite of low ornormal MCV high RDW may be used to not only reveal the masked cases of MA with concomitant irondeficiency but also separate them from the broader macrocytic anaemia group
Peripheral smear remains diagnostic however making smear for all the suspicious cases is a cumbersomeand tedious procedure Thus these parameters emerge as more reliable and stable parameters in themodern laboratories which in future may replace the older screening tools
Congreso Nacional Laboratorio Cliacutenico
2018
A favor Eficiencia Operativa
Mejora el proceso del Laboratorio
Mejor informacioacuten al Cliacutenico al mismo coste
Mejora la informacioacuten
Informa sobre la eritropoyesis deteccioacuten precoz de estados carenciales
Ayuda al cliacutenico
Estado real del paciente
En contraParaacutemetros de investigacioacuten
Dificultad de standarizar dependencia teacutecnica
Control de calidadCongreso Nacional Laboratorio Cliacutenico
2018
Severe Iron Deficiency Anemia Female 34 years
19 th March 18 th April
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
SysmexRBCHe erythrocyte Hb equivalentRetHe reticulocyte Hb equivalent(content)
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
MIC
MAC
HPO HPR
Congreso Nacional Laboratorio Cliacutenico
2018
copy 2012 Mindray Confidential 36
MINDRAY MCHrHDWHYPERHYPO
MCHr Mean RET HGB Concentration
HDW HGB Distribution Width
HYPER The percentage of hyperchromicred blood cells
HYPO The percentage of hypochromic red blood cells
Thalassemia screeningIDA treatment monitoringIDA screening
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
Hipocromo
Hipercroacutemico onormocroacutemico
iquestConcentracioacuten o contenido de Hemoglobina
Hipocroacutemiconormocroacutemico
Abbott Mindray Siemens Hypo CONCENTRACIOacuteN Hblt280gL
Sysmex Hypo CONTENIDO Hblt 17 pg
Congreso Nacional Laboratorio Cliacutenico
2018
Low Hb Density
Microcytic Factor Maf = (HbMCV)100
Nuevo moacutedulo transductor muacuteltiple con laacuteser de diodo y dos sensores oacutepticos
Anaacutelisis de hasta 50000 ceacutelulas con 7 paraacutemetros tecnoloacutegicos (leucocitos reticulocitos eritroblastos)
1 Volumen digital
2 Conductividad digital
3 5 aacutengulos de dispersioacuten de luz laacuteser digital
bull MALS (Median Angle Light Scatter)
bull UMALS (Upper Median Angle Light Scatter) 20deg a 43deg
bull LMALS (Lower Median Angle Light Scatter) 09deg a 19deg
bull LALS (Low Angle Light Scatter) asymp 51deg
bull AL2 (Axial Light Loss) 0deg a 05deg
Congreso Nacional Laboratorio Cliacutenico
2018
Hierro es un elemento criacutetico para elfuncionamiento oacuteptimo y supervivenciade las ceacutelulas
Disfuncioacuten mitocondrialActividad enzimaacutetica afectadaProteiacutenas de transporte y estructuralesproteins
Capacidad fiacutesica mermadaCapacidad de trabajo reducidaCapacidades cognitivas afectadasMorbilidad y mortalidad
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
It is generally assumed that worldwide ldquoat least half the anemia is due tonutritional iron deficiencyrdquo and that ldquoup to a prevalence of iron deficiency anemiaof 40 the prevalence of iron deficiency will be about 25 times that of anemiardquoHowever it is evident from the foregoing discussion that there are considerablevariations in both of these ratios depending on the age and sex of the peoplebeing studied the region of the world in which they live and the prevalence ratesof other causes of anemia
WHO Department of Nutrition for Health and DevelopmentAssessing the iron status of populations including literature reviews report of a Joint World Health OrganizationCenters for DiseaseControl and Prevention Technical Consultation on the Assessment of Iron Status at the Population Level Geneva Switzerland 6ndash8 April2004 ndash 2nd ed
Congreso Nacional Laboratorio Cliacutenico
2018
Estaacute bien establecido que la anemia produce una miriacuteada de secuelas tanto fiacutesicas comopsicoloacutegicas
Pero los efecto deleteacutereos se deben al deficit de hierro que es un evento previo a que seestablezca la anemia
El deacuteficit de hierrro auacuten sin anemia tiene efectos negativos en el desarrollo cognitivo y fiacutesico
Rattehalli D et al Iron deficiency without anemia do not wait for the Hemoglobin to drop
Health Policy and Technology 2013 2 45-48Congreso Nacio
nal Laboratorio Cliacutenico 2018
SuominenP et al Serum transferrin receptor and transferrin receptor-ferritin index identify healthy subjects with subclinical iron deficits Blood 1998 92 2934ndash9Halwachs-Baumann G Diagnosis of anaemia old things rearranged Wien Med Wochenschr 2012 162478ndash88
Congreso Nacional Laboratorio Cliacutenico
2018
Hemoglobina de reticulocito y su importancia en el diagnoacutestico temprano de anemiaferropeacutenica
Y Maacuterquez-Beniacutetez et al Universidad de BocayaAugust
2018 DOI 1022267rus182003133 aop
El contenido de hemoglobina de reticulocitos (CHr) es un paraacutemetro en la biometriacuteahematoloacutegica automatizada utilizado como un marcador de la biodisponibilidad delhierro en la eritropoyesis
Objetivo Exponer la aplicabilidad de la CHr como un paraacutemetro en el diagnoacutesticoprecoz de la anemia por deficiencia de hierro asiacute como su medicioacuten e interpretacioacuten
Materiales y meacutetodos Se realizoacute la revisioacuten de artiacuteculos cientiacuteficos en ingleacutes y espantildeolen las bases de datos PubMed ScienceDirect LILACS y Medline usando descriptoresvalidados en Medical Subject Headings (MeSH) considerando periodo depublicabilidad del 80 inferior a 5 antildeos
Conclusiones La CHr es un paraacutemetro de gran utilidad en el diagnoacutestico temprano deanemia ferropeacutenica y otras patologiacuteas como deficiencia funcional de hierro estadosde inflamacioacuten croacutenica y enfermedad renal croacutenica
Biomarcador temprano en el diagnoacutestico de deficiencia de hierro antes de presentarsecambios morfoloacutegicos eritrociacuteticosCongreso Nacio
nal Laboratorio Cliacutenico 2018
bull A total of 1105 NES participants (639 men 466 women)bull CHr becomes affected in a relatively early stage in the development of iron deficiency before iron
deficiency anemia and clinical symptoms become apparentbull Therefore this parameter might be useful to identify persons healthy and diseased at risk of
developing iron deficiency anemia and subsequently to apply interventions in order to prevent further development of iron deficiency anemiaCongreso Nacio
nal Laboratorio Cliacutenico 2018
Hb reticulocitaria sensible para detectar la fase inicial del deacuteficit de hierro cuando laeritropoyesis requiere maacutes cantidad que la que recibe ANTES de que la anemia seestablezca
Congreso Nacional Laboratorio Cliacutenico
2018
No ID LID P
RBC 1012L 48 (08) 437 (05) lt00001
Hb gL 135 (6) 131 (12) 0006
MCV fL 922 (21) 902 (38) 0006
MCH pg 324 (07) 306 (22) lt00001
MCHC gL 339 (6) 319 (23) 0001
RDW
Ret He pg
Hypo He
LHD
Ferritin microgL
131 (06)
338 (21)
03 (015)
28 (20)
86 (3)
145 (21)
278 (24)
69 (55)
56 (25)
16 (76)
lt00001
lt00001
lt00001
lt00001
lt00001
AUC 95 CI Cutoff Sensitivity Specificity
LHD 0898 0819-0978 50 859 841
Ret He 0914 0824-1000 299pg 868 857
Hypo He 0934 0856-1000 16 857 921
Clinical value of markers of hypochromia in the detection of latent iron deficiency in non-anemic premenopausal women
No ID Hb gt 120 gL s-ferritin was within reference intervalLatent Iron Defiency Hb gt 120 gL s-ferritin lt 30 μgL
Urrechaga E et al Journal Clin Lab Analysis 2016 30 (5) 623-627
97 women (388) in 250 apparently healthy women had latent IDCongreso Nacional Laboratorio Cliacutenico
2018
Schorer G et al Abstract Jahreskongress der Deutschen Gesellschaft fuumlr Transfusionsmedizin und Immunhaumlmatologie Rostock 15 - 18 September 2009
Congreso Nacional Laboratorio Cliacutenico
2018
Caring for Those Who Share Mitigating Iron Deficiency in Regular Blood DonorsMast Alan E
bull Iron deficiency caused by regular blood donation is a problem facing blood centers Each blood donation removes 200 to 250 mg of iron from the donor Consequently many donors become iron deficient with repeated donation
bull This presents a challenge to blood centers that has become more acute in recent years with the realization that iron deficiency even in the absence of anemia is associated with adverse effects including fatigue and decreased exercise tolerance as well as neurological symptoms such as decreased cognitive function pica and restless leg syndrome
bull REDS-II investigators performed a longitudinal study investigating the iron status of blood donors over a two year period called the REDS-II Donor Iron Status Evaluation (RISE)
bull Results from the baseline analysis of regular donors (e 2 donations per year (females) or e 3 donations per year (males) revealed that over two-thirds of female donors and over one-half of male donors have iron deficiency
Congreso Nacional Laboratorio Cliacutenico
2018
Transfusion 2013 532766-2775
bull We evaluated the diagnostic sensitivity and specificity of red blood cell (RBC) hematology analyzer indices to assess iron status as a part of donor management iron deficient erythropoiesis (IDE) and absence of iron stores (AIS)
bull STUDY DESIGN AND METHODS A total of 1659 male and female donors from the Retrovirus Epidemiology Donor Study-II (REDS-II) Donor Iron Status Evaluation (RISE) study who were either first-timereactivated (FT RA no donations for 2 years) or frequent donors were recruited into a longitudinal study of regular donation of RBCs Of these 1002 donors returned 15 to 24 months later for a final assessment
Absent iron stores (AIS) was defined as plasma ferritin level of less than 12 mgL Logarithm of the ratio of soluble transferrin receptor to ferritin of at least 207 was used to define iron-deficient erythropoiesis (IDE)
bull RESULTS HYPOm and CHr detected IDE with comparable sensitivity 72 versus 69 but differed in specificity HYPOm 68 and CHr 53
For detecting AIS sensitivity was improved to 85 for HYPOm and 81 for CHr but specificity was reduced
Venous Hb had high specificity but poor sensitivity for IDE and AIS A plasma ferritin level of less than 267 mgL was a good surrogate for assessing IDE Congreso Nacio
nal Laboratorio Cliacutenico 2018
Microcytic RBC and reticulocyte mean cell hemoglobin content predicted iron depletion with
sensitivities 70 and 64
specificities of 72 and 78 respectively
When both combined
increased the sensitivity to 82
Congreso Nacional Laboratorio Cliacutenico
2018
Depending on the number of donations during the preceding12 months
Absent iron stores were detected in up to 214 of male and278 of female donors respectively
impaired hemoglobinisation IH was present in up to 64 maleand 167 female donors with 2 and 4 preceding donationsrespectively
The defined CHr cut-off value was 280 pg to detect IH infrequent whole blood donors with AIS leading to a testspecificity of 982 (positive predictive value PPV 577) inmale and of 978 (PPV 829) in female donors
It may help to prevent the development of anemia in frequentblood donors and also can help to decide whether donordeferral or even iron substitution need to be recommended
Congreso Nacional Laboratorio Cliacutenico
2018
Of the 501 blood donors sTfR and Ret-He detected Latent Iron Deficiency in 148 and 135 donors respectively
In comparison to sTfR Ret-He had sensitivity of 927 specificity of 9716 PPV of 931 and NPV of 963
Serum Ferritin TIBC and serum Iron had comparatively lower sensitivity of 8716 797 and 777 respectively
Conclusion Ret-He can be used as a routine screening test to detect LID in blood donors
This could provide an opportunity to make appropriate and timely interventions like dietary changes or drug supplementation
Congreso Nacional Laboratorio Cliacutenico
2018
Singh A Chaudhary R Pandey HC Sonker A Identification of iron status of blood donors by using low hemoglobin density and microcytic anemia factor Asian J Transfus Sci 20181246-50
The main objective of this study was to assess ifLHD and Maf could be used for assessment ofiron status in blood donors and also to establisha cut-off for these two parameters at which atentative iron deficiency could be reportedconclusively
Results LHD and Maf were able to differentiatebetween iron deficient and iron-depleteddonors from normal donorsA cutoff of 918 for LHD was able todifferentiate iron deficient and depleted statefrom normal iron statessensitivity 919 and specificity 71respectivelya cutoff of 1016 for Mafsensitivity 946 and specificity 968
MAf = (MVC Hb) 100
Congreso Nacional Laboratorio Cliacutenico
2018
Hb reticulocitaria sensible para detectar la fase inicial del deacuteficitde hierro cuando la eritropoyesis requiere maacutes cantidad que laque recibe ANTES de que la anemia se establezca
La deteccioacuten precoz del deacuteficit de hierro en la fase del balance negativo demanda aporte contribuye a reducir sus manifestaciones cliacutenicas en los pacientes afectados mejorando la salud puacuteblica
Un tratamiento menos prolongado con suplementos y menor consumo de los recursos sanitaros Contribuye a la eficiencia y sostenibilidad de los servicios sanitarios
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
Buttarello MLaboratory diagnosis of anemia are the old and new red cell parameters useful in classification and treatment howInt Jnl Lab Hem 2016 38 (Suppl 1) 123ndash132
Congreso Nacional Laboratorio Cliacutenico
2018
Buttarello MLaboratory diagnosis of anemia are the old and new red cell parameters useful in classification and treatment howInt Jnl Lab Hem 2016 38 (Suppl 1) 123ndash132
Congreso Nacional Laboratorio Cliacutenico
2018
Ralph Green amp Ananya Datta Mitra Megaloblastic Anemias Nutritional and Other CausesMed Clin N Am 2017 101 297ndash317
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
ANEMIA CARENCIAL CAUSAS
Factores alimentariosConsumir una dieta vegetariana mal planeadaAlimentacioacuten deficiente en los bebeacutesDesnutricioacuten durante el embarazo
Deacuteficit de absorcioacutenAlcoholismo croacutenicoEnfermedad de Crohn celiaquiacutea infeccioacuten otros problemas que le dificulten al cuerpo la digestioacuten de los alimentosAnemia perniciosa (factor intriacutenseco)Cirugiacuteas para extirpar ciertas partes del estoacutemago o el intestino delgado
MedicamentosB12 omeprazol metformina colchicina aminosalicilatos neomicinaFOLATO fenitoiacutena metotrexato sulfasalacina triamtereno pirimetamina trimetoprim con sulfametoxazol barbituacutericos
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
Reacciones metaboacutelicas en las que participan la vitamina B12 y el folato bull la conversioacuten de metilmalonil-CoA a succinil-CoA donde la adenosil-cobalamina actuacutea de
cofactor Por ello un deacuteficit de B12 conlleva un aumento de metilmalonil-CoA y de su producto de hidroacutelisis el aacutecido metilmaloacutenico
bull la siacutentesis de metionina a partir de homocisteina gracias a la metionina sintetasa y a la metil-cobalamina como cofactor En esta misma reaccioacuten el metiltetrahidrofolato es transformado a tetrahidrofolato que es necesario para la siacutentesis de DNA
Congreso Nacional Laboratorio Cliacutenico
2018
Anemia macrociacutetica secundaria a deficiencia de aacutecido foacutelico y de vitamina B12(cobalamina)
La deficiencia de B12 yo aacutecido foacutelico es la causa maacutes frecuente de megaloblastosis
Dentro de distintas funciones generales del metabolismo la vitamina B12 es uncofactor esencial en la siacutentesis de ADN y ARN compromete a todas las ceacutelulas delorganismo
Su deficiencia se manifiesta en oacuterganos con alto recambio celular como la meacutedulaosea y en el sistema nervioso central (SNC) a traveacutes de la siacutentesis de mielina y lareparacioacuten axonal
La deficiencia de cobalamina es responsable de alteraciones hematoloacutegicasneuroloacutegicas neurocognitivas y neuropsiquiaacutetricas
La siacutentesis defectuosa de ADN conduce a la apoptosis y a la hemoacutelisis (intra yextramedular) causantes de la hemopoyesis inefectiva
En meacutedula la siacutentesis ineficiente de DNA causa cambios megaloblaacutesticos comoconsecuencIa anemia y citopenias
Congreso Nacional Laboratorio Cliacutenico
2018
Limitaciones de los meacutetodos diagnoacutesticos claacutesicos
Volumen Corpuscular Medio (VCM) y morfologiacutea de sangre perifeacuterica En una serie de pacientes con deacuteficit de cobalamina soacutelo un 29 teniacutean anemia y soacutelo un 36 teniacutean un VCM gt 100 fL
Un VCM normal no puede ser empleado para rechazar una determinacioacuten de nivel de cobalamina ya que hasta un 25 de casos con manifestaciones neuroloacutegicas cursan con un VCM normal
Cobalamina seacuterica (nivel de B12) Es el test diagnoacutestico rutinario inicial estaacutendar Es un test ampliamente disponible de bajo coste y automatizado Sin embargo presenta algunas limitaciones
-- Existencia de varias teacutecnicas y ausencia de un gold standard por lo que hay diferentes liacutemites de referencia
-- Variacioacuten intraindividual muy alta
La OMS publicoacute en 2008 las conclusiones de un grupo teacutecnico consultado sobre el deacuteficit de cobalamina y folato
El grupo reconocioacute que no existen unos umbrales universalmente reconocidos para definir el deacuteficit de ambas vitaminas y expresaron la necesidad de un consenso
Devalia V Hamilton MS and Molloy AM on behalf of the British Committee for standards in haematology Guidelines for the diagnosis and treatment of cobalamin and folate disorders Br J Haematol 2014 166(4) 496-513
Schrier SL Diagnosis and treatment of vitamin B12 and folate deficiency UpToDate Last updated Jun 25 2014
de Benoist B Conclusions of a WHO Technical Consultation on folate and vitamin B12 deficiencies Food Nutr Bull 200829(2 Suppl)S238ndash44Congreso Nacional Laboratorio Cliacutenico
2018
Tomado de Tefferi A Li C En Atlas of Clinical Hematology Publicado por JO Armitage Philadelphia Current Medicine 2004
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
Int Jnl Lab Hem 2007 29 327ndash334
Clin Lab 201662343-347
In ourstudy mean MCVrMCV ratio of healthy controls is130 as microcytic anemia irondeficiency anemia is121 as also macrocytic anemia vitamin B12 deficiencyanemia is 115
Congreso Nacional Laboratorio Cliacutenico
2018
Sualeh Muslim Khan Muhammad Akbar Agha
Mean cell volume of reticulocytemdashA new parameter for diagnosing sub-clinical cobalamin deficiency in blood donors Int J Lab Hem 20181ndash4
The Abbott CELL-DYN Sapphire Hematology System uses multi-angle polarized scatter separation (MAPSS) and focused flow impedance technologies
Congreso Nacional Laboratorio Cliacutenico
2018
MCVr at 985 fL yielded the highest Youdenrsquos index at sensitivity of 82 specificity of 828 AUC 0847 ( 95 CI 803-891)
Khan SM Agha MA Mean cell volume of reticulocyte-A new parameter for diagnosing sub-clinical cobalamin deficiency in blood donors
Int J Lab Hem 20181ndash4 2018 Jul 13 doi 101111ijlh12899
Congreso Nacional Laboratorio Cliacutenico
2018
Role of Cell Population Data in the detection of folate and cobalamin deficiency
J Nieto et al
XXXI st International Symposium on Technological Innovations in Laboratory Hematology ISLH 2018 10-12 May 2018 Brussels Belgium
M-V-NRET and SD-VNRET are the best discriminatory single parameters to distinguish between patients with B9B12 deficiency and reference subjects M-V-NRETAUC=0823 sensitivity 78 and specificity 86
AUC=0852 sensitivity 55 and specificity 60
Conclusions The CPD parameters of Volume and Light Scatter (M and SD of LALS angle) that inform about size and intracellular structure of RBCs provided very useful information for the detection of B9B12 deficiency
Congreso Nacional Laboratorio Cliacutenico
2018
Cell Population Data
bull Paraacutemetros poblacionales de los leucocitos
bull Describen la morfologiacutea tamantildeo
estructuras citoplasmaacuteticas
nuacutecleo aacutecidos nucleacuteicos
bull Son datos numeacutericos con los que se construyen los ejes de lo diagramas de dispersioacuten de los leucocitos
bull Dependen de la tecnologiacutea
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
High Sensitivity New Parameters for the Detection of Vitamin B12 and Folate Deficiencies Blood 2008 1125379
B12 def vs
Normals
Mann
Withney T-Test
ROC
AUC Sens Specif Cutoff signifROC
MCV p=03156 p=09533 0577
MPV p=00001 0802 792 806 lt83 p=00001
NE Mean
Volume plt00001 0862 833 778 gt1403 p=00001
MO Mean
Volume plt00001 0829 625 889 gt1723 p=00001
MRV p=00113 0705 50 964 gt1133 p=00051
Folate def vs
Normals
Mann
Withney T-Test
ROC
AUC Sens Specif Cut-off signifROC
MCV p=00798 p=06461 0665
MPV plt00001 0832 81 806 lt83 p=00001
NE Mean
Volume p=00008 087 952 694 gt1402 p=00001
MO Mean
Volume p=00002 0801 667 833 gt1696 p=00001
MRV p=00054 0731 476 964 gt1133 p=00019
The Mean Neutrophil Volume (MNE V) and Mean Monocyte Volume (MMOV) may be used for the detection of megaloblastic neutrophils and monocytes MNEV and MMOV have significantly higher sensitivity than the previous information from the red cells (MCV) detecting B12 or folate deficiency because they are not affected by the presence at the same time of Iron deficiency or other reasons of anemia
Congreso Nacional Laboratorio Cliacutenico
2018
POSTER 733
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
CPD Sysmex XN
NE SSC complejidad
NE SFL aacutecidos nucleacuteicos
NE FSC tamantildeo
NE WX
NE WY
NE WZ
MO X
MO Y
MO Z
MO WX
MO WY
MO WZ
LY X
LY Y
LY Z
LY WX
LY WY
LY WZCongreso Nacio
nal Laboratorio Cliacutenico 2018
As MCV is the mean which is calculated it is insensitive to the presence of a small number of macrocytes
Further macrocytosis can be obscured by concomitant disorders that can cause microcytosis resulting inmasked megaloblastic anaemia (MA) for example iron deficiency hereditary elliptocytosis alpha and betathalassemia
This study was undertaken to evaluate the role of NEUT-X and NEUT-Y in detecting MA on peripheral blood andalso see whether other forms of macrocytic anaemia can be differentiated from MA
In MA the peripheral blood smear shows cytopenia with macroovalocytes and hypersegmented
neutrophils (gt5 lobes in 5 neutrophils six lobes nuclei or lobe average of gt35)
In conclusion our study shows that higher values of NEUT-X and NEUT-Y in MA patients in spite of low ornormal MCV high RDW may be used to not only reveal the masked cases of MA with concomitant irondeficiency but also separate them from the broader macrocytic anaemia group
Peripheral smear remains diagnostic however making smear for all the suspicious cases is a cumbersomeand tedious procedure Thus these parameters emerge as more reliable and stable parameters in themodern laboratories which in future may replace the older screening tools
Congreso Nacional Laboratorio Cliacutenico
2018
A favor Eficiencia Operativa
Mejora el proceso del Laboratorio
Mejor informacioacuten al Cliacutenico al mismo coste
Mejora la informacioacuten
Informa sobre la eritropoyesis deteccioacuten precoz de estados carenciales
Ayuda al cliacutenico
Estado real del paciente
En contraParaacutemetros de investigacioacuten
Dificultad de standarizar dependencia teacutecnica
Control de calidadCongreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
SysmexRBCHe erythrocyte Hb equivalentRetHe reticulocyte Hb equivalent(content)
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
MIC
MAC
HPO HPR
Congreso Nacional Laboratorio Cliacutenico
2018
copy 2012 Mindray Confidential 36
MINDRAY MCHrHDWHYPERHYPO
MCHr Mean RET HGB Concentration
HDW HGB Distribution Width
HYPER The percentage of hyperchromicred blood cells
HYPO The percentage of hypochromic red blood cells
Thalassemia screeningIDA treatment monitoringIDA screening
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
Hipocromo
Hipercroacutemico onormocroacutemico
iquestConcentracioacuten o contenido de Hemoglobina
Hipocroacutemiconormocroacutemico
Abbott Mindray Siemens Hypo CONCENTRACIOacuteN Hblt280gL
Sysmex Hypo CONTENIDO Hblt 17 pg
Congreso Nacional Laboratorio Cliacutenico
2018
Low Hb Density
Microcytic Factor Maf = (HbMCV)100
Nuevo moacutedulo transductor muacuteltiple con laacuteser de diodo y dos sensores oacutepticos
Anaacutelisis de hasta 50000 ceacutelulas con 7 paraacutemetros tecnoloacutegicos (leucocitos reticulocitos eritroblastos)
1 Volumen digital
2 Conductividad digital
3 5 aacutengulos de dispersioacuten de luz laacuteser digital
bull MALS (Median Angle Light Scatter)
bull UMALS (Upper Median Angle Light Scatter) 20deg a 43deg
bull LMALS (Lower Median Angle Light Scatter) 09deg a 19deg
bull LALS (Low Angle Light Scatter) asymp 51deg
bull AL2 (Axial Light Loss) 0deg a 05deg
Congreso Nacional Laboratorio Cliacutenico
2018
Hierro es un elemento criacutetico para elfuncionamiento oacuteptimo y supervivenciade las ceacutelulas
Disfuncioacuten mitocondrialActividad enzimaacutetica afectadaProteiacutenas de transporte y estructuralesproteins
Capacidad fiacutesica mermadaCapacidad de trabajo reducidaCapacidades cognitivas afectadasMorbilidad y mortalidad
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
It is generally assumed that worldwide ldquoat least half the anemia is due tonutritional iron deficiencyrdquo and that ldquoup to a prevalence of iron deficiency anemiaof 40 the prevalence of iron deficiency will be about 25 times that of anemiardquoHowever it is evident from the foregoing discussion that there are considerablevariations in both of these ratios depending on the age and sex of the peoplebeing studied the region of the world in which they live and the prevalence ratesof other causes of anemia
WHO Department of Nutrition for Health and DevelopmentAssessing the iron status of populations including literature reviews report of a Joint World Health OrganizationCenters for DiseaseControl and Prevention Technical Consultation on the Assessment of Iron Status at the Population Level Geneva Switzerland 6ndash8 April2004 ndash 2nd ed
Congreso Nacional Laboratorio Cliacutenico
2018
Estaacute bien establecido que la anemia produce una miriacuteada de secuelas tanto fiacutesicas comopsicoloacutegicas
Pero los efecto deleteacutereos se deben al deficit de hierro que es un evento previo a que seestablezca la anemia
El deacuteficit de hierrro auacuten sin anemia tiene efectos negativos en el desarrollo cognitivo y fiacutesico
Rattehalli D et al Iron deficiency without anemia do not wait for the Hemoglobin to drop
Health Policy and Technology 2013 2 45-48Congreso Nacio
nal Laboratorio Cliacutenico 2018
SuominenP et al Serum transferrin receptor and transferrin receptor-ferritin index identify healthy subjects with subclinical iron deficits Blood 1998 92 2934ndash9Halwachs-Baumann G Diagnosis of anaemia old things rearranged Wien Med Wochenschr 2012 162478ndash88
Congreso Nacional Laboratorio Cliacutenico
2018
Hemoglobina de reticulocito y su importancia en el diagnoacutestico temprano de anemiaferropeacutenica
Y Maacuterquez-Beniacutetez et al Universidad de BocayaAugust
2018 DOI 1022267rus182003133 aop
El contenido de hemoglobina de reticulocitos (CHr) es un paraacutemetro en la biometriacuteahematoloacutegica automatizada utilizado como un marcador de la biodisponibilidad delhierro en la eritropoyesis
Objetivo Exponer la aplicabilidad de la CHr como un paraacutemetro en el diagnoacutesticoprecoz de la anemia por deficiencia de hierro asiacute como su medicioacuten e interpretacioacuten
Materiales y meacutetodos Se realizoacute la revisioacuten de artiacuteculos cientiacuteficos en ingleacutes y espantildeolen las bases de datos PubMed ScienceDirect LILACS y Medline usando descriptoresvalidados en Medical Subject Headings (MeSH) considerando periodo depublicabilidad del 80 inferior a 5 antildeos
Conclusiones La CHr es un paraacutemetro de gran utilidad en el diagnoacutestico temprano deanemia ferropeacutenica y otras patologiacuteas como deficiencia funcional de hierro estadosde inflamacioacuten croacutenica y enfermedad renal croacutenica
Biomarcador temprano en el diagnoacutestico de deficiencia de hierro antes de presentarsecambios morfoloacutegicos eritrociacuteticosCongreso Nacio
nal Laboratorio Cliacutenico 2018
bull A total of 1105 NES participants (639 men 466 women)bull CHr becomes affected in a relatively early stage in the development of iron deficiency before iron
deficiency anemia and clinical symptoms become apparentbull Therefore this parameter might be useful to identify persons healthy and diseased at risk of
developing iron deficiency anemia and subsequently to apply interventions in order to prevent further development of iron deficiency anemiaCongreso Nacio
nal Laboratorio Cliacutenico 2018
Hb reticulocitaria sensible para detectar la fase inicial del deacuteficit de hierro cuando laeritropoyesis requiere maacutes cantidad que la que recibe ANTES de que la anemia seestablezca
Congreso Nacional Laboratorio Cliacutenico
2018
No ID LID P
RBC 1012L 48 (08) 437 (05) lt00001
Hb gL 135 (6) 131 (12) 0006
MCV fL 922 (21) 902 (38) 0006
MCH pg 324 (07) 306 (22) lt00001
MCHC gL 339 (6) 319 (23) 0001
RDW
Ret He pg
Hypo He
LHD
Ferritin microgL
131 (06)
338 (21)
03 (015)
28 (20)
86 (3)
145 (21)
278 (24)
69 (55)
56 (25)
16 (76)
lt00001
lt00001
lt00001
lt00001
lt00001
AUC 95 CI Cutoff Sensitivity Specificity
LHD 0898 0819-0978 50 859 841
Ret He 0914 0824-1000 299pg 868 857
Hypo He 0934 0856-1000 16 857 921
Clinical value of markers of hypochromia in the detection of latent iron deficiency in non-anemic premenopausal women
No ID Hb gt 120 gL s-ferritin was within reference intervalLatent Iron Defiency Hb gt 120 gL s-ferritin lt 30 μgL
Urrechaga E et al Journal Clin Lab Analysis 2016 30 (5) 623-627
97 women (388) in 250 apparently healthy women had latent IDCongreso Nacional Laboratorio Cliacutenico
2018
Schorer G et al Abstract Jahreskongress der Deutschen Gesellschaft fuumlr Transfusionsmedizin und Immunhaumlmatologie Rostock 15 - 18 September 2009
Congreso Nacional Laboratorio Cliacutenico
2018
Caring for Those Who Share Mitigating Iron Deficiency in Regular Blood DonorsMast Alan E
bull Iron deficiency caused by regular blood donation is a problem facing blood centers Each blood donation removes 200 to 250 mg of iron from the donor Consequently many donors become iron deficient with repeated donation
bull This presents a challenge to blood centers that has become more acute in recent years with the realization that iron deficiency even in the absence of anemia is associated with adverse effects including fatigue and decreased exercise tolerance as well as neurological symptoms such as decreased cognitive function pica and restless leg syndrome
bull REDS-II investigators performed a longitudinal study investigating the iron status of blood donors over a two year period called the REDS-II Donor Iron Status Evaluation (RISE)
bull Results from the baseline analysis of regular donors (e 2 donations per year (females) or e 3 donations per year (males) revealed that over two-thirds of female donors and over one-half of male donors have iron deficiency
Congreso Nacional Laboratorio Cliacutenico
2018
Transfusion 2013 532766-2775
bull We evaluated the diagnostic sensitivity and specificity of red blood cell (RBC) hematology analyzer indices to assess iron status as a part of donor management iron deficient erythropoiesis (IDE) and absence of iron stores (AIS)
bull STUDY DESIGN AND METHODS A total of 1659 male and female donors from the Retrovirus Epidemiology Donor Study-II (REDS-II) Donor Iron Status Evaluation (RISE) study who were either first-timereactivated (FT RA no donations for 2 years) or frequent donors were recruited into a longitudinal study of regular donation of RBCs Of these 1002 donors returned 15 to 24 months later for a final assessment
Absent iron stores (AIS) was defined as plasma ferritin level of less than 12 mgL Logarithm of the ratio of soluble transferrin receptor to ferritin of at least 207 was used to define iron-deficient erythropoiesis (IDE)
bull RESULTS HYPOm and CHr detected IDE with comparable sensitivity 72 versus 69 but differed in specificity HYPOm 68 and CHr 53
For detecting AIS sensitivity was improved to 85 for HYPOm and 81 for CHr but specificity was reduced
Venous Hb had high specificity but poor sensitivity for IDE and AIS A plasma ferritin level of less than 267 mgL was a good surrogate for assessing IDE Congreso Nacio
nal Laboratorio Cliacutenico 2018
Microcytic RBC and reticulocyte mean cell hemoglobin content predicted iron depletion with
sensitivities 70 and 64
specificities of 72 and 78 respectively
When both combined
increased the sensitivity to 82
Congreso Nacional Laboratorio Cliacutenico
2018
Depending on the number of donations during the preceding12 months
Absent iron stores were detected in up to 214 of male and278 of female donors respectively
impaired hemoglobinisation IH was present in up to 64 maleand 167 female donors with 2 and 4 preceding donationsrespectively
The defined CHr cut-off value was 280 pg to detect IH infrequent whole blood donors with AIS leading to a testspecificity of 982 (positive predictive value PPV 577) inmale and of 978 (PPV 829) in female donors
It may help to prevent the development of anemia in frequentblood donors and also can help to decide whether donordeferral or even iron substitution need to be recommended
Congreso Nacional Laboratorio Cliacutenico
2018
Of the 501 blood donors sTfR and Ret-He detected Latent Iron Deficiency in 148 and 135 donors respectively
In comparison to sTfR Ret-He had sensitivity of 927 specificity of 9716 PPV of 931 and NPV of 963
Serum Ferritin TIBC and serum Iron had comparatively lower sensitivity of 8716 797 and 777 respectively
Conclusion Ret-He can be used as a routine screening test to detect LID in blood donors
This could provide an opportunity to make appropriate and timely interventions like dietary changes or drug supplementation
Congreso Nacional Laboratorio Cliacutenico
2018
Singh A Chaudhary R Pandey HC Sonker A Identification of iron status of blood donors by using low hemoglobin density and microcytic anemia factor Asian J Transfus Sci 20181246-50
The main objective of this study was to assess ifLHD and Maf could be used for assessment ofiron status in blood donors and also to establisha cut-off for these two parameters at which atentative iron deficiency could be reportedconclusively
Results LHD and Maf were able to differentiatebetween iron deficient and iron-depleteddonors from normal donorsA cutoff of 918 for LHD was able todifferentiate iron deficient and depleted statefrom normal iron statessensitivity 919 and specificity 71respectivelya cutoff of 1016 for Mafsensitivity 946 and specificity 968
MAf = (MVC Hb) 100
Congreso Nacional Laboratorio Cliacutenico
2018
Hb reticulocitaria sensible para detectar la fase inicial del deacuteficitde hierro cuando la eritropoyesis requiere maacutes cantidad que laque recibe ANTES de que la anemia se establezca
La deteccioacuten precoz del deacuteficit de hierro en la fase del balance negativo demanda aporte contribuye a reducir sus manifestaciones cliacutenicas en los pacientes afectados mejorando la salud puacuteblica
Un tratamiento menos prolongado con suplementos y menor consumo de los recursos sanitaros Contribuye a la eficiencia y sostenibilidad de los servicios sanitarios
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
Buttarello MLaboratory diagnosis of anemia are the old and new red cell parameters useful in classification and treatment howInt Jnl Lab Hem 2016 38 (Suppl 1) 123ndash132
Congreso Nacional Laboratorio Cliacutenico
2018
Buttarello MLaboratory diagnosis of anemia are the old and new red cell parameters useful in classification and treatment howInt Jnl Lab Hem 2016 38 (Suppl 1) 123ndash132
Congreso Nacional Laboratorio Cliacutenico
2018
Ralph Green amp Ananya Datta Mitra Megaloblastic Anemias Nutritional and Other CausesMed Clin N Am 2017 101 297ndash317
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
ANEMIA CARENCIAL CAUSAS
Factores alimentariosConsumir una dieta vegetariana mal planeadaAlimentacioacuten deficiente en los bebeacutesDesnutricioacuten durante el embarazo
Deacuteficit de absorcioacutenAlcoholismo croacutenicoEnfermedad de Crohn celiaquiacutea infeccioacuten otros problemas que le dificulten al cuerpo la digestioacuten de los alimentosAnemia perniciosa (factor intriacutenseco)Cirugiacuteas para extirpar ciertas partes del estoacutemago o el intestino delgado
MedicamentosB12 omeprazol metformina colchicina aminosalicilatos neomicinaFOLATO fenitoiacutena metotrexato sulfasalacina triamtereno pirimetamina trimetoprim con sulfametoxazol barbituacutericos
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
Reacciones metaboacutelicas en las que participan la vitamina B12 y el folato bull la conversioacuten de metilmalonil-CoA a succinil-CoA donde la adenosil-cobalamina actuacutea de
cofactor Por ello un deacuteficit de B12 conlleva un aumento de metilmalonil-CoA y de su producto de hidroacutelisis el aacutecido metilmaloacutenico
bull la siacutentesis de metionina a partir de homocisteina gracias a la metionina sintetasa y a la metil-cobalamina como cofactor En esta misma reaccioacuten el metiltetrahidrofolato es transformado a tetrahidrofolato que es necesario para la siacutentesis de DNA
Congreso Nacional Laboratorio Cliacutenico
2018
Anemia macrociacutetica secundaria a deficiencia de aacutecido foacutelico y de vitamina B12(cobalamina)
La deficiencia de B12 yo aacutecido foacutelico es la causa maacutes frecuente de megaloblastosis
Dentro de distintas funciones generales del metabolismo la vitamina B12 es uncofactor esencial en la siacutentesis de ADN y ARN compromete a todas las ceacutelulas delorganismo
Su deficiencia se manifiesta en oacuterganos con alto recambio celular como la meacutedulaosea y en el sistema nervioso central (SNC) a traveacutes de la siacutentesis de mielina y lareparacioacuten axonal
La deficiencia de cobalamina es responsable de alteraciones hematoloacutegicasneuroloacutegicas neurocognitivas y neuropsiquiaacutetricas
La siacutentesis defectuosa de ADN conduce a la apoptosis y a la hemoacutelisis (intra yextramedular) causantes de la hemopoyesis inefectiva
En meacutedula la siacutentesis ineficiente de DNA causa cambios megaloblaacutesticos comoconsecuencIa anemia y citopenias
Congreso Nacional Laboratorio Cliacutenico
2018
Limitaciones de los meacutetodos diagnoacutesticos claacutesicos
Volumen Corpuscular Medio (VCM) y morfologiacutea de sangre perifeacuterica En una serie de pacientes con deacuteficit de cobalamina soacutelo un 29 teniacutean anemia y soacutelo un 36 teniacutean un VCM gt 100 fL
Un VCM normal no puede ser empleado para rechazar una determinacioacuten de nivel de cobalamina ya que hasta un 25 de casos con manifestaciones neuroloacutegicas cursan con un VCM normal
Cobalamina seacuterica (nivel de B12) Es el test diagnoacutestico rutinario inicial estaacutendar Es un test ampliamente disponible de bajo coste y automatizado Sin embargo presenta algunas limitaciones
-- Existencia de varias teacutecnicas y ausencia de un gold standard por lo que hay diferentes liacutemites de referencia
-- Variacioacuten intraindividual muy alta
La OMS publicoacute en 2008 las conclusiones de un grupo teacutecnico consultado sobre el deacuteficit de cobalamina y folato
El grupo reconocioacute que no existen unos umbrales universalmente reconocidos para definir el deacuteficit de ambas vitaminas y expresaron la necesidad de un consenso
Devalia V Hamilton MS and Molloy AM on behalf of the British Committee for standards in haematology Guidelines for the diagnosis and treatment of cobalamin and folate disorders Br J Haematol 2014 166(4) 496-513
Schrier SL Diagnosis and treatment of vitamin B12 and folate deficiency UpToDate Last updated Jun 25 2014
de Benoist B Conclusions of a WHO Technical Consultation on folate and vitamin B12 deficiencies Food Nutr Bull 200829(2 Suppl)S238ndash44Congreso Nacional Laboratorio Cliacutenico
2018
Tomado de Tefferi A Li C En Atlas of Clinical Hematology Publicado por JO Armitage Philadelphia Current Medicine 2004
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
Int Jnl Lab Hem 2007 29 327ndash334
Clin Lab 201662343-347
In ourstudy mean MCVrMCV ratio of healthy controls is130 as microcytic anemia irondeficiency anemia is121 as also macrocytic anemia vitamin B12 deficiencyanemia is 115
Congreso Nacional Laboratorio Cliacutenico
2018
Sualeh Muslim Khan Muhammad Akbar Agha
Mean cell volume of reticulocytemdashA new parameter for diagnosing sub-clinical cobalamin deficiency in blood donors Int J Lab Hem 20181ndash4
The Abbott CELL-DYN Sapphire Hematology System uses multi-angle polarized scatter separation (MAPSS) and focused flow impedance technologies
Congreso Nacional Laboratorio Cliacutenico
2018
MCVr at 985 fL yielded the highest Youdenrsquos index at sensitivity of 82 specificity of 828 AUC 0847 ( 95 CI 803-891)
Khan SM Agha MA Mean cell volume of reticulocyte-A new parameter for diagnosing sub-clinical cobalamin deficiency in blood donors
Int J Lab Hem 20181ndash4 2018 Jul 13 doi 101111ijlh12899
Congreso Nacional Laboratorio Cliacutenico
2018
Role of Cell Population Data in the detection of folate and cobalamin deficiency
J Nieto et al
XXXI st International Symposium on Technological Innovations in Laboratory Hematology ISLH 2018 10-12 May 2018 Brussels Belgium
M-V-NRET and SD-VNRET are the best discriminatory single parameters to distinguish between patients with B9B12 deficiency and reference subjects M-V-NRETAUC=0823 sensitivity 78 and specificity 86
AUC=0852 sensitivity 55 and specificity 60
Conclusions The CPD parameters of Volume and Light Scatter (M and SD of LALS angle) that inform about size and intracellular structure of RBCs provided very useful information for the detection of B9B12 deficiency
Congreso Nacional Laboratorio Cliacutenico
2018
Cell Population Data
bull Paraacutemetros poblacionales de los leucocitos
bull Describen la morfologiacutea tamantildeo
estructuras citoplasmaacuteticas
nuacutecleo aacutecidos nucleacuteicos
bull Son datos numeacutericos con los que se construyen los ejes de lo diagramas de dispersioacuten de los leucocitos
bull Dependen de la tecnologiacutea
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
High Sensitivity New Parameters for the Detection of Vitamin B12 and Folate Deficiencies Blood 2008 1125379
B12 def vs
Normals
Mann
Withney T-Test
ROC
AUC Sens Specif Cutoff signifROC
MCV p=03156 p=09533 0577
MPV p=00001 0802 792 806 lt83 p=00001
NE Mean
Volume plt00001 0862 833 778 gt1403 p=00001
MO Mean
Volume plt00001 0829 625 889 gt1723 p=00001
MRV p=00113 0705 50 964 gt1133 p=00051
Folate def vs
Normals
Mann
Withney T-Test
ROC
AUC Sens Specif Cut-off signifROC
MCV p=00798 p=06461 0665
MPV plt00001 0832 81 806 lt83 p=00001
NE Mean
Volume p=00008 087 952 694 gt1402 p=00001
MO Mean
Volume p=00002 0801 667 833 gt1696 p=00001
MRV p=00054 0731 476 964 gt1133 p=00019
The Mean Neutrophil Volume (MNE V) and Mean Monocyte Volume (MMOV) may be used for the detection of megaloblastic neutrophils and monocytes MNEV and MMOV have significantly higher sensitivity than the previous information from the red cells (MCV) detecting B12 or folate deficiency because they are not affected by the presence at the same time of Iron deficiency or other reasons of anemia
Congreso Nacional Laboratorio Cliacutenico
2018
POSTER 733
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
CPD Sysmex XN
NE SSC complejidad
NE SFL aacutecidos nucleacuteicos
NE FSC tamantildeo
NE WX
NE WY
NE WZ
MO X
MO Y
MO Z
MO WX
MO WY
MO WZ
LY X
LY Y
LY Z
LY WX
LY WY
LY WZCongreso Nacio
nal Laboratorio Cliacutenico 2018
As MCV is the mean which is calculated it is insensitive to the presence of a small number of macrocytes
Further macrocytosis can be obscured by concomitant disorders that can cause microcytosis resulting inmasked megaloblastic anaemia (MA) for example iron deficiency hereditary elliptocytosis alpha and betathalassemia
This study was undertaken to evaluate the role of NEUT-X and NEUT-Y in detecting MA on peripheral blood andalso see whether other forms of macrocytic anaemia can be differentiated from MA
In MA the peripheral blood smear shows cytopenia with macroovalocytes and hypersegmented
neutrophils (gt5 lobes in 5 neutrophils six lobes nuclei or lobe average of gt35)
In conclusion our study shows that higher values of NEUT-X and NEUT-Y in MA patients in spite of low ornormal MCV high RDW may be used to not only reveal the masked cases of MA with concomitant irondeficiency but also separate them from the broader macrocytic anaemia group
Peripheral smear remains diagnostic however making smear for all the suspicious cases is a cumbersomeand tedious procedure Thus these parameters emerge as more reliable and stable parameters in themodern laboratories which in future may replace the older screening tools
Congreso Nacional Laboratorio Cliacutenico
2018
A favor Eficiencia Operativa
Mejora el proceso del Laboratorio
Mejor informacioacuten al Cliacutenico al mismo coste
Mejora la informacioacuten
Informa sobre la eritropoyesis deteccioacuten precoz de estados carenciales
Ayuda al cliacutenico
Estado real del paciente
En contraParaacutemetros de investigacioacuten
Dificultad de standarizar dependencia teacutecnica
Control de calidadCongreso Nacional Laboratorio Cliacutenico
2018
SysmexRBCHe erythrocyte Hb equivalentRetHe reticulocyte Hb equivalent(content)
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
MIC
MAC
HPO HPR
Congreso Nacional Laboratorio Cliacutenico
2018
copy 2012 Mindray Confidential 36
MINDRAY MCHrHDWHYPERHYPO
MCHr Mean RET HGB Concentration
HDW HGB Distribution Width
HYPER The percentage of hyperchromicred blood cells
HYPO The percentage of hypochromic red blood cells
Thalassemia screeningIDA treatment monitoringIDA screening
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
Hipocromo
Hipercroacutemico onormocroacutemico
iquestConcentracioacuten o contenido de Hemoglobina
Hipocroacutemiconormocroacutemico
Abbott Mindray Siemens Hypo CONCENTRACIOacuteN Hblt280gL
Sysmex Hypo CONTENIDO Hblt 17 pg
Congreso Nacional Laboratorio Cliacutenico
2018
Low Hb Density
Microcytic Factor Maf = (HbMCV)100
Nuevo moacutedulo transductor muacuteltiple con laacuteser de diodo y dos sensores oacutepticos
Anaacutelisis de hasta 50000 ceacutelulas con 7 paraacutemetros tecnoloacutegicos (leucocitos reticulocitos eritroblastos)
1 Volumen digital
2 Conductividad digital
3 5 aacutengulos de dispersioacuten de luz laacuteser digital
bull MALS (Median Angle Light Scatter)
bull UMALS (Upper Median Angle Light Scatter) 20deg a 43deg
bull LMALS (Lower Median Angle Light Scatter) 09deg a 19deg
bull LALS (Low Angle Light Scatter) asymp 51deg
bull AL2 (Axial Light Loss) 0deg a 05deg
Congreso Nacional Laboratorio Cliacutenico
2018
Hierro es un elemento criacutetico para elfuncionamiento oacuteptimo y supervivenciade las ceacutelulas
Disfuncioacuten mitocondrialActividad enzimaacutetica afectadaProteiacutenas de transporte y estructuralesproteins
Capacidad fiacutesica mermadaCapacidad de trabajo reducidaCapacidades cognitivas afectadasMorbilidad y mortalidad
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
It is generally assumed that worldwide ldquoat least half the anemia is due tonutritional iron deficiencyrdquo and that ldquoup to a prevalence of iron deficiency anemiaof 40 the prevalence of iron deficiency will be about 25 times that of anemiardquoHowever it is evident from the foregoing discussion that there are considerablevariations in both of these ratios depending on the age and sex of the peoplebeing studied the region of the world in which they live and the prevalence ratesof other causes of anemia
WHO Department of Nutrition for Health and DevelopmentAssessing the iron status of populations including literature reviews report of a Joint World Health OrganizationCenters for DiseaseControl and Prevention Technical Consultation on the Assessment of Iron Status at the Population Level Geneva Switzerland 6ndash8 April2004 ndash 2nd ed
Congreso Nacional Laboratorio Cliacutenico
2018
Estaacute bien establecido que la anemia produce una miriacuteada de secuelas tanto fiacutesicas comopsicoloacutegicas
Pero los efecto deleteacutereos se deben al deficit de hierro que es un evento previo a que seestablezca la anemia
El deacuteficit de hierrro auacuten sin anemia tiene efectos negativos en el desarrollo cognitivo y fiacutesico
Rattehalli D et al Iron deficiency without anemia do not wait for the Hemoglobin to drop
Health Policy and Technology 2013 2 45-48Congreso Nacio
nal Laboratorio Cliacutenico 2018
SuominenP et al Serum transferrin receptor and transferrin receptor-ferritin index identify healthy subjects with subclinical iron deficits Blood 1998 92 2934ndash9Halwachs-Baumann G Diagnosis of anaemia old things rearranged Wien Med Wochenschr 2012 162478ndash88
Congreso Nacional Laboratorio Cliacutenico
2018
Hemoglobina de reticulocito y su importancia en el diagnoacutestico temprano de anemiaferropeacutenica
Y Maacuterquez-Beniacutetez et al Universidad de BocayaAugust
2018 DOI 1022267rus182003133 aop
El contenido de hemoglobina de reticulocitos (CHr) es un paraacutemetro en la biometriacuteahematoloacutegica automatizada utilizado como un marcador de la biodisponibilidad delhierro en la eritropoyesis
Objetivo Exponer la aplicabilidad de la CHr como un paraacutemetro en el diagnoacutesticoprecoz de la anemia por deficiencia de hierro asiacute como su medicioacuten e interpretacioacuten
Materiales y meacutetodos Se realizoacute la revisioacuten de artiacuteculos cientiacuteficos en ingleacutes y espantildeolen las bases de datos PubMed ScienceDirect LILACS y Medline usando descriptoresvalidados en Medical Subject Headings (MeSH) considerando periodo depublicabilidad del 80 inferior a 5 antildeos
Conclusiones La CHr es un paraacutemetro de gran utilidad en el diagnoacutestico temprano deanemia ferropeacutenica y otras patologiacuteas como deficiencia funcional de hierro estadosde inflamacioacuten croacutenica y enfermedad renal croacutenica
Biomarcador temprano en el diagnoacutestico de deficiencia de hierro antes de presentarsecambios morfoloacutegicos eritrociacuteticosCongreso Nacio
nal Laboratorio Cliacutenico 2018
bull A total of 1105 NES participants (639 men 466 women)bull CHr becomes affected in a relatively early stage in the development of iron deficiency before iron
deficiency anemia and clinical symptoms become apparentbull Therefore this parameter might be useful to identify persons healthy and diseased at risk of
developing iron deficiency anemia and subsequently to apply interventions in order to prevent further development of iron deficiency anemiaCongreso Nacio
nal Laboratorio Cliacutenico 2018
Hb reticulocitaria sensible para detectar la fase inicial del deacuteficit de hierro cuando laeritropoyesis requiere maacutes cantidad que la que recibe ANTES de que la anemia seestablezca
Congreso Nacional Laboratorio Cliacutenico
2018
No ID LID P
RBC 1012L 48 (08) 437 (05) lt00001
Hb gL 135 (6) 131 (12) 0006
MCV fL 922 (21) 902 (38) 0006
MCH pg 324 (07) 306 (22) lt00001
MCHC gL 339 (6) 319 (23) 0001
RDW
Ret He pg
Hypo He
LHD
Ferritin microgL
131 (06)
338 (21)
03 (015)
28 (20)
86 (3)
145 (21)
278 (24)
69 (55)
56 (25)
16 (76)
lt00001
lt00001
lt00001
lt00001
lt00001
AUC 95 CI Cutoff Sensitivity Specificity
LHD 0898 0819-0978 50 859 841
Ret He 0914 0824-1000 299pg 868 857
Hypo He 0934 0856-1000 16 857 921
Clinical value of markers of hypochromia in the detection of latent iron deficiency in non-anemic premenopausal women
No ID Hb gt 120 gL s-ferritin was within reference intervalLatent Iron Defiency Hb gt 120 gL s-ferritin lt 30 μgL
Urrechaga E et al Journal Clin Lab Analysis 2016 30 (5) 623-627
97 women (388) in 250 apparently healthy women had latent IDCongreso Nacional Laboratorio Cliacutenico
2018
Schorer G et al Abstract Jahreskongress der Deutschen Gesellschaft fuumlr Transfusionsmedizin und Immunhaumlmatologie Rostock 15 - 18 September 2009
Congreso Nacional Laboratorio Cliacutenico
2018
Caring for Those Who Share Mitigating Iron Deficiency in Regular Blood DonorsMast Alan E
bull Iron deficiency caused by regular blood donation is a problem facing blood centers Each blood donation removes 200 to 250 mg of iron from the donor Consequently many donors become iron deficient with repeated donation
bull This presents a challenge to blood centers that has become more acute in recent years with the realization that iron deficiency even in the absence of anemia is associated with adverse effects including fatigue and decreased exercise tolerance as well as neurological symptoms such as decreased cognitive function pica and restless leg syndrome
bull REDS-II investigators performed a longitudinal study investigating the iron status of blood donors over a two year period called the REDS-II Donor Iron Status Evaluation (RISE)
bull Results from the baseline analysis of regular donors (e 2 donations per year (females) or e 3 donations per year (males) revealed that over two-thirds of female donors and over one-half of male donors have iron deficiency
Congreso Nacional Laboratorio Cliacutenico
2018
Transfusion 2013 532766-2775
bull We evaluated the diagnostic sensitivity and specificity of red blood cell (RBC) hematology analyzer indices to assess iron status as a part of donor management iron deficient erythropoiesis (IDE) and absence of iron stores (AIS)
bull STUDY DESIGN AND METHODS A total of 1659 male and female donors from the Retrovirus Epidemiology Donor Study-II (REDS-II) Donor Iron Status Evaluation (RISE) study who were either first-timereactivated (FT RA no donations for 2 years) or frequent donors were recruited into a longitudinal study of regular donation of RBCs Of these 1002 donors returned 15 to 24 months later for a final assessment
Absent iron stores (AIS) was defined as plasma ferritin level of less than 12 mgL Logarithm of the ratio of soluble transferrin receptor to ferritin of at least 207 was used to define iron-deficient erythropoiesis (IDE)
bull RESULTS HYPOm and CHr detected IDE with comparable sensitivity 72 versus 69 but differed in specificity HYPOm 68 and CHr 53
For detecting AIS sensitivity was improved to 85 for HYPOm and 81 for CHr but specificity was reduced
Venous Hb had high specificity but poor sensitivity for IDE and AIS A plasma ferritin level of less than 267 mgL was a good surrogate for assessing IDE Congreso Nacio
nal Laboratorio Cliacutenico 2018
Microcytic RBC and reticulocyte mean cell hemoglobin content predicted iron depletion with
sensitivities 70 and 64
specificities of 72 and 78 respectively
When both combined
increased the sensitivity to 82
Congreso Nacional Laboratorio Cliacutenico
2018
Depending on the number of donations during the preceding12 months
Absent iron stores were detected in up to 214 of male and278 of female donors respectively
impaired hemoglobinisation IH was present in up to 64 maleand 167 female donors with 2 and 4 preceding donationsrespectively
The defined CHr cut-off value was 280 pg to detect IH infrequent whole blood donors with AIS leading to a testspecificity of 982 (positive predictive value PPV 577) inmale and of 978 (PPV 829) in female donors
It may help to prevent the development of anemia in frequentblood donors and also can help to decide whether donordeferral or even iron substitution need to be recommended
Congreso Nacional Laboratorio Cliacutenico
2018
Of the 501 blood donors sTfR and Ret-He detected Latent Iron Deficiency in 148 and 135 donors respectively
In comparison to sTfR Ret-He had sensitivity of 927 specificity of 9716 PPV of 931 and NPV of 963
Serum Ferritin TIBC and serum Iron had comparatively lower sensitivity of 8716 797 and 777 respectively
Conclusion Ret-He can be used as a routine screening test to detect LID in blood donors
This could provide an opportunity to make appropriate and timely interventions like dietary changes or drug supplementation
Congreso Nacional Laboratorio Cliacutenico
2018
Singh A Chaudhary R Pandey HC Sonker A Identification of iron status of blood donors by using low hemoglobin density and microcytic anemia factor Asian J Transfus Sci 20181246-50
The main objective of this study was to assess ifLHD and Maf could be used for assessment ofiron status in blood donors and also to establisha cut-off for these two parameters at which atentative iron deficiency could be reportedconclusively
Results LHD and Maf were able to differentiatebetween iron deficient and iron-depleteddonors from normal donorsA cutoff of 918 for LHD was able todifferentiate iron deficient and depleted statefrom normal iron statessensitivity 919 and specificity 71respectivelya cutoff of 1016 for Mafsensitivity 946 and specificity 968
MAf = (MVC Hb) 100
Congreso Nacional Laboratorio Cliacutenico
2018
Hb reticulocitaria sensible para detectar la fase inicial del deacuteficitde hierro cuando la eritropoyesis requiere maacutes cantidad que laque recibe ANTES de que la anemia se establezca
La deteccioacuten precoz del deacuteficit de hierro en la fase del balance negativo demanda aporte contribuye a reducir sus manifestaciones cliacutenicas en los pacientes afectados mejorando la salud puacuteblica
Un tratamiento menos prolongado con suplementos y menor consumo de los recursos sanitaros Contribuye a la eficiencia y sostenibilidad de los servicios sanitarios
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
Buttarello MLaboratory diagnosis of anemia are the old and new red cell parameters useful in classification and treatment howInt Jnl Lab Hem 2016 38 (Suppl 1) 123ndash132
Congreso Nacional Laboratorio Cliacutenico
2018
Buttarello MLaboratory diagnosis of anemia are the old and new red cell parameters useful in classification and treatment howInt Jnl Lab Hem 2016 38 (Suppl 1) 123ndash132
Congreso Nacional Laboratorio Cliacutenico
2018
Ralph Green amp Ananya Datta Mitra Megaloblastic Anemias Nutritional and Other CausesMed Clin N Am 2017 101 297ndash317
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
ANEMIA CARENCIAL CAUSAS
Factores alimentariosConsumir una dieta vegetariana mal planeadaAlimentacioacuten deficiente en los bebeacutesDesnutricioacuten durante el embarazo
Deacuteficit de absorcioacutenAlcoholismo croacutenicoEnfermedad de Crohn celiaquiacutea infeccioacuten otros problemas que le dificulten al cuerpo la digestioacuten de los alimentosAnemia perniciosa (factor intriacutenseco)Cirugiacuteas para extirpar ciertas partes del estoacutemago o el intestino delgado
MedicamentosB12 omeprazol metformina colchicina aminosalicilatos neomicinaFOLATO fenitoiacutena metotrexato sulfasalacina triamtereno pirimetamina trimetoprim con sulfametoxazol barbituacutericos
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
Reacciones metaboacutelicas en las que participan la vitamina B12 y el folato bull la conversioacuten de metilmalonil-CoA a succinil-CoA donde la adenosil-cobalamina actuacutea de
cofactor Por ello un deacuteficit de B12 conlleva un aumento de metilmalonil-CoA y de su producto de hidroacutelisis el aacutecido metilmaloacutenico
bull la siacutentesis de metionina a partir de homocisteina gracias a la metionina sintetasa y a la metil-cobalamina como cofactor En esta misma reaccioacuten el metiltetrahidrofolato es transformado a tetrahidrofolato que es necesario para la siacutentesis de DNA
Congreso Nacional Laboratorio Cliacutenico
2018
Anemia macrociacutetica secundaria a deficiencia de aacutecido foacutelico y de vitamina B12(cobalamina)
La deficiencia de B12 yo aacutecido foacutelico es la causa maacutes frecuente de megaloblastosis
Dentro de distintas funciones generales del metabolismo la vitamina B12 es uncofactor esencial en la siacutentesis de ADN y ARN compromete a todas las ceacutelulas delorganismo
Su deficiencia se manifiesta en oacuterganos con alto recambio celular como la meacutedulaosea y en el sistema nervioso central (SNC) a traveacutes de la siacutentesis de mielina y lareparacioacuten axonal
La deficiencia de cobalamina es responsable de alteraciones hematoloacutegicasneuroloacutegicas neurocognitivas y neuropsiquiaacutetricas
La siacutentesis defectuosa de ADN conduce a la apoptosis y a la hemoacutelisis (intra yextramedular) causantes de la hemopoyesis inefectiva
En meacutedula la siacutentesis ineficiente de DNA causa cambios megaloblaacutesticos comoconsecuencIa anemia y citopenias
Congreso Nacional Laboratorio Cliacutenico
2018
Limitaciones de los meacutetodos diagnoacutesticos claacutesicos
Volumen Corpuscular Medio (VCM) y morfologiacutea de sangre perifeacuterica En una serie de pacientes con deacuteficit de cobalamina soacutelo un 29 teniacutean anemia y soacutelo un 36 teniacutean un VCM gt 100 fL
Un VCM normal no puede ser empleado para rechazar una determinacioacuten de nivel de cobalamina ya que hasta un 25 de casos con manifestaciones neuroloacutegicas cursan con un VCM normal
Cobalamina seacuterica (nivel de B12) Es el test diagnoacutestico rutinario inicial estaacutendar Es un test ampliamente disponible de bajo coste y automatizado Sin embargo presenta algunas limitaciones
-- Existencia de varias teacutecnicas y ausencia de un gold standard por lo que hay diferentes liacutemites de referencia
-- Variacioacuten intraindividual muy alta
La OMS publicoacute en 2008 las conclusiones de un grupo teacutecnico consultado sobre el deacuteficit de cobalamina y folato
El grupo reconocioacute que no existen unos umbrales universalmente reconocidos para definir el deacuteficit de ambas vitaminas y expresaron la necesidad de un consenso
Devalia V Hamilton MS and Molloy AM on behalf of the British Committee for standards in haematology Guidelines for the diagnosis and treatment of cobalamin and folate disorders Br J Haematol 2014 166(4) 496-513
Schrier SL Diagnosis and treatment of vitamin B12 and folate deficiency UpToDate Last updated Jun 25 2014
de Benoist B Conclusions of a WHO Technical Consultation on folate and vitamin B12 deficiencies Food Nutr Bull 200829(2 Suppl)S238ndash44Congreso Nacional Laboratorio Cliacutenico
2018
Tomado de Tefferi A Li C En Atlas of Clinical Hematology Publicado por JO Armitage Philadelphia Current Medicine 2004
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
Int Jnl Lab Hem 2007 29 327ndash334
Clin Lab 201662343-347
In ourstudy mean MCVrMCV ratio of healthy controls is130 as microcytic anemia irondeficiency anemia is121 as also macrocytic anemia vitamin B12 deficiencyanemia is 115
Congreso Nacional Laboratorio Cliacutenico
2018
Sualeh Muslim Khan Muhammad Akbar Agha
Mean cell volume of reticulocytemdashA new parameter for diagnosing sub-clinical cobalamin deficiency in blood donors Int J Lab Hem 20181ndash4
The Abbott CELL-DYN Sapphire Hematology System uses multi-angle polarized scatter separation (MAPSS) and focused flow impedance technologies
Congreso Nacional Laboratorio Cliacutenico
2018
MCVr at 985 fL yielded the highest Youdenrsquos index at sensitivity of 82 specificity of 828 AUC 0847 ( 95 CI 803-891)
Khan SM Agha MA Mean cell volume of reticulocyte-A new parameter for diagnosing sub-clinical cobalamin deficiency in blood donors
Int J Lab Hem 20181ndash4 2018 Jul 13 doi 101111ijlh12899
Congreso Nacional Laboratorio Cliacutenico
2018
Role of Cell Population Data in the detection of folate and cobalamin deficiency
J Nieto et al
XXXI st International Symposium on Technological Innovations in Laboratory Hematology ISLH 2018 10-12 May 2018 Brussels Belgium
M-V-NRET and SD-VNRET are the best discriminatory single parameters to distinguish between patients with B9B12 deficiency and reference subjects M-V-NRETAUC=0823 sensitivity 78 and specificity 86
AUC=0852 sensitivity 55 and specificity 60
Conclusions The CPD parameters of Volume and Light Scatter (M and SD of LALS angle) that inform about size and intracellular structure of RBCs provided very useful information for the detection of B9B12 deficiency
Congreso Nacional Laboratorio Cliacutenico
2018
Cell Population Data
bull Paraacutemetros poblacionales de los leucocitos
bull Describen la morfologiacutea tamantildeo
estructuras citoplasmaacuteticas
nuacutecleo aacutecidos nucleacuteicos
bull Son datos numeacutericos con los que se construyen los ejes de lo diagramas de dispersioacuten de los leucocitos
bull Dependen de la tecnologiacutea
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
High Sensitivity New Parameters for the Detection of Vitamin B12 and Folate Deficiencies Blood 2008 1125379
B12 def vs
Normals
Mann
Withney T-Test
ROC
AUC Sens Specif Cutoff signifROC
MCV p=03156 p=09533 0577
MPV p=00001 0802 792 806 lt83 p=00001
NE Mean
Volume plt00001 0862 833 778 gt1403 p=00001
MO Mean
Volume plt00001 0829 625 889 gt1723 p=00001
MRV p=00113 0705 50 964 gt1133 p=00051
Folate def vs
Normals
Mann
Withney T-Test
ROC
AUC Sens Specif Cut-off signifROC
MCV p=00798 p=06461 0665
MPV plt00001 0832 81 806 lt83 p=00001
NE Mean
Volume p=00008 087 952 694 gt1402 p=00001
MO Mean
Volume p=00002 0801 667 833 gt1696 p=00001
MRV p=00054 0731 476 964 gt1133 p=00019
The Mean Neutrophil Volume (MNE V) and Mean Monocyte Volume (MMOV) may be used for the detection of megaloblastic neutrophils and monocytes MNEV and MMOV have significantly higher sensitivity than the previous information from the red cells (MCV) detecting B12 or folate deficiency because they are not affected by the presence at the same time of Iron deficiency or other reasons of anemia
Congreso Nacional Laboratorio Cliacutenico
2018
POSTER 733
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
CPD Sysmex XN
NE SSC complejidad
NE SFL aacutecidos nucleacuteicos
NE FSC tamantildeo
NE WX
NE WY
NE WZ
MO X
MO Y
MO Z
MO WX
MO WY
MO WZ
LY X
LY Y
LY Z
LY WX
LY WY
LY WZCongreso Nacio
nal Laboratorio Cliacutenico 2018
As MCV is the mean which is calculated it is insensitive to the presence of a small number of macrocytes
Further macrocytosis can be obscured by concomitant disorders that can cause microcytosis resulting inmasked megaloblastic anaemia (MA) for example iron deficiency hereditary elliptocytosis alpha and betathalassemia
This study was undertaken to evaluate the role of NEUT-X and NEUT-Y in detecting MA on peripheral blood andalso see whether other forms of macrocytic anaemia can be differentiated from MA
In MA the peripheral blood smear shows cytopenia with macroovalocytes and hypersegmented
neutrophils (gt5 lobes in 5 neutrophils six lobes nuclei or lobe average of gt35)
In conclusion our study shows that higher values of NEUT-X and NEUT-Y in MA patients in spite of low ornormal MCV high RDW may be used to not only reveal the masked cases of MA with concomitant irondeficiency but also separate them from the broader macrocytic anaemia group
Peripheral smear remains diagnostic however making smear for all the suspicious cases is a cumbersomeand tedious procedure Thus these parameters emerge as more reliable and stable parameters in themodern laboratories which in future may replace the older screening tools
Congreso Nacional Laboratorio Cliacutenico
2018
A favor Eficiencia Operativa
Mejora el proceso del Laboratorio
Mejor informacioacuten al Cliacutenico al mismo coste
Mejora la informacioacuten
Informa sobre la eritropoyesis deteccioacuten precoz de estados carenciales
Ayuda al cliacutenico
Estado real del paciente
En contraParaacutemetros de investigacioacuten
Dificultad de standarizar dependencia teacutecnica
Control de calidadCongreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
MIC
MAC
HPO HPR
Congreso Nacional Laboratorio Cliacutenico
2018
copy 2012 Mindray Confidential 36
MINDRAY MCHrHDWHYPERHYPO
MCHr Mean RET HGB Concentration
HDW HGB Distribution Width
HYPER The percentage of hyperchromicred blood cells
HYPO The percentage of hypochromic red blood cells
Thalassemia screeningIDA treatment monitoringIDA screening
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
Hipocromo
Hipercroacutemico onormocroacutemico
iquestConcentracioacuten o contenido de Hemoglobina
Hipocroacutemiconormocroacutemico
Abbott Mindray Siemens Hypo CONCENTRACIOacuteN Hblt280gL
Sysmex Hypo CONTENIDO Hblt 17 pg
Congreso Nacional Laboratorio Cliacutenico
2018
Low Hb Density
Microcytic Factor Maf = (HbMCV)100
Nuevo moacutedulo transductor muacuteltiple con laacuteser de diodo y dos sensores oacutepticos
Anaacutelisis de hasta 50000 ceacutelulas con 7 paraacutemetros tecnoloacutegicos (leucocitos reticulocitos eritroblastos)
1 Volumen digital
2 Conductividad digital
3 5 aacutengulos de dispersioacuten de luz laacuteser digital
bull MALS (Median Angle Light Scatter)
bull UMALS (Upper Median Angle Light Scatter) 20deg a 43deg
bull LMALS (Lower Median Angle Light Scatter) 09deg a 19deg
bull LALS (Low Angle Light Scatter) asymp 51deg
bull AL2 (Axial Light Loss) 0deg a 05deg
Congreso Nacional Laboratorio Cliacutenico
2018
Hierro es un elemento criacutetico para elfuncionamiento oacuteptimo y supervivenciade las ceacutelulas
Disfuncioacuten mitocondrialActividad enzimaacutetica afectadaProteiacutenas de transporte y estructuralesproteins
Capacidad fiacutesica mermadaCapacidad de trabajo reducidaCapacidades cognitivas afectadasMorbilidad y mortalidad
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
It is generally assumed that worldwide ldquoat least half the anemia is due tonutritional iron deficiencyrdquo and that ldquoup to a prevalence of iron deficiency anemiaof 40 the prevalence of iron deficiency will be about 25 times that of anemiardquoHowever it is evident from the foregoing discussion that there are considerablevariations in both of these ratios depending on the age and sex of the peoplebeing studied the region of the world in which they live and the prevalence ratesof other causes of anemia
WHO Department of Nutrition for Health and DevelopmentAssessing the iron status of populations including literature reviews report of a Joint World Health OrganizationCenters for DiseaseControl and Prevention Technical Consultation on the Assessment of Iron Status at the Population Level Geneva Switzerland 6ndash8 April2004 ndash 2nd ed
Congreso Nacional Laboratorio Cliacutenico
2018
Estaacute bien establecido que la anemia produce una miriacuteada de secuelas tanto fiacutesicas comopsicoloacutegicas
Pero los efecto deleteacutereos se deben al deficit de hierro que es un evento previo a que seestablezca la anemia
El deacuteficit de hierrro auacuten sin anemia tiene efectos negativos en el desarrollo cognitivo y fiacutesico
Rattehalli D et al Iron deficiency without anemia do not wait for the Hemoglobin to drop
Health Policy and Technology 2013 2 45-48Congreso Nacio
nal Laboratorio Cliacutenico 2018
SuominenP et al Serum transferrin receptor and transferrin receptor-ferritin index identify healthy subjects with subclinical iron deficits Blood 1998 92 2934ndash9Halwachs-Baumann G Diagnosis of anaemia old things rearranged Wien Med Wochenschr 2012 162478ndash88
Congreso Nacional Laboratorio Cliacutenico
2018
Hemoglobina de reticulocito y su importancia en el diagnoacutestico temprano de anemiaferropeacutenica
Y Maacuterquez-Beniacutetez et al Universidad de BocayaAugust
2018 DOI 1022267rus182003133 aop
El contenido de hemoglobina de reticulocitos (CHr) es un paraacutemetro en la biometriacuteahematoloacutegica automatizada utilizado como un marcador de la biodisponibilidad delhierro en la eritropoyesis
Objetivo Exponer la aplicabilidad de la CHr como un paraacutemetro en el diagnoacutesticoprecoz de la anemia por deficiencia de hierro asiacute como su medicioacuten e interpretacioacuten
Materiales y meacutetodos Se realizoacute la revisioacuten de artiacuteculos cientiacuteficos en ingleacutes y espantildeolen las bases de datos PubMed ScienceDirect LILACS y Medline usando descriptoresvalidados en Medical Subject Headings (MeSH) considerando periodo depublicabilidad del 80 inferior a 5 antildeos
Conclusiones La CHr es un paraacutemetro de gran utilidad en el diagnoacutestico temprano deanemia ferropeacutenica y otras patologiacuteas como deficiencia funcional de hierro estadosde inflamacioacuten croacutenica y enfermedad renal croacutenica
Biomarcador temprano en el diagnoacutestico de deficiencia de hierro antes de presentarsecambios morfoloacutegicos eritrociacuteticosCongreso Nacio
nal Laboratorio Cliacutenico 2018
bull A total of 1105 NES participants (639 men 466 women)bull CHr becomes affected in a relatively early stage in the development of iron deficiency before iron
deficiency anemia and clinical symptoms become apparentbull Therefore this parameter might be useful to identify persons healthy and diseased at risk of
developing iron deficiency anemia and subsequently to apply interventions in order to prevent further development of iron deficiency anemiaCongreso Nacio
nal Laboratorio Cliacutenico 2018
Hb reticulocitaria sensible para detectar la fase inicial del deacuteficit de hierro cuando laeritropoyesis requiere maacutes cantidad que la que recibe ANTES de que la anemia seestablezca
Congreso Nacional Laboratorio Cliacutenico
2018
No ID LID P
RBC 1012L 48 (08) 437 (05) lt00001
Hb gL 135 (6) 131 (12) 0006
MCV fL 922 (21) 902 (38) 0006
MCH pg 324 (07) 306 (22) lt00001
MCHC gL 339 (6) 319 (23) 0001
RDW
Ret He pg
Hypo He
LHD
Ferritin microgL
131 (06)
338 (21)
03 (015)
28 (20)
86 (3)
145 (21)
278 (24)
69 (55)
56 (25)
16 (76)
lt00001
lt00001
lt00001
lt00001
lt00001
AUC 95 CI Cutoff Sensitivity Specificity
LHD 0898 0819-0978 50 859 841
Ret He 0914 0824-1000 299pg 868 857
Hypo He 0934 0856-1000 16 857 921
Clinical value of markers of hypochromia in the detection of latent iron deficiency in non-anemic premenopausal women
No ID Hb gt 120 gL s-ferritin was within reference intervalLatent Iron Defiency Hb gt 120 gL s-ferritin lt 30 μgL
Urrechaga E et al Journal Clin Lab Analysis 2016 30 (5) 623-627
97 women (388) in 250 apparently healthy women had latent IDCongreso Nacional Laboratorio Cliacutenico
2018
Schorer G et al Abstract Jahreskongress der Deutschen Gesellschaft fuumlr Transfusionsmedizin und Immunhaumlmatologie Rostock 15 - 18 September 2009
Congreso Nacional Laboratorio Cliacutenico
2018
Caring for Those Who Share Mitigating Iron Deficiency in Regular Blood DonorsMast Alan E
bull Iron deficiency caused by regular blood donation is a problem facing blood centers Each blood donation removes 200 to 250 mg of iron from the donor Consequently many donors become iron deficient with repeated donation
bull This presents a challenge to blood centers that has become more acute in recent years with the realization that iron deficiency even in the absence of anemia is associated with adverse effects including fatigue and decreased exercise tolerance as well as neurological symptoms such as decreased cognitive function pica and restless leg syndrome
bull REDS-II investigators performed a longitudinal study investigating the iron status of blood donors over a two year period called the REDS-II Donor Iron Status Evaluation (RISE)
bull Results from the baseline analysis of regular donors (e 2 donations per year (females) or e 3 donations per year (males) revealed that over two-thirds of female donors and over one-half of male donors have iron deficiency
Congreso Nacional Laboratorio Cliacutenico
2018
Transfusion 2013 532766-2775
bull We evaluated the diagnostic sensitivity and specificity of red blood cell (RBC) hematology analyzer indices to assess iron status as a part of donor management iron deficient erythropoiesis (IDE) and absence of iron stores (AIS)
bull STUDY DESIGN AND METHODS A total of 1659 male and female donors from the Retrovirus Epidemiology Donor Study-II (REDS-II) Donor Iron Status Evaluation (RISE) study who were either first-timereactivated (FT RA no donations for 2 years) or frequent donors were recruited into a longitudinal study of regular donation of RBCs Of these 1002 donors returned 15 to 24 months later for a final assessment
Absent iron stores (AIS) was defined as plasma ferritin level of less than 12 mgL Logarithm of the ratio of soluble transferrin receptor to ferritin of at least 207 was used to define iron-deficient erythropoiesis (IDE)
bull RESULTS HYPOm and CHr detected IDE with comparable sensitivity 72 versus 69 but differed in specificity HYPOm 68 and CHr 53
For detecting AIS sensitivity was improved to 85 for HYPOm and 81 for CHr but specificity was reduced
Venous Hb had high specificity but poor sensitivity for IDE and AIS A plasma ferritin level of less than 267 mgL was a good surrogate for assessing IDE Congreso Nacio
nal Laboratorio Cliacutenico 2018
Microcytic RBC and reticulocyte mean cell hemoglobin content predicted iron depletion with
sensitivities 70 and 64
specificities of 72 and 78 respectively
When both combined
increased the sensitivity to 82
Congreso Nacional Laboratorio Cliacutenico
2018
Depending on the number of donations during the preceding12 months
Absent iron stores were detected in up to 214 of male and278 of female donors respectively
impaired hemoglobinisation IH was present in up to 64 maleand 167 female donors with 2 and 4 preceding donationsrespectively
The defined CHr cut-off value was 280 pg to detect IH infrequent whole blood donors with AIS leading to a testspecificity of 982 (positive predictive value PPV 577) inmale and of 978 (PPV 829) in female donors
It may help to prevent the development of anemia in frequentblood donors and also can help to decide whether donordeferral or even iron substitution need to be recommended
Congreso Nacional Laboratorio Cliacutenico
2018
Of the 501 blood donors sTfR and Ret-He detected Latent Iron Deficiency in 148 and 135 donors respectively
In comparison to sTfR Ret-He had sensitivity of 927 specificity of 9716 PPV of 931 and NPV of 963
Serum Ferritin TIBC and serum Iron had comparatively lower sensitivity of 8716 797 and 777 respectively
Conclusion Ret-He can be used as a routine screening test to detect LID in blood donors
This could provide an opportunity to make appropriate and timely interventions like dietary changes or drug supplementation
Congreso Nacional Laboratorio Cliacutenico
2018
Singh A Chaudhary R Pandey HC Sonker A Identification of iron status of blood donors by using low hemoglobin density and microcytic anemia factor Asian J Transfus Sci 20181246-50
The main objective of this study was to assess ifLHD and Maf could be used for assessment ofiron status in blood donors and also to establisha cut-off for these two parameters at which atentative iron deficiency could be reportedconclusively
Results LHD and Maf were able to differentiatebetween iron deficient and iron-depleteddonors from normal donorsA cutoff of 918 for LHD was able todifferentiate iron deficient and depleted statefrom normal iron statessensitivity 919 and specificity 71respectivelya cutoff of 1016 for Mafsensitivity 946 and specificity 968
MAf = (MVC Hb) 100
Congreso Nacional Laboratorio Cliacutenico
2018
Hb reticulocitaria sensible para detectar la fase inicial del deacuteficitde hierro cuando la eritropoyesis requiere maacutes cantidad que laque recibe ANTES de que la anemia se establezca
La deteccioacuten precoz del deacuteficit de hierro en la fase del balance negativo demanda aporte contribuye a reducir sus manifestaciones cliacutenicas en los pacientes afectados mejorando la salud puacuteblica
Un tratamiento menos prolongado con suplementos y menor consumo de los recursos sanitaros Contribuye a la eficiencia y sostenibilidad de los servicios sanitarios
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
Buttarello MLaboratory diagnosis of anemia are the old and new red cell parameters useful in classification and treatment howInt Jnl Lab Hem 2016 38 (Suppl 1) 123ndash132
Congreso Nacional Laboratorio Cliacutenico
2018
Buttarello MLaboratory diagnosis of anemia are the old and new red cell parameters useful in classification and treatment howInt Jnl Lab Hem 2016 38 (Suppl 1) 123ndash132
Congreso Nacional Laboratorio Cliacutenico
2018
Ralph Green amp Ananya Datta Mitra Megaloblastic Anemias Nutritional and Other CausesMed Clin N Am 2017 101 297ndash317
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
ANEMIA CARENCIAL CAUSAS
Factores alimentariosConsumir una dieta vegetariana mal planeadaAlimentacioacuten deficiente en los bebeacutesDesnutricioacuten durante el embarazo
Deacuteficit de absorcioacutenAlcoholismo croacutenicoEnfermedad de Crohn celiaquiacutea infeccioacuten otros problemas que le dificulten al cuerpo la digestioacuten de los alimentosAnemia perniciosa (factor intriacutenseco)Cirugiacuteas para extirpar ciertas partes del estoacutemago o el intestino delgado
MedicamentosB12 omeprazol metformina colchicina aminosalicilatos neomicinaFOLATO fenitoiacutena metotrexato sulfasalacina triamtereno pirimetamina trimetoprim con sulfametoxazol barbituacutericos
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
Reacciones metaboacutelicas en las que participan la vitamina B12 y el folato bull la conversioacuten de metilmalonil-CoA a succinil-CoA donde la adenosil-cobalamina actuacutea de
cofactor Por ello un deacuteficit de B12 conlleva un aumento de metilmalonil-CoA y de su producto de hidroacutelisis el aacutecido metilmaloacutenico
bull la siacutentesis de metionina a partir de homocisteina gracias a la metionina sintetasa y a la metil-cobalamina como cofactor En esta misma reaccioacuten el metiltetrahidrofolato es transformado a tetrahidrofolato que es necesario para la siacutentesis de DNA
Congreso Nacional Laboratorio Cliacutenico
2018
Anemia macrociacutetica secundaria a deficiencia de aacutecido foacutelico y de vitamina B12(cobalamina)
La deficiencia de B12 yo aacutecido foacutelico es la causa maacutes frecuente de megaloblastosis
Dentro de distintas funciones generales del metabolismo la vitamina B12 es uncofactor esencial en la siacutentesis de ADN y ARN compromete a todas las ceacutelulas delorganismo
Su deficiencia se manifiesta en oacuterganos con alto recambio celular como la meacutedulaosea y en el sistema nervioso central (SNC) a traveacutes de la siacutentesis de mielina y lareparacioacuten axonal
La deficiencia de cobalamina es responsable de alteraciones hematoloacutegicasneuroloacutegicas neurocognitivas y neuropsiquiaacutetricas
La siacutentesis defectuosa de ADN conduce a la apoptosis y a la hemoacutelisis (intra yextramedular) causantes de la hemopoyesis inefectiva
En meacutedula la siacutentesis ineficiente de DNA causa cambios megaloblaacutesticos comoconsecuencIa anemia y citopenias
Congreso Nacional Laboratorio Cliacutenico
2018
Limitaciones de los meacutetodos diagnoacutesticos claacutesicos
Volumen Corpuscular Medio (VCM) y morfologiacutea de sangre perifeacuterica En una serie de pacientes con deacuteficit de cobalamina soacutelo un 29 teniacutean anemia y soacutelo un 36 teniacutean un VCM gt 100 fL
Un VCM normal no puede ser empleado para rechazar una determinacioacuten de nivel de cobalamina ya que hasta un 25 de casos con manifestaciones neuroloacutegicas cursan con un VCM normal
Cobalamina seacuterica (nivel de B12) Es el test diagnoacutestico rutinario inicial estaacutendar Es un test ampliamente disponible de bajo coste y automatizado Sin embargo presenta algunas limitaciones
-- Existencia de varias teacutecnicas y ausencia de un gold standard por lo que hay diferentes liacutemites de referencia
-- Variacioacuten intraindividual muy alta
La OMS publicoacute en 2008 las conclusiones de un grupo teacutecnico consultado sobre el deacuteficit de cobalamina y folato
El grupo reconocioacute que no existen unos umbrales universalmente reconocidos para definir el deacuteficit de ambas vitaminas y expresaron la necesidad de un consenso
Devalia V Hamilton MS and Molloy AM on behalf of the British Committee for standards in haematology Guidelines for the diagnosis and treatment of cobalamin and folate disorders Br J Haematol 2014 166(4) 496-513
Schrier SL Diagnosis and treatment of vitamin B12 and folate deficiency UpToDate Last updated Jun 25 2014
de Benoist B Conclusions of a WHO Technical Consultation on folate and vitamin B12 deficiencies Food Nutr Bull 200829(2 Suppl)S238ndash44Congreso Nacional Laboratorio Cliacutenico
2018
Tomado de Tefferi A Li C En Atlas of Clinical Hematology Publicado por JO Armitage Philadelphia Current Medicine 2004
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
Int Jnl Lab Hem 2007 29 327ndash334
Clin Lab 201662343-347
In ourstudy mean MCVrMCV ratio of healthy controls is130 as microcytic anemia irondeficiency anemia is121 as also macrocytic anemia vitamin B12 deficiencyanemia is 115
Congreso Nacional Laboratorio Cliacutenico
2018
Sualeh Muslim Khan Muhammad Akbar Agha
Mean cell volume of reticulocytemdashA new parameter for diagnosing sub-clinical cobalamin deficiency in blood donors Int J Lab Hem 20181ndash4
The Abbott CELL-DYN Sapphire Hematology System uses multi-angle polarized scatter separation (MAPSS) and focused flow impedance technologies
Congreso Nacional Laboratorio Cliacutenico
2018
MCVr at 985 fL yielded the highest Youdenrsquos index at sensitivity of 82 specificity of 828 AUC 0847 ( 95 CI 803-891)
Khan SM Agha MA Mean cell volume of reticulocyte-A new parameter for diagnosing sub-clinical cobalamin deficiency in blood donors
Int J Lab Hem 20181ndash4 2018 Jul 13 doi 101111ijlh12899
Congreso Nacional Laboratorio Cliacutenico
2018
Role of Cell Population Data in the detection of folate and cobalamin deficiency
J Nieto et al
XXXI st International Symposium on Technological Innovations in Laboratory Hematology ISLH 2018 10-12 May 2018 Brussels Belgium
M-V-NRET and SD-VNRET are the best discriminatory single parameters to distinguish between patients with B9B12 deficiency and reference subjects M-V-NRETAUC=0823 sensitivity 78 and specificity 86
AUC=0852 sensitivity 55 and specificity 60
Conclusions The CPD parameters of Volume and Light Scatter (M and SD of LALS angle) that inform about size and intracellular structure of RBCs provided very useful information for the detection of B9B12 deficiency
Congreso Nacional Laboratorio Cliacutenico
2018
Cell Population Data
bull Paraacutemetros poblacionales de los leucocitos
bull Describen la morfologiacutea tamantildeo
estructuras citoplasmaacuteticas
nuacutecleo aacutecidos nucleacuteicos
bull Son datos numeacutericos con los que se construyen los ejes de lo diagramas de dispersioacuten de los leucocitos
bull Dependen de la tecnologiacutea
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
High Sensitivity New Parameters for the Detection of Vitamin B12 and Folate Deficiencies Blood 2008 1125379
B12 def vs
Normals
Mann
Withney T-Test
ROC
AUC Sens Specif Cutoff signifROC
MCV p=03156 p=09533 0577
MPV p=00001 0802 792 806 lt83 p=00001
NE Mean
Volume plt00001 0862 833 778 gt1403 p=00001
MO Mean
Volume plt00001 0829 625 889 gt1723 p=00001
MRV p=00113 0705 50 964 gt1133 p=00051
Folate def vs
Normals
Mann
Withney T-Test
ROC
AUC Sens Specif Cut-off signifROC
MCV p=00798 p=06461 0665
MPV plt00001 0832 81 806 lt83 p=00001
NE Mean
Volume p=00008 087 952 694 gt1402 p=00001
MO Mean
Volume p=00002 0801 667 833 gt1696 p=00001
MRV p=00054 0731 476 964 gt1133 p=00019
The Mean Neutrophil Volume (MNE V) and Mean Monocyte Volume (MMOV) may be used for the detection of megaloblastic neutrophils and monocytes MNEV and MMOV have significantly higher sensitivity than the previous information from the red cells (MCV) detecting B12 or folate deficiency because they are not affected by the presence at the same time of Iron deficiency or other reasons of anemia
Congreso Nacional Laboratorio Cliacutenico
2018
POSTER 733
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
CPD Sysmex XN
NE SSC complejidad
NE SFL aacutecidos nucleacuteicos
NE FSC tamantildeo
NE WX
NE WY
NE WZ
MO X
MO Y
MO Z
MO WX
MO WY
MO WZ
LY X
LY Y
LY Z
LY WX
LY WY
LY WZCongreso Nacio
nal Laboratorio Cliacutenico 2018
As MCV is the mean which is calculated it is insensitive to the presence of a small number of macrocytes
Further macrocytosis can be obscured by concomitant disorders that can cause microcytosis resulting inmasked megaloblastic anaemia (MA) for example iron deficiency hereditary elliptocytosis alpha and betathalassemia
This study was undertaken to evaluate the role of NEUT-X and NEUT-Y in detecting MA on peripheral blood andalso see whether other forms of macrocytic anaemia can be differentiated from MA
In MA the peripheral blood smear shows cytopenia with macroovalocytes and hypersegmented
neutrophils (gt5 lobes in 5 neutrophils six lobes nuclei or lobe average of gt35)
In conclusion our study shows that higher values of NEUT-X and NEUT-Y in MA patients in spite of low ornormal MCV high RDW may be used to not only reveal the masked cases of MA with concomitant irondeficiency but also separate them from the broader macrocytic anaemia group
Peripheral smear remains diagnostic however making smear for all the suspicious cases is a cumbersomeand tedious procedure Thus these parameters emerge as more reliable and stable parameters in themodern laboratories which in future may replace the older screening tools
Congreso Nacional Laboratorio Cliacutenico
2018
A favor Eficiencia Operativa
Mejora el proceso del Laboratorio
Mejor informacioacuten al Cliacutenico al mismo coste
Mejora la informacioacuten
Informa sobre la eritropoyesis deteccioacuten precoz de estados carenciales
Ayuda al cliacutenico
Estado real del paciente
En contraParaacutemetros de investigacioacuten
Dificultad de standarizar dependencia teacutecnica
Control de calidadCongreso Nacional Laboratorio Cliacutenico
2018
MIC
MAC
HPO HPR
Congreso Nacional Laboratorio Cliacutenico
2018
copy 2012 Mindray Confidential 36
MINDRAY MCHrHDWHYPERHYPO
MCHr Mean RET HGB Concentration
HDW HGB Distribution Width
HYPER The percentage of hyperchromicred blood cells
HYPO The percentage of hypochromic red blood cells
Thalassemia screeningIDA treatment monitoringIDA screening
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
Hipocromo
Hipercroacutemico onormocroacutemico
iquestConcentracioacuten o contenido de Hemoglobina
Hipocroacutemiconormocroacutemico
Abbott Mindray Siemens Hypo CONCENTRACIOacuteN Hblt280gL
Sysmex Hypo CONTENIDO Hblt 17 pg
Congreso Nacional Laboratorio Cliacutenico
2018
Low Hb Density
Microcytic Factor Maf = (HbMCV)100
Nuevo moacutedulo transductor muacuteltiple con laacuteser de diodo y dos sensores oacutepticos
Anaacutelisis de hasta 50000 ceacutelulas con 7 paraacutemetros tecnoloacutegicos (leucocitos reticulocitos eritroblastos)
1 Volumen digital
2 Conductividad digital
3 5 aacutengulos de dispersioacuten de luz laacuteser digital
bull MALS (Median Angle Light Scatter)
bull UMALS (Upper Median Angle Light Scatter) 20deg a 43deg
bull LMALS (Lower Median Angle Light Scatter) 09deg a 19deg
bull LALS (Low Angle Light Scatter) asymp 51deg
bull AL2 (Axial Light Loss) 0deg a 05deg
Congreso Nacional Laboratorio Cliacutenico
2018
Hierro es un elemento criacutetico para elfuncionamiento oacuteptimo y supervivenciade las ceacutelulas
Disfuncioacuten mitocondrialActividad enzimaacutetica afectadaProteiacutenas de transporte y estructuralesproteins
Capacidad fiacutesica mermadaCapacidad de trabajo reducidaCapacidades cognitivas afectadasMorbilidad y mortalidad
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
It is generally assumed that worldwide ldquoat least half the anemia is due tonutritional iron deficiencyrdquo and that ldquoup to a prevalence of iron deficiency anemiaof 40 the prevalence of iron deficiency will be about 25 times that of anemiardquoHowever it is evident from the foregoing discussion that there are considerablevariations in both of these ratios depending on the age and sex of the peoplebeing studied the region of the world in which they live and the prevalence ratesof other causes of anemia
WHO Department of Nutrition for Health and DevelopmentAssessing the iron status of populations including literature reviews report of a Joint World Health OrganizationCenters for DiseaseControl and Prevention Technical Consultation on the Assessment of Iron Status at the Population Level Geneva Switzerland 6ndash8 April2004 ndash 2nd ed
Congreso Nacional Laboratorio Cliacutenico
2018
Estaacute bien establecido que la anemia produce una miriacuteada de secuelas tanto fiacutesicas comopsicoloacutegicas
Pero los efecto deleteacutereos se deben al deficit de hierro que es un evento previo a que seestablezca la anemia
El deacuteficit de hierrro auacuten sin anemia tiene efectos negativos en el desarrollo cognitivo y fiacutesico
Rattehalli D et al Iron deficiency without anemia do not wait for the Hemoglobin to drop
Health Policy and Technology 2013 2 45-48Congreso Nacio
nal Laboratorio Cliacutenico 2018
SuominenP et al Serum transferrin receptor and transferrin receptor-ferritin index identify healthy subjects with subclinical iron deficits Blood 1998 92 2934ndash9Halwachs-Baumann G Diagnosis of anaemia old things rearranged Wien Med Wochenschr 2012 162478ndash88
Congreso Nacional Laboratorio Cliacutenico
2018
Hemoglobina de reticulocito y su importancia en el diagnoacutestico temprano de anemiaferropeacutenica
Y Maacuterquez-Beniacutetez et al Universidad de BocayaAugust
2018 DOI 1022267rus182003133 aop
El contenido de hemoglobina de reticulocitos (CHr) es un paraacutemetro en la biometriacuteahematoloacutegica automatizada utilizado como un marcador de la biodisponibilidad delhierro en la eritropoyesis
Objetivo Exponer la aplicabilidad de la CHr como un paraacutemetro en el diagnoacutesticoprecoz de la anemia por deficiencia de hierro asiacute como su medicioacuten e interpretacioacuten
Materiales y meacutetodos Se realizoacute la revisioacuten de artiacuteculos cientiacuteficos en ingleacutes y espantildeolen las bases de datos PubMed ScienceDirect LILACS y Medline usando descriptoresvalidados en Medical Subject Headings (MeSH) considerando periodo depublicabilidad del 80 inferior a 5 antildeos
Conclusiones La CHr es un paraacutemetro de gran utilidad en el diagnoacutestico temprano deanemia ferropeacutenica y otras patologiacuteas como deficiencia funcional de hierro estadosde inflamacioacuten croacutenica y enfermedad renal croacutenica
Biomarcador temprano en el diagnoacutestico de deficiencia de hierro antes de presentarsecambios morfoloacutegicos eritrociacuteticosCongreso Nacio
nal Laboratorio Cliacutenico 2018
bull A total of 1105 NES participants (639 men 466 women)bull CHr becomes affected in a relatively early stage in the development of iron deficiency before iron
deficiency anemia and clinical symptoms become apparentbull Therefore this parameter might be useful to identify persons healthy and diseased at risk of
developing iron deficiency anemia and subsequently to apply interventions in order to prevent further development of iron deficiency anemiaCongreso Nacio
nal Laboratorio Cliacutenico 2018
Hb reticulocitaria sensible para detectar la fase inicial del deacuteficit de hierro cuando laeritropoyesis requiere maacutes cantidad que la que recibe ANTES de que la anemia seestablezca
Congreso Nacional Laboratorio Cliacutenico
2018
No ID LID P
RBC 1012L 48 (08) 437 (05) lt00001
Hb gL 135 (6) 131 (12) 0006
MCV fL 922 (21) 902 (38) 0006
MCH pg 324 (07) 306 (22) lt00001
MCHC gL 339 (6) 319 (23) 0001
RDW
Ret He pg
Hypo He
LHD
Ferritin microgL
131 (06)
338 (21)
03 (015)
28 (20)
86 (3)
145 (21)
278 (24)
69 (55)
56 (25)
16 (76)
lt00001
lt00001
lt00001
lt00001
lt00001
AUC 95 CI Cutoff Sensitivity Specificity
LHD 0898 0819-0978 50 859 841
Ret He 0914 0824-1000 299pg 868 857
Hypo He 0934 0856-1000 16 857 921
Clinical value of markers of hypochromia in the detection of latent iron deficiency in non-anemic premenopausal women
No ID Hb gt 120 gL s-ferritin was within reference intervalLatent Iron Defiency Hb gt 120 gL s-ferritin lt 30 μgL
Urrechaga E et al Journal Clin Lab Analysis 2016 30 (5) 623-627
97 women (388) in 250 apparently healthy women had latent IDCongreso Nacional Laboratorio Cliacutenico
2018
Schorer G et al Abstract Jahreskongress der Deutschen Gesellschaft fuumlr Transfusionsmedizin und Immunhaumlmatologie Rostock 15 - 18 September 2009
Congreso Nacional Laboratorio Cliacutenico
2018
Caring for Those Who Share Mitigating Iron Deficiency in Regular Blood DonorsMast Alan E
bull Iron deficiency caused by regular blood donation is a problem facing blood centers Each blood donation removes 200 to 250 mg of iron from the donor Consequently many donors become iron deficient with repeated donation
bull This presents a challenge to blood centers that has become more acute in recent years with the realization that iron deficiency even in the absence of anemia is associated with adverse effects including fatigue and decreased exercise tolerance as well as neurological symptoms such as decreased cognitive function pica and restless leg syndrome
bull REDS-II investigators performed a longitudinal study investigating the iron status of blood donors over a two year period called the REDS-II Donor Iron Status Evaluation (RISE)
bull Results from the baseline analysis of regular donors (e 2 donations per year (females) or e 3 donations per year (males) revealed that over two-thirds of female donors and over one-half of male donors have iron deficiency
Congreso Nacional Laboratorio Cliacutenico
2018
Transfusion 2013 532766-2775
bull We evaluated the diagnostic sensitivity and specificity of red blood cell (RBC) hematology analyzer indices to assess iron status as a part of donor management iron deficient erythropoiesis (IDE) and absence of iron stores (AIS)
bull STUDY DESIGN AND METHODS A total of 1659 male and female donors from the Retrovirus Epidemiology Donor Study-II (REDS-II) Donor Iron Status Evaluation (RISE) study who were either first-timereactivated (FT RA no donations for 2 years) or frequent donors were recruited into a longitudinal study of regular donation of RBCs Of these 1002 donors returned 15 to 24 months later for a final assessment
Absent iron stores (AIS) was defined as plasma ferritin level of less than 12 mgL Logarithm of the ratio of soluble transferrin receptor to ferritin of at least 207 was used to define iron-deficient erythropoiesis (IDE)
bull RESULTS HYPOm and CHr detected IDE with comparable sensitivity 72 versus 69 but differed in specificity HYPOm 68 and CHr 53
For detecting AIS sensitivity was improved to 85 for HYPOm and 81 for CHr but specificity was reduced
Venous Hb had high specificity but poor sensitivity for IDE and AIS A plasma ferritin level of less than 267 mgL was a good surrogate for assessing IDE Congreso Nacio
nal Laboratorio Cliacutenico 2018
Microcytic RBC and reticulocyte mean cell hemoglobin content predicted iron depletion with
sensitivities 70 and 64
specificities of 72 and 78 respectively
When both combined
increased the sensitivity to 82
Congreso Nacional Laboratorio Cliacutenico
2018
Depending on the number of donations during the preceding12 months
Absent iron stores were detected in up to 214 of male and278 of female donors respectively
impaired hemoglobinisation IH was present in up to 64 maleand 167 female donors with 2 and 4 preceding donationsrespectively
The defined CHr cut-off value was 280 pg to detect IH infrequent whole blood donors with AIS leading to a testspecificity of 982 (positive predictive value PPV 577) inmale and of 978 (PPV 829) in female donors
It may help to prevent the development of anemia in frequentblood donors and also can help to decide whether donordeferral or even iron substitution need to be recommended
Congreso Nacional Laboratorio Cliacutenico
2018
Of the 501 blood donors sTfR and Ret-He detected Latent Iron Deficiency in 148 and 135 donors respectively
In comparison to sTfR Ret-He had sensitivity of 927 specificity of 9716 PPV of 931 and NPV of 963
Serum Ferritin TIBC and serum Iron had comparatively lower sensitivity of 8716 797 and 777 respectively
Conclusion Ret-He can be used as a routine screening test to detect LID in blood donors
This could provide an opportunity to make appropriate and timely interventions like dietary changes or drug supplementation
Congreso Nacional Laboratorio Cliacutenico
2018
Singh A Chaudhary R Pandey HC Sonker A Identification of iron status of blood donors by using low hemoglobin density and microcytic anemia factor Asian J Transfus Sci 20181246-50
The main objective of this study was to assess ifLHD and Maf could be used for assessment ofiron status in blood donors and also to establisha cut-off for these two parameters at which atentative iron deficiency could be reportedconclusively
Results LHD and Maf were able to differentiatebetween iron deficient and iron-depleteddonors from normal donorsA cutoff of 918 for LHD was able todifferentiate iron deficient and depleted statefrom normal iron statessensitivity 919 and specificity 71respectivelya cutoff of 1016 for Mafsensitivity 946 and specificity 968
MAf = (MVC Hb) 100
Congreso Nacional Laboratorio Cliacutenico
2018
Hb reticulocitaria sensible para detectar la fase inicial del deacuteficitde hierro cuando la eritropoyesis requiere maacutes cantidad que laque recibe ANTES de que la anemia se establezca
La deteccioacuten precoz del deacuteficit de hierro en la fase del balance negativo demanda aporte contribuye a reducir sus manifestaciones cliacutenicas en los pacientes afectados mejorando la salud puacuteblica
Un tratamiento menos prolongado con suplementos y menor consumo de los recursos sanitaros Contribuye a la eficiencia y sostenibilidad de los servicios sanitarios
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
Buttarello MLaboratory diagnosis of anemia are the old and new red cell parameters useful in classification and treatment howInt Jnl Lab Hem 2016 38 (Suppl 1) 123ndash132
Congreso Nacional Laboratorio Cliacutenico
2018
Buttarello MLaboratory diagnosis of anemia are the old and new red cell parameters useful in classification and treatment howInt Jnl Lab Hem 2016 38 (Suppl 1) 123ndash132
Congreso Nacional Laboratorio Cliacutenico
2018
Ralph Green amp Ananya Datta Mitra Megaloblastic Anemias Nutritional and Other CausesMed Clin N Am 2017 101 297ndash317
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
ANEMIA CARENCIAL CAUSAS
Factores alimentariosConsumir una dieta vegetariana mal planeadaAlimentacioacuten deficiente en los bebeacutesDesnutricioacuten durante el embarazo
Deacuteficit de absorcioacutenAlcoholismo croacutenicoEnfermedad de Crohn celiaquiacutea infeccioacuten otros problemas que le dificulten al cuerpo la digestioacuten de los alimentosAnemia perniciosa (factor intriacutenseco)Cirugiacuteas para extirpar ciertas partes del estoacutemago o el intestino delgado
MedicamentosB12 omeprazol metformina colchicina aminosalicilatos neomicinaFOLATO fenitoiacutena metotrexato sulfasalacina triamtereno pirimetamina trimetoprim con sulfametoxazol barbituacutericos
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
Reacciones metaboacutelicas en las que participan la vitamina B12 y el folato bull la conversioacuten de metilmalonil-CoA a succinil-CoA donde la adenosil-cobalamina actuacutea de
cofactor Por ello un deacuteficit de B12 conlleva un aumento de metilmalonil-CoA y de su producto de hidroacutelisis el aacutecido metilmaloacutenico
bull la siacutentesis de metionina a partir de homocisteina gracias a la metionina sintetasa y a la metil-cobalamina como cofactor En esta misma reaccioacuten el metiltetrahidrofolato es transformado a tetrahidrofolato que es necesario para la siacutentesis de DNA
Congreso Nacional Laboratorio Cliacutenico
2018
Anemia macrociacutetica secundaria a deficiencia de aacutecido foacutelico y de vitamina B12(cobalamina)
La deficiencia de B12 yo aacutecido foacutelico es la causa maacutes frecuente de megaloblastosis
Dentro de distintas funciones generales del metabolismo la vitamina B12 es uncofactor esencial en la siacutentesis de ADN y ARN compromete a todas las ceacutelulas delorganismo
Su deficiencia se manifiesta en oacuterganos con alto recambio celular como la meacutedulaosea y en el sistema nervioso central (SNC) a traveacutes de la siacutentesis de mielina y lareparacioacuten axonal
La deficiencia de cobalamina es responsable de alteraciones hematoloacutegicasneuroloacutegicas neurocognitivas y neuropsiquiaacutetricas
La siacutentesis defectuosa de ADN conduce a la apoptosis y a la hemoacutelisis (intra yextramedular) causantes de la hemopoyesis inefectiva
En meacutedula la siacutentesis ineficiente de DNA causa cambios megaloblaacutesticos comoconsecuencIa anemia y citopenias
Congreso Nacional Laboratorio Cliacutenico
2018
Limitaciones de los meacutetodos diagnoacutesticos claacutesicos
Volumen Corpuscular Medio (VCM) y morfologiacutea de sangre perifeacuterica En una serie de pacientes con deacuteficit de cobalamina soacutelo un 29 teniacutean anemia y soacutelo un 36 teniacutean un VCM gt 100 fL
Un VCM normal no puede ser empleado para rechazar una determinacioacuten de nivel de cobalamina ya que hasta un 25 de casos con manifestaciones neuroloacutegicas cursan con un VCM normal
Cobalamina seacuterica (nivel de B12) Es el test diagnoacutestico rutinario inicial estaacutendar Es un test ampliamente disponible de bajo coste y automatizado Sin embargo presenta algunas limitaciones
-- Existencia de varias teacutecnicas y ausencia de un gold standard por lo que hay diferentes liacutemites de referencia
-- Variacioacuten intraindividual muy alta
La OMS publicoacute en 2008 las conclusiones de un grupo teacutecnico consultado sobre el deacuteficit de cobalamina y folato
El grupo reconocioacute que no existen unos umbrales universalmente reconocidos para definir el deacuteficit de ambas vitaminas y expresaron la necesidad de un consenso
Devalia V Hamilton MS and Molloy AM on behalf of the British Committee for standards in haematology Guidelines for the diagnosis and treatment of cobalamin and folate disorders Br J Haematol 2014 166(4) 496-513
Schrier SL Diagnosis and treatment of vitamin B12 and folate deficiency UpToDate Last updated Jun 25 2014
de Benoist B Conclusions of a WHO Technical Consultation on folate and vitamin B12 deficiencies Food Nutr Bull 200829(2 Suppl)S238ndash44Congreso Nacional Laboratorio Cliacutenico
2018
Tomado de Tefferi A Li C En Atlas of Clinical Hematology Publicado por JO Armitage Philadelphia Current Medicine 2004
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
Int Jnl Lab Hem 2007 29 327ndash334
Clin Lab 201662343-347
In ourstudy mean MCVrMCV ratio of healthy controls is130 as microcytic anemia irondeficiency anemia is121 as also macrocytic anemia vitamin B12 deficiencyanemia is 115
Congreso Nacional Laboratorio Cliacutenico
2018
Sualeh Muslim Khan Muhammad Akbar Agha
Mean cell volume of reticulocytemdashA new parameter for diagnosing sub-clinical cobalamin deficiency in blood donors Int J Lab Hem 20181ndash4
The Abbott CELL-DYN Sapphire Hematology System uses multi-angle polarized scatter separation (MAPSS) and focused flow impedance technologies
Congreso Nacional Laboratorio Cliacutenico
2018
MCVr at 985 fL yielded the highest Youdenrsquos index at sensitivity of 82 specificity of 828 AUC 0847 ( 95 CI 803-891)
Khan SM Agha MA Mean cell volume of reticulocyte-A new parameter for diagnosing sub-clinical cobalamin deficiency in blood donors
Int J Lab Hem 20181ndash4 2018 Jul 13 doi 101111ijlh12899
Congreso Nacional Laboratorio Cliacutenico
2018
Role of Cell Population Data in the detection of folate and cobalamin deficiency
J Nieto et al
XXXI st International Symposium on Technological Innovations in Laboratory Hematology ISLH 2018 10-12 May 2018 Brussels Belgium
M-V-NRET and SD-VNRET are the best discriminatory single parameters to distinguish between patients with B9B12 deficiency and reference subjects M-V-NRETAUC=0823 sensitivity 78 and specificity 86
AUC=0852 sensitivity 55 and specificity 60
Conclusions The CPD parameters of Volume and Light Scatter (M and SD of LALS angle) that inform about size and intracellular structure of RBCs provided very useful information for the detection of B9B12 deficiency
Congreso Nacional Laboratorio Cliacutenico
2018
Cell Population Data
bull Paraacutemetros poblacionales de los leucocitos
bull Describen la morfologiacutea tamantildeo
estructuras citoplasmaacuteticas
nuacutecleo aacutecidos nucleacuteicos
bull Son datos numeacutericos con los que se construyen los ejes de lo diagramas de dispersioacuten de los leucocitos
bull Dependen de la tecnologiacutea
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
High Sensitivity New Parameters for the Detection of Vitamin B12 and Folate Deficiencies Blood 2008 1125379
B12 def vs
Normals
Mann
Withney T-Test
ROC
AUC Sens Specif Cutoff signifROC
MCV p=03156 p=09533 0577
MPV p=00001 0802 792 806 lt83 p=00001
NE Mean
Volume plt00001 0862 833 778 gt1403 p=00001
MO Mean
Volume plt00001 0829 625 889 gt1723 p=00001
MRV p=00113 0705 50 964 gt1133 p=00051
Folate def vs
Normals
Mann
Withney T-Test
ROC
AUC Sens Specif Cut-off signifROC
MCV p=00798 p=06461 0665
MPV plt00001 0832 81 806 lt83 p=00001
NE Mean
Volume p=00008 087 952 694 gt1402 p=00001
MO Mean
Volume p=00002 0801 667 833 gt1696 p=00001
MRV p=00054 0731 476 964 gt1133 p=00019
The Mean Neutrophil Volume (MNE V) and Mean Monocyte Volume (MMOV) may be used for the detection of megaloblastic neutrophils and monocytes MNEV and MMOV have significantly higher sensitivity than the previous information from the red cells (MCV) detecting B12 or folate deficiency because they are not affected by the presence at the same time of Iron deficiency or other reasons of anemia
Congreso Nacional Laboratorio Cliacutenico
2018
POSTER 733
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
CPD Sysmex XN
NE SSC complejidad
NE SFL aacutecidos nucleacuteicos
NE FSC tamantildeo
NE WX
NE WY
NE WZ
MO X
MO Y
MO Z
MO WX
MO WY
MO WZ
LY X
LY Y
LY Z
LY WX
LY WY
LY WZCongreso Nacio
nal Laboratorio Cliacutenico 2018
As MCV is the mean which is calculated it is insensitive to the presence of a small number of macrocytes
Further macrocytosis can be obscured by concomitant disorders that can cause microcytosis resulting inmasked megaloblastic anaemia (MA) for example iron deficiency hereditary elliptocytosis alpha and betathalassemia
This study was undertaken to evaluate the role of NEUT-X and NEUT-Y in detecting MA on peripheral blood andalso see whether other forms of macrocytic anaemia can be differentiated from MA
In MA the peripheral blood smear shows cytopenia with macroovalocytes and hypersegmented
neutrophils (gt5 lobes in 5 neutrophils six lobes nuclei or lobe average of gt35)
In conclusion our study shows that higher values of NEUT-X and NEUT-Y in MA patients in spite of low ornormal MCV high RDW may be used to not only reveal the masked cases of MA with concomitant irondeficiency but also separate them from the broader macrocytic anaemia group
Peripheral smear remains diagnostic however making smear for all the suspicious cases is a cumbersomeand tedious procedure Thus these parameters emerge as more reliable and stable parameters in themodern laboratories which in future may replace the older screening tools
Congreso Nacional Laboratorio Cliacutenico
2018
A favor Eficiencia Operativa
Mejora el proceso del Laboratorio
Mejor informacioacuten al Cliacutenico al mismo coste
Mejora la informacioacuten
Informa sobre la eritropoyesis deteccioacuten precoz de estados carenciales
Ayuda al cliacutenico
Estado real del paciente
En contraParaacutemetros de investigacioacuten
Dificultad de standarizar dependencia teacutecnica
Control de calidadCongreso Nacional Laboratorio Cliacutenico
2018
copy 2012 Mindray Confidential 36
MINDRAY MCHrHDWHYPERHYPO
MCHr Mean RET HGB Concentration
HDW HGB Distribution Width
HYPER The percentage of hyperchromicred blood cells
HYPO The percentage of hypochromic red blood cells
Thalassemia screeningIDA treatment monitoringIDA screening
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
Hipocromo
Hipercroacutemico onormocroacutemico
iquestConcentracioacuten o contenido de Hemoglobina
Hipocroacutemiconormocroacutemico
Abbott Mindray Siemens Hypo CONCENTRACIOacuteN Hblt280gL
Sysmex Hypo CONTENIDO Hblt 17 pg
Congreso Nacional Laboratorio Cliacutenico
2018
Low Hb Density
Microcytic Factor Maf = (HbMCV)100
Nuevo moacutedulo transductor muacuteltiple con laacuteser de diodo y dos sensores oacutepticos
Anaacutelisis de hasta 50000 ceacutelulas con 7 paraacutemetros tecnoloacutegicos (leucocitos reticulocitos eritroblastos)
1 Volumen digital
2 Conductividad digital
3 5 aacutengulos de dispersioacuten de luz laacuteser digital
bull MALS (Median Angle Light Scatter)
bull UMALS (Upper Median Angle Light Scatter) 20deg a 43deg
bull LMALS (Lower Median Angle Light Scatter) 09deg a 19deg
bull LALS (Low Angle Light Scatter) asymp 51deg
bull AL2 (Axial Light Loss) 0deg a 05deg
Congreso Nacional Laboratorio Cliacutenico
2018
Hierro es un elemento criacutetico para elfuncionamiento oacuteptimo y supervivenciade las ceacutelulas
Disfuncioacuten mitocondrialActividad enzimaacutetica afectadaProteiacutenas de transporte y estructuralesproteins
Capacidad fiacutesica mermadaCapacidad de trabajo reducidaCapacidades cognitivas afectadasMorbilidad y mortalidad
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
It is generally assumed that worldwide ldquoat least half the anemia is due tonutritional iron deficiencyrdquo and that ldquoup to a prevalence of iron deficiency anemiaof 40 the prevalence of iron deficiency will be about 25 times that of anemiardquoHowever it is evident from the foregoing discussion that there are considerablevariations in both of these ratios depending on the age and sex of the peoplebeing studied the region of the world in which they live and the prevalence ratesof other causes of anemia
WHO Department of Nutrition for Health and DevelopmentAssessing the iron status of populations including literature reviews report of a Joint World Health OrganizationCenters for DiseaseControl and Prevention Technical Consultation on the Assessment of Iron Status at the Population Level Geneva Switzerland 6ndash8 April2004 ndash 2nd ed
Congreso Nacional Laboratorio Cliacutenico
2018
Estaacute bien establecido que la anemia produce una miriacuteada de secuelas tanto fiacutesicas comopsicoloacutegicas
Pero los efecto deleteacutereos se deben al deficit de hierro que es un evento previo a que seestablezca la anemia
El deacuteficit de hierrro auacuten sin anemia tiene efectos negativos en el desarrollo cognitivo y fiacutesico
Rattehalli D et al Iron deficiency without anemia do not wait for the Hemoglobin to drop
Health Policy and Technology 2013 2 45-48Congreso Nacio
nal Laboratorio Cliacutenico 2018
SuominenP et al Serum transferrin receptor and transferrin receptor-ferritin index identify healthy subjects with subclinical iron deficits Blood 1998 92 2934ndash9Halwachs-Baumann G Diagnosis of anaemia old things rearranged Wien Med Wochenschr 2012 162478ndash88
Congreso Nacional Laboratorio Cliacutenico
2018
Hemoglobina de reticulocito y su importancia en el diagnoacutestico temprano de anemiaferropeacutenica
Y Maacuterquez-Beniacutetez et al Universidad de BocayaAugust
2018 DOI 1022267rus182003133 aop
El contenido de hemoglobina de reticulocitos (CHr) es un paraacutemetro en la biometriacuteahematoloacutegica automatizada utilizado como un marcador de la biodisponibilidad delhierro en la eritropoyesis
Objetivo Exponer la aplicabilidad de la CHr como un paraacutemetro en el diagnoacutesticoprecoz de la anemia por deficiencia de hierro asiacute como su medicioacuten e interpretacioacuten
Materiales y meacutetodos Se realizoacute la revisioacuten de artiacuteculos cientiacuteficos en ingleacutes y espantildeolen las bases de datos PubMed ScienceDirect LILACS y Medline usando descriptoresvalidados en Medical Subject Headings (MeSH) considerando periodo depublicabilidad del 80 inferior a 5 antildeos
Conclusiones La CHr es un paraacutemetro de gran utilidad en el diagnoacutestico temprano deanemia ferropeacutenica y otras patologiacuteas como deficiencia funcional de hierro estadosde inflamacioacuten croacutenica y enfermedad renal croacutenica
Biomarcador temprano en el diagnoacutestico de deficiencia de hierro antes de presentarsecambios morfoloacutegicos eritrociacuteticosCongreso Nacio
nal Laboratorio Cliacutenico 2018
bull A total of 1105 NES participants (639 men 466 women)bull CHr becomes affected in a relatively early stage in the development of iron deficiency before iron
deficiency anemia and clinical symptoms become apparentbull Therefore this parameter might be useful to identify persons healthy and diseased at risk of
developing iron deficiency anemia and subsequently to apply interventions in order to prevent further development of iron deficiency anemiaCongreso Nacio
nal Laboratorio Cliacutenico 2018
Hb reticulocitaria sensible para detectar la fase inicial del deacuteficit de hierro cuando laeritropoyesis requiere maacutes cantidad que la que recibe ANTES de que la anemia seestablezca
Congreso Nacional Laboratorio Cliacutenico
2018
No ID LID P
RBC 1012L 48 (08) 437 (05) lt00001
Hb gL 135 (6) 131 (12) 0006
MCV fL 922 (21) 902 (38) 0006
MCH pg 324 (07) 306 (22) lt00001
MCHC gL 339 (6) 319 (23) 0001
RDW
Ret He pg
Hypo He
LHD
Ferritin microgL
131 (06)
338 (21)
03 (015)
28 (20)
86 (3)
145 (21)
278 (24)
69 (55)
56 (25)
16 (76)
lt00001
lt00001
lt00001
lt00001
lt00001
AUC 95 CI Cutoff Sensitivity Specificity
LHD 0898 0819-0978 50 859 841
Ret He 0914 0824-1000 299pg 868 857
Hypo He 0934 0856-1000 16 857 921
Clinical value of markers of hypochromia in the detection of latent iron deficiency in non-anemic premenopausal women
No ID Hb gt 120 gL s-ferritin was within reference intervalLatent Iron Defiency Hb gt 120 gL s-ferritin lt 30 μgL
Urrechaga E et al Journal Clin Lab Analysis 2016 30 (5) 623-627
97 women (388) in 250 apparently healthy women had latent IDCongreso Nacional Laboratorio Cliacutenico
2018
Schorer G et al Abstract Jahreskongress der Deutschen Gesellschaft fuumlr Transfusionsmedizin und Immunhaumlmatologie Rostock 15 - 18 September 2009
Congreso Nacional Laboratorio Cliacutenico
2018
Caring for Those Who Share Mitigating Iron Deficiency in Regular Blood DonorsMast Alan E
bull Iron deficiency caused by regular blood donation is a problem facing blood centers Each blood donation removes 200 to 250 mg of iron from the donor Consequently many donors become iron deficient with repeated donation
bull This presents a challenge to blood centers that has become more acute in recent years with the realization that iron deficiency even in the absence of anemia is associated with adverse effects including fatigue and decreased exercise tolerance as well as neurological symptoms such as decreased cognitive function pica and restless leg syndrome
bull REDS-II investigators performed a longitudinal study investigating the iron status of blood donors over a two year period called the REDS-II Donor Iron Status Evaluation (RISE)
bull Results from the baseline analysis of regular donors (e 2 donations per year (females) or e 3 donations per year (males) revealed that over two-thirds of female donors and over one-half of male donors have iron deficiency
Congreso Nacional Laboratorio Cliacutenico
2018
Transfusion 2013 532766-2775
bull We evaluated the diagnostic sensitivity and specificity of red blood cell (RBC) hematology analyzer indices to assess iron status as a part of donor management iron deficient erythropoiesis (IDE) and absence of iron stores (AIS)
bull STUDY DESIGN AND METHODS A total of 1659 male and female donors from the Retrovirus Epidemiology Donor Study-II (REDS-II) Donor Iron Status Evaluation (RISE) study who were either first-timereactivated (FT RA no donations for 2 years) or frequent donors were recruited into a longitudinal study of regular donation of RBCs Of these 1002 donors returned 15 to 24 months later for a final assessment
Absent iron stores (AIS) was defined as plasma ferritin level of less than 12 mgL Logarithm of the ratio of soluble transferrin receptor to ferritin of at least 207 was used to define iron-deficient erythropoiesis (IDE)
bull RESULTS HYPOm and CHr detected IDE with comparable sensitivity 72 versus 69 but differed in specificity HYPOm 68 and CHr 53
For detecting AIS sensitivity was improved to 85 for HYPOm and 81 for CHr but specificity was reduced
Venous Hb had high specificity but poor sensitivity for IDE and AIS A plasma ferritin level of less than 267 mgL was a good surrogate for assessing IDE Congreso Nacio
nal Laboratorio Cliacutenico 2018
Microcytic RBC and reticulocyte mean cell hemoglobin content predicted iron depletion with
sensitivities 70 and 64
specificities of 72 and 78 respectively
When both combined
increased the sensitivity to 82
Congreso Nacional Laboratorio Cliacutenico
2018
Depending on the number of donations during the preceding12 months
Absent iron stores were detected in up to 214 of male and278 of female donors respectively
impaired hemoglobinisation IH was present in up to 64 maleand 167 female donors with 2 and 4 preceding donationsrespectively
The defined CHr cut-off value was 280 pg to detect IH infrequent whole blood donors with AIS leading to a testspecificity of 982 (positive predictive value PPV 577) inmale and of 978 (PPV 829) in female donors
It may help to prevent the development of anemia in frequentblood donors and also can help to decide whether donordeferral or even iron substitution need to be recommended
Congreso Nacional Laboratorio Cliacutenico
2018
Of the 501 blood donors sTfR and Ret-He detected Latent Iron Deficiency in 148 and 135 donors respectively
In comparison to sTfR Ret-He had sensitivity of 927 specificity of 9716 PPV of 931 and NPV of 963
Serum Ferritin TIBC and serum Iron had comparatively lower sensitivity of 8716 797 and 777 respectively
Conclusion Ret-He can be used as a routine screening test to detect LID in blood donors
This could provide an opportunity to make appropriate and timely interventions like dietary changes or drug supplementation
Congreso Nacional Laboratorio Cliacutenico
2018
Singh A Chaudhary R Pandey HC Sonker A Identification of iron status of blood donors by using low hemoglobin density and microcytic anemia factor Asian J Transfus Sci 20181246-50
The main objective of this study was to assess ifLHD and Maf could be used for assessment ofiron status in blood donors and also to establisha cut-off for these two parameters at which atentative iron deficiency could be reportedconclusively
Results LHD and Maf were able to differentiatebetween iron deficient and iron-depleteddonors from normal donorsA cutoff of 918 for LHD was able todifferentiate iron deficient and depleted statefrom normal iron statessensitivity 919 and specificity 71respectivelya cutoff of 1016 for Mafsensitivity 946 and specificity 968
MAf = (MVC Hb) 100
Congreso Nacional Laboratorio Cliacutenico
2018
Hb reticulocitaria sensible para detectar la fase inicial del deacuteficitde hierro cuando la eritropoyesis requiere maacutes cantidad que laque recibe ANTES de que la anemia se establezca
La deteccioacuten precoz del deacuteficit de hierro en la fase del balance negativo demanda aporte contribuye a reducir sus manifestaciones cliacutenicas en los pacientes afectados mejorando la salud puacuteblica
Un tratamiento menos prolongado con suplementos y menor consumo de los recursos sanitaros Contribuye a la eficiencia y sostenibilidad de los servicios sanitarios
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
Buttarello MLaboratory diagnosis of anemia are the old and new red cell parameters useful in classification and treatment howInt Jnl Lab Hem 2016 38 (Suppl 1) 123ndash132
Congreso Nacional Laboratorio Cliacutenico
2018
Buttarello MLaboratory diagnosis of anemia are the old and new red cell parameters useful in classification and treatment howInt Jnl Lab Hem 2016 38 (Suppl 1) 123ndash132
Congreso Nacional Laboratorio Cliacutenico
2018
Ralph Green amp Ananya Datta Mitra Megaloblastic Anemias Nutritional and Other CausesMed Clin N Am 2017 101 297ndash317
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
ANEMIA CARENCIAL CAUSAS
Factores alimentariosConsumir una dieta vegetariana mal planeadaAlimentacioacuten deficiente en los bebeacutesDesnutricioacuten durante el embarazo
Deacuteficit de absorcioacutenAlcoholismo croacutenicoEnfermedad de Crohn celiaquiacutea infeccioacuten otros problemas que le dificulten al cuerpo la digestioacuten de los alimentosAnemia perniciosa (factor intriacutenseco)Cirugiacuteas para extirpar ciertas partes del estoacutemago o el intestino delgado
MedicamentosB12 omeprazol metformina colchicina aminosalicilatos neomicinaFOLATO fenitoiacutena metotrexato sulfasalacina triamtereno pirimetamina trimetoprim con sulfametoxazol barbituacutericos
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
Reacciones metaboacutelicas en las que participan la vitamina B12 y el folato bull la conversioacuten de metilmalonil-CoA a succinil-CoA donde la adenosil-cobalamina actuacutea de
cofactor Por ello un deacuteficit de B12 conlleva un aumento de metilmalonil-CoA y de su producto de hidroacutelisis el aacutecido metilmaloacutenico
bull la siacutentesis de metionina a partir de homocisteina gracias a la metionina sintetasa y a la metil-cobalamina como cofactor En esta misma reaccioacuten el metiltetrahidrofolato es transformado a tetrahidrofolato que es necesario para la siacutentesis de DNA
Congreso Nacional Laboratorio Cliacutenico
2018
Anemia macrociacutetica secundaria a deficiencia de aacutecido foacutelico y de vitamina B12(cobalamina)
La deficiencia de B12 yo aacutecido foacutelico es la causa maacutes frecuente de megaloblastosis
Dentro de distintas funciones generales del metabolismo la vitamina B12 es uncofactor esencial en la siacutentesis de ADN y ARN compromete a todas las ceacutelulas delorganismo
Su deficiencia se manifiesta en oacuterganos con alto recambio celular como la meacutedulaosea y en el sistema nervioso central (SNC) a traveacutes de la siacutentesis de mielina y lareparacioacuten axonal
La deficiencia de cobalamina es responsable de alteraciones hematoloacutegicasneuroloacutegicas neurocognitivas y neuropsiquiaacutetricas
La siacutentesis defectuosa de ADN conduce a la apoptosis y a la hemoacutelisis (intra yextramedular) causantes de la hemopoyesis inefectiva
En meacutedula la siacutentesis ineficiente de DNA causa cambios megaloblaacutesticos comoconsecuencIa anemia y citopenias
Congreso Nacional Laboratorio Cliacutenico
2018
Limitaciones de los meacutetodos diagnoacutesticos claacutesicos
Volumen Corpuscular Medio (VCM) y morfologiacutea de sangre perifeacuterica En una serie de pacientes con deacuteficit de cobalamina soacutelo un 29 teniacutean anemia y soacutelo un 36 teniacutean un VCM gt 100 fL
Un VCM normal no puede ser empleado para rechazar una determinacioacuten de nivel de cobalamina ya que hasta un 25 de casos con manifestaciones neuroloacutegicas cursan con un VCM normal
Cobalamina seacuterica (nivel de B12) Es el test diagnoacutestico rutinario inicial estaacutendar Es un test ampliamente disponible de bajo coste y automatizado Sin embargo presenta algunas limitaciones
-- Existencia de varias teacutecnicas y ausencia de un gold standard por lo que hay diferentes liacutemites de referencia
-- Variacioacuten intraindividual muy alta
La OMS publicoacute en 2008 las conclusiones de un grupo teacutecnico consultado sobre el deacuteficit de cobalamina y folato
El grupo reconocioacute que no existen unos umbrales universalmente reconocidos para definir el deacuteficit de ambas vitaminas y expresaron la necesidad de un consenso
Devalia V Hamilton MS and Molloy AM on behalf of the British Committee for standards in haematology Guidelines for the diagnosis and treatment of cobalamin and folate disorders Br J Haematol 2014 166(4) 496-513
Schrier SL Diagnosis and treatment of vitamin B12 and folate deficiency UpToDate Last updated Jun 25 2014
de Benoist B Conclusions of a WHO Technical Consultation on folate and vitamin B12 deficiencies Food Nutr Bull 200829(2 Suppl)S238ndash44Congreso Nacional Laboratorio Cliacutenico
2018
Tomado de Tefferi A Li C En Atlas of Clinical Hematology Publicado por JO Armitage Philadelphia Current Medicine 2004
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
Int Jnl Lab Hem 2007 29 327ndash334
Clin Lab 201662343-347
In ourstudy mean MCVrMCV ratio of healthy controls is130 as microcytic anemia irondeficiency anemia is121 as also macrocytic anemia vitamin B12 deficiencyanemia is 115
Congreso Nacional Laboratorio Cliacutenico
2018
Sualeh Muslim Khan Muhammad Akbar Agha
Mean cell volume of reticulocytemdashA new parameter for diagnosing sub-clinical cobalamin deficiency in blood donors Int J Lab Hem 20181ndash4
The Abbott CELL-DYN Sapphire Hematology System uses multi-angle polarized scatter separation (MAPSS) and focused flow impedance technologies
Congreso Nacional Laboratorio Cliacutenico
2018
MCVr at 985 fL yielded the highest Youdenrsquos index at sensitivity of 82 specificity of 828 AUC 0847 ( 95 CI 803-891)
Khan SM Agha MA Mean cell volume of reticulocyte-A new parameter for diagnosing sub-clinical cobalamin deficiency in blood donors
Int J Lab Hem 20181ndash4 2018 Jul 13 doi 101111ijlh12899
Congreso Nacional Laboratorio Cliacutenico
2018
Role of Cell Population Data in the detection of folate and cobalamin deficiency
J Nieto et al
XXXI st International Symposium on Technological Innovations in Laboratory Hematology ISLH 2018 10-12 May 2018 Brussels Belgium
M-V-NRET and SD-VNRET are the best discriminatory single parameters to distinguish between patients with B9B12 deficiency and reference subjects M-V-NRETAUC=0823 sensitivity 78 and specificity 86
AUC=0852 sensitivity 55 and specificity 60
Conclusions The CPD parameters of Volume and Light Scatter (M and SD of LALS angle) that inform about size and intracellular structure of RBCs provided very useful information for the detection of B9B12 deficiency
Congreso Nacional Laboratorio Cliacutenico
2018
Cell Population Data
bull Paraacutemetros poblacionales de los leucocitos
bull Describen la morfologiacutea tamantildeo
estructuras citoplasmaacuteticas
nuacutecleo aacutecidos nucleacuteicos
bull Son datos numeacutericos con los que se construyen los ejes de lo diagramas de dispersioacuten de los leucocitos
bull Dependen de la tecnologiacutea
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
High Sensitivity New Parameters for the Detection of Vitamin B12 and Folate Deficiencies Blood 2008 1125379
B12 def vs
Normals
Mann
Withney T-Test
ROC
AUC Sens Specif Cutoff signifROC
MCV p=03156 p=09533 0577
MPV p=00001 0802 792 806 lt83 p=00001
NE Mean
Volume plt00001 0862 833 778 gt1403 p=00001
MO Mean
Volume plt00001 0829 625 889 gt1723 p=00001
MRV p=00113 0705 50 964 gt1133 p=00051
Folate def vs
Normals
Mann
Withney T-Test
ROC
AUC Sens Specif Cut-off signifROC
MCV p=00798 p=06461 0665
MPV plt00001 0832 81 806 lt83 p=00001
NE Mean
Volume p=00008 087 952 694 gt1402 p=00001
MO Mean
Volume p=00002 0801 667 833 gt1696 p=00001
MRV p=00054 0731 476 964 gt1133 p=00019
The Mean Neutrophil Volume (MNE V) and Mean Monocyte Volume (MMOV) may be used for the detection of megaloblastic neutrophils and monocytes MNEV and MMOV have significantly higher sensitivity than the previous information from the red cells (MCV) detecting B12 or folate deficiency because they are not affected by the presence at the same time of Iron deficiency or other reasons of anemia
Congreso Nacional Laboratorio Cliacutenico
2018
POSTER 733
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
CPD Sysmex XN
NE SSC complejidad
NE SFL aacutecidos nucleacuteicos
NE FSC tamantildeo
NE WX
NE WY
NE WZ
MO X
MO Y
MO Z
MO WX
MO WY
MO WZ
LY X
LY Y
LY Z
LY WX
LY WY
LY WZCongreso Nacio
nal Laboratorio Cliacutenico 2018
As MCV is the mean which is calculated it is insensitive to the presence of a small number of macrocytes
Further macrocytosis can be obscured by concomitant disorders that can cause microcytosis resulting inmasked megaloblastic anaemia (MA) for example iron deficiency hereditary elliptocytosis alpha and betathalassemia
This study was undertaken to evaluate the role of NEUT-X and NEUT-Y in detecting MA on peripheral blood andalso see whether other forms of macrocytic anaemia can be differentiated from MA
In MA the peripheral blood smear shows cytopenia with macroovalocytes and hypersegmented
neutrophils (gt5 lobes in 5 neutrophils six lobes nuclei or lobe average of gt35)
In conclusion our study shows that higher values of NEUT-X and NEUT-Y in MA patients in spite of low ornormal MCV high RDW may be used to not only reveal the masked cases of MA with concomitant irondeficiency but also separate them from the broader macrocytic anaemia group
Peripheral smear remains diagnostic however making smear for all the suspicious cases is a cumbersomeand tedious procedure Thus these parameters emerge as more reliable and stable parameters in themodern laboratories which in future may replace the older screening tools
Congreso Nacional Laboratorio Cliacutenico
2018
A favor Eficiencia Operativa
Mejora el proceso del Laboratorio
Mejor informacioacuten al Cliacutenico al mismo coste
Mejora la informacioacuten
Informa sobre la eritropoyesis deteccioacuten precoz de estados carenciales
Ayuda al cliacutenico
Estado real del paciente
En contraParaacutemetros de investigacioacuten
Dificultad de standarizar dependencia teacutecnica
Control de calidadCongreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
Hipocromo
Hipercroacutemico onormocroacutemico
iquestConcentracioacuten o contenido de Hemoglobina
Hipocroacutemiconormocroacutemico
Abbott Mindray Siemens Hypo CONCENTRACIOacuteN Hblt280gL
Sysmex Hypo CONTENIDO Hblt 17 pg
Congreso Nacional Laboratorio Cliacutenico
2018
Low Hb Density
Microcytic Factor Maf = (HbMCV)100
Nuevo moacutedulo transductor muacuteltiple con laacuteser de diodo y dos sensores oacutepticos
Anaacutelisis de hasta 50000 ceacutelulas con 7 paraacutemetros tecnoloacutegicos (leucocitos reticulocitos eritroblastos)
1 Volumen digital
2 Conductividad digital
3 5 aacutengulos de dispersioacuten de luz laacuteser digital
bull MALS (Median Angle Light Scatter)
bull UMALS (Upper Median Angle Light Scatter) 20deg a 43deg
bull LMALS (Lower Median Angle Light Scatter) 09deg a 19deg
bull LALS (Low Angle Light Scatter) asymp 51deg
bull AL2 (Axial Light Loss) 0deg a 05deg
Congreso Nacional Laboratorio Cliacutenico
2018
Hierro es un elemento criacutetico para elfuncionamiento oacuteptimo y supervivenciade las ceacutelulas
Disfuncioacuten mitocondrialActividad enzimaacutetica afectadaProteiacutenas de transporte y estructuralesproteins
Capacidad fiacutesica mermadaCapacidad de trabajo reducidaCapacidades cognitivas afectadasMorbilidad y mortalidad
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
It is generally assumed that worldwide ldquoat least half the anemia is due tonutritional iron deficiencyrdquo and that ldquoup to a prevalence of iron deficiency anemiaof 40 the prevalence of iron deficiency will be about 25 times that of anemiardquoHowever it is evident from the foregoing discussion that there are considerablevariations in both of these ratios depending on the age and sex of the peoplebeing studied the region of the world in which they live and the prevalence ratesof other causes of anemia
WHO Department of Nutrition for Health and DevelopmentAssessing the iron status of populations including literature reviews report of a Joint World Health OrganizationCenters for DiseaseControl and Prevention Technical Consultation on the Assessment of Iron Status at the Population Level Geneva Switzerland 6ndash8 April2004 ndash 2nd ed
Congreso Nacional Laboratorio Cliacutenico
2018
Estaacute bien establecido que la anemia produce una miriacuteada de secuelas tanto fiacutesicas comopsicoloacutegicas
Pero los efecto deleteacutereos se deben al deficit de hierro que es un evento previo a que seestablezca la anemia
El deacuteficit de hierrro auacuten sin anemia tiene efectos negativos en el desarrollo cognitivo y fiacutesico
Rattehalli D et al Iron deficiency without anemia do not wait for the Hemoglobin to drop
Health Policy and Technology 2013 2 45-48Congreso Nacio
nal Laboratorio Cliacutenico 2018
SuominenP et al Serum transferrin receptor and transferrin receptor-ferritin index identify healthy subjects with subclinical iron deficits Blood 1998 92 2934ndash9Halwachs-Baumann G Diagnosis of anaemia old things rearranged Wien Med Wochenschr 2012 162478ndash88
Congreso Nacional Laboratorio Cliacutenico
2018
Hemoglobina de reticulocito y su importancia en el diagnoacutestico temprano de anemiaferropeacutenica
Y Maacuterquez-Beniacutetez et al Universidad de BocayaAugust
2018 DOI 1022267rus182003133 aop
El contenido de hemoglobina de reticulocitos (CHr) es un paraacutemetro en la biometriacuteahematoloacutegica automatizada utilizado como un marcador de la biodisponibilidad delhierro en la eritropoyesis
Objetivo Exponer la aplicabilidad de la CHr como un paraacutemetro en el diagnoacutesticoprecoz de la anemia por deficiencia de hierro asiacute como su medicioacuten e interpretacioacuten
Materiales y meacutetodos Se realizoacute la revisioacuten de artiacuteculos cientiacuteficos en ingleacutes y espantildeolen las bases de datos PubMed ScienceDirect LILACS y Medline usando descriptoresvalidados en Medical Subject Headings (MeSH) considerando periodo depublicabilidad del 80 inferior a 5 antildeos
Conclusiones La CHr es un paraacutemetro de gran utilidad en el diagnoacutestico temprano deanemia ferropeacutenica y otras patologiacuteas como deficiencia funcional de hierro estadosde inflamacioacuten croacutenica y enfermedad renal croacutenica
Biomarcador temprano en el diagnoacutestico de deficiencia de hierro antes de presentarsecambios morfoloacutegicos eritrociacuteticosCongreso Nacio
nal Laboratorio Cliacutenico 2018
bull A total of 1105 NES participants (639 men 466 women)bull CHr becomes affected in a relatively early stage in the development of iron deficiency before iron
deficiency anemia and clinical symptoms become apparentbull Therefore this parameter might be useful to identify persons healthy and diseased at risk of
developing iron deficiency anemia and subsequently to apply interventions in order to prevent further development of iron deficiency anemiaCongreso Nacio
nal Laboratorio Cliacutenico 2018
Hb reticulocitaria sensible para detectar la fase inicial del deacuteficit de hierro cuando laeritropoyesis requiere maacutes cantidad que la que recibe ANTES de que la anemia seestablezca
Congreso Nacional Laboratorio Cliacutenico
2018
No ID LID P
RBC 1012L 48 (08) 437 (05) lt00001
Hb gL 135 (6) 131 (12) 0006
MCV fL 922 (21) 902 (38) 0006
MCH pg 324 (07) 306 (22) lt00001
MCHC gL 339 (6) 319 (23) 0001
RDW
Ret He pg
Hypo He
LHD
Ferritin microgL
131 (06)
338 (21)
03 (015)
28 (20)
86 (3)
145 (21)
278 (24)
69 (55)
56 (25)
16 (76)
lt00001
lt00001
lt00001
lt00001
lt00001
AUC 95 CI Cutoff Sensitivity Specificity
LHD 0898 0819-0978 50 859 841
Ret He 0914 0824-1000 299pg 868 857
Hypo He 0934 0856-1000 16 857 921
Clinical value of markers of hypochromia in the detection of latent iron deficiency in non-anemic premenopausal women
No ID Hb gt 120 gL s-ferritin was within reference intervalLatent Iron Defiency Hb gt 120 gL s-ferritin lt 30 μgL
Urrechaga E et al Journal Clin Lab Analysis 2016 30 (5) 623-627
97 women (388) in 250 apparently healthy women had latent IDCongreso Nacional Laboratorio Cliacutenico
2018
Schorer G et al Abstract Jahreskongress der Deutschen Gesellschaft fuumlr Transfusionsmedizin und Immunhaumlmatologie Rostock 15 - 18 September 2009
Congreso Nacional Laboratorio Cliacutenico
2018
Caring for Those Who Share Mitigating Iron Deficiency in Regular Blood DonorsMast Alan E
bull Iron deficiency caused by regular blood donation is a problem facing blood centers Each blood donation removes 200 to 250 mg of iron from the donor Consequently many donors become iron deficient with repeated donation
bull This presents a challenge to blood centers that has become more acute in recent years with the realization that iron deficiency even in the absence of anemia is associated with adverse effects including fatigue and decreased exercise tolerance as well as neurological symptoms such as decreased cognitive function pica and restless leg syndrome
bull REDS-II investigators performed a longitudinal study investigating the iron status of blood donors over a two year period called the REDS-II Donor Iron Status Evaluation (RISE)
bull Results from the baseline analysis of regular donors (e 2 donations per year (females) or e 3 donations per year (males) revealed that over two-thirds of female donors and over one-half of male donors have iron deficiency
Congreso Nacional Laboratorio Cliacutenico
2018
Transfusion 2013 532766-2775
bull We evaluated the diagnostic sensitivity and specificity of red blood cell (RBC) hematology analyzer indices to assess iron status as a part of donor management iron deficient erythropoiesis (IDE) and absence of iron stores (AIS)
bull STUDY DESIGN AND METHODS A total of 1659 male and female donors from the Retrovirus Epidemiology Donor Study-II (REDS-II) Donor Iron Status Evaluation (RISE) study who were either first-timereactivated (FT RA no donations for 2 years) or frequent donors were recruited into a longitudinal study of regular donation of RBCs Of these 1002 donors returned 15 to 24 months later for a final assessment
Absent iron stores (AIS) was defined as plasma ferritin level of less than 12 mgL Logarithm of the ratio of soluble transferrin receptor to ferritin of at least 207 was used to define iron-deficient erythropoiesis (IDE)
bull RESULTS HYPOm and CHr detected IDE with comparable sensitivity 72 versus 69 but differed in specificity HYPOm 68 and CHr 53
For detecting AIS sensitivity was improved to 85 for HYPOm and 81 for CHr but specificity was reduced
Venous Hb had high specificity but poor sensitivity for IDE and AIS A plasma ferritin level of less than 267 mgL was a good surrogate for assessing IDE Congreso Nacio
nal Laboratorio Cliacutenico 2018
Microcytic RBC and reticulocyte mean cell hemoglobin content predicted iron depletion with
sensitivities 70 and 64
specificities of 72 and 78 respectively
When both combined
increased the sensitivity to 82
Congreso Nacional Laboratorio Cliacutenico
2018
Depending on the number of donations during the preceding12 months
Absent iron stores were detected in up to 214 of male and278 of female donors respectively
impaired hemoglobinisation IH was present in up to 64 maleand 167 female donors with 2 and 4 preceding donationsrespectively
The defined CHr cut-off value was 280 pg to detect IH infrequent whole blood donors with AIS leading to a testspecificity of 982 (positive predictive value PPV 577) inmale and of 978 (PPV 829) in female donors
It may help to prevent the development of anemia in frequentblood donors and also can help to decide whether donordeferral or even iron substitution need to be recommended
Congreso Nacional Laboratorio Cliacutenico
2018
Of the 501 blood donors sTfR and Ret-He detected Latent Iron Deficiency in 148 and 135 donors respectively
In comparison to sTfR Ret-He had sensitivity of 927 specificity of 9716 PPV of 931 and NPV of 963
Serum Ferritin TIBC and serum Iron had comparatively lower sensitivity of 8716 797 and 777 respectively
Conclusion Ret-He can be used as a routine screening test to detect LID in blood donors
This could provide an opportunity to make appropriate and timely interventions like dietary changes or drug supplementation
Congreso Nacional Laboratorio Cliacutenico
2018
Singh A Chaudhary R Pandey HC Sonker A Identification of iron status of blood donors by using low hemoglobin density and microcytic anemia factor Asian J Transfus Sci 20181246-50
The main objective of this study was to assess ifLHD and Maf could be used for assessment ofiron status in blood donors and also to establisha cut-off for these two parameters at which atentative iron deficiency could be reportedconclusively
Results LHD and Maf were able to differentiatebetween iron deficient and iron-depleteddonors from normal donorsA cutoff of 918 for LHD was able todifferentiate iron deficient and depleted statefrom normal iron statessensitivity 919 and specificity 71respectivelya cutoff of 1016 for Mafsensitivity 946 and specificity 968
MAf = (MVC Hb) 100
Congreso Nacional Laboratorio Cliacutenico
2018
Hb reticulocitaria sensible para detectar la fase inicial del deacuteficitde hierro cuando la eritropoyesis requiere maacutes cantidad que laque recibe ANTES de que la anemia se establezca
La deteccioacuten precoz del deacuteficit de hierro en la fase del balance negativo demanda aporte contribuye a reducir sus manifestaciones cliacutenicas en los pacientes afectados mejorando la salud puacuteblica
Un tratamiento menos prolongado con suplementos y menor consumo de los recursos sanitaros Contribuye a la eficiencia y sostenibilidad de los servicios sanitarios
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
Buttarello MLaboratory diagnosis of anemia are the old and new red cell parameters useful in classification and treatment howInt Jnl Lab Hem 2016 38 (Suppl 1) 123ndash132
Congreso Nacional Laboratorio Cliacutenico
2018
Buttarello MLaboratory diagnosis of anemia are the old and new red cell parameters useful in classification and treatment howInt Jnl Lab Hem 2016 38 (Suppl 1) 123ndash132
Congreso Nacional Laboratorio Cliacutenico
2018
Ralph Green amp Ananya Datta Mitra Megaloblastic Anemias Nutritional and Other CausesMed Clin N Am 2017 101 297ndash317
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
ANEMIA CARENCIAL CAUSAS
Factores alimentariosConsumir una dieta vegetariana mal planeadaAlimentacioacuten deficiente en los bebeacutesDesnutricioacuten durante el embarazo
Deacuteficit de absorcioacutenAlcoholismo croacutenicoEnfermedad de Crohn celiaquiacutea infeccioacuten otros problemas que le dificulten al cuerpo la digestioacuten de los alimentosAnemia perniciosa (factor intriacutenseco)Cirugiacuteas para extirpar ciertas partes del estoacutemago o el intestino delgado
MedicamentosB12 omeprazol metformina colchicina aminosalicilatos neomicinaFOLATO fenitoiacutena metotrexato sulfasalacina triamtereno pirimetamina trimetoprim con sulfametoxazol barbituacutericos
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
Reacciones metaboacutelicas en las que participan la vitamina B12 y el folato bull la conversioacuten de metilmalonil-CoA a succinil-CoA donde la adenosil-cobalamina actuacutea de
cofactor Por ello un deacuteficit de B12 conlleva un aumento de metilmalonil-CoA y de su producto de hidroacutelisis el aacutecido metilmaloacutenico
bull la siacutentesis de metionina a partir de homocisteina gracias a la metionina sintetasa y a la metil-cobalamina como cofactor En esta misma reaccioacuten el metiltetrahidrofolato es transformado a tetrahidrofolato que es necesario para la siacutentesis de DNA
Congreso Nacional Laboratorio Cliacutenico
2018
Anemia macrociacutetica secundaria a deficiencia de aacutecido foacutelico y de vitamina B12(cobalamina)
La deficiencia de B12 yo aacutecido foacutelico es la causa maacutes frecuente de megaloblastosis
Dentro de distintas funciones generales del metabolismo la vitamina B12 es uncofactor esencial en la siacutentesis de ADN y ARN compromete a todas las ceacutelulas delorganismo
Su deficiencia se manifiesta en oacuterganos con alto recambio celular como la meacutedulaosea y en el sistema nervioso central (SNC) a traveacutes de la siacutentesis de mielina y lareparacioacuten axonal
La deficiencia de cobalamina es responsable de alteraciones hematoloacutegicasneuroloacutegicas neurocognitivas y neuropsiquiaacutetricas
La siacutentesis defectuosa de ADN conduce a la apoptosis y a la hemoacutelisis (intra yextramedular) causantes de la hemopoyesis inefectiva
En meacutedula la siacutentesis ineficiente de DNA causa cambios megaloblaacutesticos comoconsecuencIa anemia y citopenias
Congreso Nacional Laboratorio Cliacutenico
2018
Limitaciones de los meacutetodos diagnoacutesticos claacutesicos
Volumen Corpuscular Medio (VCM) y morfologiacutea de sangre perifeacuterica En una serie de pacientes con deacuteficit de cobalamina soacutelo un 29 teniacutean anemia y soacutelo un 36 teniacutean un VCM gt 100 fL
Un VCM normal no puede ser empleado para rechazar una determinacioacuten de nivel de cobalamina ya que hasta un 25 de casos con manifestaciones neuroloacutegicas cursan con un VCM normal
Cobalamina seacuterica (nivel de B12) Es el test diagnoacutestico rutinario inicial estaacutendar Es un test ampliamente disponible de bajo coste y automatizado Sin embargo presenta algunas limitaciones
-- Existencia de varias teacutecnicas y ausencia de un gold standard por lo que hay diferentes liacutemites de referencia
-- Variacioacuten intraindividual muy alta
La OMS publicoacute en 2008 las conclusiones de un grupo teacutecnico consultado sobre el deacuteficit de cobalamina y folato
El grupo reconocioacute que no existen unos umbrales universalmente reconocidos para definir el deacuteficit de ambas vitaminas y expresaron la necesidad de un consenso
Devalia V Hamilton MS and Molloy AM on behalf of the British Committee for standards in haematology Guidelines for the diagnosis and treatment of cobalamin and folate disorders Br J Haematol 2014 166(4) 496-513
Schrier SL Diagnosis and treatment of vitamin B12 and folate deficiency UpToDate Last updated Jun 25 2014
de Benoist B Conclusions of a WHO Technical Consultation on folate and vitamin B12 deficiencies Food Nutr Bull 200829(2 Suppl)S238ndash44Congreso Nacional Laboratorio Cliacutenico
2018
Tomado de Tefferi A Li C En Atlas of Clinical Hematology Publicado por JO Armitage Philadelphia Current Medicine 2004
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
Int Jnl Lab Hem 2007 29 327ndash334
Clin Lab 201662343-347
In ourstudy mean MCVrMCV ratio of healthy controls is130 as microcytic anemia irondeficiency anemia is121 as also macrocytic anemia vitamin B12 deficiencyanemia is 115
Congreso Nacional Laboratorio Cliacutenico
2018
Sualeh Muslim Khan Muhammad Akbar Agha
Mean cell volume of reticulocytemdashA new parameter for diagnosing sub-clinical cobalamin deficiency in blood donors Int J Lab Hem 20181ndash4
The Abbott CELL-DYN Sapphire Hematology System uses multi-angle polarized scatter separation (MAPSS) and focused flow impedance technologies
Congreso Nacional Laboratorio Cliacutenico
2018
MCVr at 985 fL yielded the highest Youdenrsquos index at sensitivity of 82 specificity of 828 AUC 0847 ( 95 CI 803-891)
Khan SM Agha MA Mean cell volume of reticulocyte-A new parameter for diagnosing sub-clinical cobalamin deficiency in blood donors
Int J Lab Hem 20181ndash4 2018 Jul 13 doi 101111ijlh12899
Congreso Nacional Laboratorio Cliacutenico
2018
Role of Cell Population Data in the detection of folate and cobalamin deficiency
J Nieto et al
XXXI st International Symposium on Technological Innovations in Laboratory Hematology ISLH 2018 10-12 May 2018 Brussels Belgium
M-V-NRET and SD-VNRET are the best discriminatory single parameters to distinguish between patients with B9B12 deficiency and reference subjects M-V-NRETAUC=0823 sensitivity 78 and specificity 86
AUC=0852 sensitivity 55 and specificity 60
Conclusions The CPD parameters of Volume and Light Scatter (M and SD of LALS angle) that inform about size and intracellular structure of RBCs provided very useful information for the detection of B9B12 deficiency
Congreso Nacional Laboratorio Cliacutenico
2018
Cell Population Data
bull Paraacutemetros poblacionales de los leucocitos
bull Describen la morfologiacutea tamantildeo
estructuras citoplasmaacuteticas
nuacutecleo aacutecidos nucleacuteicos
bull Son datos numeacutericos con los que se construyen los ejes de lo diagramas de dispersioacuten de los leucocitos
bull Dependen de la tecnologiacutea
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
High Sensitivity New Parameters for the Detection of Vitamin B12 and Folate Deficiencies Blood 2008 1125379
B12 def vs
Normals
Mann
Withney T-Test
ROC
AUC Sens Specif Cutoff signifROC
MCV p=03156 p=09533 0577
MPV p=00001 0802 792 806 lt83 p=00001
NE Mean
Volume plt00001 0862 833 778 gt1403 p=00001
MO Mean
Volume plt00001 0829 625 889 gt1723 p=00001
MRV p=00113 0705 50 964 gt1133 p=00051
Folate def vs
Normals
Mann
Withney T-Test
ROC
AUC Sens Specif Cut-off signifROC
MCV p=00798 p=06461 0665
MPV plt00001 0832 81 806 lt83 p=00001
NE Mean
Volume p=00008 087 952 694 gt1402 p=00001
MO Mean
Volume p=00002 0801 667 833 gt1696 p=00001
MRV p=00054 0731 476 964 gt1133 p=00019
The Mean Neutrophil Volume (MNE V) and Mean Monocyte Volume (MMOV) may be used for the detection of megaloblastic neutrophils and monocytes MNEV and MMOV have significantly higher sensitivity than the previous information from the red cells (MCV) detecting B12 or folate deficiency because they are not affected by the presence at the same time of Iron deficiency or other reasons of anemia
Congreso Nacional Laboratorio Cliacutenico
2018
POSTER 733
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
CPD Sysmex XN
NE SSC complejidad
NE SFL aacutecidos nucleacuteicos
NE FSC tamantildeo
NE WX
NE WY
NE WZ
MO X
MO Y
MO Z
MO WX
MO WY
MO WZ
LY X
LY Y
LY Z
LY WX
LY WY
LY WZCongreso Nacio
nal Laboratorio Cliacutenico 2018
As MCV is the mean which is calculated it is insensitive to the presence of a small number of macrocytes
Further macrocytosis can be obscured by concomitant disorders that can cause microcytosis resulting inmasked megaloblastic anaemia (MA) for example iron deficiency hereditary elliptocytosis alpha and betathalassemia
This study was undertaken to evaluate the role of NEUT-X and NEUT-Y in detecting MA on peripheral blood andalso see whether other forms of macrocytic anaemia can be differentiated from MA
In MA the peripheral blood smear shows cytopenia with macroovalocytes and hypersegmented
neutrophils (gt5 lobes in 5 neutrophils six lobes nuclei or lobe average of gt35)
In conclusion our study shows that higher values of NEUT-X and NEUT-Y in MA patients in spite of low ornormal MCV high RDW may be used to not only reveal the masked cases of MA with concomitant irondeficiency but also separate them from the broader macrocytic anaemia group
Peripheral smear remains diagnostic however making smear for all the suspicious cases is a cumbersomeand tedious procedure Thus these parameters emerge as more reliable and stable parameters in themodern laboratories which in future may replace the older screening tools
Congreso Nacional Laboratorio Cliacutenico
2018
A favor Eficiencia Operativa
Mejora el proceso del Laboratorio
Mejor informacioacuten al Cliacutenico al mismo coste
Mejora la informacioacuten
Informa sobre la eritropoyesis deteccioacuten precoz de estados carenciales
Ayuda al cliacutenico
Estado real del paciente
En contraParaacutemetros de investigacioacuten
Dificultad de standarizar dependencia teacutecnica
Control de calidadCongreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
Hipocromo
Hipercroacutemico onormocroacutemico
iquestConcentracioacuten o contenido de Hemoglobina
Hipocroacutemiconormocroacutemico
Abbott Mindray Siemens Hypo CONCENTRACIOacuteN Hblt280gL
Sysmex Hypo CONTENIDO Hblt 17 pg
Congreso Nacional Laboratorio Cliacutenico
2018
Low Hb Density
Microcytic Factor Maf = (HbMCV)100
Nuevo moacutedulo transductor muacuteltiple con laacuteser de diodo y dos sensores oacutepticos
Anaacutelisis de hasta 50000 ceacutelulas con 7 paraacutemetros tecnoloacutegicos (leucocitos reticulocitos eritroblastos)
1 Volumen digital
2 Conductividad digital
3 5 aacutengulos de dispersioacuten de luz laacuteser digital
bull MALS (Median Angle Light Scatter)
bull UMALS (Upper Median Angle Light Scatter) 20deg a 43deg
bull LMALS (Lower Median Angle Light Scatter) 09deg a 19deg
bull LALS (Low Angle Light Scatter) asymp 51deg
bull AL2 (Axial Light Loss) 0deg a 05deg
Congreso Nacional Laboratorio Cliacutenico
2018
Hierro es un elemento criacutetico para elfuncionamiento oacuteptimo y supervivenciade las ceacutelulas
Disfuncioacuten mitocondrialActividad enzimaacutetica afectadaProteiacutenas de transporte y estructuralesproteins
Capacidad fiacutesica mermadaCapacidad de trabajo reducidaCapacidades cognitivas afectadasMorbilidad y mortalidad
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
It is generally assumed that worldwide ldquoat least half the anemia is due tonutritional iron deficiencyrdquo and that ldquoup to a prevalence of iron deficiency anemiaof 40 the prevalence of iron deficiency will be about 25 times that of anemiardquoHowever it is evident from the foregoing discussion that there are considerablevariations in both of these ratios depending on the age and sex of the peoplebeing studied the region of the world in which they live and the prevalence ratesof other causes of anemia
WHO Department of Nutrition for Health and DevelopmentAssessing the iron status of populations including literature reviews report of a Joint World Health OrganizationCenters for DiseaseControl and Prevention Technical Consultation on the Assessment of Iron Status at the Population Level Geneva Switzerland 6ndash8 April2004 ndash 2nd ed
Congreso Nacional Laboratorio Cliacutenico
2018
Estaacute bien establecido que la anemia produce una miriacuteada de secuelas tanto fiacutesicas comopsicoloacutegicas
Pero los efecto deleteacutereos se deben al deficit de hierro que es un evento previo a que seestablezca la anemia
El deacuteficit de hierrro auacuten sin anemia tiene efectos negativos en el desarrollo cognitivo y fiacutesico
Rattehalli D et al Iron deficiency without anemia do not wait for the Hemoglobin to drop
Health Policy and Technology 2013 2 45-48Congreso Nacio
nal Laboratorio Cliacutenico 2018
SuominenP et al Serum transferrin receptor and transferrin receptor-ferritin index identify healthy subjects with subclinical iron deficits Blood 1998 92 2934ndash9Halwachs-Baumann G Diagnosis of anaemia old things rearranged Wien Med Wochenschr 2012 162478ndash88
Congreso Nacional Laboratorio Cliacutenico
2018
Hemoglobina de reticulocito y su importancia en el diagnoacutestico temprano de anemiaferropeacutenica
Y Maacuterquez-Beniacutetez et al Universidad de BocayaAugust
2018 DOI 1022267rus182003133 aop
El contenido de hemoglobina de reticulocitos (CHr) es un paraacutemetro en la biometriacuteahematoloacutegica automatizada utilizado como un marcador de la biodisponibilidad delhierro en la eritropoyesis
Objetivo Exponer la aplicabilidad de la CHr como un paraacutemetro en el diagnoacutesticoprecoz de la anemia por deficiencia de hierro asiacute como su medicioacuten e interpretacioacuten
Materiales y meacutetodos Se realizoacute la revisioacuten de artiacuteculos cientiacuteficos en ingleacutes y espantildeolen las bases de datos PubMed ScienceDirect LILACS y Medline usando descriptoresvalidados en Medical Subject Headings (MeSH) considerando periodo depublicabilidad del 80 inferior a 5 antildeos
Conclusiones La CHr es un paraacutemetro de gran utilidad en el diagnoacutestico temprano deanemia ferropeacutenica y otras patologiacuteas como deficiencia funcional de hierro estadosde inflamacioacuten croacutenica y enfermedad renal croacutenica
Biomarcador temprano en el diagnoacutestico de deficiencia de hierro antes de presentarsecambios morfoloacutegicos eritrociacuteticosCongreso Nacio
nal Laboratorio Cliacutenico 2018
bull A total of 1105 NES participants (639 men 466 women)bull CHr becomes affected in a relatively early stage in the development of iron deficiency before iron
deficiency anemia and clinical symptoms become apparentbull Therefore this parameter might be useful to identify persons healthy and diseased at risk of
developing iron deficiency anemia and subsequently to apply interventions in order to prevent further development of iron deficiency anemiaCongreso Nacio
nal Laboratorio Cliacutenico 2018
Hb reticulocitaria sensible para detectar la fase inicial del deacuteficit de hierro cuando laeritropoyesis requiere maacutes cantidad que la que recibe ANTES de que la anemia seestablezca
Congreso Nacional Laboratorio Cliacutenico
2018
No ID LID P
RBC 1012L 48 (08) 437 (05) lt00001
Hb gL 135 (6) 131 (12) 0006
MCV fL 922 (21) 902 (38) 0006
MCH pg 324 (07) 306 (22) lt00001
MCHC gL 339 (6) 319 (23) 0001
RDW
Ret He pg
Hypo He
LHD
Ferritin microgL
131 (06)
338 (21)
03 (015)
28 (20)
86 (3)
145 (21)
278 (24)
69 (55)
56 (25)
16 (76)
lt00001
lt00001
lt00001
lt00001
lt00001
AUC 95 CI Cutoff Sensitivity Specificity
LHD 0898 0819-0978 50 859 841
Ret He 0914 0824-1000 299pg 868 857
Hypo He 0934 0856-1000 16 857 921
Clinical value of markers of hypochromia in the detection of latent iron deficiency in non-anemic premenopausal women
No ID Hb gt 120 gL s-ferritin was within reference intervalLatent Iron Defiency Hb gt 120 gL s-ferritin lt 30 μgL
Urrechaga E et al Journal Clin Lab Analysis 2016 30 (5) 623-627
97 women (388) in 250 apparently healthy women had latent IDCongreso Nacional Laboratorio Cliacutenico
2018
Schorer G et al Abstract Jahreskongress der Deutschen Gesellschaft fuumlr Transfusionsmedizin und Immunhaumlmatologie Rostock 15 - 18 September 2009
Congreso Nacional Laboratorio Cliacutenico
2018
Caring for Those Who Share Mitigating Iron Deficiency in Regular Blood DonorsMast Alan E
bull Iron deficiency caused by regular blood donation is a problem facing blood centers Each blood donation removes 200 to 250 mg of iron from the donor Consequently many donors become iron deficient with repeated donation
bull This presents a challenge to blood centers that has become more acute in recent years with the realization that iron deficiency even in the absence of anemia is associated with adverse effects including fatigue and decreased exercise tolerance as well as neurological symptoms such as decreased cognitive function pica and restless leg syndrome
bull REDS-II investigators performed a longitudinal study investigating the iron status of blood donors over a two year period called the REDS-II Donor Iron Status Evaluation (RISE)
bull Results from the baseline analysis of regular donors (e 2 donations per year (females) or e 3 donations per year (males) revealed that over two-thirds of female donors and over one-half of male donors have iron deficiency
Congreso Nacional Laboratorio Cliacutenico
2018
Transfusion 2013 532766-2775
bull We evaluated the diagnostic sensitivity and specificity of red blood cell (RBC) hematology analyzer indices to assess iron status as a part of donor management iron deficient erythropoiesis (IDE) and absence of iron stores (AIS)
bull STUDY DESIGN AND METHODS A total of 1659 male and female donors from the Retrovirus Epidemiology Donor Study-II (REDS-II) Donor Iron Status Evaluation (RISE) study who were either first-timereactivated (FT RA no donations for 2 years) or frequent donors were recruited into a longitudinal study of regular donation of RBCs Of these 1002 donors returned 15 to 24 months later for a final assessment
Absent iron stores (AIS) was defined as plasma ferritin level of less than 12 mgL Logarithm of the ratio of soluble transferrin receptor to ferritin of at least 207 was used to define iron-deficient erythropoiesis (IDE)
bull RESULTS HYPOm and CHr detected IDE with comparable sensitivity 72 versus 69 but differed in specificity HYPOm 68 and CHr 53
For detecting AIS sensitivity was improved to 85 for HYPOm and 81 for CHr but specificity was reduced
Venous Hb had high specificity but poor sensitivity for IDE and AIS A plasma ferritin level of less than 267 mgL was a good surrogate for assessing IDE Congreso Nacio
nal Laboratorio Cliacutenico 2018
Microcytic RBC and reticulocyte mean cell hemoglobin content predicted iron depletion with
sensitivities 70 and 64
specificities of 72 and 78 respectively
When both combined
increased the sensitivity to 82
Congreso Nacional Laboratorio Cliacutenico
2018
Depending on the number of donations during the preceding12 months
Absent iron stores were detected in up to 214 of male and278 of female donors respectively
impaired hemoglobinisation IH was present in up to 64 maleand 167 female donors with 2 and 4 preceding donationsrespectively
The defined CHr cut-off value was 280 pg to detect IH infrequent whole blood donors with AIS leading to a testspecificity of 982 (positive predictive value PPV 577) inmale and of 978 (PPV 829) in female donors
It may help to prevent the development of anemia in frequentblood donors and also can help to decide whether donordeferral or even iron substitution need to be recommended
Congreso Nacional Laboratorio Cliacutenico
2018
Of the 501 blood donors sTfR and Ret-He detected Latent Iron Deficiency in 148 and 135 donors respectively
In comparison to sTfR Ret-He had sensitivity of 927 specificity of 9716 PPV of 931 and NPV of 963
Serum Ferritin TIBC and serum Iron had comparatively lower sensitivity of 8716 797 and 777 respectively
Conclusion Ret-He can be used as a routine screening test to detect LID in blood donors
This could provide an opportunity to make appropriate and timely interventions like dietary changes or drug supplementation
Congreso Nacional Laboratorio Cliacutenico
2018
Singh A Chaudhary R Pandey HC Sonker A Identification of iron status of blood donors by using low hemoglobin density and microcytic anemia factor Asian J Transfus Sci 20181246-50
The main objective of this study was to assess ifLHD and Maf could be used for assessment ofiron status in blood donors and also to establisha cut-off for these two parameters at which atentative iron deficiency could be reportedconclusively
Results LHD and Maf were able to differentiatebetween iron deficient and iron-depleteddonors from normal donorsA cutoff of 918 for LHD was able todifferentiate iron deficient and depleted statefrom normal iron statessensitivity 919 and specificity 71respectivelya cutoff of 1016 for Mafsensitivity 946 and specificity 968
MAf = (MVC Hb) 100
Congreso Nacional Laboratorio Cliacutenico
2018
Hb reticulocitaria sensible para detectar la fase inicial del deacuteficitde hierro cuando la eritropoyesis requiere maacutes cantidad que laque recibe ANTES de que la anemia se establezca
La deteccioacuten precoz del deacuteficit de hierro en la fase del balance negativo demanda aporte contribuye a reducir sus manifestaciones cliacutenicas en los pacientes afectados mejorando la salud puacuteblica
Un tratamiento menos prolongado con suplementos y menor consumo de los recursos sanitaros Contribuye a la eficiencia y sostenibilidad de los servicios sanitarios
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
Buttarello MLaboratory diagnosis of anemia are the old and new red cell parameters useful in classification and treatment howInt Jnl Lab Hem 2016 38 (Suppl 1) 123ndash132
Congreso Nacional Laboratorio Cliacutenico
2018
Buttarello MLaboratory diagnosis of anemia are the old and new red cell parameters useful in classification and treatment howInt Jnl Lab Hem 2016 38 (Suppl 1) 123ndash132
Congreso Nacional Laboratorio Cliacutenico
2018
Ralph Green amp Ananya Datta Mitra Megaloblastic Anemias Nutritional and Other CausesMed Clin N Am 2017 101 297ndash317
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
ANEMIA CARENCIAL CAUSAS
Factores alimentariosConsumir una dieta vegetariana mal planeadaAlimentacioacuten deficiente en los bebeacutesDesnutricioacuten durante el embarazo
Deacuteficit de absorcioacutenAlcoholismo croacutenicoEnfermedad de Crohn celiaquiacutea infeccioacuten otros problemas que le dificulten al cuerpo la digestioacuten de los alimentosAnemia perniciosa (factor intriacutenseco)Cirugiacuteas para extirpar ciertas partes del estoacutemago o el intestino delgado
MedicamentosB12 omeprazol metformina colchicina aminosalicilatos neomicinaFOLATO fenitoiacutena metotrexato sulfasalacina triamtereno pirimetamina trimetoprim con sulfametoxazol barbituacutericos
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
Reacciones metaboacutelicas en las que participan la vitamina B12 y el folato bull la conversioacuten de metilmalonil-CoA a succinil-CoA donde la adenosil-cobalamina actuacutea de
cofactor Por ello un deacuteficit de B12 conlleva un aumento de metilmalonil-CoA y de su producto de hidroacutelisis el aacutecido metilmaloacutenico
bull la siacutentesis de metionina a partir de homocisteina gracias a la metionina sintetasa y a la metil-cobalamina como cofactor En esta misma reaccioacuten el metiltetrahidrofolato es transformado a tetrahidrofolato que es necesario para la siacutentesis de DNA
Congreso Nacional Laboratorio Cliacutenico
2018
Anemia macrociacutetica secundaria a deficiencia de aacutecido foacutelico y de vitamina B12(cobalamina)
La deficiencia de B12 yo aacutecido foacutelico es la causa maacutes frecuente de megaloblastosis
Dentro de distintas funciones generales del metabolismo la vitamina B12 es uncofactor esencial en la siacutentesis de ADN y ARN compromete a todas las ceacutelulas delorganismo
Su deficiencia se manifiesta en oacuterganos con alto recambio celular como la meacutedulaosea y en el sistema nervioso central (SNC) a traveacutes de la siacutentesis de mielina y lareparacioacuten axonal
La deficiencia de cobalamina es responsable de alteraciones hematoloacutegicasneuroloacutegicas neurocognitivas y neuropsiquiaacutetricas
La siacutentesis defectuosa de ADN conduce a la apoptosis y a la hemoacutelisis (intra yextramedular) causantes de la hemopoyesis inefectiva
En meacutedula la siacutentesis ineficiente de DNA causa cambios megaloblaacutesticos comoconsecuencIa anemia y citopenias
Congreso Nacional Laboratorio Cliacutenico
2018
Limitaciones de los meacutetodos diagnoacutesticos claacutesicos
Volumen Corpuscular Medio (VCM) y morfologiacutea de sangre perifeacuterica En una serie de pacientes con deacuteficit de cobalamina soacutelo un 29 teniacutean anemia y soacutelo un 36 teniacutean un VCM gt 100 fL
Un VCM normal no puede ser empleado para rechazar una determinacioacuten de nivel de cobalamina ya que hasta un 25 de casos con manifestaciones neuroloacutegicas cursan con un VCM normal
Cobalamina seacuterica (nivel de B12) Es el test diagnoacutestico rutinario inicial estaacutendar Es un test ampliamente disponible de bajo coste y automatizado Sin embargo presenta algunas limitaciones
-- Existencia de varias teacutecnicas y ausencia de un gold standard por lo que hay diferentes liacutemites de referencia
-- Variacioacuten intraindividual muy alta
La OMS publicoacute en 2008 las conclusiones de un grupo teacutecnico consultado sobre el deacuteficit de cobalamina y folato
El grupo reconocioacute que no existen unos umbrales universalmente reconocidos para definir el deacuteficit de ambas vitaminas y expresaron la necesidad de un consenso
Devalia V Hamilton MS and Molloy AM on behalf of the British Committee for standards in haematology Guidelines for the diagnosis and treatment of cobalamin and folate disorders Br J Haematol 2014 166(4) 496-513
Schrier SL Diagnosis and treatment of vitamin B12 and folate deficiency UpToDate Last updated Jun 25 2014
de Benoist B Conclusions of a WHO Technical Consultation on folate and vitamin B12 deficiencies Food Nutr Bull 200829(2 Suppl)S238ndash44Congreso Nacional Laboratorio Cliacutenico
2018
Tomado de Tefferi A Li C En Atlas of Clinical Hematology Publicado por JO Armitage Philadelphia Current Medicine 2004
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
Int Jnl Lab Hem 2007 29 327ndash334
Clin Lab 201662343-347
In ourstudy mean MCVrMCV ratio of healthy controls is130 as microcytic anemia irondeficiency anemia is121 as also macrocytic anemia vitamin B12 deficiencyanemia is 115
Congreso Nacional Laboratorio Cliacutenico
2018
Sualeh Muslim Khan Muhammad Akbar Agha
Mean cell volume of reticulocytemdashA new parameter for diagnosing sub-clinical cobalamin deficiency in blood donors Int J Lab Hem 20181ndash4
The Abbott CELL-DYN Sapphire Hematology System uses multi-angle polarized scatter separation (MAPSS) and focused flow impedance technologies
Congreso Nacional Laboratorio Cliacutenico
2018
MCVr at 985 fL yielded the highest Youdenrsquos index at sensitivity of 82 specificity of 828 AUC 0847 ( 95 CI 803-891)
Khan SM Agha MA Mean cell volume of reticulocyte-A new parameter for diagnosing sub-clinical cobalamin deficiency in blood donors
Int J Lab Hem 20181ndash4 2018 Jul 13 doi 101111ijlh12899
Congreso Nacional Laboratorio Cliacutenico
2018
Role of Cell Population Data in the detection of folate and cobalamin deficiency
J Nieto et al
XXXI st International Symposium on Technological Innovations in Laboratory Hematology ISLH 2018 10-12 May 2018 Brussels Belgium
M-V-NRET and SD-VNRET are the best discriminatory single parameters to distinguish between patients with B9B12 deficiency and reference subjects M-V-NRETAUC=0823 sensitivity 78 and specificity 86
AUC=0852 sensitivity 55 and specificity 60
Conclusions The CPD parameters of Volume and Light Scatter (M and SD of LALS angle) that inform about size and intracellular structure of RBCs provided very useful information for the detection of B9B12 deficiency
Congreso Nacional Laboratorio Cliacutenico
2018
Cell Population Data
bull Paraacutemetros poblacionales de los leucocitos
bull Describen la morfologiacutea tamantildeo
estructuras citoplasmaacuteticas
nuacutecleo aacutecidos nucleacuteicos
bull Son datos numeacutericos con los que se construyen los ejes de lo diagramas de dispersioacuten de los leucocitos
bull Dependen de la tecnologiacutea
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
High Sensitivity New Parameters for the Detection of Vitamin B12 and Folate Deficiencies Blood 2008 1125379
B12 def vs
Normals
Mann
Withney T-Test
ROC
AUC Sens Specif Cutoff signifROC
MCV p=03156 p=09533 0577
MPV p=00001 0802 792 806 lt83 p=00001
NE Mean
Volume plt00001 0862 833 778 gt1403 p=00001
MO Mean
Volume plt00001 0829 625 889 gt1723 p=00001
MRV p=00113 0705 50 964 gt1133 p=00051
Folate def vs
Normals
Mann
Withney T-Test
ROC
AUC Sens Specif Cut-off signifROC
MCV p=00798 p=06461 0665
MPV plt00001 0832 81 806 lt83 p=00001
NE Mean
Volume p=00008 087 952 694 gt1402 p=00001
MO Mean
Volume p=00002 0801 667 833 gt1696 p=00001
MRV p=00054 0731 476 964 gt1133 p=00019
The Mean Neutrophil Volume (MNE V) and Mean Monocyte Volume (MMOV) may be used for the detection of megaloblastic neutrophils and monocytes MNEV and MMOV have significantly higher sensitivity than the previous information from the red cells (MCV) detecting B12 or folate deficiency because they are not affected by the presence at the same time of Iron deficiency or other reasons of anemia
Congreso Nacional Laboratorio Cliacutenico
2018
POSTER 733
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
CPD Sysmex XN
NE SSC complejidad
NE SFL aacutecidos nucleacuteicos
NE FSC tamantildeo
NE WX
NE WY
NE WZ
MO X
MO Y
MO Z
MO WX
MO WY
MO WZ
LY X
LY Y
LY Z
LY WX
LY WY
LY WZCongreso Nacio
nal Laboratorio Cliacutenico 2018
As MCV is the mean which is calculated it is insensitive to the presence of a small number of macrocytes
Further macrocytosis can be obscured by concomitant disorders that can cause microcytosis resulting inmasked megaloblastic anaemia (MA) for example iron deficiency hereditary elliptocytosis alpha and betathalassemia
This study was undertaken to evaluate the role of NEUT-X and NEUT-Y in detecting MA on peripheral blood andalso see whether other forms of macrocytic anaemia can be differentiated from MA
In MA the peripheral blood smear shows cytopenia with macroovalocytes and hypersegmented
neutrophils (gt5 lobes in 5 neutrophils six lobes nuclei or lobe average of gt35)
In conclusion our study shows that higher values of NEUT-X and NEUT-Y in MA patients in spite of low ornormal MCV high RDW may be used to not only reveal the masked cases of MA with concomitant irondeficiency but also separate them from the broader macrocytic anaemia group
Peripheral smear remains diagnostic however making smear for all the suspicious cases is a cumbersomeand tedious procedure Thus these parameters emerge as more reliable and stable parameters in themodern laboratories which in future may replace the older screening tools
Congreso Nacional Laboratorio Cliacutenico
2018
A favor Eficiencia Operativa
Mejora el proceso del Laboratorio
Mejor informacioacuten al Cliacutenico al mismo coste
Mejora la informacioacuten
Informa sobre la eritropoyesis deteccioacuten precoz de estados carenciales
Ayuda al cliacutenico
Estado real del paciente
En contraParaacutemetros de investigacioacuten
Dificultad de standarizar dependencia teacutecnica
Control de calidadCongreso Nacional Laboratorio Cliacutenico
2018
Hipocromo
Hipercroacutemico onormocroacutemico
iquestConcentracioacuten o contenido de Hemoglobina
Hipocroacutemiconormocroacutemico
Abbott Mindray Siemens Hypo CONCENTRACIOacuteN Hblt280gL
Sysmex Hypo CONTENIDO Hblt 17 pg
Congreso Nacional Laboratorio Cliacutenico
2018
Low Hb Density
Microcytic Factor Maf = (HbMCV)100
Nuevo moacutedulo transductor muacuteltiple con laacuteser de diodo y dos sensores oacutepticos
Anaacutelisis de hasta 50000 ceacutelulas con 7 paraacutemetros tecnoloacutegicos (leucocitos reticulocitos eritroblastos)
1 Volumen digital
2 Conductividad digital
3 5 aacutengulos de dispersioacuten de luz laacuteser digital
bull MALS (Median Angle Light Scatter)
bull UMALS (Upper Median Angle Light Scatter) 20deg a 43deg
bull LMALS (Lower Median Angle Light Scatter) 09deg a 19deg
bull LALS (Low Angle Light Scatter) asymp 51deg
bull AL2 (Axial Light Loss) 0deg a 05deg
Congreso Nacional Laboratorio Cliacutenico
2018
Hierro es un elemento criacutetico para elfuncionamiento oacuteptimo y supervivenciade las ceacutelulas
Disfuncioacuten mitocondrialActividad enzimaacutetica afectadaProteiacutenas de transporte y estructuralesproteins
Capacidad fiacutesica mermadaCapacidad de trabajo reducidaCapacidades cognitivas afectadasMorbilidad y mortalidad
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
It is generally assumed that worldwide ldquoat least half the anemia is due tonutritional iron deficiencyrdquo and that ldquoup to a prevalence of iron deficiency anemiaof 40 the prevalence of iron deficiency will be about 25 times that of anemiardquoHowever it is evident from the foregoing discussion that there are considerablevariations in both of these ratios depending on the age and sex of the peoplebeing studied the region of the world in which they live and the prevalence ratesof other causes of anemia
WHO Department of Nutrition for Health and DevelopmentAssessing the iron status of populations including literature reviews report of a Joint World Health OrganizationCenters for DiseaseControl and Prevention Technical Consultation on the Assessment of Iron Status at the Population Level Geneva Switzerland 6ndash8 April2004 ndash 2nd ed
Congreso Nacional Laboratorio Cliacutenico
2018
Estaacute bien establecido que la anemia produce una miriacuteada de secuelas tanto fiacutesicas comopsicoloacutegicas
Pero los efecto deleteacutereos se deben al deficit de hierro que es un evento previo a que seestablezca la anemia
El deacuteficit de hierrro auacuten sin anemia tiene efectos negativos en el desarrollo cognitivo y fiacutesico
Rattehalli D et al Iron deficiency without anemia do not wait for the Hemoglobin to drop
Health Policy and Technology 2013 2 45-48Congreso Nacio
nal Laboratorio Cliacutenico 2018
SuominenP et al Serum transferrin receptor and transferrin receptor-ferritin index identify healthy subjects with subclinical iron deficits Blood 1998 92 2934ndash9Halwachs-Baumann G Diagnosis of anaemia old things rearranged Wien Med Wochenschr 2012 162478ndash88
Congreso Nacional Laboratorio Cliacutenico
2018
Hemoglobina de reticulocito y su importancia en el diagnoacutestico temprano de anemiaferropeacutenica
Y Maacuterquez-Beniacutetez et al Universidad de BocayaAugust
2018 DOI 1022267rus182003133 aop
El contenido de hemoglobina de reticulocitos (CHr) es un paraacutemetro en la biometriacuteahematoloacutegica automatizada utilizado como un marcador de la biodisponibilidad delhierro en la eritropoyesis
Objetivo Exponer la aplicabilidad de la CHr como un paraacutemetro en el diagnoacutesticoprecoz de la anemia por deficiencia de hierro asiacute como su medicioacuten e interpretacioacuten
Materiales y meacutetodos Se realizoacute la revisioacuten de artiacuteculos cientiacuteficos en ingleacutes y espantildeolen las bases de datos PubMed ScienceDirect LILACS y Medline usando descriptoresvalidados en Medical Subject Headings (MeSH) considerando periodo depublicabilidad del 80 inferior a 5 antildeos
Conclusiones La CHr es un paraacutemetro de gran utilidad en el diagnoacutestico temprano deanemia ferropeacutenica y otras patologiacuteas como deficiencia funcional de hierro estadosde inflamacioacuten croacutenica y enfermedad renal croacutenica
Biomarcador temprano en el diagnoacutestico de deficiencia de hierro antes de presentarsecambios morfoloacutegicos eritrociacuteticosCongreso Nacio
nal Laboratorio Cliacutenico 2018
bull A total of 1105 NES participants (639 men 466 women)bull CHr becomes affected in a relatively early stage in the development of iron deficiency before iron
deficiency anemia and clinical symptoms become apparentbull Therefore this parameter might be useful to identify persons healthy and diseased at risk of
developing iron deficiency anemia and subsequently to apply interventions in order to prevent further development of iron deficiency anemiaCongreso Nacio
nal Laboratorio Cliacutenico 2018
Hb reticulocitaria sensible para detectar la fase inicial del deacuteficit de hierro cuando laeritropoyesis requiere maacutes cantidad que la que recibe ANTES de que la anemia seestablezca
Congreso Nacional Laboratorio Cliacutenico
2018
No ID LID P
RBC 1012L 48 (08) 437 (05) lt00001
Hb gL 135 (6) 131 (12) 0006
MCV fL 922 (21) 902 (38) 0006
MCH pg 324 (07) 306 (22) lt00001
MCHC gL 339 (6) 319 (23) 0001
RDW
Ret He pg
Hypo He
LHD
Ferritin microgL
131 (06)
338 (21)
03 (015)
28 (20)
86 (3)
145 (21)
278 (24)
69 (55)
56 (25)
16 (76)
lt00001
lt00001
lt00001
lt00001
lt00001
AUC 95 CI Cutoff Sensitivity Specificity
LHD 0898 0819-0978 50 859 841
Ret He 0914 0824-1000 299pg 868 857
Hypo He 0934 0856-1000 16 857 921
Clinical value of markers of hypochromia in the detection of latent iron deficiency in non-anemic premenopausal women
No ID Hb gt 120 gL s-ferritin was within reference intervalLatent Iron Defiency Hb gt 120 gL s-ferritin lt 30 μgL
Urrechaga E et al Journal Clin Lab Analysis 2016 30 (5) 623-627
97 women (388) in 250 apparently healthy women had latent IDCongreso Nacional Laboratorio Cliacutenico
2018
Schorer G et al Abstract Jahreskongress der Deutschen Gesellschaft fuumlr Transfusionsmedizin und Immunhaumlmatologie Rostock 15 - 18 September 2009
Congreso Nacional Laboratorio Cliacutenico
2018
Caring for Those Who Share Mitigating Iron Deficiency in Regular Blood DonorsMast Alan E
bull Iron deficiency caused by regular blood donation is a problem facing blood centers Each blood donation removes 200 to 250 mg of iron from the donor Consequently many donors become iron deficient with repeated donation
bull This presents a challenge to blood centers that has become more acute in recent years with the realization that iron deficiency even in the absence of anemia is associated with adverse effects including fatigue and decreased exercise tolerance as well as neurological symptoms such as decreased cognitive function pica and restless leg syndrome
bull REDS-II investigators performed a longitudinal study investigating the iron status of blood donors over a two year period called the REDS-II Donor Iron Status Evaluation (RISE)
bull Results from the baseline analysis of regular donors (e 2 donations per year (females) or e 3 donations per year (males) revealed that over two-thirds of female donors and over one-half of male donors have iron deficiency
Congreso Nacional Laboratorio Cliacutenico
2018
Transfusion 2013 532766-2775
bull We evaluated the diagnostic sensitivity and specificity of red blood cell (RBC) hematology analyzer indices to assess iron status as a part of donor management iron deficient erythropoiesis (IDE) and absence of iron stores (AIS)
bull STUDY DESIGN AND METHODS A total of 1659 male and female donors from the Retrovirus Epidemiology Donor Study-II (REDS-II) Donor Iron Status Evaluation (RISE) study who were either first-timereactivated (FT RA no donations for 2 years) or frequent donors were recruited into a longitudinal study of regular donation of RBCs Of these 1002 donors returned 15 to 24 months later for a final assessment
Absent iron stores (AIS) was defined as plasma ferritin level of less than 12 mgL Logarithm of the ratio of soluble transferrin receptor to ferritin of at least 207 was used to define iron-deficient erythropoiesis (IDE)
bull RESULTS HYPOm and CHr detected IDE with comparable sensitivity 72 versus 69 but differed in specificity HYPOm 68 and CHr 53
For detecting AIS sensitivity was improved to 85 for HYPOm and 81 for CHr but specificity was reduced
Venous Hb had high specificity but poor sensitivity for IDE and AIS A plasma ferritin level of less than 267 mgL was a good surrogate for assessing IDE Congreso Nacio
nal Laboratorio Cliacutenico 2018
Microcytic RBC and reticulocyte mean cell hemoglobin content predicted iron depletion with
sensitivities 70 and 64
specificities of 72 and 78 respectively
When both combined
increased the sensitivity to 82
Congreso Nacional Laboratorio Cliacutenico
2018
Depending on the number of donations during the preceding12 months
Absent iron stores were detected in up to 214 of male and278 of female donors respectively
impaired hemoglobinisation IH was present in up to 64 maleand 167 female donors with 2 and 4 preceding donationsrespectively
The defined CHr cut-off value was 280 pg to detect IH infrequent whole blood donors with AIS leading to a testspecificity of 982 (positive predictive value PPV 577) inmale and of 978 (PPV 829) in female donors
It may help to prevent the development of anemia in frequentblood donors and also can help to decide whether donordeferral or even iron substitution need to be recommended
Congreso Nacional Laboratorio Cliacutenico
2018
Of the 501 blood donors sTfR and Ret-He detected Latent Iron Deficiency in 148 and 135 donors respectively
In comparison to sTfR Ret-He had sensitivity of 927 specificity of 9716 PPV of 931 and NPV of 963
Serum Ferritin TIBC and serum Iron had comparatively lower sensitivity of 8716 797 and 777 respectively
Conclusion Ret-He can be used as a routine screening test to detect LID in blood donors
This could provide an opportunity to make appropriate and timely interventions like dietary changes or drug supplementation
Congreso Nacional Laboratorio Cliacutenico
2018
Singh A Chaudhary R Pandey HC Sonker A Identification of iron status of blood donors by using low hemoglobin density and microcytic anemia factor Asian J Transfus Sci 20181246-50
The main objective of this study was to assess ifLHD and Maf could be used for assessment ofiron status in blood donors and also to establisha cut-off for these two parameters at which atentative iron deficiency could be reportedconclusively
Results LHD and Maf were able to differentiatebetween iron deficient and iron-depleteddonors from normal donorsA cutoff of 918 for LHD was able todifferentiate iron deficient and depleted statefrom normal iron statessensitivity 919 and specificity 71respectivelya cutoff of 1016 for Mafsensitivity 946 and specificity 968
MAf = (MVC Hb) 100
Congreso Nacional Laboratorio Cliacutenico
2018
Hb reticulocitaria sensible para detectar la fase inicial del deacuteficitde hierro cuando la eritropoyesis requiere maacutes cantidad que laque recibe ANTES de que la anemia se establezca
La deteccioacuten precoz del deacuteficit de hierro en la fase del balance negativo demanda aporte contribuye a reducir sus manifestaciones cliacutenicas en los pacientes afectados mejorando la salud puacuteblica
Un tratamiento menos prolongado con suplementos y menor consumo de los recursos sanitaros Contribuye a la eficiencia y sostenibilidad de los servicios sanitarios
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
Buttarello MLaboratory diagnosis of anemia are the old and new red cell parameters useful in classification and treatment howInt Jnl Lab Hem 2016 38 (Suppl 1) 123ndash132
Congreso Nacional Laboratorio Cliacutenico
2018
Buttarello MLaboratory diagnosis of anemia are the old and new red cell parameters useful in classification and treatment howInt Jnl Lab Hem 2016 38 (Suppl 1) 123ndash132
Congreso Nacional Laboratorio Cliacutenico
2018
Ralph Green amp Ananya Datta Mitra Megaloblastic Anemias Nutritional and Other CausesMed Clin N Am 2017 101 297ndash317
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
ANEMIA CARENCIAL CAUSAS
Factores alimentariosConsumir una dieta vegetariana mal planeadaAlimentacioacuten deficiente en los bebeacutesDesnutricioacuten durante el embarazo
Deacuteficit de absorcioacutenAlcoholismo croacutenicoEnfermedad de Crohn celiaquiacutea infeccioacuten otros problemas que le dificulten al cuerpo la digestioacuten de los alimentosAnemia perniciosa (factor intriacutenseco)Cirugiacuteas para extirpar ciertas partes del estoacutemago o el intestino delgado
MedicamentosB12 omeprazol metformina colchicina aminosalicilatos neomicinaFOLATO fenitoiacutena metotrexato sulfasalacina triamtereno pirimetamina trimetoprim con sulfametoxazol barbituacutericos
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
Reacciones metaboacutelicas en las que participan la vitamina B12 y el folato bull la conversioacuten de metilmalonil-CoA a succinil-CoA donde la adenosil-cobalamina actuacutea de
cofactor Por ello un deacuteficit de B12 conlleva un aumento de metilmalonil-CoA y de su producto de hidroacutelisis el aacutecido metilmaloacutenico
bull la siacutentesis de metionina a partir de homocisteina gracias a la metionina sintetasa y a la metil-cobalamina como cofactor En esta misma reaccioacuten el metiltetrahidrofolato es transformado a tetrahidrofolato que es necesario para la siacutentesis de DNA
Congreso Nacional Laboratorio Cliacutenico
2018
Anemia macrociacutetica secundaria a deficiencia de aacutecido foacutelico y de vitamina B12(cobalamina)
La deficiencia de B12 yo aacutecido foacutelico es la causa maacutes frecuente de megaloblastosis
Dentro de distintas funciones generales del metabolismo la vitamina B12 es uncofactor esencial en la siacutentesis de ADN y ARN compromete a todas las ceacutelulas delorganismo
Su deficiencia se manifiesta en oacuterganos con alto recambio celular como la meacutedulaosea y en el sistema nervioso central (SNC) a traveacutes de la siacutentesis de mielina y lareparacioacuten axonal
La deficiencia de cobalamina es responsable de alteraciones hematoloacutegicasneuroloacutegicas neurocognitivas y neuropsiquiaacutetricas
La siacutentesis defectuosa de ADN conduce a la apoptosis y a la hemoacutelisis (intra yextramedular) causantes de la hemopoyesis inefectiva
En meacutedula la siacutentesis ineficiente de DNA causa cambios megaloblaacutesticos comoconsecuencIa anemia y citopenias
Congreso Nacional Laboratorio Cliacutenico
2018
Limitaciones de los meacutetodos diagnoacutesticos claacutesicos
Volumen Corpuscular Medio (VCM) y morfologiacutea de sangre perifeacuterica En una serie de pacientes con deacuteficit de cobalamina soacutelo un 29 teniacutean anemia y soacutelo un 36 teniacutean un VCM gt 100 fL
Un VCM normal no puede ser empleado para rechazar una determinacioacuten de nivel de cobalamina ya que hasta un 25 de casos con manifestaciones neuroloacutegicas cursan con un VCM normal
Cobalamina seacuterica (nivel de B12) Es el test diagnoacutestico rutinario inicial estaacutendar Es un test ampliamente disponible de bajo coste y automatizado Sin embargo presenta algunas limitaciones
-- Existencia de varias teacutecnicas y ausencia de un gold standard por lo que hay diferentes liacutemites de referencia
-- Variacioacuten intraindividual muy alta
La OMS publicoacute en 2008 las conclusiones de un grupo teacutecnico consultado sobre el deacuteficit de cobalamina y folato
El grupo reconocioacute que no existen unos umbrales universalmente reconocidos para definir el deacuteficit de ambas vitaminas y expresaron la necesidad de un consenso
Devalia V Hamilton MS and Molloy AM on behalf of the British Committee for standards in haematology Guidelines for the diagnosis and treatment of cobalamin and folate disorders Br J Haematol 2014 166(4) 496-513
Schrier SL Diagnosis and treatment of vitamin B12 and folate deficiency UpToDate Last updated Jun 25 2014
de Benoist B Conclusions of a WHO Technical Consultation on folate and vitamin B12 deficiencies Food Nutr Bull 200829(2 Suppl)S238ndash44Congreso Nacional Laboratorio Cliacutenico
2018
Tomado de Tefferi A Li C En Atlas of Clinical Hematology Publicado por JO Armitage Philadelphia Current Medicine 2004
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
Int Jnl Lab Hem 2007 29 327ndash334
Clin Lab 201662343-347
In ourstudy mean MCVrMCV ratio of healthy controls is130 as microcytic anemia irondeficiency anemia is121 as also macrocytic anemia vitamin B12 deficiencyanemia is 115
Congreso Nacional Laboratorio Cliacutenico
2018
Sualeh Muslim Khan Muhammad Akbar Agha
Mean cell volume of reticulocytemdashA new parameter for diagnosing sub-clinical cobalamin deficiency in blood donors Int J Lab Hem 20181ndash4
The Abbott CELL-DYN Sapphire Hematology System uses multi-angle polarized scatter separation (MAPSS) and focused flow impedance technologies
Congreso Nacional Laboratorio Cliacutenico
2018
MCVr at 985 fL yielded the highest Youdenrsquos index at sensitivity of 82 specificity of 828 AUC 0847 ( 95 CI 803-891)
Khan SM Agha MA Mean cell volume of reticulocyte-A new parameter for diagnosing sub-clinical cobalamin deficiency in blood donors
Int J Lab Hem 20181ndash4 2018 Jul 13 doi 101111ijlh12899
Congreso Nacional Laboratorio Cliacutenico
2018
Role of Cell Population Data in the detection of folate and cobalamin deficiency
J Nieto et al
XXXI st International Symposium on Technological Innovations in Laboratory Hematology ISLH 2018 10-12 May 2018 Brussels Belgium
M-V-NRET and SD-VNRET are the best discriminatory single parameters to distinguish between patients with B9B12 deficiency and reference subjects M-V-NRETAUC=0823 sensitivity 78 and specificity 86
AUC=0852 sensitivity 55 and specificity 60
Conclusions The CPD parameters of Volume and Light Scatter (M and SD of LALS angle) that inform about size and intracellular structure of RBCs provided very useful information for the detection of B9B12 deficiency
Congreso Nacional Laboratorio Cliacutenico
2018
Cell Population Data
bull Paraacutemetros poblacionales de los leucocitos
bull Describen la morfologiacutea tamantildeo
estructuras citoplasmaacuteticas
nuacutecleo aacutecidos nucleacuteicos
bull Son datos numeacutericos con los que se construyen los ejes de lo diagramas de dispersioacuten de los leucocitos
bull Dependen de la tecnologiacutea
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
High Sensitivity New Parameters for the Detection of Vitamin B12 and Folate Deficiencies Blood 2008 1125379
B12 def vs
Normals
Mann
Withney T-Test
ROC
AUC Sens Specif Cutoff signifROC
MCV p=03156 p=09533 0577
MPV p=00001 0802 792 806 lt83 p=00001
NE Mean
Volume plt00001 0862 833 778 gt1403 p=00001
MO Mean
Volume plt00001 0829 625 889 gt1723 p=00001
MRV p=00113 0705 50 964 gt1133 p=00051
Folate def vs
Normals
Mann
Withney T-Test
ROC
AUC Sens Specif Cut-off signifROC
MCV p=00798 p=06461 0665
MPV plt00001 0832 81 806 lt83 p=00001
NE Mean
Volume p=00008 087 952 694 gt1402 p=00001
MO Mean
Volume p=00002 0801 667 833 gt1696 p=00001
MRV p=00054 0731 476 964 gt1133 p=00019
The Mean Neutrophil Volume (MNE V) and Mean Monocyte Volume (MMOV) may be used for the detection of megaloblastic neutrophils and monocytes MNEV and MMOV have significantly higher sensitivity than the previous information from the red cells (MCV) detecting B12 or folate deficiency because they are not affected by the presence at the same time of Iron deficiency or other reasons of anemia
Congreso Nacional Laboratorio Cliacutenico
2018
POSTER 733
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
CPD Sysmex XN
NE SSC complejidad
NE SFL aacutecidos nucleacuteicos
NE FSC tamantildeo
NE WX
NE WY
NE WZ
MO X
MO Y
MO Z
MO WX
MO WY
MO WZ
LY X
LY Y
LY Z
LY WX
LY WY
LY WZCongreso Nacio
nal Laboratorio Cliacutenico 2018
As MCV is the mean which is calculated it is insensitive to the presence of a small number of macrocytes
Further macrocytosis can be obscured by concomitant disorders that can cause microcytosis resulting inmasked megaloblastic anaemia (MA) for example iron deficiency hereditary elliptocytosis alpha and betathalassemia
This study was undertaken to evaluate the role of NEUT-X and NEUT-Y in detecting MA on peripheral blood andalso see whether other forms of macrocytic anaemia can be differentiated from MA
In MA the peripheral blood smear shows cytopenia with macroovalocytes and hypersegmented
neutrophils (gt5 lobes in 5 neutrophils six lobes nuclei or lobe average of gt35)
In conclusion our study shows that higher values of NEUT-X and NEUT-Y in MA patients in spite of low ornormal MCV high RDW may be used to not only reveal the masked cases of MA with concomitant irondeficiency but also separate them from the broader macrocytic anaemia group
Peripheral smear remains diagnostic however making smear for all the suspicious cases is a cumbersomeand tedious procedure Thus these parameters emerge as more reliable and stable parameters in themodern laboratories which in future may replace the older screening tools
Congreso Nacional Laboratorio Cliacutenico
2018
A favor Eficiencia Operativa
Mejora el proceso del Laboratorio
Mejor informacioacuten al Cliacutenico al mismo coste
Mejora la informacioacuten
Informa sobre la eritropoyesis deteccioacuten precoz de estados carenciales
Ayuda al cliacutenico
Estado real del paciente
En contraParaacutemetros de investigacioacuten
Dificultad de standarizar dependencia teacutecnica
Control de calidadCongreso Nacional Laboratorio Cliacutenico
2018
Low Hb Density
Microcytic Factor Maf = (HbMCV)100
Nuevo moacutedulo transductor muacuteltiple con laacuteser de diodo y dos sensores oacutepticos
Anaacutelisis de hasta 50000 ceacutelulas con 7 paraacutemetros tecnoloacutegicos (leucocitos reticulocitos eritroblastos)
1 Volumen digital
2 Conductividad digital
3 5 aacutengulos de dispersioacuten de luz laacuteser digital
bull MALS (Median Angle Light Scatter)
bull UMALS (Upper Median Angle Light Scatter) 20deg a 43deg
bull LMALS (Lower Median Angle Light Scatter) 09deg a 19deg
bull LALS (Low Angle Light Scatter) asymp 51deg
bull AL2 (Axial Light Loss) 0deg a 05deg
Congreso Nacional Laboratorio Cliacutenico
2018
Hierro es un elemento criacutetico para elfuncionamiento oacuteptimo y supervivenciade las ceacutelulas
Disfuncioacuten mitocondrialActividad enzimaacutetica afectadaProteiacutenas de transporte y estructuralesproteins
Capacidad fiacutesica mermadaCapacidad de trabajo reducidaCapacidades cognitivas afectadasMorbilidad y mortalidad
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
It is generally assumed that worldwide ldquoat least half the anemia is due tonutritional iron deficiencyrdquo and that ldquoup to a prevalence of iron deficiency anemiaof 40 the prevalence of iron deficiency will be about 25 times that of anemiardquoHowever it is evident from the foregoing discussion that there are considerablevariations in both of these ratios depending on the age and sex of the peoplebeing studied the region of the world in which they live and the prevalence ratesof other causes of anemia
WHO Department of Nutrition for Health and DevelopmentAssessing the iron status of populations including literature reviews report of a Joint World Health OrganizationCenters for DiseaseControl and Prevention Technical Consultation on the Assessment of Iron Status at the Population Level Geneva Switzerland 6ndash8 April2004 ndash 2nd ed
Congreso Nacional Laboratorio Cliacutenico
2018
Estaacute bien establecido que la anemia produce una miriacuteada de secuelas tanto fiacutesicas comopsicoloacutegicas
Pero los efecto deleteacutereos se deben al deficit de hierro que es un evento previo a que seestablezca la anemia
El deacuteficit de hierrro auacuten sin anemia tiene efectos negativos en el desarrollo cognitivo y fiacutesico
Rattehalli D et al Iron deficiency without anemia do not wait for the Hemoglobin to drop
Health Policy and Technology 2013 2 45-48Congreso Nacio
nal Laboratorio Cliacutenico 2018
SuominenP et al Serum transferrin receptor and transferrin receptor-ferritin index identify healthy subjects with subclinical iron deficits Blood 1998 92 2934ndash9Halwachs-Baumann G Diagnosis of anaemia old things rearranged Wien Med Wochenschr 2012 162478ndash88
Congreso Nacional Laboratorio Cliacutenico
2018
Hemoglobina de reticulocito y su importancia en el diagnoacutestico temprano de anemiaferropeacutenica
Y Maacuterquez-Beniacutetez et al Universidad de BocayaAugust
2018 DOI 1022267rus182003133 aop
El contenido de hemoglobina de reticulocitos (CHr) es un paraacutemetro en la biometriacuteahematoloacutegica automatizada utilizado como un marcador de la biodisponibilidad delhierro en la eritropoyesis
Objetivo Exponer la aplicabilidad de la CHr como un paraacutemetro en el diagnoacutesticoprecoz de la anemia por deficiencia de hierro asiacute como su medicioacuten e interpretacioacuten
Materiales y meacutetodos Se realizoacute la revisioacuten de artiacuteculos cientiacuteficos en ingleacutes y espantildeolen las bases de datos PubMed ScienceDirect LILACS y Medline usando descriptoresvalidados en Medical Subject Headings (MeSH) considerando periodo depublicabilidad del 80 inferior a 5 antildeos
Conclusiones La CHr es un paraacutemetro de gran utilidad en el diagnoacutestico temprano deanemia ferropeacutenica y otras patologiacuteas como deficiencia funcional de hierro estadosde inflamacioacuten croacutenica y enfermedad renal croacutenica
Biomarcador temprano en el diagnoacutestico de deficiencia de hierro antes de presentarsecambios morfoloacutegicos eritrociacuteticosCongreso Nacio
nal Laboratorio Cliacutenico 2018
bull A total of 1105 NES participants (639 men 466 women)bull CHr becomes affected in a relatively early stage in the development of iron deficiency before iron
deficiency anemia and clinical symptoms become apparentbull Therefore this parameter might be useful to identify persons healthy and diseased at risk of
developing iron deficiency anemia and subsequently to apply interventions in order to prevent further development of iron deficiency anemiaCongreso Nacio
nal Laboratorio Cliacutenico 2018
Hb reticulocitaria sensible para detectar la fase inicial del deacuteficit de hierro cuando laeritropoyesis requiere maacutes cantidad que la que recibe ANTES de que la anemia seestablezca
Congreso Nacional Laboratorio Cliacutenico
2018
No ID LID P
RBC 1012L 48 (08) 437 (05) lt00001
Hb gL 135 (6) 131 (12) 0006
MCV fL 922 (21) 902 (38) 0006
MCH pg 324 (07) 306 (22) lt00001
MCHC gL 339 (6) 319 (23) 0001
RDW
Ret He pg
Hypo He
LHD
Ferritin microgL
131 (06)
338 (21)
03 (015)
28 (20)
86 (3)
145 (21)
278 (24)
69 (55)
56 (25)
16 (76)
lt00001
lt00001
lt00001
lt00001
lt00001
AUC 95 CI Cutoff Sensitivity Specificity
LHD 0898 0819-0978 50 859 841
Ret He 0914 0824-1000 299pg 868 857
Hypo He 0934 0856-1000 16 857 921
Clinical value of markers of hypochromia in the detection of latent iron deficiency in non-anemic premenopausal women
No ID Hb gt 120 gL s-ferritin was within reference intervalLatent Iron Defiency Hb gt 120 gL s-ferritin lt 30 μgL
Urrechaga E et al Journal Clin Lab Analysis 2016 30 (5) 623-627
97 women (388) in 250 apparently healthy women had latent IDCongreso Nacional Laboratorio Cliacutenico
2018
Schorer G et al Abstract Jahreskongress der Deutschen Gesellschaft fuumlr Transfusionsmedizin und Immunhaumlmatologie Rostock 15 - 18 September 2009
Congreso Nacional Laboratorio Cliacutenico
2018
Caring for Those Who Share Mitigating Iron Deficiency in Regular Blood DonorsMast Alan E
bull Iron deficiency caused by regular blood donation is a problem facing blood centers Each blood donation removes 200 to 250 mg of iron from the donor Consequently many donors become iron deficient with repeated donation
bull This presents a challenge to blood centers that has become more acute in recent years with the realization that iron deficiency even in the absence of anemia is associated with adverse effects including fatigue and decreased exercise tolerance as well as neurological symptoms such as decreased cognitive function pica and restless leg syndrome
bull REDS-II investigators performed a longitudinal study investigating the iron status of blood donors over a two year period called the REDS-II Donor Iron Status Evaluation (RISE)
bull Results from the baseline analysis of regular donors (e 2 donations per year (females) or e 3 donations per year (males) revealed that over two-thirds of female donors and over one-half of male donors have iron deficiency
Congreso Nacional Laboratorio Cliacutenico
2018
Transfusion 2013 532766-2775
bull We evaluated the diagnostic sensitivity and specificity of red blood cell (RBC) hematology analyzer indices to assess iron status as a part of donor management iron deficient erythropoiesis (IDE) and absence of iron stores (AIS)
bull STUDY DESIGN AND METHODS A total of 1659 male and female donors from the Retrovirus Epidemiology Donor Study-II (REDS-II) Donor Iron Status Evaluation (RISE) study who were either first-timereactivated (FT RA no donations for 2 years) or frequent donors were recruited into a longitudinal study of regular donation of RBCs Of these 1002 donors returned 15 to 24 months later for a final assessment
Absent iron stores (AIS) was defined as plasma ferritin level of less than 12 mgL Logarithm of the ratio of soluble transferrin receptor to ferritin of at least 207 was used to define iron-deficient erythropoiesis (IDE)
bull RESULTS HYPOm and CHr detected IDE with comparable sensitivity 72 versus 69 but differed in specificity HYPOm 68 and CHr 53
For detecting AIS sensitivity was improved to 85 for HYPOm and 81 for CHr but specificity was reduced
Venous Hb had high specificity but poor sensitivity for IDE and AIS A plasma ferritin level of less than 267 mgL was a good surrogate for assessing IDE Congreso Nacio
nal Laboratorio Cliacutenico 2018
Microcytic RBC and reticulocyte mean cell hemoglobin content predicted iron depletion with
sensitivities 70 and 64
specificities of 72 and 78 respectively
When both combined
increased the sensitivity to 82
Congreso Nacional Laboratorio Cliacutenico
2018
Depending on the number of donations during the preceding12 months
Absent iron stores were detected in up to 214 of male and278 of female donors respectively
impaired hemoglobinisation IH was present in up to 64 maleand 167 female donors with 2 and 4 preceding donationsrespectively
The defined CHr cut-off value was 280 pg to detect IH infrequent whole blood donors with AIS leading to a testspecificity of 982 (positive predictive value PPV 577) inmale and of 978 (PPV 829) in female donors
It may help to prevent the development of anemia in frequentblood donors and also can help to decide whether donordeferral or even iron substitution need to be recommended
Congreso Nacional Laboratorio Cliacutenico
2018
Of the 501 blood donors sTfR and Ret-He detected Latent Iron Deficiency in 148 and 135 donors respectively
In comparison to sTfR Ret-He had sensitivity of 927 specificity of 9716 PPV of 931 and NPV of 963
Serum Ferritin TIBC and serum Iron had comparatively lower sensitivity of 8716 797 and 777 respectively
Conclusion Ret-He can be used as a routine screening test to detect LID in blood donors
This could provide an opportunity to make appropriate and timely interventions like dietary changes or drug supplementation
Congreso Nacional Laboratorio Cliacutenico
2018
Singh A Chaudhary R Pandey HC Sonker A Identification of iron status of blood donors by using low hemoglobin density and microcytic anemia factor Asian J Transfus Sci 20181246-50
The main objective of this study was to assess ifLHD and Maf could be used for assessment ofiron status in blood donors and also to establisha cut-off for these two parameters at which atentative iron deficiency could be reportedconclusively
Results LHD and Maf were able to differentiatebetween iron deficient and iron-depleteddonors from normal donorsA cutoff of 918 for LHD was able todifferentiate iron deficient and depleted statefrom normal iron statessensitivity 919 and specificity 71respectivelya cutoff of 1016 for Mafsensitivity 946 and specificity 968
MAf = (MVC Hb) 100
Congreso Nacional Laboratorio Cliacutenico
2018
Hb reticulocitaria sensible para detectar la fase inicial del deacuteficitde hierro cuando la eritropoyesis requiere maacutes cantidad que laque recibe ANTES de que la anemia se establezca
La deteccioacuten precoz del deacuteficit de hierro en la fase del balance negativo demanda aporte contribuye a reducir sus manifestaciones cliacutenicas en los pacientes afectados mejorando la salud puacuteblica
Un tratamiento menos prolongado con suplementos y menor consumo de los recursos sanitaros Contribuye a la eficiencia y sostenibilidad de los servicios sanitarios
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
Buttarello MLaboratory diagnosis of anemia are the old and new red cell parameters useful in classification and treatment howInt Jnl Lab Hem 2016 38 (Suppl 1) 123ndash132
Congreso Nacional Laboratorio Cliacutenico
2018
Buttarello MLaboratory diagnosis of anemia are the old and new red cell parameters useful in classification and treatment howInt Jnl Lab Hem 2016 38 (Suppl 1) 123ndash132
Congreso Nacional Laboratorio Cliacutenico
2018
Ralph Green amp Ananya Datta Mitra Megaloblastic Anemias Nutritional and Other CausesMed Clin N Am 2017 101 297ndash317
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
ANEMIA CARENCIAL CAUSAS
Factores alimentariosConsumir una dieta vegetariana mal planeadaAlimentacioacuten deficiente en los bebeacutesDesnutricioacuten durante el embarazo
Deacuteficit de absorcioacutenAlcoholismo croacutenicoEnfermedad de Crohn celiaquiacutea infeccioacuten otros problemas que le dificulten al cuerpo la digestioacuten de los alimentosAnemia perniciosa (factor intriacutenseco)Cirugiacuteas para extirpar ciertas partes del estoacutemago o el intestino delgado
MedicamentosB12 omeprazol metformina colchicina aminosalicilatos neomicinaFOLATO fenitoiacutena metotrexato sulfasalacina triamtereno pirimetamina trimetoprim con sulfametoxazol barbituacutericos
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
Reacciones metaboacutelicas en las que participan la vitamina B12 y el folato bull la conversioacuten de metilmalonil-CoA a succinil-CoA donde la adenosil-cobalamina actuacutea de
cofactor Por ello un deacuteficit de B12 conlleva un aumento de metilmalonil-CoA y de su producto de hidroacutelisis el aacutecido metilmaloacutenico
bull la siacutentesis de metionina a partir de homocisteina gracias a la metionina sintetasa y a la metil-cobalamina como cofactor En esta misma reaccioacuten el metiltetrahidrofolato es transformado a tetrahidrofolato que es necesario para la siacutentesis de DNA
Congreso Nacional Laboratorio Cliacutenico
2018
Anemia macrociacutetica secundaria a deficiencia de aacutecido foacutelico y de vitamina B12(cobalamina)
La deficiencia de B12 yo aacutecido foacutelico es la causa maacutes frecuente de megaloblastosis
Dentro de distintas funciones generales del metabolismo la vitamina B12 es uncofactor esencial en la siacutentesis de ADN y ARN compromete a todas las ceacutelulas delorganismo
Su deficiencia se manifiesta en oacuterganos con alto recambio celular como la meacutedulaosea y en el sistema nervioso central (SNC) a traveacutes de la siacutentesis de mielina y lareparacioacuten axonal
La deficiencia de cobalamina es responsable de alteraciones hematoloacutegicasneuroloacutegicas neurocognitivas y neuropsiquiaacutetricas
La siacutentesis defectuosa de ADN conduce a la apoptosis y a la hemoacutelisis (intra yextramedular) causantes de la hemopoyesis inefectiva
En meacutedula la siacutentesis ineficiente de DNA causa cambios megaloblaacutesticos comoconsecuencIa anemia y citopenias
Congreso Nacional Laboratorio Cliacutenico
2018
Limitaciones de los meacutetodos diagnoacutesticos claacutesicos
Volumen Corpuscular Medio (VCM) y morfologiacutea de sangre perifeacuterica En una serie de pacientes con deacuteficit de cobalamina soacutelo un 29 teniacutean anemia y soacutelo un 36 teniacutean un VCM gt 100 fL
Un VCM normal no puede ser empleado para rechazar una determinacioacuten de nivel de cobalamina ya que hasta un 25 de casos con manifestaciones neuroloacutegicas cursan con un VCM normal
Cobalamina seacuterica (nivel de B12) Es el test diagnoacutestico rutinario inicial estaacutendar Es un test ampliamente disponible de bajo coste y automatizado Sin embargo presenta algunas limitaciones
-- Existencia de varias teacutecnicas y ausencia de un gold standard por lo que hay diferentes liacutemites de referencia
-- Variacioacuten intraindividual muy alta
La OMS publicoacute en 2008 las conclusiones de un grupo teacutecnico consultado sobre el deacuteficit de cobalamina y folato
El grupo reconocioacute que no existen unos umbrales universalmente reconocidos para definir el deacuteficit de ambas vitaminas y expresaron la necesidad de un consenso
Devalia V Hamilton MS and Molloy AM on behalf of the British Committee for standards in haematology Guidelines for the diagnosis and treatment of cobalamin and folate disorders Br J Haematol 2014 166(4) 496-513
Schrier SL Diagnosis and treatment of vitamin B12 and folate deficiency UpToDate Last updated Jun 25 2014
de Benoist B Conclusions of a WHO Technical Consultation on folate and vitamin B12 deficiencies Food Nutr Bull 200829(2 Suppl)S238ndash44Congreso Nacional Laboratorio Cliacutenico
2018
Tomado de Tefferi A Li C En Atlas of Clinical Hematology Publicado por JO Armitage Philadelphia Current Medicine 2004
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
Int Jnl Lab Hem 2007 29 327ndash334
Clin Lab 201662343-347
In ourstudy mean MCVrMCV ratio of healthy controls is130 as microcytic anemia irondeficiency anemia is121 as also macrocytic anemia vitamin B12 deficiencyanemia is 115
Congreso Nacional Laboratorio Cliacutenico
2018
Sualeh Muslim Khan Muhammad Akbar Agha
Mean cell volume of reticulocytemdashA new parameter for diagnosing sub-clinical cobalamin deficiency in blood donors Int J Lab Hem 20181ndash4
The Abbott CELL-DYN Sapphire Hematology System uses multi-angle polarized scatter separation (MAPSS) and focused flow impedance technologies
Congreso Nacional Laboratorio Cliacutenico
2018
MCVr at 985 fL yielded the highest Youdenrsquos index at sensitivity of 82 specificity of 828 AUC 0847 ( 95 CI 803-891)
Khan SM Agha MA Mean cell volume of reticulocyte-A new parameter for diagnosing sub-clinical cobalamin deficiency in blood donors
Int J Lab Hem 20181ndash4 2018 Jul 13 doi 101111ijlh12899
Congreso Nacional Laboratorio Cliacutenico
2018
Role of Cell Population Data in the detection of folate and cobalamin deficiency
J Nieto et al
XXXI st International Symposium on Technological Innovations in Laboratory Hematology ISLH 2018 10-12 May 2018 Brussels Belgium
M-V-NRET and SD-VNRET are the best discriminatory single parameters to distinguish between patients with B9B12 deficiency and reference subjects M-V-NRETAUC=0823 sensitivity 78 and specificity 86
AUC=0852 sensitivity 55 and specificity 60
Conclusions The CPD parameters of Volume and Light Scatter (M and SD of LALS angle) that inform about size and intracellular structure of RBCs provided very useful information for the detection of B9B12 deficiency
Congreso Nacional Laboratorio Cliacutenico
2018
Cell Population Data
bull Paraacutemetros poblacionales de los leucocitos
bull Describen la morfologiacutea tamantildeo
estructuras citoplasmaacuteticas
nuacutecleo aacutecidos nucleacuteicos
bull Son datos numeacutericos con los que se construyen los ejes de lo diagramas de dispersioacuten de los leucocitos
bull Dependen de la tecnologiacutea
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
High Sensitivity New Parameters for the Detection of Vitamin B12 and Folate Deficiencies Blood 2008 1125379
B12 def vs
Normals
Mann
Withney T-Test
ROC
AUC Sens Specif Cutoff signifROC
MCV p=03156 p=09533 0577
MPV p=00001 0802 792 806 lt83 p=00001
NE Mean
Volume plt00001 0862 833 778 gt1403 p=00001
MO Mean
Volume plt00001 0829 625 889 gt1723 p=00001
MRV p=00113 0705 50 964 gt1133 p=00051
Folate def vs
Normals
Mann
Withney T-Test
ROC
AUC Sens Specif Cut-off signifROC
MCV p=00798 p=06461 0665
MPV plt00001 0832 81 806 lt83 p=00001
NE Mean
Volume p=00008 087 952 694 gt1402 p=00001
MO Mean
Volume p=00002 0801 667 833 gt1696 p=00001
MRV p=00054 0731 476 964 gt1133 p=00019
The Mean Neutrophil Volume (MNE V) and Mean Monocyte Volume (MMOV) may be used for the detection of megaloblastic neutrophils and monocytes MNEV and MMOV have significantly higher sensitivity than the previous information from the red cells (MCV) detecting B12 or folate deficiency because they are not affected by the presence at the same time of Iron deficiency or other reasons of anemia
Congreso Nacional Laboratorio Cliacutenico
2018
POSTER 733
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
CPD Sysmex XN
NE SSC complejidad
NE SFL aacutecidos nucleacuteicos
NE FSC tamantildeo
NE WX
NE WY
NE WZ
MO X
MO Y
MO Z
MO WX
MO WY
MO WZ
LY X
LY Y
LY Z
LY WX
LY WY
LY WZCongreso Nacio
nal Laboratorio Cliacutenico 2018
As MCV is the mean which is calculated it is insensitive to the presence of a small number of macrocytes
Further macrocytosis can be obscured by concomitant disorders that can cause microcytosis resulting inmasked megaloblastic anaemia (MA) for example iron deficiency hereditary elliptocytosis alpha and betathalassemia
This study was undertaken to evaluate the role of NEUT-X and NEUT-Y in detecting MA on peripheral blood andalso see whether other forms of macrocytic anaemia can be differentiated from MA
In MA the peripheral blood smear shows cytopenia with macroovalocytes and hypersegmented
neutrophils (gt5 lobes in 5 neutrophils six lobes nuclei or lobe average of gt35)
In conclusion our study shows that higher values of NEUT-X and NEUT-Y in MA patients in spite of low ornormal MCV high RDW may be used to not only reveal the masked cases of MA with concomitant irondeficiency but also separate them from the broader macrocytic anaemia group
Peripheral smear remains diagnostic however making smear for all the suspicious cases is a cumbersomeand tedious procedure Thus these parameters emerge as more reliable and stable parameters in themodern laboratories which in future may replace the older screening tools
Congreso Nacional Laboratorio Cliacutenico
2018
A favor Eficiencia Operativa
Mejora el proceso del Laboratorio
Mejor informacioacuten al Cliacutenico al mismo coste
Mejora la informacioacuten
Informa sobre la eritropoyesis deteccioacuten precoz de estados carenciales
Ayuda al cliacutenico
Estado real del paciente
En contraParaacutemetros de investigacioacuten
Dificultad de standarizar dependencia teacutecnica
Control de calidadCongreso Nacional Laboratorio Cliacutenico
2018
Hierro es un elemento criacutetico para elfuncionamiento oacuteptimo y supervivenciade las ceacutelulas
Disfuncioacuten mitocondrialActividad enzimaacutetica afectadaProteiacutenas de transporte y estructuralesproteins
Capacidad fiacutesica mermadaCapacidad de trabajo reducidaCapacidades cognitivas afectadasMorbilidad y mortalidad
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
It is generally assumed that worldwide ldquoat least half the anemia is due tonutritional iron deficiencyrdquo and that ldquoup to a prevalence of iron deficiency anemiaof 40 the prevalence of iron deficiency will be about 25 times that of anemiardquoHowever it is evident from the foregoing discussion that there are considerablevariations in both of these ratios depending on the age and sex of the peoplebeing studied the region of the world in which they live and the prevalence ratesof other causes of anemia
WHO Department of Nutrition for Health and DevelopmentAssessing the iron status of populations including literature reviews report of a Joint World Health OrganizationCenters for DiseaseControl and Prevention Technical Consultation on the Assessment of Iron Status at the Population Level Geneva Switzerland 6ndash8 April2004 ndash 2nd ed
Congreso Nacional Laboratorio Cliacutenico
2018
Estaacute bien establecido que la anemia produce una miriacuteada de secuelas tanto fiacutesicas comopsicoloacutegicas
Pero los efecto deleteacutereos se deben al deficit de hierro que es un evento previo a que seestablezca la anemia
El deacuteficit de hierrro auacuten sin anemia tiene efectos negativos en el desarrollo cognitivo y fiacutesico
Rattehalli D et al Iron deficiency without anemia do not wait for the Hemoglobin to drop
Health Policy and Technology 2013 2 45-48Congreso Nacio
nal Laboratorio Cliacutenico 2018
SuominenP et al Serum transferrin receptor and transferrin receptor-ferritin index identify healthy subjects with subclinical iron deficits Blood 1998 92 2934ndash9Halwachs-Baumann G Diagnosis of anaemia old things rearranged Wien Med Wochenschr 2012 162478ndash88
Congreso Nacional Laboratorio Cliacutenico
2018
Hemoglobina de reticulocito y su importancia en el diagnoacutestico temprano de anemiaferropeacutenica
Y Maacuterquez-Beniacutetez et al Universidad de BocayaAugust
2018 DOI 1022267rus182003133 aop
El contenido de hemoglobina de reticulocitos (CHr) es un paraacutemetro en la biometriacuteahematoloacutegica automatizada utilizado como un marcador de la biodisponibilidad delhierro en la eritropoyesis
Objetivo Exponer la aplicabilidad de la CHr como un paraacutemetro en el diagnoacutesticoprecoz de la anemia por deficiencia de hierro asiacute como su medicioacuten e interpretacioacuten
Materiales y meacutetodos Se realizoacute la revisioacuten de artiacuteculos cientiacuteficos en ingleacutes y espantildeolen las bases de datos PubMed ScienceDirect LILACS y Medline usando descriptoresvalidados en Medical Subject Headings (MeSH) considerando periodo depublicabilidad del 80 inferior a 5 antildeos
Conclusiones La CHr es un paraacutemetro de gran utilidad en el diagnoacutestico temprano deanemia ferropeacutenica y otras patologiacuteas como deficiencia funcional de hierro estadosde inflamacioacuten croacutenica y enfermedad renal croacutenica
Biomarcador temprano en el diagnoacutestico de deficiencia de hierro antes de presentarsecambios morfoloacutegicos eritrociacuteticosCongreso Nacio
nal Laboratorio Cliacutenico 2018
bull A total of 1105 NES participants (639 men 466 women)bull CHr becomes affected in a relatively early stage in the development of iron deficiency before iron
deficiency anemia and clinical symptoms become apparentbull Therefore this parameter might be useful to identify persons healthy and diseased at risk of
developing iron deficiency anemia and subsequently to apply interventions in order to prevent further development of iron deficiency anemiaCongreso Nacio
nal Laboratorio Cliacutenico 2018
Hb reticulocitaria sensible para detectar la fase inicial del deacuteficit de hierro cuando laeritropoyesis requiere maacutes cantidad que la que recibe ANTES de que la anemia seestablezca
Congreso Nacional Laboratorio Cliacutenico
2018
No ID LID P
RBC 1012L 48 (08) 437 (05) lt00001
Hb gL 135 (6) 131 (12) 0006
MCV fL 922 (21) 902 (38) 0006
MCH pg 324 (07) 306 (22) lt00001
MCHC gL 339 (6) 319 (23) 0001
RDW
Ret He pg
Hypo He
LHD
Ferritin microgL
131 (06)
338 (21)
03 (015)
28 (20)
86 (3)
145 (21)
278 (24)
69 (55)
56 (25)
16 (76)
lt00001
lt00001
lt00001
lt00001
lt00001
AUC 95 CI Cutoff Sensitivity Specificity
LHD 0898 0819-0978 50 859 841
Ret He 0914 0824-1000 299pg 868 857
Hypo He 0934 0856-1000 16 857 921
Clinical value of markers of hypochromia in the detection of latent iron deficiency in non-anemic premenopausal women
No ID Hb gt 120 gL s-ferritin was within reference intervalLatent Iron Defiency Hb gt 120 gL s-ferritin lt 30 μgL
Urrechaga E et al Journal Clin Lab Analysis 2016 30 (5) 623-627
97 women (388) in 250 apparently healthy women had latent IDCongreso Nacional Laboratorio Cliacutenico
2018
Schorer G et al Abstract Jahreskongress der Deutschen Gesellschaft fuumlr Transfusionsmedizin und Immunhaumlmatologie Rostock 15 - 18 September 2009
Congreso Nacional Laboratorio Cliacutenico
2018
Caring for Those Who Share Mitigating Iron Deficiency in Regular Blood DonorsMast Alan E
bull Iron deficiency caused by regular blood donation is a problem facing blood centers Each blood donation removes 200 to 250 mg of iron from the donor Consequently many donors become iron deficient with repeated donation
bull This presents a challenge to blood centers that has become more acute in recent years with the realization that iron deficiency even in the absence of anemia is associated with adverse effects including fatigue and decreased exercise tolerance as well as neurological symptoms such as decreased cognitive function pica and restless leg syndrome
bull REDS-II investigators performed a longitudinal study investigating the iron status of blood donors over a two year period called the REDS-II Donor Iron Status Evaluation (RISE)
bull Results from the baseline analysis of regular donors (e 2 donations per year (females) or e 3 donations per year (males) revealed that over two-thirds of female donors and over one-half of male donors have iron deficiency
Congreso Nacional Laboratorio Cliacutenico
2018
Transfusion 2013 532766-2775
bull We evaluated the diagnostic sensitivity and specificity of red blood cell (RBC) hematology analyzer indices to assess iron status as a part of donor management iron deficient erythropoiesis (IDE) and absence of iron stores (AIS)
bull STUDY DESIGN AND METHODS A total of 1659 male and female donors from the Retrovirus Epidemiology Donor Study-II (REDS-II) Donor Iron Status Evaluation (RISE) study who were either first-timereactivated (FT RA no donations for 2 years) or frequent donors were recruited into a longitudinal study of regular donation of RBCs Of these 1002 donors returned 15 to 24 months later for a final assessment
Absent iron stores (AIS) was defined as plasma ferritin level of less than 12 mgL Logarithm of the ratio of soluble transferrin receptor to ferritin of at least 207 was used to define iron-deficient erythropoiesis (IDE)
bull RESULTS HYPOm and CHr detected IDE with comparable sensitivity 72 versus 69 but differed in specificity HYPOm 68 and CHr 53
For detecting AIS sensitivity was improved to 85 for HYPOm and 81 for CHr but specificity was reduced
Venous Hb had high specificity but poor sensitivity for IDE and AIS A plasma ferritin level of less than 267 mgL was a good surrogate for assessing IDE Congreso Nacio
nal Laboratorio Cliacutenico 2018
Microcytic RBC and reticulocyte mean cell hemoglobin content predicted iron depletion with
sensitivities 70 and 64
specificities of 72 and 78 respectively
When both combined
increased the sensitivity to 82
Congreso Nacional Laboratorio Cliacutenico
2018
Depending on the number of donations during the preceding12 months
Absent iron stores were detected in up to 214 of male and278 of female donors respectively
impaired hemoglobinisation IH was present in up to 64 maleand 167 female donors with 2 and 4 preceding donationsrespectively
The defined CHr cut-off value was 280 pg to detect IH infrequent whole blood donors with AIS leading to a testspecificity of 982 (positive predictive value PPV 577) inmale and of 978 (PPV 829) in female donors
It may help to prevent the development of anemia in frequentblood donors and also can help to decide whether donordeferral or even iron substitution need to be recommended
Congreso Nacional Laboratorio Cliacutenico
2018
Of the 501 blood donors sTfR and Ret-He detected Latent Iron Deficiency in 148 and 135 donors respectively
In comparison to sTfR Ret-He had sensitivity of 927 specificity of 9716 PPV of 931 and NPV of 963
Serum Ferritin TIBC and serum Iron had comparatively lower sensitivity of 8716 797 and 777 respectively
Conclusion Ret-He can be used as a routine screening test to detect LID in blood donors
This could provide an opportunity to make appropriate and timely interventions like dietary changes or drug supplementation
Congreso Nacional Laboratorio Cliacutenico
2018
Singh A Chaudhary R Pandey HC Sonker A Identification of iron status of blood donors by using low hemoglobin density and microcytic anemia factor Asian J Transfus Sci 20181246-50
The main objective of this study was to assess ifLHD and Maf could be used for assessment ofiron status in blood donors and also to establisha cut-off for these two parameters at which atentative iron deficiency could be reportedconclusively
Results LHD and Maf were able to differentiatebetween iron deficient and iron-depleteddonors from normal donorsA cutoff of 918 for LHD was able todifferentiate iron deficient and depleted statefrom normal iron statessensitivity 919 and specificity 71respectivelya cutoff of 1016 for Mafsensitivity 946 and specificity 968
MAf = (MVC Hb) 100
Congreso Nacional Laboratorio Cliacutenico
2018
Hb reticulocitaria sensible para detectar la fase inicial del deacuteficitde hierro cuando la eritropoyesis requiere maacutes cantidad que laque recibe ANTES de que la anemia se establezca
La deteccioacuten precoz del deacuteficit de hierro en la fase del balance negativo demanda aporte contribuye a reducir sus manifestaciones cliacutenicas en los pacientes afectados mejorando la salud puacuteblica
Un tratamiento menos prolongado con suplementos y menor consumo de los recursos sanitaros Contribuye a la eficiencia y sostenibilidad de los servicios sanitarios
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
Buttarello MLaboratory diagnosis of anemia are the old and new red cell parameters useful in classification and treatment howInt Jnl Lab Hem 2016 38 (Suppl 1) 123ndash132
Congreso Nacional Laboratorio Cliacutenico
2018
Buttarello MLaboratory diagnosis of anemia are the old and new red cell parameters useful in classification and treatment howInt Jnl Lab Hem 2016 38 (Suppl 1) 123ndash132
Congreso Nacional Laboratorio Cliacutenico
2018
Ralph Green amp Ananya Datta Mitra Megaloblastic Anemias Nutritional and Other CausesMed Clin N Am 2017 101 297ndash317
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
ANEMIA CARENCIAL CAUSAS
Factores alimentariosConsumir una dieta vegetariana mal planeadaAlimentacioacuten deficiente en los bebeacutesDesnutricioacuten durante el embarazo
Deacuteficit de absorcioacutenAlcoholismo croacutenicoEnfermedad de Crohn celiaquiacutea infeccioacuten otros problemas que le dificulten al cuerpo la digestioacuten de los alimentosAnemia perniciosa (factor intriacutenseco)Cirugiacuteas para extirpar ciertas partes del estoacutemago o el intestino delgado
MedicamentosB12 omeprazol metformina colchicina aminosalicilatos neomicinaFOLATO fenitoiacutena metotrexato sulfasalacina triamtereno pirimetamina trimetoprim con sulfametoxazol barbituacutericos
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
Reacciones metaboacutelicas en las que participan la vitamina B12 y el folato bull la conversioacuten de metilmalonil-CoA a succinil-CoA donde la adenosil-cobalamina actuacutea de
cofactor Por ello un deacuteficit de B12 conlleva un aumento de metilmalonil-CoA y de su producto de hidroacutelisis el aacutecido metilmaloacutenico
bull la siacutentesis de metionina a partir de homocisteina gracias a la metionina sintetasa y a la metil-cobalamina como cofactor En esta misma reaccioacuten el metiltetrahidrofolato es transformado a tetrahidrofolato que es necesario para la siacutentesis de DNA
Congreso Nacional Laboratorio Cliacutenico
2018
Anemia macrociacutetica secundaria a deficiencia de aacutecido foacutelico y de vitamina B12(cobalamina)
La deficiencia de B12 yo aacutecido foacutelico es la causa maacutes frecuente de megaloblastosis
Dentro de distintas funciones generales del metabolismo la vitamina B12 es uncofactor esencial en la siacutentesis de ADN y ARN compromete a todas las ceacutelulas delorganismo
Su deficiencia se manifiesta en oacuterganos con alto recambio celular como la meacutedulaosea y en el sistema nervioso central (SNC) a traveacutes de la siacutentesis de mielina y lareparacioacuten axonal
La deficiencia de cobalamina es responsable de alteraciones hematoloacutegicasneuroloacutegicas neurocognitivas y neuropsiquiaacutetricas
La siacutentesis defectuosa de ADN conduce a la apoptosis y a la hemoacutelisis (intra yextramedular) causantes de la hemopoyesis inefectiva
En meacutedula la siacutentesis ineficiente de DNA causa cambios megaloblaacutesticos comoconsecuencIa anemia y citopenias
Congreso Nacional Laboratorio Cliacutenico
2018
Limitaciones de los meacutetodos diagnoacutesticos claacutesicos
Volumen Corpuscular Medio (VCM) y morfologiacutea de sangre perifeacuterica En una serie de pacientes con deacuteficit de cobalamina soacutelo un 29 teniacutean anemia y soacutelo un 36 teniacutean un VCM gt 100 fL
Un VCM normal no puede ser empleado para rechazar una determinacioacuten de nivel de cobalamina ya que hasta un 25 de casos con manifestaciones neuroloacutegicas cursan con un VCM normal
Cobalamina seacuterica (nivel de B12) Es el test diagnoacutestico rutinario inicial estaacutendar Es un test ampliamente disponible de bajo coste y automatizado Sin embargo presenta algunas limitaciones
-- Existencia de varias teacutecnicas y ausencia de un gold standard por lo que hay diferentes liacutemites de referencia
-- Variacioacuten intraindividual muy alta
La OMS publicoacute en 2008 las conclusiones de un grupo teacutecnico consultado sobre el deacuteficit de cobalamina y folato
El grupo reconocioacute que no existen unos umbrales universalmente reconocidos para definir el deacuteficit de ambas vitaminas y expresaron la necesidad de un consenso
Devalia V Hamilton MS and Molloy AM on behalf of the British Committee for standards in haematology Guidelines for the diagnosis and treatment of cobalamin and folate disorders Br J Haematol 2014 166(4) 496-513
Schrier SL Diagnosis and treatment of vitamin B12 and folate deficiency UpToDate Last updated Jun 25 2014
de Benoist B Conclusions of a WHO Technical Consultation on folate and vitamin B12 deficiencies Food Nutr Bull 200829(2 Suppl)S238ndash44Congreso Nacional Laboratorio Cliacutenico
2018
Tomado de Tefferi A Li C En Atlas of Clinical Hematology Publicado por JO Armitage Philadelphia Current Medicine 2004
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
Int Jnl Lab Hem 2007 29 327ndash334
Clin Lab 201662343-347
In ourstudy mean MCVrMCV ratio of healthy controls is130 as microcytic anemia irondeficiency anemia is121 as also macrocytic anemia vitamin B12 deficiencyanemia is 115
Congreso Nacional Laboratorio Cliacutenico
2018
Sualeh Muslim Khan Muhammad Akbar Agha
Mean cell volume of reticulocytemdashA new parameter for diagnosing sub-clinical cobalamin deficiency in blood donors Int J Lab Hem 20181ndash4
The Abbott CELL-DYN Sapphire Hematology System uses multi-angle polarized scatter separation (MAPSS) and focused flow impedance technologies
Congreso Nacional Laboratorio Cliacutenico
2018
MCVr at 985 fL yielded the highest Youdenrsquos index at sensitivity of 82 specificity of 828 AUC 0847 ( 95 CI 803-891)
Khan SM Agha MA Mean cell volume of reticulocyte-A new parameter for diagnosing sub-clinical cobalamin deficiency in blood donors
Int J Lab Hem 20181ndash4 2018 Jul 13 doi 101111ijlh12899
Congreso Nacional Laboratorio Cliacutenico
2018
Role of Cell Population Data in the detection of folate and cobalamin deficiency
J Nieto et al
XXXI st International Symposium on Technological Innovations in Laboratory Hematology ISLH 2018 10-12 May 2018 Brussels Belgium
M-V-NRET and SD-VNRET are the best discriminatory single parameters to distinguish between patients with B9B12 deficiency and reference subjects M-V-NRETAUC=0823 sensitivity 78 and specificity 86
AUC=0852 sensitivity 55 and specificity 60
Conclusions The CPD parameters of Volume and Light Scatter (M and SD of LALS angle) that inform about size and intracellular structure of RBCs provided very useful information for the detection of B9B12 deficiency
Congreso Nacional Laboratorio Cliacutenico
2018
Cell Population Data
bull Paraacutemetros poblacionales de los leucocitos
bull Describen la morfologiacutea tamantildeo
estructuras citoplasmaacuteticas
nuacutecleo aacutecidos nucleacuteicos
bull Son datos numeacutericos con los que se construyen los ejes de lo diagramas de dispersioacuten de los leucocitos
bull Dependen de la tecnologiacutea
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
High Sensitivity New Parameters for the Detection of Vitamin B12 and Folate Deficiencies Blood 2008 1125379
B12 def vs
Normals
Mann
Withney T-Test
ROC
AUC Sens Specif Cutoff signifROC
MCV p=03156 p=09533 0577
MPV p=00001 0802 792 806 lt83 p=00001
NE Mean
Volume plt00001 0862 833 778 gt1403 p=00001
MO Mean
Volume plt00001 0829 625 889 gt1723 p=00001
MRV p=00113 0705 50 964 gt1133 p=00051
Folate def vs
Normals
Mann
Withney T-Test
ROC
AUC Sens Specif Cut-off signifROC
MCV p=00798 p=06461 0665
MPV plt00001 0832 81 806 lt83 p=00001
NE Mean
Volume p=00008 087 952 694 gt1402 p=00001
MO Mean
Volume p=00002 0801 667 833 gt1696 p=00001
MRV p=00054 0731 476 964 gt1133 p=00019
The Mean Neutrophil Volume (MNE V) and Mean Monocyte Volume (MMOV) may be used for the detection of megaloblastic neutrophils and monocytes MNEV and MMOV have significantly higher sensitivity than the previous information from the red cells (MCV) detecting B12 or folate deficiency because they are not affected by the presence at the same time of Iron deficiency or other reasons of anemia
Congreso Nacional Laboratorio Cliacutenico
2018
POSTER 733
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
CPD Sysmex XN
NE SSC complejidad
NE SFL aacutecidos nucleacuteicos
NE FSC tamantildeo
NE WX
NE WY
NE WZ
MO X
MO Y
MO Z
MO WX
MO WY
MO WZ
LY X
LY Y
LY Z
LY WX
LY WY
LY WZCongreso Nacio
nal Laboratorio Cliacutenico 2018
As MCV is the mean which is calculated it is insensitive to the presence of a small number of macrocytes
Further macrocytosis can be obscured by concomitant disorders that can cause microcytosis resulting inmasked megaloblastic anaemia (MA) for example iron deficiency hereditary elliptocytosis alpha and betathalassemia
This study was undertaken to evaluate the role of NEUT-X and NEUT-Y in detecting MA on peripheral blood andalso see whether other forms of macrocytic anaemia can be differentiated from MA
In MA the peripheral blood smear shows cytopenia with macroovalocytes and hypersegmented
neutrophils (gt5 lobes in 5 neutrophils six lobes nuclei or lobe average of gt35)
In conclusion our study shows that higher values of NEUT-X and NEUT-Y in MA patients in spite of low ornormal MCV high RDW may be used to not only reveal the masked cases of MA with concomitant irondeficiency but also separate them from the broader macrocytic anaemia group
Peripheral smear remains diagnostic however making smear for all the suspicious cases is a cumbersomeand tedious procedure Thus these parameters emerge as more reliable and stable parameters in themodern laboratories which in future may replace the older screening tools
Congreso Nacional Laboratorio Cliacutenico
2018
A favor Eficiencia Operativa
Mejora el proceso del Laboratorio
Mejor informacioacuten al Cliacutenico al mismo coste
Mejora la informacioacuten
Informa sobre la eritropoyesis deteccioacuten precoz de estados carenciales
Ayuda al cliacutenico
Estado real del paciente
En contraParaacutemetros de investigacioacuten
Dificultad de standarizar dependencia teacutecnica
Control de calidadCongreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
It is generally assumed that worldwide ldquoat least half the anemia is due tonutritional iron deficiencyrdquo and that ldquoup to a prevalence of iron deficiency anemiaof 40 the prevalence of iron deficiency will be about 25 times that of anemiardquoHowever it is evident from the foregoing discussion that there are considerablevariations in both of these ratios depending on the age and sex of the peoplebeing studied the region of the world in which they live and the prevalence ratesof other causes of anemia
WHO Department of Nutrition for Health and DevelopmentAssessing the iron status of populations including literature reviews report of a Joint World Health OrganizationCenters for DiseaseControl and Prevention Technical Consultation on the Assessment of Iron Status at the Population Level Geneva Switzerland 6ndash8 April2004 ndash 2nd ed
Congreso Nacional Laboratorio Cliacutenico
2018
Estaacute bien establecido que la anemia produce una miriacuteada de secuelas tanto fiacutesicas comopsicoloacutegicas
Pero los efecto deleteacutereos se deben al deficit de hierro que es un evento previo a que seestablezca la anemia
El deacuteficit de hierrro auacuten sin anemia tiene efectos negativos en el desarrollo cognitivo y fiacutesico
Rattehalli D et al Iron deficiency without anemia do not wait for the Hemoglobin to drop
Health Policy and Technology 2013 2 45-48Congreso Nacio
nal Laboratorio Cliacutenico 2018
SuominenP et al Serum transferrin receptor and transferrin receptor-ferritin index identify healthy subjects with subclinical iron deficits Blood 1998 92 2934ndash9Halwachs-Baumann G Diagnosis of anaemia old things rearranged Wien Med Wochenschr 2012 162478ndash88
Congreso Nacional Laboratorio Cliacutenico
2018
Hemoglobina de reticulocito y su importancia en el diagnoacutestico temprano de anemiaferropeacutenica
Y Maacuterquez-Beniacutetez et al Universidad de BocayaAugust
2018 DOI 1022267rus182003133 aop
El contenido de hemoglobina de reticulocitos (CHr) es un paraacutemetro en la biometriacuteahematoloacutegica automatizada utilizado como un marcador de la biodisponibilidad delhierro en la eritropoyesis
Objetivo Exponer la aplicabilidad de la CHr como un paraacutemetro en el diagnoacutesticoprecoz de la anemia por deficiencia de hierro asiacute como su medicioacuten e interpretacioacuten
Materiales y meacutetodos Se realizoacute la revisioacuten de artiacuteculos cientiacuteficos en ingleacutes y espantildeolen las bases de datos PubMed ScienceDirect LILACS y Medline usando descriptoresvalidados en Medical Subject Headings (MeSH) considerando periodo depublicabilidad del 80 inferior a 5 antildeos
Conclusiones La CHr es un paraacutemetro de gran utilidad en el diagnoacutestico temprano deanemia ferropeacutenica y otras patologiacuteas como deficiencia funcional de hierro estadosde inflamacioacuten croacutenica y enfermedad renal croacutenica
Biomarcador temprano en el diagnoacutestico de deficiencia de hierro antes de presentarsecambios morfoloacutegicos eritrociacuteticosCongreso Nacio
nal Laboratorio Cliacutenico 2018
bull A total of 1105 NES participants (639 men 466 women)bull CHr becomes affected in a relatively early stage in the development of iron deficiency before iron
deficiency anemia and clinical symptoms become apparentbull Therefore this parameter might be useful to identify persons healthy and diseased at risk of
developing iron deficiency anemia and subsequently to apply interventions in order to prevent further development of iron deficiency anemiaCongreso Nacio
nal Laboratorio Cliacutenico 2018
Hb reticulocitaria sensible para detectar la fase inicial del deacuteficit de hierro cuando laeritropoyesis requiere maacutes cantidad que la que recibe ANTES de que la anemia seestablezca
Congreso Nacional Laboratorio Cliacutenico
2018
No ID LID P
RBC 1012L 48 (08) 437 (05) lt00001
Hb gL 135 (6) 131 (12) 0006
MCV fL 922 (21) 902 (38) 0006
MCH pg 324 (07) 306 (22) lt00001
MCHC gL 339 (6) 319 (23) 0001
RDW
Ret He pg
Hypo He
LHD
Ferritin microgL
131 (06)
338 (21)
03 (015)
28 (20)
86 (3)
145 (21)
278 (24)
69 (55)
56 (25)
16 (76)
lt00001
lt00001
lt00001
lt00001
lt00001
AUC 95 CI Cutoff Sensitivity Specificity
LHD 0898 0819-0978 50 859 841
Ret He 0914 0824-1000 299pg 868 857
Hypo He 0934 0856-1000 16 857 921
Clinical value of markers of hypochromia in the detection of latent iron deficiency in non-anemic premenopausal women
No ID Hb gt 120 gL s-ferritin was within reference intervalLatent Iron Defiency Hb gt 120 gL s-ferritin lt 30 μgL
Urrechaga E et al Journal Clin Lab Analysis 2016 30 (5) 623-627
97 women (388) in 250 apparently healthy women had latent IDCongreso Nacional Laboratorio Cliacutenico
2018
Schorer G et al Abstract Jahreskongress der Deutschen Gesellschaft fuumlr Transfusionsmedizin und Immunhaumlmatologie Rostock 15 - 18 September 2009
Congreso Nacional Laboratorio Cliacutenico
2018
Caring for Those Who Share Mitigating Iron Deficiency in Regular Blood DonorsMast Alan E
bull Iron deficiency caused by regular blood donation is a problem facing blood centers Each blood donation removes 200 to 250 mg of iron from the donor Consequently many donors become iron deficient with repeated donation
bull This presents a challenge to blood centers that has become more acute in recent years with the realization that iron deficiency even in the absence of anemia is associated with adverse effects including fatigue and decreased exercise tolerance as well as neurological symptoms such as decreased cognitive function pica and restless leg syndrome
bull REDS-II investigators performed a longitudinal study investigating the iron status of blood donors over a two year period called the REDS-II Donor Iron Status Evaluation (RISE)
bull Results from the baseline analysis of regular donors (e 2 donations per year (females) or e 3 donations per year (males) revealed that over two-thirds of female donors and over one-half of male donors have iron deficiency
Congreso Nacional Laboratorio Cliacutenico
2018
Transfusion 2013 532766-2775
bull We evaluated the diagnostic sensitivity and specificity of red blood cell (RBC) hematology analyzer indices to assess iron status as a part of donor management iron deficient erythropoiesis (IDE) and absence of iron stores (AIS)
bull STUDY DESIGN AND METHODS A total of 1659 male and female donors from the Retrovirus Epidemiology Donor Study-II (REDS-II) Donor Iron Status Evaluation (RISE) study who were either first-timereactivated (FT RA no donations for 2 years) or frequent donors were recruited into a longitudinal study of regular donation of RBCs Of these 1002 donors returned 15 to 24 months later for a final assessment
Absent iron stores (AIS) was defined as plasma ferritin level of less than 12 mgL Logarithm of the ratio of soluble transferrin receptor to ferritin of at least 207 was used to define iron-deficient erythropoiesis (IDE)
bull RESULTS HYPOm and CHr detected IDE with comparable sensitivity 72 versus 69 but differed in specificity HYPOm 68 and CHr 53
For detecting AIS sensitivity was improved to 85 for HYPOm and 81 for CHr but specificity was reduced
Venous Hb had high specificity but poor sensitivity for IDE and AIS A plasma ferritin level of less than 267 mgL was a good surrogate for assessing IDE Congreso Nacio
nal Laboratorio Cliacutenico 2018
Microcytic RBC and reticulocyte mean cell hemoglobin content predicted iron depletion with
sensitivities 70 and 64
specificities of 72 and 78 respectively
When both combined
increased the sensitivity to 82
Congreso Nacional Laboratorio Cliacutenico
2018
Depending on the number of donations during the preceding12 months
Absent iron stores were detected in up to 214 of male and278 of female donors respectively
impaired hemoglobinisation IH was present in up to 64 maleand 167 female donors with 2 and 4 preceding donationsrespectively
The defined CHr cut-off value was 280 pg to detect IH infrequent whole blood donors with AIS leading to a testspecificity of 982 (positive predictive value PPV 577) inmale and of 978 (PPV 829) in female donors
It may help to prevent the development of anemia in frequentblood donors and also can help to decide whether donordeferral or even iron substitution need to be recommended
Congreso Nacional Laboratorio Cliacutenico
2018
Of the 501 blood donors sTfR and Ret-He detected Latent Iron Deficiency in 148 and 135 donors respectively
In comparison to sTfR Ret-He had sensitivity of 927 specificity of 9716 PPV of 931 and NPV of 963
Serum Ferritin TIBC and serum Iron had comparatively lower sensitivity of 8716 797 and 777 respectively
Conclusion Ret-He can be used as a routine screening test to detect LID in blood donors
This could provide an opportunity to make appropriate and timely interventions like dietary changes or drug supplementation
Congreso Nacional Laboratorio Cliacutenico
2018
Singh A Chaudhary R Pandey HC Sonker A Identification of iron status of blood donors by using low hemoglobin density and microcytic anemia factor Asian J Transfus Sci 20181246-50
The main objective of this study was to assess ifLHD and Maf could be used for assessment ofiron status in blood donors and also to establisha cut-off for these two parameters at which atentative iron deficiency could be reportedconclusively
Results LHD and Maf were able to differentiatebetween iron deficient and iron-depleteddonors from normal donorsA cutoff of 918 for LHD was able todifferentiate iron deficient and depleted statefrom normal iron statessensitivity 919 and specificity 71respectivelya cutoff of 1016 for Mafsensitivity 946 and specificity 968
MAf = (MVC Hb) 100
Congreso Nacional Laboratorio Cliacutenico
2018
Hb reticulocitaria sensible para detectar la fase inicial del deacuteficitde hierro cuando la eritropoyesis requiere maacutes cantidad que laque recibe ANTES de que la anemia se establezca
La deteccioacuten precoz del deacuteficit de hierro en la fase del balance negativo demanda aporte contribuye a reducir sus manifestaciones cliacutenicas en los pacientes afectados mejorando la salud puacuteblica
Un tratamiento menos prolongado con suplementos y menor consumo de los recursos sanitaros Contribuye a la eficiencia y sostenibilidad de los servicios sanitarios
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
Buttarello MLaboratory diagnosis of anemia are the old and new red cell parameters useful in classification and treatment howInt Jnl Lab Hem 2016 38 (Suppl 1) 123ndash132
Congreso Nacional Laboratorio Cliacutenico
2018
Buttarello MLaboratory diagnosis of anemia are the old and new red cell parameters useful in classification and treatment howInt Jnl Lab Hem 2016 38 (Suppl 1) 123ndash132
Congreso Nacional Laboratorio Cliacutenico
2018
Ralph Green amp Ananya Datta Mitra Megaloblastic Anemias Nutritional and Other CausesMed Clin N Am 2017 101 297ndash317
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
ANEMIA CARENCIAL CAUSAS
Factores alimentariosConsumir una dieta vegetariana mal planeadaAlimentacioacuten deficiente en los bebeacutesDesnutricioacuten durante el embarazo
Deacuteficit de absorcioacutenAlcoholismo croacutenicoEnfermedad de Crohn celiaquiacutea infeccioacuten otros problemas que le dificulten al cuerpo la digestioacuten de los alimentosAnemia perniciosa (factor intriacutenseco)Cirugiacuteas para extirpar ciertas partes del estoacutemago o el intestino delgado
MedicamentosB12 omeprazol metformina colchicina aminosalicilatos neomicinaFOLATO fenitoiacutena metotrexato sulfasalacina triamtereno pirimetamina trimetoprim con sulfametoxazol barbituacutericos
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
Reacciones metaboacutelicas en las que participan la vitamina B12 y el folato bull la conversioacuten de metilmalonil-CoA a succinil-CoA donde la adenosil-cobalamina actuacutea de
cofactor Por ello un deacuteficit de B12 conlleva un aumento de metilmalonil-CoA y de su producto de hidroacutelisis el aacutecido metilmaloacutenico
bull la siacutentesis de metionina a partir de homocisteina gracias a la metionina sintetasa y a la metil-cobalamina como cofactor En esta misma reaccioacuten el metiltetrahidrofolato es transformado a tetrahidrofolato que es necesario para la siacutentesis de DNA
Congreso Nacional Laboratorio Cliacutenico
2018
Anemia macrociacutetica secundaria a deficiencia de aacutecido foacutelico y de vitamina B12(cobalamina)
La deficiencia de B12 yo aacutecido foacutelico es la causa maacutes frecuente de megaloblastosis
Dentro de distintas funciones generales del metabolismo la vitamina B12 es uncofactor esencial en la siacutentesis de ADN y ARN compromete a todas las ceacutelulas delorganismo
Su deficiencia se manifiesta en oacuterganos con alto recambio celular como la meacutedulaosea y en el sistema nervioso central (SNC) a traveacutes de la siacutentesis de mielina y lareparacioacuten axonal
La deficiencia de cobalamina es responsable de alteraciones hematoloacutegicasneuroloacutegicas neurocognitivas y neuropsiquiaacutetricas
La siacutentesis defectuosa de ADN conduce a la apoptosis y a la hemoacutelisis (intra yextramedular) causantes de la hemopoyesis inefectiva
En meacutedula la siacutentesis ineficiente de DNA causa cambios megaloblaacutesticos comoconsecuencIa anemia y citopenias
Congreso Nacional Laboratorio Cliacutenico
2018
Limitaciones de los meacutetodos diagnoacutesticos claacutesicos
Volumen Corpuscular Medio (VCM) y morfologiacutea de sangre perifeacuterica En una serie de pacientes con deacuteficit de cobalamina soacutelo un 29 teniacutean anemia y soacutelo un 36 teniacutean un VCM gt 100 fL
Un VCM normal no puede ser empleado para rechazar una determinacioacuten de nivel de cobalamina ya que hasta un 25 de casos con manifestaciones neuroloacutegicas cursan con un VCM normal
Cobalamina seacuterica (nivel de B12) Es el test diagnoacutestico rutinario inicial estaacutendar Es un test ampliamente disponible de bajo coste y automatizado Sin embargo presenta algunas limitaciones
-- Existencia de varias teacutecnicas y ausencia de un gold standard por lo que hay diferentes liacutemites de referencia
-- Variacioacuten intraindividual muy alta
La OMS publicoacute en 2008 las conclusiones de un grupo teacutecnico consultado sobre el deacuteficit de cobalamina y folato
El grupo reconocioacute que no existen unos umbrales universalmente reconocidos para definir el deacuteficit de ambas vitaminas y expresaron la necesidad de un consenso
Devalia V Hamilton MS and Molloy AM on behalf of the British Committee for standards in haematology Guidelines for the diagnosis and treatment of cobalamin and folate disorders Br J Haematol 2014 166(4) 496-513
Schrier SL Diagnosis and treatment of vitamin B12 and folate deficiency UpToDate Last updated Jun 25 2014
de Benoist B Conclusions of a WHO Technical Consultation on folate and vitamin B12 deficiencies Food Nutr Bull 200829(2 Suppl)S238ndash44Congreso Nacional Laboratorio Cliacutenico
2018
Tomado de Tefferi A Li C En Atlas of Clinical Hematology Publicado por JO Armitage Philadelphia Current Medicine 2004
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
Int Jnl Lab Hem 2007 29 327ndash334
Clin Lab 201662343-347
In ourstudy mean MCVrMCV ratio of healthy controls is130 as microcytic anemia irondeficiency anemia is121 as also macrocytic anemia vitamin B12 deficiencyanemia is 115
Congreso Nacional Laboratorio Cliacutenico
2018
Sualeh Muslim Khan Muhammad Akbar Agha
Mean cell volume of reticulocytemdashA new parameter for diagnosing sub-clinical cobalamin deficiency in blood donors Int J Lab Hem 20181ndash4
The Abbott CELL-DYN Sapphire Hematology System uses multi-angle polarized scatter separation (MAPSS) and focused flow impedance technologies
Congreso Nacional Laboratorio Cliacutenico
2018
MCVr at 985 fL yielded the highest Youdenrsquos index at sensitivity of 82 specificity of 828 AUC 0847 ( 95 CI 803-891)
Khan SM Agha MA Mean cell volume of reticulocyte-A new parameter for diagnosing sub-clinical cobalamin deficiency in blood donors
Int J Lab Hem 20181ndash4 2018 Jul 13 doi 101111ijlh12899
Congreso Nacional Laboratorio Cliacutenico
2018
Role of Cell Population Data in the detection of folate and cobalamin deficiency
J Nieto et al
XXXI st International Symposium on Technological Innovations in Laboratory Hematology ISLH 2018 10-12 May 2018 Brussels Belgium
M-V-NRET and SD-VNRET are the best discriminatory single parameters to distinguish between patients with B9B12 deficiency and reference subjects M-V-NRETAUC=0823 sensitivity 78 and specificity 86
AUC=0852 sensitivity 55 and specificity 60
Conclusions The CPD parameters of Volume and Light Scatter (M and SD of LALS angle) that inform about size and intracellular structure of RBCs provided very useful information for the detection of B9B12 deficiency
Congreso Nacional Laboratorio Cliacutenico
2018
Cell Population Data
bull Paraacutemetros poblacionales de los leucocitos
bull Describen la morfologiacutea tamantildeo
estructuras citoplasmaacuteticas
nuacutecleo aacutecidos nucleacuteicos
bull Son datos numeacutericos con los que se construyen los ejes de lo diagramas de dispersioacuten de los leucocitos
bull Dependen de la tecnologiacutea
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
High Sensitivity New Parameters for the Detection of Vitamin B12 and Folate Deficiencies Blood 2008 1125379
B12 def vs
Normals
Mann
Withney T-Test
ROC
AUC Sens Specif Cutoff signifROC
MCV p=03156 p=09533 0577
MPV p=00001 0802 792 806 lt83 p=00001
NE Mean
Volume plt00001 0862 833 778 gt1403 p=00001
MO Mean
Volume plt00001 0829 625 889 gt1723 p=00001
MRV p=00113 0705 50 964 gt1133 p=00051
Folate def vs
Normals
Mann
Withney T-Test
ROC
AUC Sens Specif Cut-off signifROC
MCV p=00798 p=06461 0665
MPV plt00001 0832 81 806 lt83 p=00001
NE Mean
Volume p=00008 087 952 694 gt1402 p=00001
MO Mean
Volume p=00002 0801 667 833 gt1696 p=00001
MRV p=00054 0731 476 964 gt1133 p=00019
The Mean Neutrophil Volume (MNE V) and Mean Monocyte Volume (MMOV) may be used for the detection of megaloblastic neutrophils and monocytes MNEV and MMOV have significantly higher sensitivity than the previous information from the red cells (MCV) detecting B12 or folate deficiency because they are not affected by the presence at the same time of Iron deficiency or other reasons of anemia
Congreso Nacional Laboratorio Cliacutenico
2018
POSTER 733
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
CPD Sysmex XN
NE SSC complejidad
NE SFL aacutecidos nucleacuteicos
NE FSC tamantildeo
NE WX
NE WY
NE WZ
MO X
MO Y
MO Z
MO WX
MO WY
MO WZ
LY X
LY Y
LY Z
LY WX
LY WY
LY WZCongreso Nacio
nal Laboratorio Cliacutenico 2018
As MCV is the mean which is calculated it is insensitive to the presence of a small number of macrocytes
Further macrocytosis can be obscured by concomitant disorders that can cause microcytosis resulting inmasked megaloblastic anaemia (MA) for example iron deficiency hereditary elliptocytosis alpha and betathalassemia
This study was undertaken to evaluate the role of NEUT-X and NEUT-Y in detecting MA on peripheral blood andalso see whether other forms of macrocytic anaemia can be differentiated from MA
In MA the peripheral blood smear shows cytopenia with macroovalocytes and hypersegmented
neutrophils (gt5 lobes in 5 neutrophils six lobes nuclei or lobe average of gt35)
In conclusion our study shows that higher values of NEUT-X and NEUT-Y in MA patients in spite of low ornormal MCV high RDW may be used to not only reveal the masked cases of MA with concomitant irondeficiency but also separate them from the broader macrocytic anaemia group
Peripheral smear remains diagnostic however making smear for all the suspicious cases is a cumbersomeand tedious procedure Thus these parameters emerge as more reliable and stable parameters in themodern laboratories which in future may replace the older screening tools
Congreso Nacional Laboratorio Cliacutenico
2018
A favor Eficiencia Operativa
Mejora el proceso del Laboratorio
Mejor informacioacuten al Cliacutenico al mismo coste
Mejora la informacioacuten
Informa sobre la eritropoyesis deteccioacuten precoz de estados carenciales
Ayuda al cliacutenico
Estado real del paciente
En contraParaacutemetros de investigacioacuten
Dificultad de standarizar dependencia teacutecnica
Control de calidadCongreso Nacional Laboratorio Cliacutenico
2018
It is generally assumed that worldwide ldquoat least half the anemia is due tonutritional iron deficiencyrdquo and that ldquoup to a prevalence of iron deficiency anemiaof 40 the prevalence of iron deficiency will be about 25 times that of anemiardquoHowever it is evident from the foregoing discussion that there are considerablevariations in both of these ratios depending on the age and sex of the peoplebeing studied the region of the world in which they live and the prevalence ratesof other causes of anemia
WHO Department of Nutrition for Health and DevelopmentAssessing the iron status of populations including literature reviews report of a Joint World Health OrganizationCenters for DiseaseControl and Prevention Technical Consultation on the Assessment of Iron Status at the Population Level Geneva Switzerland 6ndash8 April2004 ndash 2nd ed
Congreso Nacional Laboratorio Cliacutenico
2018
Estaacute bien establecido que la anemia produce una miriacuteada de secuelas tanto fiacutesicas comopsicoloacutegicas
Pero los efecto deleteacutereos se deben al deficit de hierro que es un evento previo a que seestablezca la anemia
El deacuteficit de hierrro auacuten sin anemia tiene efectos negativos en el desarrollo cognitivo y fiacutesico
Rattehalli D et al Iron deficiency without anemia do not wait for the Hemoglobin to drop
Health Policy and Technology 2013 2 45-48Congreso Nacio
nal Laboratorio Cliacutenico 2018
SuominenP et al Serum transferrin receptor and transferrin receptor-ferritin index identify healthy subjects with subclinical iron deficits Blood 1998 92 2934ndash9Halwachs-Baumann G Diagnosis of anaemia old things rearranged Wien Med Wochenschr 2012 162478ndash88
Congreso Nacional Laboratorio Cliacutenico
2018
Hemoglobina de reticulocito y su importancia en el diagnoacutestico temprano de anemiaferropeacutenica
Y Maacuterquez-Beniacutetez et al Universidad de BocayaAugust
2018 DOI 1022267rus182003133 aop
El contenido de hemoglobina de reticulocitos (CHr) es un paraacutemetro en la biometriacuteahematoloacutegica automatizada utilizado como un marcador de la biodisponibilidad delhierro en la eritropoyesis
Objetivo Exponer la aplicabilidad de la CHr como un paraacutemetro en el diagnoacutesticoprecoz de la anemia por deficiencia de hierro asiacute como su medicioacuten e interpretacioacuten
Materiales y meacutetodos Se realizoacute la revisioacuten de artiacuteculos cientiacuteficos en ingleacutes y espantildeolen las bases de datos PubMed ScienceDirect LILACS y Medline usando descriptoresvalidados en Medical Subject Headings (MeSH) considerando periodo depublicabilidad del 80 inferior a 5 antildeos
Conclusiones La CHr es un paraacutemetro de gran utilidad en el diagnoacutestico temprano deanemia ferropeacutenica y otras patologiacuteas como deficiencia funcional de hierro estadosde inflamacioacuten croacutenica y enfermedad renal croacutenica
Biomarcador temprano en el diagnoacutestico de deficiencia de hierro antes de presentarsecambios morfoloacutegicos eritrociacuteticosCongreso Nacio
nal Laboratorio Cliacutenico 2018
bull A total of 1105 NES participants (639 men 466 women)bull CHr becomes affected in a relatively early stage in the development of iron deficiency before iron
deficiency anemia and clinical symptoms become apparentbull Therefore this parameter might be useful to identify persons healthy and diseased at risk of
developing iron deficiency anemia and subsequently to apply interventions in order to prevent further development of iron deficiency anemiaCongreso Nacio
nal Laboratorio Cliacutenico 2018
Hb reticulocitaria sensible para detectar la fase inicial del deacuteficit de hierro cuando laeritropoyesis requiere maacutes cantidad que la que recibe ANTES de que la anemia seestablezca
Congreso Nacional Laboratorio Cliacutenico
2018
No ID LID P
RBC 1012L 48 (08) 437 (05) lt00001
Hb gL 135 (6) 131 (12) 0006
MCV fL 922 (21) 902 (38) 0006
MCH pg 324 (07) 306 (22) lt00001
MCHC gL 339 (6) 319 (23) 0001
RDW
Ret He pg
Hypo He
LHD
Ferritin microgL
131 (06)
338 (21)
03 (015)
28 (20)
86 (3)
145 (21)
278 (24)
69 (55)
56 (25)
16 (76)
lt00001
lt00001
lt00001
lt00001
lt00001
AUC 95 CI Cutoff Sensitivity Specificity
LHD 0898 0819-0978 50 859 841
Ret He 0914 0824-1000 299pg 868 857
Hypo He 0934 0856-1000 16 857 921
Clinical value of markers of hypochromia in the detection of latent iron deficiency in non-anemic premenopausal women
No ID Hb gt 120 gL s-ferritin was within reference intervalLatent Iron Defiency Hb gt 120 gL s-ferritin lt 30 μgL
Urrechaga E et al Journal Clin Lab Analysis 2016 30 (5) 623-627
97 women (388) in 250 apparently healthy women had latent IDCongreso Nacional Laboratorio Cliacutenico
2018
Schorer G et al Abstract Jahreskongress der Deutschen Gesellschaft fuumlr Transfusionsmedizin und Immunhaumlmatologie Rostock 15 - 18 September 2009
Congreso Nacional Laboratorio Cliacutenico
2018
Caring for Those Who Share Mitigating Iron Deficiency in Regular Blood DonorsMast Alan E
bull Iron deficiency caused by regular blood donation is a problem facing blood centers Each blood donation removes 200 to 250 mg of iron from the donor Consequently many donors become iron deficient with repeated donation
bull This presents a challenge to blood centers that has become more acute in recent years with the realization that iron deficiency even in the absence of anemia is associated with adverse effects including fatigue and decreased exercise tolerance as well as neurological symptoms such as decreased cognitive function pica and restless leg syndrome
bull REDS-II investigators performed a longitudinal study investigating the iron status of blood donors over a two year period called the REDS-II Donor Iron Status Evaluation (RISE)
bull Results from the baseline analysis of regular donors (e 2 donations per year (females) or e 3 donations per year (males) revealed that over two-thirds of female donors and over one-half of male donors have iron deficiency
Congreso Nacional Laboratorio Cliacutenico
2018
Transfusion 2013 532766-2775
bull We evaluated the diagnostic sensitivity and specificity of red blood cell (RBC) hematology analyzer indices to assess iron status as a part of donor management iron deficient erythropoiesis (IDE) and absence of iron stores (AIS)
bull STUDY DESIGN AND METHODS A total of 1659 male and female donors from the Retrovirus Epidemiology Donor Study-II (REDS-II) Donor Iron Status Evaluation (RISE) study who were either first-timereactivated (FT RA no donations for 2 years) or frequent donors were recruited into a longitudinal study of regular donation of RBCs Of these 1002 donors returned 15 to 24 months later for a final assessment
Absent iron stores (AIS) was defined as plasma ferritin level of less than 12 mgL Logarithm of the ratio of soluble transferrin receptor to ferritin of at least 207 was used to define iron-deficient erythropoiesis (IDE)
bull RESULTS HYPOm and CHr detected IDE with comparable sensitivity 72 versus 69 but differed in specificity HYPOm 68 and CHr 53
For detecting AIS sensitivity was improved to 85 for HYPOm and 81 for CHr but specificity was reduced
Venous Hb had high specificity but poor sensitivity for IDE and AIS A plasma ferritin level of less than 267 mgL was a good surrogate for assessing IDE Congreso Nacio
nal Laboratorio Cliacutenico 2018
Microcytic RBC and reticulocyte mean cell hemoglobin content predicted iron depletion with
sensitivities 70 and 64
specificities of 72 and 78 respectively
When both combined
increased the sensitivity to 82
Congreso Nacional Laboratorio Cliacutenico
2018
Depending on the number of donations during the preceding12 months
Absent iron stores were detected in up to 214 of male and278 of female donors respectively
impaired hemoglobinisation IH was present in up to 64 maleand 167 female donors with 2 and 4 preceding donationsrespectively
The defined CHr cut-off value was 280 pg to detect IH infrequent whole blood donors with AIS leading to a testspecificity of 982 (positive predictive value PPV 577) inmale and of 978 (PPV 829) in female donors
It may help to prevent the development of anemia in frequentblood donors and also can help to decide whether donordeferral or even iron substitution need to be recommended
Congreso Nacional Laboratorio Cliacutenico
2018
Of the 501 blood donors sTfR and Ret-He detected Latent Iron Deficiency in 148 and 135 donors respectively
In comparison to sTfR Ret-He had sensitivity of 927 specificity of 9716 PPV of 931 and NPV of 963
Serum Ferritin TIBC and serum Iron had comparatively lower sensitivity of 8716 797 and 777 respectively
Conclusion Ret-He can be used as a routine screening test to detect LID in blood donors
This could provide an opportunity to make appropriate and timely interventions like dietary changes or drug supplementation
Congreso Nacional Laboratorio Cliacutenico
2018
Singh A Chaudhary R Pandey HC Sonker A Identification of iron status of blood donors by using low hemoglobin density and microcytic anemia factor Asian J Transfus Sci 20181246-50
The main objective of this study was to assess ifLHD and Maf could be used for assessment ofiron status in blood donors and also to establisha cut-off for these two parameters at which atentative iron deficiency could be reportedconclusively
Results LHD and Maf were able to differentiatebetween iron deficient and iron-depleteddonors from normal donorsA cutoff of 918 for LHD was able todifferentiate iron deficient and depleted statefrom normal iron statessensitivity 919 and specificity 71respectivelya cutoff of 1016 for Mafsensitivity 946 and specificity 968
MAf = (MVC Hb) 100
Congreso Nacional Laboratorio Cliacutenico
2018
Hb reticulocitaria sensible para detectar la fase inicial del deacuteficitde hierro cuando la eritropoyesis requiere maacutes cantidad que laque recibe ANTES de que la anemia se establezca
La deteccioacuten precoz del deacuteficit de hierro en la fase del balance negativo demanda aporte contribuye a reducir sus manifestaciones cliacutenicas en los pacientes afectados mejorando la salud puacuteblica
Un tratamiento menos prolongado con suplementos y menor consumo de los recursos sanitaros Contribuye a la eficiencia y sostenibilidad de los servicios sanitarios
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
Buttarello MLaboratory diagnosis of anemia are the old and new red cell parameters useful in classification and treatment howInt Jnl Lab Hem 2016 38 (Suppl 1) 123ndash132
Congreso Nacional Laboratorio Cliacutenico
2018
Buttarello MLaboratory diagnosis of anemia are the old and new red cell parameters useful in classification and treatment howInt Jnl Lab Hem 2016 38 (Suppl 1) 123ndash132
Congreso Nacional Laboratorio Cliacutenico
2018
Ralph Green amp Ananya Datta Mitra Megaloblastic Anemias Nutritional and Other CausesMed Clin N Am 2017 101 297ndash317
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
ANEMIA CARENCIAL CAUSAS
Factores alimentariosConsumir una dieta vegetariana mal planeadaAlimentacioacuten deficiente en los bebeacutesDesnutricioacuten durante el embarazo
Deacuteficit de absorcioacutenAlcoholismo croacutenicoEnfermedad de Crohn celiaquiacutea infeccioacuten otros problemas que le dificulten al cuerpo la digestioacuten de los alimentosAnemia perniciosa (factor intriacutenseco)Cirugiacuteas para extirpar ciertas partes del estoacutemago o el intestino delgado
MedicamentosB12 omeprazol metformina colchicina aminosalicilatos neomicinaFOLATO fenitoiacutena metotrexato sulfasalacina triamtereno pirimetamina trimetoprim con sulfametoxazol barbituacutericos
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
Reacciones metaboacutelicas en las que participan la vitamina B12 y el folato bull la conversioacuten de metilmalonil-CoA a succinil-CoA donde la adenosil-cobalamina actuacutea de
cofactor Por ello un deacuteficit de B12 conlleva un aumento de metilmalonil-CoA y de su producto de hidroacutelisis el aacutecido metilmaloacutenico
bull la siacutentesis de metionina a partir de homocisteina gracias a la metionina sintetasa y a la metil-cobalamina como cofactor En esta misma reaccioacuten el metiltetrahidrofolato es transformado a tetrahidrofolato que es necesario para la siacutentesis de DNA
Congreso Nacional Laboratorio Cliacutenico
2018
Anemia macrociacutetica secundaria a deficiencia de aacutecido foacutelico y de vitamina B12(cobalamina)
La deficiencia de B12 yo aacutecido foacutelico es la causa maacutes frecuente de megaloblastosis
Dentro de distintas funciones generales del metabolismo la vitamina B12 es uncofactor esencial en la siacutentesis de ADN y ARN compromete a todas las ceacutelulas delorganismo
Su deficiencia se manifiesta en oacuterganos con alto recambio celular como la meacutedulaosea y en el sistema nervioso central (SNC) a traveacutes de la siacutentesis de mielina y lareparacioacuten axonal
La deficiencia de cobalamina es responsable de alteraciones hematoloacutegicasneuroloacutegicas neurocognitivas y neuropsiquiaacutetricas
La siacutentesis defectuosa de ADN conduce a la apoptosis y a la hemoacutelisis (intra yextramedular) causantes de la hemopoyesis inefectiva
En meacutedula la siacutentesis ineficiente de DNA causa cambios megaloblaacutesticos comoconsecuencIa anemia y citopenias
Congreso Nacional Laboratorio Cliacutenico
2018
Limitaciones de los meacutetodos diagnoacutesticos claacutesicos
Volumen Corpuscular Medio (VCM) y morfologiacutea de sangre perifeacuterica En una serie de pacientes con deacuteficit de cobalamina soacutelo un 29 teniacutean anemia y soacutelo un 36 teniacutean un VCM gt 100 fL
Un VCM normal no puede ser empleado para rechazar una determinacioacuten de nivel de cobalamina ya que hasta un 25 de casos con manifestaciones neuroloacutegicas cursan con un VCM normal
Cobalamina seacuterica (nivel de B12) Es el test diagnoacutestico rutinario inicial estaacutendar Es un test ampliamente disponible de bajo coste y automatizado Sin embargo presenta algunas limitaciones
-- Existencia de varias teacutecnicas y ausencia de un gold standard por lo que hay diferentes liacutemites de referencia
-- Variacioacuten intraindividual muy alta
La OMS publicoacute en 2008 las conclusiones de un grupo teacutecnico consultado sobre el deacuteficit de cobalamina y folato
El grupo reconocioacute que no existen unos umbrales universalmente reconocidos para definir el deacuteficit de ambas vitaminas y expresaron la necesidad de un consenso
Devalia V Hamilton MS and Molloy AM on behalf of the British Committee for standards in haematology Guidelines for the diagnosis and treatment of cobalamin and folate disorders Br J Haematol 2014 166(4) 496-513
Schrier SL Diagnosis and treatment of vitamin B12 and folate deficiency UpToDate Last updated Jun 25 2014
de Benoist B Conclusions of a WHO Technical Consultation on folate and vitamin B12 deficiencies Food Nutr Bull 200829(2 Suppl)S238ndash44Congreso Nacional Laboratorio Cliacutenico
2018
Tomado de Tefferi A Li C En Atlas of Clinical Hematology Publicado por JO Armitage Philadelphia Current Medicine 2004
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
Int Jnl Lab Hem 2007 29 327ndash334
Clin Lab 201662343-347
In ourstudy mean MCVrMCV ratio of healthy controls is130 as microcytic anemia irondeficiency anemia is121 as also macrocytic anemia vitamin B12 deficiencyanemia is 115
Congreso Nacional Laboratorio Cliacutenico
2018
Sualeh Muslim Khan Muhammad Akbar Agha
Mean cell volume of reticulocytemdashA new parameter for diagnosing sub-clinical cobalamin deficiency in blood donors Int J Lab Hem 20181ndash4
The Abbott CELL-DYN Sapphire Hematology System uses multi-angle polarized scatter separation (MAPSS) and focused flow impedance technologies
Congreso Nacional Laboratorio Cliacutenico
2018
MCVr at 985 fL yielded the highest Youdenrsquos index at sensitivity of 82 specificity of 828 AUC 0847 ( 95 CI 803-891)
Khan SM Agha MA Mean cell volume of reticulocyte-A new parameter for diagnosing sub-clinical cobalamin deficiency in blood donors
Int J Lab Hem 20181ndash4 2018 Jul 13 doi 101111ijlh12899
Congreso Nacional Laboratorio Cliacutenico
2018
Role of Cell Population Data in the detection of folate and cobalamin deficiency
J Nieto et al
XXXI st International Symposium on Technological Innovations in Laboratory Hematology ISLH 2018 10-12 May 2018 Brussels Belgium
M-V-NRET and SD-VNRET are the best discriminatory single parameters to distinguish between patients with B9B12 deficiency and reference subjects M-V-NRETAUC=0823 sensitivity 78 and specificity 86
AUC=0852 sensitivity 55 and specificity 60
Conclusions The CPD parameters of Volume and Light Scatter (M and SD of LALS angle) that inform about size and intracellular structure of RBCs provided very useful information for the detection of B9B12 deficiency
Congreso Nacional Laboratorio Cliacutenico
2018
Cell Population Data
bull Paraacutemetros poblacionales de los leucocitos
bull Describen la morfologiacutea tamantildeo
estructuras citoplasmaacuteticas
nuacutecleo aacutecidos nucleacuteicos
bull Son datos numeacutericos con los que se construyen los ejes de lo diagramas de dispersioacuten de los leucocitos
bull Dependen de la tecnologiacutea
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
High Sensitivity New Parameters for the Detection of Vitamin B12 and Folate Deficiencies Blood 2008 1125379
B12 def vs
Normals
Mann
Withney T-Test
ROC
AUC Sens Specif Cutoff signifROC
MCV p=03156 p=09533 0577
MPV p=00001 0802 792 806 lt83 p=00001
NE Mean
Volume plt00001 0862 833 778 gt1403 p=00001
MO Mean
Volume plt00001 0829 625 889 gt1723 p=00001
MRV p=00113 0705 50 964 gt1133 p=00051
Folate def vs
Normals
Mann
Withney T-Test
ROC
AUC Sens Specif Cut-off signifROC
MCV p=00798 p=06461 0665
MPV plt00001 0832 81 806 lt83 p=00001
NE Mean
Volume p=00008 087 952 694 gt1402 p=00001
MO Mean
Volume p=00002 0801 667 833 gt1696 p=00001
MRV p=00054 0731 476 964 gt1133 p=00019
The Mean Neutrophil Volume (MNE V) and Mean Monocyte Volume (MMOV) may be used for the detection of megaloblastic neutrophils and monocytes MNEV and MMOV have significantly higher sensitivity than the previous information from the red cells (MCV) detecting B12 or folate deficiency because they are not affected by the presence at the same time of Iron deficiency or other reasons of anemia
Congreso Nacional Laboratorio Cliacutenico
2018
POSTER 733
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
CPD Sysmex XN
NE SSC complejidad
NE SFL aacutecidos nucleacuteicos
NE FSC tamantildeo
NE WX
NE WY
NE WZ
MO X
MO Y
MO Z
MO WX
MO WY
MO WZ
LY X
LY Y
LY Z
LY WX
LY WY
LY WZCongreso Nacio
nal Laboratorio Cliacutenico 2018
As MCV is the mean which is calculated it is insensitive to the presence of a small number of macrocytes
Further macrocytosis can be obscured by concomitant disorders that can cause microcytosis resulting inmasked megaloblastic anaemia (MA) for example iron deficiency hereditary elliptocytosis alpha and betathalassemia
This study was undertaken to evaluate the role of NEUT-X and NEUT-Y in detecting MA on peripheral blood andalso see whether other forms of macrocytic anaemia can be differentiated from MA
In MA the peripheral blood smear shows cytopenia with macroovalocytes and hypersegmented
neutrophils (gt5 lobes in 5 neutrophils six lobes nuclei or lobe average of gt35)
In conclusion our study shows that higher values of NEUT-X and NEUT-Y in MA patients in spite of low ornormal MCV high RDW may be used to not only reveal the masked cases of MA with concomitant irondeficiency but also separate them from the broader macrocytic anaemia group
Peripheral smear remains diagnostic however making smear for all the suspicious cases is a cumbersomeand tedious procedure Thus these parameters emerge as more reliable and stable parameters in themodern laboratories which in future may replace the older screening tools
Congreso Nacional Laboratorio Cliacutenico
2018
A favor Eficiencia Operativa
Mejora el proceso del Laboratorio
Mejor informacioacuten al Cliacutenico al mismo coste
Mejora la informacioacuten
Informa sobre la eritropoyesis deteccioacuten precoz de estados carenciales
Ayuda al cliacutenico
Estado real del paciente
En contraParaacutemetros de investigacioacuten
Dificultad de standarizar dependencia teacutecnica
Control de calidadCongreso Nacional Laboratorio Cliacutenico
2018
Estaacute bien establecido que la anemia produce una miriacuteada de secuelas tanto fiacutesicas comopsicoloacutegicas
Pero los efecto deleteacutereos se deben al deficit de hierro que es un evento previo a que seestablezca la anemia
El deacuteficit de hierrro auacuten sin anemia tiene efectos negativos en el desarrollo cognitivo y fiacutesico
Rattehalli D et al Iron deficiency without anemia do not wait for the Hemoglobin to drop
Health Policy and Technology 2013 2 45-48Congreso Nacio
nal Laboratorio Cliacutenico 2018
SuominenP et al Serum transferrin receptor and transferrin receptor-ferritin index identify healthy subjects with subclinical iron deficits Blood 1998 92 2934ndash9Halwachs-Baumann G Diagnosis of anaemia old things rearranged Wien Med Wochenschr 2012 162478ndash88
Congreso Nacional Laboratorio Cliacutenico
2018
Hemoglobina de reticulocito y su importancia en el diagnoacutestico temprano de anemiaferropeacutenica
Y Maacuterquez-Beniacutetez et al Universidad de BocayaAugust
2018 DOI 1022267rus182003133 aop
El contenido de hemoglobina de reticulocitos (CHr) es un paraacutemetro en la biometriacuteahematoloacutegica automatizada utilizado como un marcador de la biodisponibilidad delhierro en la eritropoyesis
Objetivo Exponer la aplicabilidad de la CHr como un paraacutemetro en el diagnoacutesticoprecoz de la anemia por deficiencia de hierro asiacute como su medicioacuten e interpretacioacuten
Materiales y meacutetodos Se realizoacute la revisioacuten de artiacuteculos cientiacuteficos en ingleacutes y espantildeolen las bases de datos PubMed ScienceDirect LILACS y Medline usando descriptoresvalidados en Medical Subject Headings (MeSH) considerando periodo depublicabilidad del 80 inferior a 5 antildeos
Conclusiones La CHr es un paraacutemetro de gran utilidad en el diagnoacutestico temprano deanemia ferropeacutenica y otras patologiacuteas como deficiencia funcional de hierro estadosde inflamacioacuten croacutenica y enfermedad renal croacutenica
Biomarcador temprano en el diagnoacutestico de deficiencia de hierro antes de presentarsecambios morfoloacutegicos eritrociacuteticosCongreso Nacio
nal Laboratorio Cliacutenico 2018
bull A total of 1105 NES participants (639 men 466 women)bull CHr becomes affected in a relatively early stage in the development of iron deficiency before iron
deficiency anemia and clinical symptoms become apparentbull Therefore this parameter might be useful to identify persons healthy and diseased at risk of
developing iron deficiency anemia and subsequently to apply interventions in order to prevent further development of iron deficiency anemiaCongreso Nacio
nal Laboratorio Cliacutenico 2018
Hb reticulocitaria sensible para detectar la fase inicial del deacuteficit de hierro cuando laeritropoyesis requiere maacutes cantidad que la que recibe ANTES de que la anemia seestablezca
Congreso Nacional Laboratorio Cliacutenico
2018
No ID LID P
RBC 1012L 48 (08) 437 (05) lt00001
Hb gL 135 (6) 131 (12) 0006
MCV fL 922 (21) 902 (38) 0006
MCH pg 324 (07) 306 (22) lt00001
MCHC gL 339 (6) 319 (23) 0001
RDW
Ret He pg
Hypo He
LHD
Ferritin microgL
131 (06)
338 (21)
03 (015)
28 (20)
86 (3)
145 (21)
278 (24)
69 (55)
56 (25)
16 (76)
lt00001
lt00001
lt00001
lt00001
lt00001
AUC 95 CI Cutoff Sensitivity Specificity
LHD 0898 0819-0978 50 859 841
Ret He 0914 0824-1000 299pg 868 857
Hypo He 0934 0856-1000 16 857 921
Clinical value of markers of hypochromia in the detection of latent iron deficiency in non-anemic premenopausal women
No ID Hb gt 120 gL s-ferritin was within reference intervalLatent Iron Defiency Hb gt 120 gL s-ferritin lt 30 μgL
Urrechaga E et al Journal Clin Lab Analysis 2016 30 (5) 623-627
97 women (388) in 250 apparently healthy women had latent IDCongreso Nacional Laboratorio Cliacutenico
2018
Schorer G et al Abstract Jahreskongress der Deutschen Gesellschaft fuumlr Transfusionsmedizin und Immunhaumlmatologie Rostock 15 - 18 September 2009
Congreso Nacional Laboratorio Cliacutenico
2018
Caring for Those Who Share Mitigating Iron Deficiency in Regular Blood DonorsMast Alan E
bull Iron deficiency caused by regular blood donation is a problem facing blood centers Each blood donation removes 200 to 250 mg of iron from the donor Consequently many donors become iron deficient with repeated donation
bull This presents a challenge to blood centers that has become more acute in recent years with the realization that iron deficiency even in the absence of anemia is associated with adverse effects including fatigue and decreased exercise tolerance as well as neurological symptoms such as decreased cognitive function pica and restless leg syndrome
bull REDS-II investigators performed a longitudinal study investigating the iron status of blood donors over a two year period called the REDS-II Donor Iron Status Evaluation (RISE)
bull Results from the baseline analysis of regular donors (e 2 donations per year (females) or e 3 donations per year (males) revealed that over two-thirds of female donors and over one-half of male donors have iron deficiency
Congreso Nacional Laboratorio Cliacutenico
2018
Transfusion 2013 532766-2775
bull We evaluated the diagnostic sensitivity and specificity of red blood cell (RBC) hematology analyzer indices to assess iron status as a part of donor management iron deficient erythropoiesis (IDE) and absence of iron stores (AIS)
bull STUDY DESIGN AND METHODS A total of 1659 male and female donors from the Retrovirus Epidemiology Donor Study-II (REDS-II) Donor Iron Status Evaluation (RISE) study who were either first-timereactivated (FT RA no donations for 2 years) or frequent donors were recruited into a longitudinal study of regular donation of RBCs Of these 1002 donors returned 15 to 24 months later for a final assessment
Absent iron stores (AIS) was defined as plasma ferritin level of less than 12 mgL Logarithm of the ratio of soluble transferrin receptor to ferritin of at least 207 was used to define iron-deficient erythropoiesis (IDE)
bull RESULTS HYPOm and CHr detected IDE with comparable sensitivity 72 versus 69 but differed in specificity HYPOm 68 and CHr 53
For detecting AIS sensitivity was improved to 85 for HYPOm and 81 for CHr but specificity was reduced
Venous Hb had high specificity but poor sensitivity for IDE and AIS A plasma ferritin level of less than 267 mgL was a good surrogate for assessing IDE Congreso Nacio
nal Laboratorio Cliacutenico 2018
Microcytic RBC and reticulocyte mean cell hemoglobin content predicted iron depletion with
sensitivities 70 and 64
specificities of 72 and 78 respectively
When both combined
increased the sensitivity to 82
Congreso Nacional Laboratorio Cliacutenico
2018
Depending on the number of donations during the preceding12 months
Absent iron stores were detected in up to 214 of male and278 of female donors respectively
impaired hemoglobinisation IH was present in up to 64 maleand 167 female donors with 2 and 4 preceding donationsrespectively
The defined CHr cut-off value was 280 pg to detect IH infrequent whole blood donors with AIS leading to a testspecificity of 982 (positive predictive value PPV 577) inmale and of 978 (PPV 829) in female donors
It may help to prevent the development of anemia in frequentblood donors and also can help to decide whether donordeferral or even iron substitution need to be recommended
Congreso Nacional Laboratorio Cliacutenico
2018
Of the 501 blood donors sTfR and Ret-He detected Latent Iron Deficiency in 148 and 135 donors respectively
In comparison to sTfR Ret-He had sensitivity of 927 specificity of 9716 PPV of 931 and NPV of 963
Serum Ferritin TIBC and serum Iron had comparatively lower sensitivity of 8716 797 and 777 respectively
Conclusion Ret-He can be used as a routine screening test to detect LID in blood donors
This could provide an opportunity to make appropriate and timely interventions like dietary changes or drug supplementation
Congreso Nacional Laboratorio Cliacutenico
2018
Singh A Chaudhary R Pandey HC Sonker A Identification of iron status of blood donors by using low hemoglobin density and microcytic anemia factor Asian J Transfus Sci 20181246-50
The main objective of this study was to assess ifLHD and Maf could be used for assessment ofiron status in blood donors and also to establisha cut-off for these two parameters at which atentative iron deficiency could be reportedconclusively
Results LHD and Maf were able to differentiatebetween iron deficient and iron-depleteddonors from normal donorsA cutoff of 918 for LHD was able todifferentiate iron deficient and depleted statefrom normal iron statessensitivity 919 and specificity 71respectivelya cutoff of 1016 for Mafsensitivity 946 and specificity 968
MAf = (MVC Hb) 100
Congreso Nacional Laboratorio Cliacutenico
2018
Hb reticulocitaria sensible para detectar la fase inicial del deacuteficitde hierro cuando la eritropoyesis requiere maacutes cantidad que laque recibe ANTES de que la anemia se establezca
La deteccioacuten precoz del deacuteficit de hierro en la fase del balance negativo demanda aporte contribuye a reducir sus manifestaciones cliacutenicas en los pacientes afectados mejorando la salud puacuteblica
Un tratamiento menos prolongado con suplementos y menor consumo de los recursos sanitaros Contribuye a la eficiencia y sostenibilidad de los servicios sanitarios
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
Buttarello MLaboratory diagnosis of anemia are the old and new red cell parameters useful in classification and treatment howInt Jnl Lab Hem 2016 38 (Suppl 1) 123ndash132
Congreso Nacional Laboratorio Cliacutenico
2018
Buttarello MLaboratory diagnosis of anemia are the old and new red cell parameters useful in classification and treatment howInt Jnl Lab Hem 2016 38 (Suppl 1) 123ndash132
Congreso Nacional Laboratorio Cliacutenico
2018
Ralph Green amp Ananya Datta Mitra Megaloblastic Anemias Nutritional and Other CausesMed Clin N Am 2017 101 297ndash317
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
ANEMIA CARENCIAL CAUSAS
Factores alimentariosConsumir una dieta vegetariana mal planeadaAlimentacioacuten deficiente en los bebeacutesDesnutricioacuten durante el embarazo
Deacuteficit de absorcioacutenAlcoholismo croacutenicoEnfermedad de Crohn celiaquiacutea infeccioacuten otros problemas que le dificulten al cuerpo la digestioacuten de los alimentosAnemia perniciosa (factor intriacutenseco)Cirugiacuteas para extirpar ciertas partes del estoacutemago o el intestino delgado
MedicamentosB12 omeprazol metformina colchicina aminosalicilatos neomicinaFOLATO fenitoiacutena metotrexato sulfasalacina triamtereno pirimetamina trimetoprim con sulfametoxazol barbituacutericos
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
Reacciones metaboacutelicas en las que participan la vitamina B12 y el folato bull la conversioacuten de metilmalonil-CoA a succinil-CoA donde la adenosil-cobalamina actuacutea de
cofactor Por ello un deacuteficit de B12 conlleva un aumento de metilmalonil-CoA y de su producto de hidroacutelisis el aacutecido metilmaloacutenico
bull la siacutentesis de metionina a partir de homocisteina gracias a la metionina sintetasa y a la metil-cobalamina como cofactor En esta misma reaccioacuten el metiltetrahidrofolato es transformado a tetrahidrofolato que es necesario para la siacutentesis de DNA
Congreso Nacional Laboratorio Cliacutenico
2018
Anemia macrociacutetica secundaria a deficiencia de aacutecido foacutelico y de vitamina B12(cobalamina)
La deficiencia de B12 yo aacutecido foacutelico es la causa maacutes frecuente de megaloblastosis
Dentro de distintas funciones generales del metabolismo la vitamina B12 es uncofactor esencial en la siacutentesis de ADN y ARN compromete a todas las ceacutelulas delorganismo
Su deficiencia se manifiesta en oacuterganos con alto recambio celular como la meacutedulaosea y en el sistema nervioso central (SNC) a traveacutes de la siacutentesis de mielina y lareparacioacuten axonal
La deficiencia de cobalamina es responsable de alteraciones hematoloacutegicasneuroloacutegicas neurocognitivas y neuropsiquiaacutetricas
La siacutentesis defectuosa de ADN conduce a la apoptosis y a la hemoacutelisis (intra yextramedular) causantes de la hemopoyesis inefectiva
En meacutedula la siacutentesis ineficiente de DNA causa cambios megaloblaacutesticos comoconsecuencIa anemia y citopenias
Congreso Nacional Laboratorio Cliacutenico
2018
Limitaciones de los meacutetodos diagnoacutesticos claacutesicos
Volumen Corpuscular Medio (VCM) y morfologiacutea de sangre perifeacuterica En una serie de pacientes con deacuteficit de cobalamina soacutelo un 29 teniacutean anemia y soacutelo un 36 teniacutean un VCM gt 100 fL
Un VCM normal no puede ser empleado para rechazar una determinacioacuten de nivel de cobalamina ya que hasta un 25 de casos con manifestaciones neuroloacutegicas cursan con un VCM normal
Cobalamina seacuterica (nivel de B12) Es el test diagnoacutestico rutinario inicial estaacutendar Es un test ampliamente disponible de bajo coste y automatizado Sin embargo presenta algunas limitaciones
-- Existencia de varias teacutecnicas y ausencia de un gold standard por lo que hay diferentes liacutemites de referencia
-- Variacioacuten intraindividual muy alta
La OMS publicoacute en 2008 las conclusiones de un grupo teacutecnico consultado sobre el deacuteficit de cobalamina y folato
El grupo reconocioacute que no existen unos umbrales universalmente reconocidos para definir el deacuteficit de ambas vitaminas y expresaron la necesidad de un consenso
Devalia V Hamilton MS and Molloy AM on behalf of the British Committee for standards in haematology Guidelines for the diagnosis and treatment of cobalamin and folate disorders Br J Haematol 2014 166(4) 496-513
Schrier SL Diagnosis and treatment of vitamin B12 and folate deficiency UpToDate Last updated Jun 25 2014
de Benoist B Conclusions of a WHO Technical Consultation on folate and vitamin B12 deficiencies Food Nutr Bull 200829(2 Suppl)S238ndash44Congreso Nacional Laboratorio Cliacutenico
2018
Tomado de Tefferi A Li C En Atlas of Clinical Hematology Publicado por JO Armitage Philadelphia Current Medicine 2004
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
Int Jnl Lab Hem 2007 29 327ndash334
Clin Lab 201662343-347
In ourstudy mean MCVrMCV ratio of healthy controls is130 as microcytic anemia irondeficiency anemia is121 as also macrocytic anemia vitamin B12 deficiencyanemia is 115
Congreso Nacional Laboratorio Cliacutenico
2018
Sualeh Muslim Khan Muhammad Akbar Agha
Mean cell volume of reticulocytemdashA new parameter for diagnosing sub-clinical cobalamin deficiency in blood donors Int J Lab Hem 20181ndash4
The Abbott CELL-DYN Sapphire Hematology System uses multi-angle polarized scatter separation (MAPSS) and focused flow impedance technologies
Congreso Nacional Laboratorio Cliacutenico
2018
MCVr at 985 fL yielded the highest Youdenrsquos index at sensitivity of 82 specificity of 828 AUC 0847 ( 95 CI 803-891)
Khan SM Agha MA Mean cell volume of reticulocyte-A new parameter for diagnosing sub-clinical cobalamin deficiency in blood donors
Int J Lab Hem 20181ndash4 2018 Jul 13 doi 101111ijlh12899
Congreso Nacional Laboratorio Cliacutenico
2018
Role of Cell Population Data in the detection of folate and cobalamin deficiency
J Nieto et al
XXXI st International Symposium on Technological Innovations in Laboratory Hematology ISLH 2018 10-12 May 2018 Brussels Belgium
M-V-NRET and SD-VNRET are the best discriminatory single parameters to distinguish between patients with B9B12 deficiency and reference subjects M-V-NRETAUC=0823 sensitivity 78 and specificity 86
AUC=0852 sensitivity 55 and specificity 60
Conclusions The CPD parameters of Volume and Light Scatter (M and SD of LALS angle) that inform about size and intracellular structure of RBCs provided very useful information for the detection of B9B12 deficiency
Congreso Nacional Laboratorio Cliacutenico
2018
Cell Population Data
bull Paraacutemetros poblacionales de los leucocitos
bull Describen la morfologiacutea tamantildeo
estructuras citoplasmaacuteticas
nuacutecleo aacutecidos nucleacuteicos
bull Son datos numeacutericos con los que se construyen los ejes de lo diagramas de dispersioacuten de los leucocitos
bull Dependen de la tecnologiacutea
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
High Sensitivity New Parameters for the Detection of Vitamin B12 and Folate Deficiencies Blood 2008 1125379
B12 def vs
Normals
Mann
Withney T-Test
ROC
AUC Sens Specif Cutoff signifROC
MCV p=03156 p=09533 0577
MPV p=00001 0802 792 806 lt83 p=00001
NE Mean
Volume plt00001 0862 833 778 gt1403 p=00001
MO Mean
Volume plt00001 0829 625 889 gt1723 p=00001
MRV p=00113 0705 50 964 gt1133 p=00051
Folate def vs
Normals
Mann
Withney T-Test
ROC
AUC Sens Specif Cut-off signifROC
MCV p=00798 p=06461 0665
MPV plt00001 0832 81 806 lt83 p=00001
NE Mean
Volume p=00008 087 952 694 gt1402 p=00001
MO Mean
Volume p=00002 0801 667 833 gt1696 p=00001
MRV p=00054 0731 476 964 gt1133 p=00019
The Mean Neutrophil Volume (MNE V) and Mean Monocyte Volume (MMOV) may be used for the detection of megaloblastic neutrophils and monocytes MNEV and MMOV have significantly higher sensitivity than the previous information from the red cells (MCV) detecting B12 or folate deficiency because they are not affected by the presence at the same time of Iron deficiency or other reasons of anemia
Congreso Nacional Laboratorio Cliacutenico
2018
POSTER 733
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
CPD Sysmex XN
NE SSC complejidad
NE SFL aacutecidos nucleacuteicos
NE FSC tamantildeo
NE WX
NE WY
NE WZ
MO X
MO Y
MO Z
MO WX
MO WY
MO WZ
LY X
LY Y
LY Z
LY WX
LY WY
LY WZCongreso Nacio
nal Laboratorio Cliacutenico 2018
As MCV is the mean which is calculated it is insensitive to the presence of a small number of macrocytes
Further macrocytosis can be obscured by concomitant disorders that can cause microcytosis resulting inmasked megaloblastic anaemia (MA) for example iron deficiency hereditary elliptocytosis alpha and betathalassemia
This study was undertaken to evaluate the role of NEUT-X and NEUT-Y in detecting MA on peripheral blood andalso see whether other forms of macrocytic anaemia can be differentiated from MA
In MA the peripheral blood smear shows cytopenia with macroovalocytes and hypersegmented
neutrophils (gt5 lobes in 5 neutrophils six lobes nuclei or lobe average of gt35)
In conclusion our study shows that higher values of NEUT-X and NEUT-Y in MA patients in spite of low ornormal MCV high RDW may be used to not only reveal the masked cases of MA with concomitant irondeficiency but also separate them from the broader macrocytic anaemia group
Peripheral smear remains diagnostic however making smear for all the suspicious cases is a cumbersomeand tedious procedure Thus these parameters emerge as more reliable and stable parameters in themodern laboratories which in future may replace the older screening tools
Congreso Nacional Laboratorio Cliacutenico
2018
A favor Eficiencia Operativa
Mejora el proceso del Laboratorio
Mejor informacioacuten al Cliacutenico al mismo coste
Mejora la informacioacuten
Informa sobre la eritropoyesis deteccioacuten precoz de estados carenciales
Ayuda al cliacutenico
Estado real del paciente
En contraParaacutemetros de investigacioacuten
Dificultad de standarizar dependencia teacutecnica
Control de calidadCongreso Nacional Laboratorio Cliacutenico
2018
SuominenP et al Serum transferrin receptor and transferrin receptor-ferritin index identify healthy subjects with subclinical iron deficits Blood 1998 92 2934ndash9Halwachs-Baumann G Diagnosis of anaemia old things rearranged Wien Med Wochenschr 2012 162478ndash88
Congreso Nacional Laboratorio Cliacutenico
2018
Hemoglobina de reticulocito y su importancia en el diagnoacutestico temprano de anemiaferropeacutenica
Y Maacuterquez-Beniacutetez et al Universidad de BocayaAugust
2018 DOI 1022267rus182003133 aop
El contenido de hemoglobina de reticulocitos (CHr) es un paraacutemetro en la biometriacuteahematoloacutegica automatizada utilizado como un marcador de la biodisponibilidad delhierro en la eritropoyesis
Objetivo Exponer la aplicabilidad de la CHr como un paraacutemetro en el diagnoacutesticoprecoz de la anemia por deficiencia de hierro asiacute como su medicioacuten e interpretacioacuten
Materiales y meacutetodos Se realizoacute la revisioacuten de artiacuteculos cientiacuteficos en ingleacutes y espantildeolen las bases de datos PubMed ScienceDirect LILACS y Medline usando descriptoresvalidados en Medical Subject Headings (MeSH) considerando periodo depublicabilidad del 80 inferior a 5 antildeos
Conclusiones La CHr es un paraacutemetro de gran utilidad en el diagnoacutestico temprano deanemia ferropeacutenica y otras patologiacuteas como deficiencia funcional de hierro estadosde inflamacioacuten croacutenica y enfermedad renal croacutenica
Biomarcador temprano en el diagnoacutestico de deficiencia de hierro antes de presentarsecambios morfoloacutegicos eritrociacuteticosCongreso Nacio
nal Laboratorio Cliacutenico 2018
bull A total of 1105 NES participants (639 men 466 women)bull CHr becomes affected in a relatively early stage in the development of iron deficiency before iron
deficiency anemia and clinical symptoms become apparentbull Therefore this parameter might be useful to identify persons healthy and diseased at risk of
developing iron deficiency anemia and subsequently to apply interventions in order to prevent further development of iron deficiency anemiaCongreso Nacio
nal Laboratorio Cliacutenico 2018
Hb reticulocitaria sensible para detectar la fase inicial del deacuteficit de hierro cuando laeritropoyesis requiere maacutes cantidad que la que recibe ANTES de que la anemia seestablezca
Congreso Nacional Laboratorio Cliacutenico
2018
No ID LID P
RBC 1012L 48 (08) 437 (05) lt00001
Hb gL 135 (6) 131 (12) 0006
MCV fL 922 (21) 902 (38) 0006
MCH pg 324 (07) 306 (22) lt00001
MCHC gL 339 (6) 319 (23) 0001
RDW
Ret He pg
Hypo He
LHD
Ferritin microgL
131 (06)
338 (21)
03 (015)
28 (20)
86 (3)
145 (21)
278 (24)
69 (55)
56 (25)
16 (76)
lt00001
lt00001
lt00001
lt00001
lt00001
AUC 95 CI Cutoff Sensitivity Specificity
LHD 0898 0819-0978 50 859 841
Ret He 0914 0824-1000 299pg 868 857
Hypo He 0934 0856-1000 16 857 921
Clinical value of markers of hypochromia in the detection of latent iron deficiency in non-anemic premenopausal women
No ID Hb gt 120 gL s-ferritin was within reference intervalLatent Iron Defiency Hb gt 120 gL s-ferritin lt 30 μgL
Urrechaga E et al Journal Clin Lab Analysis 2016 30 (5) 623-627
97 women (388) in 250 apparently healthy women had latent IDCongreso Nacional Laboratorio Cliacutenico
2018
Schorer G et al Abstract Jahreskongress der Deutschen Gesellschaft fuumlr Transfusionsmedizin und Immunhaumlmatologie Rostock 15 - 18 September 2009
Congreso Nacional Laboratorio Cliacutenico
2018
Caring for Those Who Share Mitigating Iron Deficiency in Regular Blood DonorsMast Alan E
bull Iron deficiency caused by regular blood donation is a problem facing blood centers Each blood donation removes 200 to 250 mg of iron from the donor Consequently many donors become iron deficient with repeated donation
bull This presents a challenge to blood centers that has become more acute in recent years with the realization that iron deficiency even in the absence of anemia is associated with adverse effects including fatigue and decreased exercise tolerance as well as neurological symptoms such as decreased cognitive function pica and restless leg syndrome
bull REDS-II investigators performed a longitudinal study investigating the iron status of blood donors over a two year period called the REDS-II Donor Iron Status Evaluation (RISE)
bull Results from the baseline analysis of regular donors (e 2 donations per year (females) or e 3 donations per year (males) revealed that over two-thirds of female donors and over one-half of male donors have iron deficiency
Congreso Nacional Laboratorio Cliacutenico
2018
Transfusion 2013 532766-2775
bull We evaluated the diagnostic sensitivity and specificity of red blood cell (RBC) hematology analyzer indices to assess iron status as a part of donor management iron deficient erythropoiesis (IDE) and absence of iron stores (AIS)
bull STUDY DESIGN AND METHODS A total of 1659 male and female donors from the Retrovirus Epidemiology Donor Study-II (REDS-II) Donor Iron Status Evaluation (RISE) study who were either first-timereactivated (FT RA no donations for 2 years) or frequent donors were recruited into a longitudinal study of regular donation of RBCs Of these 1002 donors returned 15 to 24 months later for a final assessment
Absent iron stores (AIS) was defined as plasma ferritin level of less than 12 mgL Logarithm of the ratio of soluble transferrin receptor to ferritin of at least 207 was used to define iron-deficient erythropoiesis (IDE)
bull RESULTS HYPOm and CHr detected IDE with comparable sensitivity 72 versus 69 but differed in specificity HYPOm 68 and CHr 53
For detecting AIS sensitivity was improved to 85 for HYPOm and 81 for CHr but specificity was reduced
Venous Hb had high specificity but poor sensitivity for IDE and AIS A plasma ferritin level of less than 267 mgL was a good surrogate for assessing IDE Congreso Nacio
nal Laboratorio Cliacutenico 2018
Microcytic RBC and reticulocyte mean cell hemoglobin content predicted iron depletion with
sensitivities 70 and 64
specificities of 72 and 78 respectively
When both combined
increased the sensitivity to 82
Congreso Nacional Laboratorio Cliacutenico
2018
Depending on the number of donations during the preceding12 months
Absent iron stores were detected in up to 214 of male and278 of female donors respectively
impaired hemoglobinisation IH was present in up to 64 maleand 167 female donors with 2 and 4 preceding donationsrespectively
The defined CHr cut-off value was 280 pg to detect IH infrequent whole blood donors with AIS leading to a testspecificity of 982 (positive predictive value PPV 577) inmale and of 978 (PPV 829) in female donors
It may help to prevent the development of anemia in frequentblood donors and also can help to decide whether donordeferral or even iron substitution need to be recommended
Congreso Nacional Laboratorio Cliacutenico
2018
Of the 501 blood donors sTfR and Ret-He detected Latent Iron Deficiency in 148 and 135 donors respectively
In comparison to sTfR Ret-He had sensitivity of 927 specificity of 9716 PPV of 931 and NPV of 963
Serum Ferritin TIBC and serum Iron had comparatively lower sensitivity of 8716 797 and 777 respectively
Conclusion Ret-He can be used as a routine screening test to detect LID in blood donors
This could provide an opportunity to make appropriate and timely interventions like dietary changes or drug supplementation
Congreso Nacional Laboratorio Cliacutenico
2018
Singh A Chaudhary R Pandey HC Sonker A Identification of iron status of blood donors by using low hemoglobin density and microcytic anemia factor Asian J Transfus Sci 20181246-50
The main objective of this study was to assess ifLHD and Maf could be used for assessment ofiron status in blood donors and also to establisha cut-off for these two parameters at which atentative iron deficiency could be reportedconclusively
Results LHD and Maf were able to differentiatebetween iron deficient and iron-depleteddonors from normal donorsA cutoff of 918 for LHD was able todifferentiate iron deficient and depleted statefrom normal iron statessensitivity 919 and specificity 71respectivelya cutoff of 1016 for Mafsensitivity 946 and specificity 968
MAf = (MVC Hb) 100
Congreso Nacional Laboratorio Cliacutenico
2018
Hb reticulocitaria sensible para detectar la fase inicial del deacuteficitde hierro cuando la eritropoyesis requiere maacutes cantidad que laque recibe ANTES de que la anemia se establezca
La deteccioacuten precoz del deacuteficit de hierro en la fase del balance negativo demanda aporte contribuye a reducir sus manifestaciones cliacutenicas en los pacientes afectados mejorando la salud puacuteblica
Un tratamiento menos prolongado con suplementos y menor consumo de los recursos sanitaros Contribuye a la eficiencia y sostenibilidad de los servicios sanitarios
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
Buttarello MLaboratory diagnosis of anemia are the old and new red cell parameters useful in classification and treatment howInt Jnl Lab Hem 2016 38 (Suppl 1) 123ndash132
Congreso Nacional Laboratorio Cliacutenico
2018
Buttarello MLaboratory diagnosis of anemia are the old and new red cell parameters useful in classification and treatment howInt Jnl Lab Hem 2016 38 (Suppl 1) 123ndash132
Congreso Nacional Laboratorio Cliacutenico
2018
Ralph Green amp Ananya Datta Mitra Megaloblastic Anemias Nutritional and Other CausesMed Clin N Am 2017 101 297ndash317
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
ANEMIA CARENCIAL CAUSAS
Factores alimentariosConsumir una dieta vegetariana mal planeadaAlimentacioacuten deficiente en los bebeacutesDesnutricioacuten durante el embarazo
Deacuteficit de absorcioacutenAlcoholismo croacutenicoEnfermedad de Crohn celiaquiacutea infeccioacuten otros problemas que le dificulten al cuerpo la digestioacuten de los alimentosAnemia perniciosa (factor intriacutenseco)Cirugiacuteas para extirpar ciertas partes del estoacutemago o el intestino delgado
MedicamentosB12 omeprazol metformina colchicina aminosalicilatos neomicinaFOLATO fenitoiacutena metotrexato sulfasalacina triamtereno pirimetamina trimetoprim con sulfametoxazol barbituacutericos
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
Reacciones metaboacutelicas en las que participan la vitamina B12 y el folato bull la conversioacuten de metilmalonil-CoA a succinil-CoA donde la adenosil-cobalamina actuacutea de
cofactor Por ello un deacuteficit de B12 conlleva un aumento de metilmalonil-CoA y de su producto de hidroacutelisis el aacutecido metilmaloacutenico
bull la siacutentesis de metionina a partir de homocisteina gracias a la metionina sintetasa y a la metil-cobalamina como cofactor En esta misma reaccioacuten el metiltetrahidrofolato es transformado a tetrahidrofolato que es necesario para la siacutentesis de DNA
Congreso Nacional Laboratorio Cliacutenico
2018
Anemia macrociacutetica secundaria a deficiencia de aacutecido foacutelico y de vitamina B12(cobalamina)
La deficiencia de B12 yo aacutecido foacutelico es la causa maacutes frecuente de megaloblastosis
Dentro de distintas funciones generales del metabolismo la vitamina B12 es uncofactor esencial en la siacutentesis de ADN y ARN compromete a todas las ceacutelulas delorganismo
Su deficiencia se manifiesta en oacuterganos con alto recambio celular como la meacutedulaosea y en el sistema nervioso central (SNC) a traveacutes de la siacutentesis de mielina y lareparacioacuten axonal
La deficiencia de cobalamina es responsable de alteraciones hematoloacutegicasneuroloacutegicas neurocognitivas y neuropsiquiaacutetricas
La siacutentesis defectuosa de ADN conduce a la apoptosis y a la hemoacutelisis (intra yextramedular) causantes de la hemopoyesis inefectiva
En meacutedula la siacutentesis ineficiente de DNA causa cambios megaloblaacutesticos comoconsecuencIa anemia y citopenias
Congreso Nacional Laboratorio Cliacutenico
2018
Limitaciones de los meacutetodos diagnoacutesticos claacutesicos
Volumen Corpuscular Medio (VCM) y morfologiacutea de sangre perifeacuterica En una serie de pacientes con deacuteficit de cobalamina soacutelo un 29 teniacutean anemia y soacutelo un 36 teniacutean un VCM gt 100 fL
Un VCM normal no puede ser empleado para rechazar una determinacioacuten de nivel de cobalamina ya que hasta un 25 de casos con manifestaciones neuroloacutegicas cursan con un VCM normal
Cobalamina seacuterica (nivel de B12) Es el test diagnoacutestico rutinario inicial estaacutendar Es un test ampliamente disponible de bajo coste y automatizado Sin embargo presenta algunas limitaciones
-- Existencia de varias teacutecnicas y ausencia de un gold standard por lo que hay diferentes liacutemites de referencia
-- Variacioacuten intraindividual muy alta
La OMS publicoacute en 2008 las conclusiones de un grupo teacutecnico consultado sobre el deacuteficit de cobalamina y folato
El grupo reconocioacute que no existen unos umbrales universalmente reconocidos para definir el deacuteficit de ambas vitaminas y expresaron la necesidad de un consenso
Devalia V Hamilton MS and Molloy AM on behalf of the British Committee for standards in haematology Guidelines for the diagnosis and treatment of cobalamin and folate disorders Br J Haematol 2014 166(4) 496-513
Schrier SL Diagnosis and treatment of vitamin B12 and folate deficiency UpToDate Last updated Jun 25 2014
de Benoist B Conclusions of a WHO Technical Consultation on folate and vitamin B12 deficiencies Food Nutr Bull 200829(2 Suppl)S238ndash44Congreso Nacional Laboratorio Cliacutenico
2018
Tomado de Tefferi A Li C En Atlas of Clinical Hematology Publicado por JO Armitage Philadelphia Current Medicine 2004
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
Int Jnl Lab Hem 2007 29 327ndash334
Clin Lab 201662343-347
In ourstudy mean MCVrMCV ratio of healthy controls is130 as microcytic anemia irondeficiency anemia is121 as also macrocytic anemia vitamin B12 deficiencyanemia is 115
Congreso Nacional Laboratorio Cliacutenico
2018
Sualeh Muslim Khan Muhammad Akbar Agha
Mean cell volume of reticulocytemdashA new parameter for diagnosing sub-clinical cobalamin deficiency in blood donors Int J Lab Hem 20181ndash4
The Abbott CELL-DYN Sapphire Hematology System uses multi-angle polarized scatter separation (MAPSS) and focused flow impedance technologies
Congreso Nacional Laboratorio Cliacutenico
2018
MCVr at 985 fL yielded the highest Youdenrsquos index at sensitivity of 82 specificity of 828 AUC 0847 ( 95 CI 803-891)
Khan SM Agha MA Mean cell volume of reticulocyte-A new parameter for diagnosing sub-clinical cobalamin deficiency in blood donors
Int J Lab Hem 20181ndash4 2018 Jul 13 doi 101111ijlh12899
Congreso Nacional Laboratorio Cliacutenico
2018
Role of Cell Population Data in the detection of folate and cobalamin deficiency
J Nieto et al
XXXI st International Symposium on Technological Innovations in Laboratory Hematology ISLH 2018 10-12 May 2018 Brussels Belgium
M-V-NRET and SD-VNRET are the best discriminatory single parameters to distinguish between patients with B9B12 deficiency and reference subjects M-V-NRETAUC=0823 sensitivity 78 and specificity 86
AUC=0852 sensitivity 55 and specificity 60
Conclusions The CPD parameters of Volume and Light Scatter (M and SD of LALS angle) that inform about size and intracellular structure of RBCs provided very useful information for the detection of B9B12 deficiency
Congreso Nacional Laboratorio Cliacutenico
2018
Cell Population Data
bull Paraacutemetros poblacionales de los leucocitos
bull Describen la morfologiacutea tamantildeo
estructuras citoplasmaacuteticas
nuacutecleo aacutecidos nucleacuteicos
bull Son datos numeacutericos con los que se construyen los ejes de lo diagramas de dispersioacuten de los leucocitos
bull Dependen de la tecnologiacutea
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
High Sensitivity New Parameters for the Detection of Vitamin B12 and Folate Deficiencies Blood 2008 1125379
B12 def vs
Normals
Mann
Withney T-Test
ROC
AUC Sens Specif Cutoff signifROC
MCV p=03156 p=09533 0577
MPV p=00001 0802 792 806 lt83 p=00001
NE Mean
Volume plt00001 0862 833 778 gt1403 p=00001
MO Mean
Volume plt00001 0829 625 889 gt1723 p=00001
MRV p=00113 0705 50 964 gt1133 p=00051
Folate def vs
Normals
Mann
Withney T-Test
ROC
AUC Sens Specif Cut-off signifROC
MCV p=00798 p=06461 0665
MPV plt00001 0832 81 806 lt83 p=00001
NE Mean
Volume p=00008 087 952 694 gt1402 p=00001
MO Mean
Volume p=00002 0801 667 833 gt1696 p=00001
MRV p=00054 0731 476 964 gt1133 p=00019
The Mean Neutrophil Volume (MNE V) and Mean Monocyte Volume (MMOV) may be used for the detection of megaloblastic neutrophils and monocytes MNEV and MMOV have significantly higher sensitivity than the previous information from the red cells (MCV) detecting B12 or folate deficiency because they are not affected by the presence at the same time of Iron deficiency or other reasons of anemia
Congreso Nacional Laboratorio Cliacutenico
2018
POSTER 733
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
CPD Sysmex XN
NE SSC complejidad
NE SFL aacutecidos nucleacuteicos
NE FSC tamantildeo
NE WX
NE WY
NE WZ
MO X
MO Y
MO Z
MO WX
MO WY
MO WZ
LY X
LY Y
LY Z
LY WX
LY WY
LY WZCongreso Nacio
nal Laboratorio Cliacutenico 2018
As MCV is the mean which is calculated it is insensitive to the presence of a small number of macrocytes
Further macrocytosis can be obscured by concomitant disorders that can cause microcytosis resulting inmasked megaloblastic anaemia (MA) for example iron deficiency hereditary elliptocytosis alpha and betathalassemia
This study was undertaken to evaluate the role of NEUT-X and NEUT-Y in detecting MA on peripheral blood andalso see whether other forms of macrocytic anaemia can be differentiated from MA
In MA the peripheral blood smear shows cytopenia with macroovalocytes and hypersegmented
neutrophils (gt5 lobes in 5 neutrophils six lobes nuclei or lobe average of gt35)
In conclusion our study shows that higher values of NEUT-X and NEUT-Y in MA patients in spite of low ornormal MCV high RDW may be used to not only reveal the masked cases of MA with concomitant irondeficiency but also separate them from the broader macrocytic anaemia group
Peripheral smear remains diagnostic however making smear for all the suspicious cases is a cumbersomeand tedious procedure Thus these parameters emerge as more reliable and stable parameters in themodern laboratories which in future may replace the older screening tools
Congreso Nacional Laboratorio Cliacutenico
2018
A favor Eficiencia Operativa
Mejora el proceso del Laboratorio
Mejor informacioacuten al Cliacutenico al mismo coste
Mejora la informacioacuten
Informa sobre la eritropoyesis deteccioacuten precoz de estados carenciales
Ayuda al cliacutenico
Estado real del paciente
En contraParaacutemetros de investigacioacuten
Dificultad de standarizar dependencia teacutecnica
Control de calidadCongreso Nacional Laboratorio Cliacutenico
2018
Hemoglobina de reticulocito y su importancia en el diagnoacutestico temprano de anemiaferropeacutenica
Y Maacuterquez-Beniacutetez et al Universidad de BocayaAugust
2018 DOI 1022267rus182003133 aop
El contenido de hemoglobina de reticulocitos (CHr) es un paraacutemetro en la biometriacuteahematoloacutegica automatizada utilizado como un marcador de la biodisponibilidad delhierro en la eritropoyesis
Objetivo Exponer la aplicabilidad de la CHr como un paraacutemetro en el diagnoacutesticoprecoz de la anemia por deficiencia de hierro asiacute como su medicioacuten e interpretacioacuten
Materiales y meacutetodos Se realizoacute la revisioacuten de artiacuteculos cientiacuteficos en ingleacutes y espantildeolen las bases de datos PubMed ScienceDirect LILACS y Medline usando descriptoresvalidados en Medical Subject Headings (MeSH) considerando periodo depublicabilidad del 80 inferior a 5 antildeos
Conclusiones La CHr es un paraacutemetro de gran utilidad en el diagnoacutestico temprano deanemia ferropeacutenica y otras patologiacuteas como deficiencia funcional de hierro estadosde inflamacioacuten croacutenica y enfermedad renal croacutenica
Biomarcador temprano en el diagnoacutestico de deficiencia de hierro antes de presentarsecambios morfoloacutegicos eritrociacuteticosCongreso Nacio
nal Laboratorio Cliacutenico 2018
bull A total of 1105 NES participants (639 men 466 women)bull CHr becomes affected in a relatively early stage in the development of iron deficiency before iron
deficiency anemia and clinical symptoms become apparentbull Therefore this parameter might be useful to identify persons healthy and diseased at risk of
developing iron deficiency anemia and subsequently to apply interventions in order to prevent further development of iron deficiency anemiaCongreso Nacio
nal Laboratorio Cliacutenico 2018
Hb reticulocitaria sensible para detectar la fase inicial del deacuteficit de hierro cuando laeritropoyesis requiere maacutes cantidad que la que recibe ANTES de que la anemia seestablezca
Congreso Nacional Laboratorio Cliacutenico
2018
No ID LID P
RBC 1012L 48 (08) 437 (05) lt00001
Hb gL 135 (6) 131 (12) 0006
MCV fL 922 (21) 902 (38) 0006
MCH pg 324 (07) 306 (22) lt00001
MCHC gL 339 (6) 319 (23) 0001
RDW
Ret He pg
Hypo He
LHD
Ferritin microgL
131 (06)
338 (21)
03 (015)
28 (20)
86 (3)
145 (21)
278 (24)
69 (55)
56 (25)
16 (76)
lt00001
lt00001
lt00001
lt00001
lt00001
AUC 95 CI Cutoff Sensitivity Specificity
LHD 0898 0819-0978 50 859 841
Ret He 0914 0824-1000 299pg 868 857
Hypo He 0934 0856-1000 16 857 921
Clinical value of markers of hypochromia in the detection of latent iron deficiency in non-anemic premenopausal women
No ID Hb gt 120 gL s-ferritin was within reference intervalLatent Iron Defiency Hb gt 120 gL s-ferritin lt 30 μgL
Urrechaga E et al Journal Clin Lab Analysis 2016 30 (5) 623-627
97 women (388) in 250 apparently healthy women had latent IDCongreso Nacional Laboratorio Cliacutenico
2018
Schorer G et al Abstract Jahreskongress der Deutschen Gesellschaft fuumlr Transfusionsmedizin und Immunhaumlmatologie Rostock 15 - 18 September 2009
Congreso Nacional Laboratorio Cliacutenico
2018
Caring for Those Who Share Mitigating Iron Deficiency in Regular Blood DonorsMast Alan E
bull Iron deficiency caused by regular blood donation is a problem facing blood centers Each blood donation removes 200 to 250 mg of iron from the donor Consequently many donors become iron deficient with repeated donation
bull This presents a challenge to blood centers that has become more acute in recent years with the realization that iron deficiency even in the absence of anemia is associated with adverse effects including fatigue and decreased exercise tolerance as well as neurological symptoms such as decreased cognitive function pica and restless leg syndrome
bull REDS-II investigators performed a longitudinal study investigating the iron status of blood donors over a two year period called the REDS-II Donor Iron Status Evaluation (RISE)
bull Results from the baseline analysis of regular donors (e 2 donations per year (females) or e 3 donations per year (males) revealed that over two-thirds of female donors and over one-half of male donors have iron deficiency
Congreso Nacional Laboratorio Cliacutenico
2018
Transfusion 2013 532766-2775
bull We evaluated the diagnostic sensitivity and specificity of red blood cell (RBC) hematology analyzer indices to assess iron status as a part of donor management iron deficient erythropoiesis (IDE) and absence of iron stores (AIS)
bull STUDY DESIGN AND METHODS A total of 1659 male and female donors from the Retrovirus Epidemiology Donor Study-II (REDS-II) Donor Iron Status Evaluation (RISE) study who were either first-timereactivated (FT RA no donations for 2 years) or frequent donors were recruited into a longitudinal study of regular donation of RBCs Of these 1002 donors returned 15 to 24 months later for a final assessment
Absent iron stores (AIS) was defined as plasma ferritin level of less than 12 mgL Logarithm of the ratio of soluble transferrin receptor to ferritin of at least 207 was used to define iron-deficient erythropoiesis (IDE)
bull RESULTS HYPOm and CHr detected IDE with comparable sensitivity 72 versus 69 but differed in specificity HYPOm 68 and CHr 53
For detecting AIS sensitivity was improved to 85 for HYPOm and 81 for CHr but specificity was reduced
Venous Hb had high specificity but poor sensitivity for IDE and AIS A plasma ferritin level of less than 267 mgL was a good surrogate for assessing IDE Congreso Nacio
nal Laboratorio Cliacutenico 2018
Microcytic RBC and reticulocyte mean cell hemoglobin content predicted iron depletion with
sensitivities 70 and 64
specificities of 72 and 78 respectively
When both combined
increased the sensitivity to 82
Congreso Nacional Laboratorio Cliacutenico
2018
Depending on the number of donations during the preceding12 months
Absent iron stores were detected in up to 214 of male and278 of female donors respectively
impaired hemoglobinisation IH was present in up to 64 maleand 167 female donors with 2 and 4 preceding donationsrespectively
The defined CHr cut-off value was 280 pg to detect IH infrequent whole blood donors with AIS leading to a testspecificity of 982 (positive predictive value PPV 577) inmale and of 978 (PPV 829) in female donors
It may help to prevent the development of anemia in frequentblood donors and also can help to decide whether donordeferral or even iron substitution need to be recommended
Congreso Nacional Laboratorio Cliacutenico
2018
Of the 501 blood donors sTfR and Ret-He detected Latent Iron Deficiency in 148 and 135 donors respectively
In comparison to sTfR Ret-He had sensitivity of 927 specificity of 9716 PPV of 931 and NPV of 963
Serum Ferritin TIBC and serum Iron had comparatively lower sensitivity of 8716 797 and 777 respectively
Conclusion Ret-He can be used as a routine screening test to detect LID in blood donors
This could provide an opportunity to make appropriate and timely interventions like dietary changes or drug supplementation
Congreso Nacional Laboratorio Cliacutenico
2018
Singh A Chaudhary R Pandey HC Sonker A Identification of iron status of blood donors by using low hemoglobin density and microcytic anemia factor Asian J Transfus Sci 20181246-50
The main objective of this study was to assess ifLHD and Maf could be used for assessment ofiron status in blood donors and also to establisha cut-off for these two parameters at which atentative iron deficiency could be reportedconclusively
Results LHD and Maf were able to differentiatebetween iron deficient and iron-depleteddonors from normal donorsA cutoff of 918 for LHD was able todifferentiate iron deficient and depleted statefrom normal iron statessensitivity 919 and specificity 71respectivelya cutoff of 1016 for Mafsensitivity 946 and specificity 968
MAf = (MVC Hb) 100
Congreso Nacional Laboratorio Cliacutenico
2018
Hb reticulocitaria sensible para detectar la fase inicial del deacuteficitde hierro cuando la eritropoyesis requiere maacutes cantidad que laque recibe ANTES de que la anemia se establezca
La deteccioacuten precoz del deacuteficit de hierro en la fase del balance negativo demanda aporte contribuye a reducir sus manifestaciones cliacutenicas en los pacientes afectados mejorando la salud puacuteblica
Un tratamiento menos prolongado con suplementos y menor consumo de los recursos sanitaros Contribuye a la eficiencia y sostenibilidad de los servicios sanitarios
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
Buttarello MLaboratory diagnosis of anemia are the old and new red cell parameters useful in classification and treatment howInt Jnl Lab Hem 2016 38 (Suppl 1) 123ndash132
Congreso Nacional Laboratorio Cliacutenico
2018
Buttarello MLaboratory diagnosis of anemia are the old and new red cell parameters useful in classification and treatment howInt Jnl Lab Hem 2016 38 (Suppl 1) 123ndash132
Congreso Nacional Laboratorio Cliacutenico
2018
Ralph Green amp Ananya Datta Mitra Megaloblastic Anemias Nutritional and Other CausesMed Clin N Am 2017 101 297ndash317
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
ANEMIA CARENCIAL CAUSAS
Factores alimentariosConsumir una dieta vegetariana mal planeadaAlimentacioacuten deficiente en los bebeacutesDesnutricioacuten durante el embarazo
Deacuteficit de absorcioacutenAlcoholismo croacutenicoEnfermedad de Crohn celiaquiacutea infeccioacuten otros problemas que le dificulten al cuerpo la digestioacuten de los alimentosAnemia perniciosa (factor intriacutenseco)Cirugiacuteas para extirpar ciertas partes del estoacutemago o el intestino delgado
MedicamentosB12 omeprazol metformina colchicina aminosalicilatos neomicinaFOLATO fenitoiacutena metotrexato sulfasalacina triamtereno pirimetamina trimetoprim con sulfametoxazol barbituacutericos
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
Reacciones metaboacutelicas en las que participan la vitamina B12 y el folato bull la conversioacuten de metilmalonil-CoA a succinil-CoA donde la adenosil-cobalamina actuacutea de
cofactor Por ello un deacuteficit de B12 conlleva un aumento de metilmalonil-CoA y de su producto de hidroacutelisis el aacutecido metilmaloacutenico
bull la siacutentesis de metionina a partir de homocisteina gracias a la metionina sintetasa y a la metil-cobalamina como cofactor En esta misma reaccioacuten el metiltetrahidrofolato es transformado a tetrahidrofolato que es necesario para la siacutentesis de DNA
Congreso Nacional Laboratorio Cliacutenico
2018
Anemia macrociacutetica secundaria a deficiencia de aacutecido foacutelico y de vitamina B12(cobalamina)
La deficiencia de B12 yo aacutecido foacutelico es la causa maacutes frecuente de megaloblastosis
Dentro de distintas funciones generales del metabolismo la vitamina B12 es uncofactor esencial en la siacutentesis de ADN y ARN compromete a todas las ceacutelulas delorganismo
Su deficiencia se manifiesta en oacuterganos con alto recambio celular como la meacutedulaosea y en el sistema nervioso central (SNC) a traveacutes de la siacutentesis de mielina y lareparacioacuten axonal
La deficiencia de cobalamina es responsable de alteraciones hematoloacutegicasneuroloacutegicas neurocognitivas y neuropsiquiaacutetricas
La siacutentesis defectuosa de ADN conduce a la apoptosis y a la hemoacutelisis (intra yextramedular) causantes de la hemopoyesis inefectiva
En meacutedula la siacutentesis ineficiente de DNA causa cambios megaloblaacutesticos comoconsecuencIa anemia y citopenias
Congreso Nacional Laboratorio Cliacutenico
2018
Limitaciones de los meacutetodos diagnoacutesticos claacutesicos
Volumen Corpuscular Medio (VCM) y morfologiacutea de sangre perifeacuterica En una serie de pacientes con deacuteficit de cobalamina soacutelo un 29 teniacutean anemia y soacutelo un 36 teniacutean un VCM gt 100 fL
Un VCM normal no puede ser empleado para rechazar una determinacioacuten de nivel de cobalamina ya que hasta un 25 de casos con manifestaciones neuroloacutegicas cursan con un VCM normal
Cobalamina seacuterica (nivel de B12) Es el test diagnoacutestico rutinario inicial estaacutendar Es un test ampliamente disponible de bajo coste y automatizado Sin embargo presenta algunas limitaciones
-- Existencia de varias teacutecnicas y ausencia de un gold standard por lo que hay diferentes liacutemites de referencia
-- Variacioacuten intraindividual muy alta
La OMS publicoacute en 2008 las conclusiones de un grupo teacutecnico consultado sobre el deacuteficit de cobalamina y folato
El grupo reconocioacute que no existen unos umbrales universalmente reconocidos para definir el deacuteficit de ambas vitaminas y expresaron la necesidad de un consenso
Devalia V Hamilton MS and Molloy AM on behalf of the British Committee for standards in haematology Guidelines for the diagnosis and treatment of cobalamin and folate disorders Br J Haematol 2014 166(4) 496-513
Schrier SL Diagnosis and treatment of vitamin B12 and folate deficiency UpToDate Last updated Jun 25 2014
de Benoist B Conclusions of a WHO Technical Consultation on folate and vitamin B12 deficiencies Food Nutr Bull 200829(2 Suppl)S238ndash44Congreso Nacional Laboratorio Cliacutenico
2018
Tomado de Tefferi A Li C En Atlas of Clinical Hematology Publicado por JO Armitage Philadelphia Current Medicine 2004
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
Int Jnl Lab Hem 2007 29 327ndash334
Clin Lab 201662343-347
In ourstudy mean MCVrMCV ratio of healthy controls is130 as microcytic anemia irondeficiency anemia is121 as also macrocytic anemia vitamin B12 deficiencyanemia is 115
Congreso Nacional Laboratorio Cliacutenico
2018
Sualeh Muslim Khan Muhammad Akbar Agha
Mean cell volume of reticulocytemdashA new parameter for diagnosing sub-clinical cobalamin deficiency in blood donors Int J Lab Hem 20181ndash4
The Abbott CELL-DYN Sapphire Hematology System uses multi-angle polarized scatter separation (MAPSS) and focused flow impedance technologies
Congreso Nacional Laboratorio Cliacutenico
2018
MCVr at 985 fL yielded the highest Youdenrsquos index at sensitivity of 82 specificity of 828 AUC 0847 ( 95 CI 803-891)
Khan SM Agha MA Mean cell volume of reticulocyte-A new parameter for diagnosing sub-clinical cobalamin deficiency in blood donors
Int J Lab Hem 20181ndash4 2018 Jul 13 doi 101111ijlh12899
Congreso Nacional Laboratorio Cliacutenico
2018
Role of Cell Population Data in the detection of folate and cobalamin deficiency
J Nieto et al
XXXI st International Symposium on Technological Innovations in Laboratory Hematology ISLH 2018 10-12 May 2018 Brussels Belgium
M-V-NRET and SD-VNRET are the best discriminatory single parameters to distinguish between patients with B9B12 deficiency and reference subjects M-V-NRETAUC=0823 sensitivity 78 and specificity 86
AUC=0852 sensitivity 55 and specificity 60
Conclusions The CPD parameters of Volume and Light Scatter (M and SD of LALS angle) that inform about size and intracellular structure of RBCs provided very useful information for the detection of B9B12 deficiency
Congreso Nacional Laboratorio Cliacutenico
2018
Cell Population Data
bull Paraacutemetros poblacionales de los leucocitos
bull Describen la morfologiacutea tamantildeo
estructuras citoplasmaacuteticas
nuacutecleo aacutecidos nucleacuteicos
bull Son datos numeacutericos con los que se construyen los ejes de lo diagramas de dispersioacuten de los leucocitos
bull Dependen de la tecnologiacutea
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
High Sensitivity New Parameters for the Detection of Vitamin B12 and Folate Deficiencies Blood 2008 1125379
B12 def vs
Normals
Mann
Withney T-Test
ROC
AUC Sens Specif Cutoff signifROC
MCV p=03156 p=09533 0577
MPV p=00001 0802 792 806 lt83 p=00001
NE Mean
Volume plt00001 0862 833 778 gt1403 p=00001
MO Mean
Volume plt00001 0829 625 889 gt1723 p=00001
MRV p=00113 0705 50 964 gt1133 p=00051
Folate def vs
Normals
Mann
Withney T-Test
ROC
AUC Sens Specif Cut-off signifROC
MCV p=00798 p=06461 0665
MPV plt00001 0832 81 806 lt83 p=00001
NE Mean
Volume p=00008 087 952 694 gt1402 p=00001
MO Mean
Volume p=00002 0801 667 833 gt1696 p=00001
MRV p=00054 0731 476 964 gt1133 p=00019
The Mean Neutrophil Volume (MNE V) and Mean Monocyte Volume (MMOV) may be used for the detection of megaloblastic neutrophils and monocytes MNEV and MMOV have significantly higher sensitivity than the previous information from the red cells (MCV) detecting B12 or folate deficiency because they are not affected by the presence at the same time of Iron deficiency or other reasons of anemia
Congreso Nacional Laboratorio Cliacutenico
2018
POSTER 733
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
CPD Sysmex XN
NE SSC complejidad
NE SFL aacutecidos nucleacuteicos
NE FSC tamantildeo
NE WX
NE WY
NE WZ
MO X
MO Y
MO Z
MO WX
MO WY
MO WZ
LY X
LY Y
LY Z
LY WX
LY WY
LY WZCongreso Nacio
nal Laboratorio Cliacutenico 2018
As MCV is the mean which is calculated it is insensitive to the presence of a small number of macrocytes
Further macrocytosis can be obscured by concomitant disorders that can cause microcytosis resulting inmasked megaloblastic anaemia (MA) for example iron deficiency hereditary elliptocytosis alpha and betathalassemia
This study was undertaken to evaluate the role of NEUT-X and NEUT-Y in detecting MA on peripheral blood andalso see whether other forms of macrocytic anaemia can be differentiated from MA
In MA the peripheral blood smear shows cytopenia with macroovalocytes and hypersegmented
neutrophils (gt5 lobes in 5 neutrophils six lobes nuclei or lobe average of gt35)
In conclusion our study shows that higher values of NEUT-X and NEUT-Y in MA patients in spite of low ornormal MCV high RDW may be used to not only reveal the masked cases of MA with concomitant irondeficiency but also separate them from the broader macrocytic anaemia group
Peripheral smear remains diagnostic however making smear for all the suspicious cases is a cumbersomeand tedious procedure Thus these parameters emerge as more reliable and stable parameters in themodern laboratories which in future may replace the older screening tools
Congreso Nacional Laboratorio Cliacutenico
2018
A favor Eficiencia Operativa
Mejora el proceso del Laboratorio
Mejor informacioacuten al Cliacutenico al mismo coste
Mejora la informacioacuten
Informa sobre la eritropoyesis deteccioacuten precoz de estados carenciales
Ayuda al cliacutenico
Estado real del paciente
En contraParaacutemetros de investigacioacuten
Dificultad de standarizar dependencia teacutecnica
Control de calidadCongreso Nacional Laboratorio Cliacutenico
2018
bull A total of 1105 NES participants (639 men 466 women)bull CHr becomes affected in a relatively early stage in the development of iron deficiency before iron
deficiency anemia and clinical symptoms become apparentbull Therefore this parameter might be useful to identify persons healthy and diseased at risk of
developing iron deficiency anemia and subsequently to apply interventions in order to prevent further development of iron deficiency anemiaCongreso Nacio
nal Laboratorio Cliacutenico 2018
Hb reticulocitaria sensible para detectar la fase inicial del deacuteficit de hierro cuando laeritropoyesis requiere maacutes cantidad que la que recibe ANTES de que la anemia seestablezca
Congreso Nacional Laboratorio Cliacutenico
2018
No ID LID P
RBC 1012L 48 (08) 437 (05) lt00001
Hb gL 135 (6) 131 (12) 0006
MCV fL 922 (21) 902 (38) 0006
MCH pg 324 (07) 306 (22) lt00001
MCHC gL 339 (6) 319 (23) 0001
RDW
Ret He pg
Hypo He
LHD
Ferritin microgL
131 (06)
338 (21)
03 (015)
28 (20)
86 (3)
145 (21)
278 (24)
69 (55)
56 (25)
16 (76)
lt00001
lt00001
lt00001
lt00001
lt00001
AUC 95 CI Cutoff Sensitivity Specificity
LHD 0898 0819-0978 50 859 841
Ret He 0914 0824-1000 299pg 868 857
Hypo He 0934 0856-1000 16 857 921
Clinical value of markers of hypochromia in the detection of latent iron deficiency in non-anemic premenopausal women
No ID Hb gt 120 gL s-ferritin was within reference intervalLatent Iron Defiency Hb gt 120 gL s-ferritin lt 30 μgL
Urrechaga E et al Journal Clin Lab Analysis 2016 30 (5) 623-627
97 women (388) in 250 apparently healthy women had latent IDCongreso Nacional Laboratorio Cliacutenico
2018
Schorer G et al Abstract Jahreskongress der Deutschen Gesellschaft fuumlr Transfusionsmedizin und Immunhaumlmatologie Rostock 15 - 18 September 2009
Congreso Nacional Laboratorio Cliacutenico
2018
Caring for Those Who Share Mitigating Iron Deficiency in Regular Blood DonorsMast Alan E
bull Iron deficiency caused by regular blood donation is a problem facing blood centers Each blood donation removes 200 to 250 mg of iron from the donor Consequently many donors become iron deficient with repeated donation
bull This presents a challenge to blood centers that has become more acute in recent years with the realization that iron deficiency even in the absence of anemia is associated with adverse effects including fatigue and decreased exercise tolerance as well as neurological symptoms such as decreased cognitive function pica and restless leg syndrome
bull REDS-II investigators performed a longitudinal study investigating the iron status of blood donors over a two year period called the REDS-II Donor Iron Status Evaluation (RISE)
bull Results from the baseline analysis of regular donors (e 2 donations per year (females) or e 3 donations per year (males) revealed that over two-thirds of female donors and over one-half of male donors have iron deficiency
Congreso Nacional Laboratorio Cliacutenico
2018
Transfusion 2013 532766-2775
bull We evaluated the diagnostic sensitivity and specificity of red blood cell (RBC) hematology analyzer indices to assess iron status as a part of donor management iron deficient erythropoiesis (IDE) and absence of iron stores (AIS)
bull STUDY DESIGN AND METHODS A total of 1659 male and female donors from the Retrovirus Epidemiology Donor Study-II (REDS-II) Donor Iron Status Evaluation (RISE) study who were either first-timereactivated (FT RA no donations for 2 years) or frequent donors were recruited into a longitudinal study of regular donation of RBCs Of these 1002 donors returned 15 to 24 months later for a final assessment
Absent iron stores (AIS) was defined as plasma ferritin level of less than 12 mgL Logarithm of the ratio of soluble transferrin receptor to ferritin of at least 207 was used to define iron-deficient erythropoiesis (IDE)
bull RESULTS HYPOm and CHr detected IDE with comparable sensitivity 72 versus 69 but differed in specificity HYPOm 68 and CHr 53
For detecting AIS sensitivity was improved to 85 for HYPOm and 81 for CHr but specificity was reduced
Venous Hb had high specificity but poor sensitivity for IDE and AIS A plasma ferritin level of less than 267 mgL was a good surrogate for assessing IDE Congreso Nacio
nal Laboratorio Cliacutenico 2018
Microcytic RBC and reticulocyte mean cell hemoglobin content predicted iron depletion with
sensitivities 70 and 64
specificities of 72 and 78 respectively
When both combined
increased the sensitivity to 82
Congreso Nacional Laboratorio Cliacutenico
2018
Depending on the number of donations during the preceding12 months
Absent iron stores were detected in up to 214 of male and278 of female donors respectively
impaired hemoglobinisation IH was present in up to 64 maleand 167 female donors with 2 and 4 preceding donationsrespectively
The defined CHr cut-off value was 280 pg to detect IH infrequent whole blood donors with AIS leading to a testspecificity of 982 (positive predictive value PPV 577) inmale and of 978 (PPV 829) in female donors
It may help to prevent the development of anemia in frequentblood donors and also can help to decide whether donordeferral or even iron substitution need to be recommended
Congreso Nacional Laboratorio Cliacutenico
2018
Of the 501 blood donors sTfR and Ret-He detected Latent Iron Deficiency in 148 and 135 donors respectively
In comparison to sTfR Ret-He had sensitivity of 927 specificity of 9716 PPV of 931 and NPV of 963
Serum Ferritin TIBC and serum Iron had comparatively lower sensitivity of 8716 797 and 777 respectively
Conclusion Ret-He can be used as a routine screening test to detect LID in blood donors
This could provide an opportunity to make appropriate and timely interventions like dietary changes or drug supplementation
Congreso Nacional Laboratorio Cliacutenico
2018
Singh A Chaudhary R Pandey HC Sonker A Identification of iron status of blood donors by using low hemoglobin density and microcytic anemia factor Asian J Transfus Sci 20181246-50
The main objective of this study was to assess ifLHD and Maf could be used for assessment ofiron status in blood donors and also to establisha cut-off for these two parameters at which atentative iron deficiency could be reportedconclusively
Results LHD and Maf were able to differentiatebetween iron deficient and iron-depleteddonors from normal donorsA cutoff of 918 for LHD was able todifferentiate iron deficient and depleted statefrom normal iron statessensitivity 919 and specificity 71respectivelya cutoff of 1016 for Mafsensitivity 946 and specificity 968
MAf = (MVC Hb) 100
Congreso Nacional Laboratorio Cliacutenico
2018
Hb reticulocitaria sensible para detectar la fase inicial del deacuteficitde hierro cuando la eritropoyesis requiere maacutes cantidad que laque recibe ANTES de que la anemia se establezca
La deteccioacuten precoz del deacuteficit de hierro en la fase del balance negativo demanda aporte contribuye a reducir sus manifestaciones cliacutenicas en los pacientes afectados mejorando la salud puacuteblica
Un tratamiento menos prolongado con suplementos y menor consumo de los recursos sanitaros Contribuye a la eficiencia y sostenibilidad de los servicios sanitarios
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
Buttarello MLaboratory diagnosis of anemia are the old and new red cell parameters useful in classification and treatment howInt Jnl Lab Hem 2016 38 (Suppl 1) 123ndash132
Congreso Nacional Laboratorio Cliacutenico
2018
Buttarello MLaboratory diagnosis of anemia are the old and new red cell parameters useful in classification and treatment howInt Jnl Lab Hem 2016 38 (Suppl 1) 123ndash132
Congreso Nacional Laboratorio Cliacutenico
2018
Ralph Green amp Ananya Datta Mitra Megaloblastic Anemias Nutritional and Other CausesMed Clin N Am 2017 101 297ndash317
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
ANEMIA CARENCIAL CAUSAS
Factores alimentariosConsumir una dieta vegetariana mal planeadaAlimentacioacuten deficiente en los bebeacutesDesnutricioacuten durante el embarazo
Deacuteficit de absorcioacutenAlcoholismo croacutenicoEnfermedad de Crohn celiaquiacutea infeccioacuten otros problemas que le dificulten al cuerpo la digestioacuten de los alimentosAnemia perniciosa (factor intriacutenseco)Cirugiacuteas para extirpar ciertas partes del estoacutemago o el intestino delgado
MedicamentosB12 omeprazol metformina colchicina aminosalicilatos neomicinaFOLATO fenitoiacutena metotrexato sulfasalacina triamtereno pirimetamina trimetoprim con sulfametoxazol barbituacutericos
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
Reacciones metaboacutelicas en las que participan la vitamina B12 y el folato bull la conversioacuten de metilmalonil-CoA a succinil-CoA donde la adenosil-cobalamina actuacutea de
cofactor Por ello un deacuteficit de B12 conlleva un aumento de metilmalonil-CoA y de su producto de hidroacutelisis el aacutecido metilmaloacutenico
bull la siacutentesis de metionina a partir de homocisteina gracias a la metionina sintetasa y a la metil-cobalamina como cofactor En esta misma reaccioacuten el metiltetrahidrofolato es transformado a tetrahidrofolato que es necesario para la siacutentesis de DNA
Congreso Nacional Laboratorio Cliacutenico
2018
Anemia macrociacutetica secundaria a deficiencia de aacutecido foacutelico y de vitamina B12(cobalamina)
La deficiencia de B12 yo aacutecido foacutelico es la causa maacutes frecuente de megaloblastosis
Dentro de distintas funciones generales del metabolismo la vitamina B12 es uncofactor esencial en la siacutentesis de ADN y ARN compromete a todas las ceacutelulas delorganismo
Su deficiencia se manifiesta en oacuterganos con alto recambio celular como la meacutedulaosea y en el sistema nervioso central (SNC) a traveacutes de la siacutentesis de mielina y lareparacioacuten axonal
La deficiencia de cobalamina es responsable de alteraciones hematoloacutegicasneuroloacutegicas neurocognitivas y neuropsiquiaacutetricas
La siacutentesis defectuosa de ADN conduce a la apoptosis y a la hemoacutelisis (intra yextramedular) causantes de la hemopoyesis inefectiva
En meacutedula la siacutentesis ineficiente de DNA causa cambios megaloblaacutesticos comoconsecuencIa anemia y citopenias
Congreso Nacional Laboratorio Cliacutenico
2018
Limitaciones de los meacutetodos diagnoacutesticos claacutesicos
Volumen Corpuscular Medio (VCM) y morfologiacutea de sangre perifeacuterica En una serie de pacientes con deacuteficit de cobalamina soacutelo un 29 teniacutean anemia y soacutelo un 36 teniacutean un VCM gt 100 fL
Un VCM normal no puede ser empleado para rechazar una determinacioacuten de nivel de cobalamina ya que hasta un 25 de casos con manifestaciones neuroloacutegicas cursan con un VCM normal
Cobalamina seacuterica (nivel de B12) Es el test diagnoacutestico rutinario inicial estaacutendar Es un test ampliamente disponible de bajo coste y automatizado Sin embargo presenta algunas limitaciones
-- Existencia de varias teacutecnicas y ausencia de un gold standard por lo que hay diferentes liacutemites de referencia
-- Variacioacuten intraindividual muy alta
La OMS publicoacute en 2008 las conclusiones de un grupo teacutecnico consultado sobre el deacuteficit de cobalamina y folato
El grupo reconocioacute que no existen unos umbrales universalmente reconocidos para definir el deacuteficit de ambas vitaminas y expresaron la necesidad de un consenso
Devalia V Hamilton MS and Molloy AM on behalf of the British Committee for standards in haematology Guidelines for the diagnosis and treatment of cobalamin and folate disorders Br J Haematol 2014 166(4) 496-513
Schrier SL Diagnosis and treatment of vitamin B12 and folate deficiency UpToDate Last updated Jun 25 2014
de Benoist B Conclusions of a WHO Technical Consultation on folate and vitamin B12 deficiencies Food Nutr Bull 200829(2 Suppl)S238ndash44Congreso Nacional Laboratorio Cliacutenico
2018
Tomado de Tefferi A Li C En Atlas of Clinical Hematology Publicado por JO Armitage Philadelphia Current Medicine 2004
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
Int Jnl Lab Hem 2007 29 327ndash334
Clin Lab 201662343-347
In ourstudy mean MCVrMCV ratio of healthy controls is130 as microcytic anemia irondeficiency anemia is121 as also macrocytic anemia vitamin B12 deficiencyanemia is 115
Congreso Nacional Laboratorio Cliacutenico
2018
Sualeh Muslim Khan Muhammad Akbar Agha
Mean cell volume of reticulocytemdashA new parameter for diagnosing sub-clinical cobalamin deficiency in blood donors Int J Lab Hem 20181ndash4
The Abbott CELL-DYN Sapphire Hematology System uses multi-angle polarized scatter separation (MAPSS) and focused flow impedance technologies
Congreso Nacional Laboratorio Cliacutenico
2018
MCVr at 985 fL yielded the highest Youdenrsquos index at sensitivity of 82 specificity of 828 AUC 0847 ( 95 CI 803-891)
Khan SM Agha MA Mean cell volume of reticulocyte-A new parameter for diagnosing sub-clinical cobalamin deficiency in blood donors
Int J Lab Hem 20181ndash4 2018 Jul 13 doi 101111ijlh12899
Congreso Nacional Laboratorio Cliacutenico
2018
Role of Cell Population Data in the detection of folate and cobalamin deficiency
J Nieto et al
XXXI st International Symposium on Technological Innovations in Laboratory Hematology ISLH 2018 10-12 May 2018 Brussels Belgium
M-V-NRET and SD-VNRET are the best discriminatory single parameters to distinguish between patients with B9B12 deficiency and reference subjects M-V-NRETAUC=0823 sensitivity 78 and specificity 86
AUC=0852 sensitivity 55 and specificity 60
Conclusions The CPD parameters of Volume and Light Scatter (M and SD of LALS angle) that inform about size and intracellular structure of RBCs provided very useful information for the detection of B9B12 deficiency
Congreso Nacional Laboratorio Cliacutenico
2018
Cell Population Data
bull Paraacutemetros poblacionales de los leucocitos
bull Describen la morfologiacutea tamantildeo
estructuras citoplasmaacuteticas
nuacutecleo aacutecidos nucleacuteicos
bull Son datos numeacutericos con los que se construyen los ejes de lo diagramas de dispersioacuten de los leucocitos
bull Dependen de la tecnologiacutea
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
High Sensitivity New Parameters for the Detection of Vitamin B12 and Folate Deficiencies Blood 2008 1125379
B12 def vs
Normals
Mann
Withney T-Test
ROC
AUC Sens Specif Cutoff signifROC
MCV p=03156 p=09533 0577
MPV p=00001 0802 792 806 lt83 p=00001
NE Mean
Volume plt00001 0862 833 778 gt1403 p=00001
MO Mean
Volume plt00001 0829 625 889 gt1723 p=00001
MRV p=00113 0705 50 964 gt1133 p=00051
Folate def vs
Normals
Mann
Withney T-Test
ROC
AUC Sens Specif Cut-off signifROC
MCV p=00798 p=06461 0665
MPV plt00001 0832 81 806 lt83 p=00001
NE Mean
Volume p=00008 087 952 694 gt1402 p=00001
MO Mean
Volume p=00002 0801 667 833 gt1696 p=00001
MRV p=00054 0731 476 964 gt1133 p=00019
The Mean Neutrophil Volume (MNE V) and Mean Monocyte Volume (MMOV) may be used for the detection of megaloblastic neutrophils and monocytes MNEV and MMOV have significantly higher sensitivity than the previous information from the red cells (MCV) detecting B12 or folate deficiency because they are not affected by the presence at the same time of Iron deficiency or other reasons of anemia
Congreso Nacional Laboratorio Cliacutenico
2018
POSTER 733
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
CPD Sysmex XN
NE SSC complejidad
NE SFL aacutecidos nucleacuteicos
NE FSC tamantildeo
NE WX
NE WY
NE WZ
MO X
MO Y
MO Z
MO WX
MO WY
MO WZ
LY X
LY Y
LY Z
LY WX
LY WY
LY WZCongreso Nacio
nal Laboratorio Cliacutenico 2018
As MCV is the mean which is calculated it is insensitive to the presence of a small number of macrocytes
Further macrocytosis can be obscured by concomitant disorders that can cause microcytosis resulting inmasked megaloblastic anaemia (MA) for example iron deficiency hereditary elliptocytosis alpha and betathalassemia
This study was undertaken to evaluate the role of NEUT-X and NEUT-Y in detecting MA on peripheral blood andalso see whether other forms of macrocytic anaemia can be differentiated from MA
In MA the peripheral blood smear shows cytopenia with macroovalocytes and hypersegmented
neutrophils (gt5 lobes in 5 neutrophils six lobes nuclei or lobe average of gt35)
In conclusion our study shows that higher values of NEUT-X and NEUT-Y in MA patients in spite of low ornormal MCV high RDW may be used to not only reveal the masked cases of MA with concomitant irondeficiency but also separate them from the broader macrocytic anaemia group
Peripheral smear remains diagnostic however making smear for all the suspicious cases is a cumbersomeand tedious procedure Thus these parameters emerge as more reliable and stable parameters in themodern laboratories which in future may replace the older screening tools
Congreso Nacional Laboratorio Cliacutenico
2018
A favor Eficiencia Operativa
Mejora el proceso del Laboratorio
Mejor informacioacuten al Cliacutenico al mismo coste
Mejora la informacioacuten
Informa sobre la eritropoyesis deteccioacuten precoz de estados carenciales
Ayuda al cliacutenico
Estado real del paciente
En contraParaacutemetros de investigacioacuten
Dificultad de standarizar dependencia teacutecnica
Control de calidadCongreso Nacional Laboratorio Cliacutenico
2018
Hb reticulocitaria sensible para detectar la fase inicial del deacuteficit de hierro cuando laeritropoyesis requiere maacutes cantidad que la que recibe ANTES de que la anemia seestablezca
Congreso Nacional Laboratorio Cliacutenico
2018
No ID LID P
RBC 1012L 48 (08) 437 (05) lt00001
Hb gL 135 (6) 131 (12) 0006
MCV fL 922 (21) 902 (38) 0006
MCH pg 324 (07) 306 (22) lt00001
MCHC gL 339 (6) 319 (23) 0001
RDW
Ret He pg
Hypo He
LHD
Ferritin microgL
131 (06)
338 (21)
03 (015)
28 (20)
86 (3)
145 (21)
278 (24)
69 (55)
56 (25)
16 (76)
lt00001
lt00001
lt00001
lt00001
lt00001
AUC 95 CI Cutoff Sensitivity Specificity
LHD 0898 0819-0978 50 859 841
Ret He 0914 0824-1000 299pg 868 857
Hypo He 0934 0856-1000 16 857 921
Clinical value of markers of hypochromia in the detection of latent iron deficiency in non-anemic premenopausal women
No ID Hb gt 120 gL s-ferritin was within reference intervalLatent Iron Defiency Hb gt 120 gL s-ferritin lt 30 μgL
Urrechaga E et al Journal Clin Lab Analysis 2016 30 (5) 623-627
97 women (388) in 250 apparently healthy women had latent IDCongreso Nacional Laboratorio Cliacutenico
2018
Schorer G et al Abstract Jahreskongress der Deutschen Gesellschaft fuumlr Transfusionsmedizin und Immunhaumlmatologie Rostock 15 - 18 September 2009
Congreso Nacional Laboratorio Cliacutenico
2018
Caring for Those Who Share Mitigating Iron Deficiency in Regular Blood DonorsMast Alan E
bull Iron deficiency caused by regular blood donation is a problem facing blood centers Each blood donation removes 200 to 250 mg of iron from the donor Consequently many donors become iron deficient with repeated donation
bull This presents a challenge to blood centers that has become more acute in recent years with the realization that iron deficiency even in the absence of anemia is associated with adverse effects including fatigue and decreased exercise tolerance as well as neurological symptoms such as decreased cognitive function pica and restless leg syndrome
bull REDS-II investigators performed a longitudinal study investigating the iron status of blood donors over a two year period called the REDS-II Donor Iron Status Evaluation (RISE)
bull Results from the baseline analysis of regular donors (e 2 donations per year (females) or e 3 donations per year (males) revealed that over two-thirds of female donors and over one-half of male donors have iron deficiency
Congreso Nacional Laboratorio Cliacutenico
2018
Transfusion 2013 532766-2775
bull We evaluated the diagnostic sensitivity and specificity of red blood cell (RBC) hematology analyzer indices to assess iron status as a part of donor management iron deficient erythropoiesis (IDE) and absence of iron stores (AIS)
bull STUDY DESIGN AND METHODS A total of 1659 male and female donors from the Retrovirus Epidemiology Donor Study-II (REDS-II) Donor Iron Status Evaluation (RISE) study who were either first-timereactivated (FT RA no donations for 2 years) or frequent donors were recruited into a longitudinal study of regular donation of RBCs Of these 1002 donors returned 15 to 24 months later for a final assessment
Absent iron stores (AIS) was defined as plasma ferritin level of less than 12 mgL Logarithm of the ratio of soluble transferrin receptor to ferritin of at least 207 was used to define iron-deficient erythropoiesis (IDE)
bull RESULTS HYPOm and CHr detected IDE with comparable sensitivity 72 versus 69 but differed in specificity HYPOm 68 and CHr 53
For detecting AIS sensitivity was improved to 85 for HYPOm and 81 for CHr but specificity was reduced
Venous Hb had high specificity but poor sensitivity for IDE and AIS A plasma ferritin level of less than 267 mgL was a good surrogate for assessing IDE Congreso Nacio
nal Laboratorio Cliacutenico 2018
Microcytic RBC and reticulocyte mean cell hemoglobin content predicted iron depletion with
sensitivities 70 and 64
specificities of 72 and 78 respectively
When both combined
increased the sensitivity to 82
Congreso Nacional Laboratorio Cliacutenico
2018
Depending on the number of donations during the preceding12 months
Absent iron stores were detected in up to 214 of male and278 of female donors respectively
impaired hemoglobinisation IH was present in up to 64 maleand 167 female donors with 2 and 4 preceding donationsrespectively
The defined CHr cut-off value was 280 pg to detect IH infrequent whole blood donors with AIS leading to a testspecificity of 982 (positive predictive value PPV 577) inmale and of 978 (PPV 829) in female donors
It may help to prevent the development of anemia in frequentblood donors and also can help to decide whether donordeferral or even iron substitution need to be recommended
Congreso Nacional Laboratorio Cliacutenico
2018
Of the 501 blood donors sTfR and Ret-He detected Latent Iron Deficiency in 148 and 135 donors respectively
In comparison to sTfR Ret-He had sensitivity of 927 specificity of 9716 PPV of 931 and NPV of 963
Serum Ferritin TIBC and serum Iron had comparatively lower sensitivity of 8716 797 and 777 respectively
Conclusion Ret-He can be used as a routine screening test to detect LID in blood donors
This could provide an opportunity to make appropriate and timely interventions like dietary changes or drug supplementation
Congreso Nacional Laboratorio Cliacutenico
2018
Singh A Chaudhary R Pandey HC Sonker A Identification of iron status of blood donors by using low hemoglobin density and microcytic anemia factor Asian J Transfus Sci 20181246-50
The main objective of this study was to assess ifLHD and Maf could be used for assessment ofiron status in blood donors and also to establisha cut-off for these two parameters at which atentative iron deficiency could be reportedconclusively
Results LHD and Maf were able to differentiatebetween iron deficient and iron-depleteddonors from normal donorsA cutoff of 918 for LHD was able todifferentiate iron deficient and depleted statefrom normal iron statessensitivity 919 and specificity 71respectivelya cutoff of 1016 for Mafsensitivity 946 and specificity 968
MAf = (MVC Hb) 100
Congreso Nacional Laboratorio Cliacutenico
2018
Hb reticulocitaria sensible para detectar la fase inicial del deacuteficitde hierro cuando la eritropoyesis requiere maacutes cantidad que laque recibe ANTES de que la anemia se establezca
La deteccioacuten precoz del deacuteficit de hierro en la fase del balance negativo demanda aporte contribuye a reducir sus manifestaciones cliacutenicas en los pacientes afectados mejorando la salud puacuteblica
Un tratamiento menos prolongado con suplementos y menor consumo de los recursos sanitaros Contribuye a la eficiencia y sostenibilidad de los servicios sanitarios
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
Buttarello MLaboratory diagnosis of anemia are the old and new red cell parameters useful in classification and treatment howInt Jnl Lab Hem 2016 38 (Suppl 1) 123ndash132
Congreso Nacional Laboratorio Cliacutenico
2018
Buttarello MLaboratory diagnosis of anemia are the old and new red cell parameters useful in classification and treatment howInt Jnl Lab Hem 2016 38 (Suppl 1) 123ndash132
Congreso Nacional Laboratorio Cliacutenico
2018
Ralph Green amp Ananya Datta Mitra Megaloblastic Anemias Nutritional and Other CausesMed Clin N Am 2017 101 297ndash317
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
ANEMIA CARENCIAL CAUSAS
Factores alimentariosConsumir una dieta vegetariana mal planeadaAlimentacioacuten deficiente en los bebeacutesDesnutricioacuten durante el embarazo
Deacuteficit de absorcioacutenAlcoholismo croacutenicoEnfermedad de Crohn celiaquiacutea infeccioacuten otros problemas que le dificulten al cuerpo la digestioacuten de los alimentosAnemia perniciosa (factor intriacutenseco)Cirugiacuteas para extirpar ciertas partes del estoacutemago o el intestino delgado
MedicamentosB12 omeprazol metformina colchicina aminosalicilatos neomicinaFOLATO fenitoiacutena metotrexato sulfasalacina triamtereno pirimetamina trimetoprim con sulfametoxazol barbituacutericos
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
Reacciones metaboacutelicas en las que participan la vitamina B12 y el folato bull la conversioacuten de metilmalonil-CoA a succinil-CoA donde la adenosil-cobalamina actuacutea de
cofactor Por ello un deacuteficit de B12 conlleva un aumento de metilmalonil-CoA y de su producto de hidroacutelisis el aacutecido metilmaloacutenico
bull la siacutentesis de metionina a partir de homocisteina gracias a la metionina sintetasa y a la metil-cobalamina como cofactor En esta misma reaccioacuten el metiltetrahidrofolato es transformado a tetrahidrofolato que es necesario para la siacutentesis de DNA
Congreso Nacional Laboratorio Cliacutenico
2018
Anemia macrociacutetica secundaria a deficiencia de aacutecido foacutelico y de vitamina B12(cobalamina)
La deficiencia de B12 yo aacutecido foacutelico es la causa maacutes frecuente de megaloblastosis
Dentro de distintas funciones generales del metabolismo la vitamina B12 es uncofactor esencial en la siacutentesis de ADN y ARN compromete a todas las ceacutelulas delorganismo
Su deficiencia se manifiesta en oacuterganos con alto recambio celular como la meacutedulaosea y en el sistema nervioso central (SNC) a traveacutes de la siacutentesis de mielina y lareparacioacuten axonal
La deficiencia de cobalamina es responsable de alteraciones hematoloacutegicasneuroloacutegicas neurocognitivas y neuropsiquiaacutetricas
La siacutentesis defectuosa de ADN conduce a la apoptosis y a la hemoacutelisis (intra yextramedular) causantes de la hemopoyesis inefectiva
En meacutedula la siacutentesis ineficiente de DNA causa cambios megaloblaacutesticos comoconsecuencIa anemia y citopenias
Congreso Nacional Laboratorio Cliacutenico
2018
Limitaciones de los meacutetodos diagnoacutesticos claacutesicos
Volumen Corpuscular Medio (VCM) y morfologiacutea de sangre perifeacuterica En una serie de pacientes con deacuteficit de cobalamina soacutelo un 29 teniacutean anemia y soacutelo un 36 teniacutean un VCM gt 100 fL
Un VCM normal no puede ser empleado para rechazar una determinacioacuten de nivel de cobalamina ya que hasta un 25 de casos con manifestaciones neuroloacutegicas cursan con un VCM normal
Cobalamina seacuterica (nivel de B12) Es el test diagnoacutestico rutinario inicial estaacutendar Es un test ampliamente disponible de bajo coste y automatizado Sin embargo presenta algunas limitaciones
-- Existencia de varias teacutecnicas y ausencia de un gold standard por lo que hay diferentes liacutemites de referencia
-- Variacioacuten intraindividual muy alta
La OMS publicoacute en 2008 las conclusiones de un grupo teacutecnico consultado sobre el deacuteficit de cobalamina y folato
El grupo reconocioacute que no existen unos umbrales universalmente reconocidos para definir el deacuteficit de ambas vitaminas y expresaron la necesidad de un consenso
Devalia V Hamilton MS and Molloy AM on behalf of the British Committee for standards in haematology Guidelines for the diagnosis and treatment of cobalamin and folate disorders Br J Haematol 2014 166(4) 496-513
Schrier SL Diagnosis and treatment of vitamin B12 and folate deficiency UpToDate Last updated Jun 25 2014
de Benoist B Conclusions of a WHO Technical Consultation on folate and vitamin B12 deficiencies Food Nutr Bull 200829(2 Suppl)S238ndash44Congreso Nacional Laboratorio Cliacutenico
2018
Tomado de Tefferi A Li C En Atlas of Clinical Hematology Publicado por JO Armitage Philadelphia Current Medicine 2004
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
Int Jnl Lab Hem 2007 29 327ndash334
Clin Lab 201662343-347
In ourstudy mean MCVrMCV ratio of healthy controls is130 as microcytic anemia irondeficiency anemia is121 as also macrocytic anemia vitamin B12 deficiencyanemia is 115
Congreso Nacional Laboratorio Cliacutenico
2018
Sualeh Muslim Khan Muhammad Akbar Agha
Mean cell volume of reticulocytemdashA new parameter for diagnosing sub-clinical cobalamin deficiency in blood donors Int J Lab Hem 20181ndash4
The Abbott CELL-DYN Sapphire Hematology System uses multi-angle polarized scatter separation (MAPSS) and focused flow impedance technologies
Congreso Nacional Laboratorio Cliacutenico
2018
MCVr at 985 fL yielded the highest Youdenrsquos index at sensitivity of 82 specificity of 828 AUC 0847 ( 95 CI 803-891)
Khan SM Agha MA Mean cell volume of reticulocyte-A new parameter for diagnosing sub-clinical cobalamin deficiency in blood donors
Int J Lab Hem 20181ndash4 2018 Jul 13 doi 101111ijlh12899
Congreso Nacional Laboratorio Cliacutenico
2018
Role of Cell Population Data in the detection of folate and cobalamin deficiency
J Nieto et al
XXXI st International Symposium on Technological Innovations in Laboratory Hematology ISLH 2018 10-12 May 2018 Brussels Belgium
M-V-NRET and SD-VNRET are the best discriminatory single parameters to distinguish between patients with B9B12 deficiency and reference subjects M-V-NRETAUC=0823 sensitivity 78 and specificity 86
AUC=0852 sensitivity 55 and specificity 60
Conclusions The CPD parameters of Volume and Light Scatter (M and SD of LALS angle) that inform about size and intracellular structure of RBCs provided very useful information for the detection of B9B12 deficiency
Congreso Nacional Laboratorio Cliacutenico
2018
Cell Population Data
bull Paraacutemetros poblacionales de los leucocitos
bull Describen la morfologiacutea tamantildeo
estructuras citoplasmaacuteticas
nuacutecleo aacutecidos nucleacuteicos
bull Son datos numeacutericos con los que se construyen los ejes de lo diagramas de dispersioacuten de los leucocitos
bull Dependen de la tecnologiacutea
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
High Sensitivity New Parameters for the Detection of Vitamin B12 and Folate Deficiencies Blood 2008 1125379
B12 def vs
Normals
Mann
Withney T-Test
ROC
AUC Sens Specif Cutoff signifROC
MCV p=03156 p=09533 0577
MPV p=00001 0802 792 806 lt83 p=00001
NE Mean
Volume plt00001 0862 833 778 gt1403 p=00001
MO Mean
Volume plt00001 0829 625 889 gt1723 p=00001
MRV p=00113 0705 50 964 gt1133 p=00051
Folate def vs
Normals
Mann
Withney T-Test
ROC
AUC Sens Specif Cut-off signifROC
MCV p=00798 p=06461 0665
MPV plt00001 0832 81 806 lt83 p=00001
NE Mean
Volume p=00008 087 952 694 gt1402 p=00001
MO Mean
Volume p=00002 0801 667 833 gt1696 p=00001
MRV p=00054 0731 476 964 gt1133 p=00019
The Mean Neutrophil Volume (MNE V) and Mean Monocyte Volume (MMOV) may be used for the detection of megaloblastic neutrophils and monocytes MNEV and MMOV have significantly higher sensitivity than the previous information from the red cells (MCV) detecting B12 or folate deficiency because they are not affected by the presence at the same time of Iron deficiency or other reasons of anemia
Congreso Nacional Laboratorio Cliacutenico
2018
POSTER 733
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
CPD Sysmex XN
NE SSC complejidad
NE SFL aacutecidos nucleacuteicos
NE FSC tamantildeo
NE WX
NE WY
NE WZ
MO X
MO Y
MO Z
MO WX
MO WY
MO WZ
LY X
LY Y
LY Z
LY WX
LY WY
LY WZCongreso Nacio
nal Laboratorio Cliacutenico 2018
As MCV is the mean which is calculated it is insensitive to the presence of a small number of macrocytes
Further macrocytosis can be obscured by concomitant disorders that can cause microcytosis resulting inmasked megaloblastic anaemia (MA) for example iron deficiency hereditary elliptocytosis alpha and betathalassemia
This study was undertaken to evaluate the role of NEUT-X and NEUT-Y in detecting MA on peripheral blood andalso see whether other forms of macrocytic anaemia can be differentiated from MA
In MA the peripheral blood smear shows cytopenia with macroovalocytes and hypersegmented
neutrophils (gt5 lobes in 5 neutrophils six lobes nuclei or lobe average of gt35)
In conclusion our study shows that higher values of NEUT-X and NEUT-Y in MA patients in spite of low ornormal MCV high RDW may be used to not only reveal the masked cases of MA with concomitant irondeficiency but also separate them from the broader macrocytic anaemia group
Peripheral smear remains diagnostic however making smear for all the suspicious cases is a cumbersomeand tedious procedure Thus these parameters emerge as more reliable and stable parameters in themodern laboratories which in future may replace the older screening tools
Congreso Nacional Laboratorio Cliacutenico
2018
A favor Eficiencia Operativa
Mejora el proceso del Laboratorio
Mejor informacioacuten al Cliacutenico al mismo coste
Mejora la informacioacuten
Informa sobre la eritropoyesis deteccioacuten precoz de estados carenciales
Ayuda al cliacutenico
Estado real del paciente
En contraParaacutemetros de investigacioacuten
Dificultad de standarizar dependencia teacutecnica
Control de calidadCongreso Nacional Laboratorio Cliacutenico
2018
No ID LID P
RBC 1012L 48 (08) 437 (05) lt00001
Hb gL 135 (6) 131 (12) 0006
MCV fL 922 (21) 902 (38) 0006
MCH pg 324 (07) 306 (22) lt00001
MCHC gL 339 (6) 319 (23) 0001
RDW
Ret He pg
Hypo He
LHD
Ferritin microgL
131 (06)
338 (21)
03 (015)
28 (20)
86 (3)
145 (21)
278 (24)
69 (55)
56 (25)
16 (76)
lt00001
lt00001
lt00001
lt00001
lt00001
AUC 95 CI Cutoff Sensitivity Specificity
LHD 0898 0819-0978 50 859 841
Ret He 0914 0824-1000 299pg 868 857
Hypo He 0934 0856-1000 16 857 921
Clinical value of markers of hypochromia in the detection of latent iron deficiency in non-anemic premenopausal women
No ID Hb gt 120 gL s-ferritin was within reference intervalLatent Iron Defiency Hb gt 120 gL s-ferritin lt 30 μgL
Urrechaga E et al Journal Clin Lab Analysis 2016 30 (5) 623-627
97 women (388) in 250 apparently healthy women had latent IDCongreso Nacional Laboratorio Cliacutenico
2018
Schorer G et al Abstract Jahreskongress der Deutschen Gesellschaft fuumlr Transfusionsmedizin und Immunhaumlmatologie Rostock 15 - 18 September 2009
Congreso Nacional Laboratorio Cliacutenico
2018
Caring for Those Who Share Mitigating Iron Deficiency in Regular Blood DonorsMast Alan E
bull Iron deficiency caused by regular blood donation is a problem facing blood centers Each blood donation removes 200 to 250 mg of iron from the donor Consequently many donors become iron deficient with repeated donation
bull This presents a challenge to blood centers that has become more acute in recent years with the realization that iron deficiency even in the absence of anemia is associated with adverse effects including fatigue and decreased exercise tolerance as well as neurological symptoms such as decreased cognitive function pica and restless leg syndrome
bull REDS-II investigators performed a longitudinal study investigating the iron status of blood donors over a two year period called the REDS-II Donor Iron Status Evaluation (RISE)
bull Results from the baseline analysis of regular donors (e 2 donations per year (females) or e 3 donations per year (males) revealed that over two-thirds of female donors and over one-half of male donors have iron deficiency
Congreso Nacional Laboratorio Cliacutenico
2018
Transfusion 2013 532766-2775
bull We evaluated the diagnostic sensitivity and specificity of red blood cell (RBC) hematology analyzer indices to assess iron status as a part of donor management iron deficient erythropoiesis (IDE) and absence of iron stores (AIS)
bull STUDY DESIGN AND METHODS A total of 1659 male and female donors from the Retrovirus Epidemiology Donor Study-II (REDS-II) Donor Iron Status Evaluation (RISE) study who were either first-timereactivated (FT RA no donations for 2 years) or frequent donors were recruited into a longitudinal study of regular donation of RBCs Of these 1002 donors returned 15 to 24 months later for a final assessment
Absent iron stores (AIS) was defined as plasma ferritin level of less than 12 mgL Logarithm of the ratio of soluble transferrin receptor to ferritin of at least 207 was used to define iron-deficient erythropoiesis (IDE)
bull RESULTS HYPOm and CHr detected IDE with comparable sensitivity 72 versus 69 but differed in specificity HYPOm 68 and CHr 53
For detecting AIS sensitivity was improved to 85 for HYPOm and 81 for CHr but specificity was reduced
Venous Hb had high specificity but poor sensitivity for IDE and AIS A plasma ferritin level of less than 267 mgL was a good surrogate for assessing IDE Congreso Nacio
nal Laboratorio Cliacutenico 2018
Microcytic RBC and reticulocyte mean cell hemoglobin content predicted iron depletion with
sensitivities 70 and 64
specificities of 72 and 78 respectively
When both combined
increased the sensitivity to 82
Congreso Nacional Laboratorio Cliacutenico
2018
Depending on the number of donations during the preceding12 months
Absent iron stores were detected in up to 214 of male and278 of female donors respectively
impaired hemoglobinisation IH was present in up to 64 maleand 167 female donors with 2 and 4 preceding donationsrespectively
The defined CHr cut-off value was 280 pg to detect IH infrequent whole blood donors with AIS leading to a testspecificity of 982 (positive predictive value PPV 577) inmale and of 978 (PPV 829) in female donors
It may help to prevent the development of anemia in frequentblood donors and also can help to decide whether donordeferral or even iron substitution need to be recommended
Congreso Nacional Laboratorio Cliacutenico
2018
Of the 501 blood donors sTfR and Ret-He detected Latent Iron Deficiency in 148 and 135 donors respectively
In comparison to sTfR Ret-He had sensitivity of 927 specificity of 9716 PPV of 931 and NPV of 963
Serum Ferritin TIBC and serum Iron had comparatively lower sensitivity of 8716 797 and 777 respectively
Conclusion Ret-He can be used as a routine screening test to detect LID in blood donors
This could provide an opportunity to make appropriate and timely interventions like dietary changes or drug supplementation
Congreso Nacional Laboratorio Cliacutenico
2018
Singh A Chaudhary R Pandey HC Sonker A Identification of iron status of blood donors by using low hemoglobin density and microcytic anemia factor Asian J Transfus Sci 20181246-50
The main objective of this study was to assess ifLHD and Maf could be used for assessment ofiron status in blood donors and also to establisha cut-off for these two parameters at which atentative iron deficiency could be reportedconclusively
Results LHD and Maf were able to differentiatebetween iron deficient and iron-depleteddonors from normal donorsA cutoff of 918 for LHD was able todifferentiate iron deficient and depleted statefrom normal iron statessensitivity 919 and specificity 71respectivelya cutoff of 1016 for Mafsensitivity 946 and specificity 968
MAf = (MVC Hb) 100
Congreso Nacional Laboratorio Cliacutenico
2018
Hb reticulocitaria sensible para detectar la fase inicial del deacuteficitde hierro cuando la eritropoyesis requiere maacutes cantidad que laque recibe ANTES de que la anemia se establezca
La deteccioacuten precoz del deacuteficit de hierro en la fase del balance negativo demanda aporte contribuye a reducir sus manifestaciones cliacutenicas en los pacientes afectados mejorando la salud puacuteblica
Un tratamiento menos prolongado con suplementos y menor consumo de los recursos sanitaros Contribuye a la eficiencia y sostenibilidad de los servicios sanitarios
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
Buttarello MLaboratory diagnosis of anemia are the old and new red cell parameters useful in classification and treatment howInt Jnl Lab Hem 2016 38 (Suppl 1) 123ndash132
Congreso Nacional Laboratorio Cliacutenico
2018
Buttarello MLaboratory diagnosis of anemia are the old and new red cell parameters useful in classification and treatment howInt Jnl Lab Hem 2016 38 (Suppl 1) 123ndash132
Congreso Nacional Laboratorio Cliacutenico
2018
Ralph Green amp Ananya Datta Mitra Megaloblastic Anemias Nutritional and Other CausesMed Clin N Am 2017 101 297ndash317
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
ANEMIA CARENCIAL CAUSAS
Factores alimentariosConsumir una dieta vegetariana mal planeadaAlimentacioacuten deficiente en los bebeacutesDesnutricioacuten durante el embarazo
Deacuteficit de absorcioacutenAlcoholismo croacutenicoEnfermedad de Crohn celiaquiacutea infeccioacuten otros problemas que le dificulten al cuerpo la digestioacuten de los alimentosAnemia perniciosa (factor intriacutenseco)Cirugiacuteas para extirpar ciertas partes del estoacutemago o el intestino delgado
MedicamentosB12 omeprazol metformina colchicina aminosalicilatos neomicinaFOLATO fenitoiacutena metotrexato sulfasalacina triamtereno pirimetamina trimetoprim con sulfametoxazol barbituacutericos
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
Reacciones metaboacutelicas en las que participan la vitamina B12 y el folato bull la conversioacuten de metilmalonil-CoA a succinil-CoA donde la adenosil-cobalamina actuacutea de
cofactor Por ello un deacuteficit de B12 conlleva un aumento de metilmalonil-CoA y de su producto de hidroacutelisis el aacutecido metilmaloacutenico
bull la siacutentesis de metionina a partir de homocisteina gracias a la metionina sintetasa y a la metil-cobalamina como cofactor En esta misma reaccioacuten el metiltetrahidrofolato es transformado a tetrahidrofolato que es necesario para la siacutentesis de DNA
Congreso Nacional Laboratorio Cliacutenico
2018
Anemia macrociacutetica secundaria a deficiencia de aacutecido foacutelico y de vitamina B12(cobalamina)
La deficiencia de B12 yo aacutecido foacutelico es la causa maacutes frecuente de megaloblastosis
Dentro de distintas funciones generales del metabolismo la vitamina B12 es uncofactor esencial en la siacutentesis de ADN y ARN compromete a todas las ceacutelulas delorganismo
Su deficiencia se manifiesta en oacuterganos con alto recambio celular como la meacutedulaosea y en el sistema nervioso central (SNC) a traveacutes de la siacutentesis de mielina y lareparacioacuten axonal
La deficiencia de cobalamina es responsable de alteraciones hematoloacutegicasneuroloacutegicas neurocognitivas y neuropsiquiaacutetricas
La siacutentesis defectuosa de ADN conduce a la apoptosis y a la hemoacutelisis (intra yextramedular) causantes de la hemopoyesis inefectiva
En meacutedula la siacutentesis ineficiente de DNA causa cambios megaloblaacutesticos comoconsecuencIa anemia y citopenias
Congreso Nacional Laboratorio Cliacutenico
2018
Limitaciones de los meacutetodos diagnoacutesticos claacutesicos
Volumen Corpuscular Medio (VCM) y morfologiacutea de sangre perifeacuterica En una serie de pacientes con deacuteficit de cobalamina soacutelo un 29 teniacutean anemia y soacutelo un 36 teniacutean un VCM gt 100 fL
Un VCM normal no puede ser empleado para rechazar una determinacioacuten de nivel de cobalamina ya que hasta un 25 de casos con manifestaciones neuroloacutegicas cursan con un VCM normal
Cobalamina seacuterica (nivel de B12) Es el test diagnoacutestico rutinario inicial estaacutendar Es un test ampliamente disponible de bajo coste y automatizado Sin embargo presenta algunas limitaciones
-- Existencia de varias teacutecnicas y ausencia de un gold standard por lo que hay diferentes liacutemites de referencia
-- Variacioacuten intraindividual muy alta
La OMS publicoacute en 2008 las conclusiones de un grupo teacutecnico consultado sobre el deacuteficit de cobalamina y folato
El grupo reconocioacute que no existen unos umbrales universalmente reconocidos para definir el deacuteficit de ambas vitaminas y expresaron la necesidad de un consenso
Devalia V Hamilton MS and Molloy AM on behalf of the British Committee for standards in haematology Guidelines for the diagnosis and treatment of cobalamin and folate disorders Br J Haematol 2014 166(4) 496-513
Schrier SL Diagnosis and treatment of vitamin B12 and folate deficiency UpToDate Last updated Jun 25 2014
de Benoist B Conclusions of a WHO Technical Consultation on folate and vitamin B12 deficiencies Food Nutr Bull 200829(2 Suppl)S238ndash44Congreso Nacional Laboratorio Cliacutenico
2018
Tomado de Tefferi A Li C En Atlas of Clinical Hematology Publicado por JO Armitage Philadelphia Current Medicine 2004
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
Int Jnl Lab Hem 2007 29 327ndash334
Clin Lab 201662343-347
In ourstudy mean MCVrMCV ratio of healthy controls is130 as microcytic anemia irondeficiency anemia is121 as also macrocytic anemia vitamin B12 deficiencyanemia is 115
Congreso Nacional Laboratorio Cliacutenico
2018
Sualeh Muslim Khan Muhammad Akbar Agha
Mean cell volume of reticulocytemdashA new parameter for diagnosing sub-clinical cobalamin deficiency in blood donors Int J Lab Hem 20181ndash4
The Abbott CELL-DYN Sapphire Hematology System uses multi-angle polarized scatter separation (MAPSS) and focused flow impedance technologies
Congreso Nacional Laboratorio Cliacutenico
2018
MCVr at 985 fL yielded the highest Youdenrsquos index at sensitivity of 82 specificity of 828 AUC 0847 ( 95 CI 803-891)
Khan SM Agha MA Mean cell volume of reticulocyte-A new parameter for diagnosing sub-clinical cobalamin deficiency in blood donors
Int J Lab Hem 20181ndash4 2018 Jul 13 doi 101111ijlh12899
Congreso Nacional Laboratorio Cliacutenico
2018
Role of Cell Population Data in the detection of folate and cobalamin deficiency
J Nieto et al
XXXI st International Symposium on Technological Innovations in Laboratory Hematology ISLH 2018 10-12 May 2018 Brussels Belgium
M-V-NRET and SD-VNRET are the best discriminatory single parameters to distinguish between patients with B9B12 deficiency and reference subjects M-V-NRETAUC=0823 sensitivity 78 and specificity 86
AUC=0852 sensitivity 55 and specificity 60
Conclusions The CPD parameters of Volume and Light Scatter (M and SD of LALS angle) that inform about size and intracellular structure of RBCs provided very useful information for the detection of B9B12 deficiency
Congreso Nacional Laboratorio Cliacutenico
2018
Cell Population Data
bull Paraacutemetros poblacionales de los leucocitos
bull Describen la morfologiacutea tamantildeo
estructuras citoplasmaacuteticas
nuacutecleo aacutecidos nucleacuteicos
bull Son datos numeacutericos con los que se construyen los ejes de lo diagramas de dispersioacuten de los leucocitos
bull Dependen de la tecnologiacutea
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
High Sensitivity New Parameters for the Detection of Vitamin B12 and Folate Deficiencies Blood 2008 1125379
B12 def vs
Normals
Mann
Withney T-Test
ROC
AUC Sens Specif Cutoff signifROC
MCV p=03156 p=09533 0577
MPV p=00001 0802 792 806 lt83 p=00001
NE Mean
Volume plt00001 0862 833 778 gt1403 p=00001
MO Mean
Volume plt00001 0829 625 889 gt1723 p=00001
MRV p=00113 0705 50 964 gt1133 p=00051
Folate def vs
Normals
Mann
Withney T-Test
ROC
AUC Sens Specif Cut-off signifROC
MCV p=00798 p=06461 0665
MPV plt00001 0832 81 806 lt83 p=00001
NE Mean
Volume p=00008 087 952 694 gt1402 p=00001
MO Mean
Volume p=00002 0801 667 833 gt1696 p=00001
MRV p=00054 0731 476 964 gt1133 p=00019
The Mean Neutrophil Volume (MNE V) and Mean Monocyte Volume (MMOV) may be used for the detection of megaloblastic neutrophils and monocytes MNEV and MMOV have significantly higher sensitivity than the previous information from the red cells (MCV) detecting B12 or folate deficiency because they are not affected by the presence at the same time of Iron deficiency or other reasons of anemia
Congreso Nacional Laboratorio Cliacutenico
2018
POSTER 733
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
CPD Sysmex XN
NE SSC complejidad
NE SFL aacutecidos nucleacuteicos
NE FSC tamantildeo
NE WX
NE WY
NE WZ
MO X
MO Y
MO Z
MO WX
MO WY
MO WZ
LY X
LY Y
LY Z
LY WX
LY WY
LY WZCongreso Nacio
nal Laboratorio Cliacutenico 2018
As MCV is the mean which is calculated it is insensitive to the presence of a small number of macrocytes
Further macrocytosis can be obscured by concomitant disorders that can cause microcytosis resulting inmasked megaloblastic anaemia (MA) for example iron deficiency hereditary elliptocytosis alpha and betathalassemia
This study was undertaken to evaluate the role of NEUT-X and NEUT-Y in detecting MA on peripheral blood andalso see whether other forms of macrocytic anaemia can be differentiated from MA
In MA the peripheral blood smear shows cytopenia with macroovalocytes and hypersegmented
neutrophils (gt5 lobes in 5 neutrophils six lobes nuclei or lobe average of gt35)
In conclusion our study shows that higher values of NEUT-X and NEUT-Y in MA patients in spite of low ornormal MCV high RDW may be used to not only reveal the masked cases of MA with concomitant irondeficiency but also separate them from the broader macrocytic anaemia group
Peripheral smear remains diagnostic however making smear for all the suspicious cases is a cumbersomeand tedious procedure Thus these parameters emerge as more reliable and stable parameters in themodern laboratories which in future may replace the older screening tools
Congreso Nacional Laboratorio Cliacutenico
2018
A favor Eficiencia Operativa
Mejora el proceso del Laboratorio
Mejor informacioacuten al Cliacutenico al mismo coste
Mejora la informacioacuten
Informa sobre la eritropoyesis deteccioacuten precoz de estados carenciales
Ayuda al cliacutenico
Estado real del paciente
En contraParaacutemetros de investigacioacuten
Dificultad de standarizar dependencia teacutecnica
Control de calidadCongreso Nacional Laboratorio Cliacutenico
2018
Schorer G et al Abstract Jahreskongress der Deutschen Gesellschaft fuumlr Transfusionsmedizin und Immunhaumlmatologie Rostock 15 - 18 September 2009
Congreso Nacional Laboratorio Cliacutenico
2018
Caring for Those Who Share Mitigating Iron Deficiency in Regular Blood DonorsMast Alan E
bull Iron deficiency caused by regular blood donation is a problem facing blood centers Each blood donation removes 200 to 250 mg of iron from the donor Consequently many donors become iron deficient with repeated donation
bull This presents a challenge to blood centers that has become more acute in recent years with the realization that iron deficiency even in the absence of anemia is associated with adverse effects including fatigue and decreased exercise tolerance as well as neurological symptoms such as decreased cognitive function pica and restless leg syndrome
bull REDS-II investigators performed a longitudinal study investigating the iron status of blood donors over a two year period called the REDS-II Donor Iron Status Evaluation (RISE)
bull Results from the baseline analysis of regular donors (e 2 donations per year (females) or e 3 donations per year (males) revealed that over two-thirds of female donors and over one-half of male donors have iron deficiency
Congreso Nacional Laboratorio Cliacutenico
2018
Transfusion 2013 532766-2775
bull We evaluated the diagnostic sensitivity and specificity of red blood cell (RBC) hematology analyzer indices to assess iron status as a part of donor management iron deficient erythropoiesis (IDE) and absence of iron stores (AIS)
bull STUDY DESIGN AND METHODS A total of 1659 male and female donors from the Retrovirus Epidemiology Donor Study-II (REDS-II) Donor Iron Status Evaluation (RISE) study who were either first-timereactivated (FT RA no donations for 2 years) or frequent donors were recruited into a longitudinal study of regular donation of RBCs Of these 1002 donors returned 15 to 24 months later for a final assessment
Absent iron stores (AIS) was defined as plasma ferritin level of less than 12 mgL Logarithm of the ratio of soluble transferrin receptor to ferritin of at least 207 was used to define iron-deficient erythropoiesis (IDE)
bull RESULTS HYPOm and CHr detected IDE with comparable sensitivity 72 versus 69 but differed in specificity HYPOm 68 and CHr 53
For detecting AIS sensitivity was improved to 85 for HYPOm and 81 for CHr but specificity was reduced
Venous Hb had high specificity but poor sensitivity for IDE and AIS A plasma ferritin level of less than 267 mgL was a good surrogate for assessing IDE Congreso Nacio
nal Laboratorio Cliacutenico 2018
Microcytic RBC and reticulocyte mean cell hemoglobin content predicted iron depletion with
sensitivities 70 and 64
specificities of 72 and 78 respectively
When both combined
increased the sensitivity to 82
Congreso Nacional Laboratorio Cliacutenico
2018
Depending on the number of donations during the preceding12 months
Absent iron stores were detected in up to 214 of male and278 of female donors respectively
impaired hemoglobinisation IH was present in up to 64 maleand 167 female donors with 2 and 4 preceding donationsrespectively
The defined CHr cut-off value was 280 pg to detect IH infrequent whole blood donors with AIS leading to a testspecificity of 982 (positive predictive value PPV 577) inmale and of 978 (PPV 829) in female donors
It may help to prevent the development of anemia in frequentblood donors and also can help to decide whether donordeferral or even iron substitution need to be recommended
Congreso Nacional Laboratorio Cliacutenico
2018
Of the 501 blood donors sTfR and Ret-He detected Latent Iron Deficiency in 148 and 135 donors respectively
In comparison to sTfR Ret-He had sensitivity of 927 specificity of 9716 PPV of 931 and NPV of 963
Serum Ferritin TIBC and serum Iron had comparatively lower sensitivity of 8716 797 and 777 respectively
Conclusion Ret-He can be used as a routine screening test to detect LID in blood donors
This could provide an opportunity to make appropriate and timely interventions like dietary changes or drug supplementation
Congreso Nacional Laboratorio Cliacutenico
2018
Singh A Chaudhary R Pandey HC Sonker A Identification of iron status of blood donors by using low hemoglobin density and microcytic anemia factor Asian J Transfus Sci 20181246-50
The main objective of this study was to assess ifLHD and Maf could be used for assessment ofiron status in blood donors and also to establisha cut-off for these two parameters at which atentative iron deficiency could be reportedconclusively
Results LHD and Maf were able to differentiatebetween iron deficient and iron-depleteddonors from normal donorsA cutoff of 918 for LHD was able todifferentiate iron deficient and depleted statefrom normal iron statessensitivity 919 and specificity 71respectivelya cutoff of 1016 for Mafsensitivity 946 and specificity 968
MAf = (MVC Hb) 100
Congreso Nacional Laboratorio Cliacutenico
2018
Hb reticulocitaria sensible para detectar la fase inicial del deacuteficitde hierro cuando la eritropoyesis requiere maacutes cantidad que laque recibe ANTES de que la anemia se establezca
La deteccioacuten precoz del deacuteficit de hierro en la fase del balance negativo demanda aporte contribuye a reducir sus manifestaciones cliacutenicas en los pacientes afectados mejorando la salud puacuteblica
Un tratamiento menos prolongado con suplementos y menor consumo de los recursos sanitaros Contribuye a la eficiencia y sostenibilidad de los servicios sanitarios
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
Buttarello MLaboratory diagnosis of anemia are the old and new red cell parameters useful in classification and treatment howInt Jnl Lab Hem 2016 38 (Suppl 1) 123ndash132
Congreso Nacional Laboratorio Cliacutenico
2018
Buttarello MLaboratory diagnosis of anemia are the old and new red cell parameters useful in classification and treatment howInt Jnl Lab Hem 2016 38 (Suppl 1) 123ndash132
Congreso Nacional Laboratorio Cliacutenico
2018
Ralph Green amp Ananya Datta Mitra Megaloblastic Anemias Nutritional and Other CausesMed Clin N Am 2017 101 297ndash317
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
ANEMIA CARENCIAL CAUSAS
Factores alimentariosConsumir una dieta vegetariana mal planeadaAlimentacioacuten deficiente en los bebeacutesDesnutricioacuten durante el embarazo
Deacuteficit de absorcioacutenAlcoholismo croacutenicoEnfermedad de Crohn celiaquiacutea infeccioacuten otros problemas que le dificulten al cuerpo la digestioacuten de los alimentosAnemia perniciosa (factor intriacutenseco)Cirugiacuteas para extirpar ciertas partes del estoacutemago o el intestino delgado
MedicamentosB12 omeprazol metformina colchicina aminosalicilatos neomicinaFOLATO fenitoiacutena metotrexato sulfasalacina triamtereno pirimetamina trimetoprim con sulfametoxazol barbituacutericos
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
Reacciones metaboacutelicas en las que participan la vitamina B12 y el folato bull la conversioacuten de metilmalonil-CoA a succinil-CoA donde la adenosil-cobalamina actuacutea de
cofactor Por ello un deacuteficit de B12 conlleva un aumento de metilmalonil-CoA y de su producto de hidroacutelisis el aacutecido metilmaloacutenico
bull la siacutentesis de metionina a partir de homocisteina gracias a la metionina sintetasa y a la metil-cobalamina como cofactor En esta misma reaccioacuten el metiltetrahidrofolato es transformado a tetrahidrofolato que es necesario para la siacutentesis de DNA
Congreso Nacional Laboratorio Cliacutenico
2018
Anemia macrociacutetica secundaria a deficiencia de aacutecido foacutelico y de vitamina B12(cobalamina)
La deficiencia de B12 yo aacutecido foacutelico es la causa maacutes frecuente de megaloblastosis
Dentro de distintas funciones generales del metabolismo la vitamina B12 es uncofactor esencial en la siacutentesis de ADN y ARN compromete a todas las ceacutelulas delorganismo
Su deficiencia se manifiesta en oacuterganos con alto recambio celular como la meacutedulaosea y en el sistema nervioso central (SNC) a traveacutes de la siacutentesis de mielina y lareparacioacuten axonal
La deficiencia de cobalamina es responsable de alteraciones hematoloacutegicasneuroloacutegicas neurocognitivas y neuropsiquiaacutetricas
La siacutentesis defectuosa de ADN conduce a la apoptosis y a la hemoacutelisis (intra yextramedular) causantes de la hemopoyesis inefectiva
En meacutedula la siacutentesis ineficiente de DNA causa cambios megaloblaacutesticos comoconsecuencIa anemia y citopenias
Congreso Nacional Laboratorio Cliacutenico
2018
Limitaciones de los meacutetodos diagnoacutesticos claacutesicos
Volumen Corpuscular Medio (VCM) y morfologiacutea de sangre perifeacuterica En una serie de pacientes con deacuteficit de cobalamina soacutelo un 29 teniacutean anemia y soacutelo un 36 teniacutean un VCM gt 100 fL
Un VCM normal no puede ser empleado para rechazar una determinacioacuten de nivel de cobalamina ya que hasta un 25 de casos con manifestaciones neuroloacutegicas cursan con un VCM normal
Cobalamina seacuterica (nivel de B12) Es el test diagnoacutestico rutinario inicial estaacutendar Es un test ampliamente disponible de bajo coste y automatizado Sin embargo presenta algunas limitaciones
-- Existencia de varias teacutecnicas y ausencia de un gold standard por lo que hay diferentes liacutemites de referencia
-- Variacioacuten intraindividual muy alta
La OMS publicoacute en 2008 las conclusiones de un grupo teacutecnico consultado sobre el deacuteficit de cobalamina y folato
El grupo reconocioacute que no existen unos umbrales universalmente reconocidos para definir el deacuteficit de ambas vitaminas y expresaron la necesidad de un consenso
Devalia V Hamilton MS and Molloy AM on behalf of the British Committee for standards in haematology Guidelines for the diagnosis and treatment of cobalamin and folate disorders Br J Haematol 2014 166(4) 496-513
Schrier SL Diagnosis and treatment of vitamin B12 and folate deficiency UpToDate Last updated Jun 25 2014
de Benoist B Conclusions of a WHO Technical Consultation on folate and vitamin B12 deficiencies Food Nutr Bull 200829(2 Suppl)S238ndash44Congreso Nacional Laboratorio Cliacutenico
2018
Tomado de Tefferi A Li C En Atlas of Clinical Hematology Publicado por JO Armitage Philadelphia Current Medicine 2004
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
Int Jnl Lab Hem 2007 29 327ndash334
Clin Lab 201662343-347
In ourstudy mean MCVrMCV ratio of healthy controls is130 as microcytic anemia irondeficiency anemia is121 as also macrocytic anemia vitamin B12 deficiencyanemia is 115
Congreso Nacional Laboratorio Cliacutenico
2018
Sualeh Muslim Khan Muhammad Akbar Agha
Mean cell volume of reticulocytemdashA new parameter for diagnosing sub-clinical cobalamin deficiency in blood donors Int J Lab Hem 20181ndash4
The Abbott CELL-DYN Sapphire Hematology System uses multi-angle polarized scatter separation (MAPSS) and focused flow impedance technologies
Congreso Nacional Laboratorio Cliacutenico
2018
MCVr at 985 fL yielded the highest Youdenrsquos index at sensitivity of 82 specificity of 828 AUC 0847 ( 95 CI 803-891)
Khan SM Agha MA Mean cell volume of reticulocyte-A new parameter for diagnosing sub-clinical cobalamin deficiency in blood donors
Int J Lab Hem 20181ndash4 2018 Jul 13 doi 101111ijlh12899
Congreso Nacional Laboratorio Cliacutenico
2018
Role of Cell Population Data in the detection of folate and cobalamin deficiency
J Nieto et al
XXXI st International Symposium on Technological Innovations in Laboratory Hematology ISLH 2018 10-12 May 2018 Brussels Belgium
M-V-NRET and SD-VNRET are the best discriminatory single parameters to distinguish between patients with B9B12 deficiency and reference subjects M-V-NRETAUC=0823 sensitivity 78 and specificity 86
AUC=0852 sensitivity 55 and specificity 60
Conclusions The CPD parameters of Volume and Light Scatter (M and SD of LALS angle) that inform about size and intracellular structure of RBCs provided very useful information for the detection of B9B12 deficiency
Congreso Nacional Laboratorio Cliacutenico
2018
Cell Population Data
bull Paraacutemetros poblacionales de los leucocitos
bull Describen la morfologiacutea tamantildeo
estructuras citoplasmaacuteticas
nuacutecleo aacutecidos nucleacuteicos
bull Son datos numeacutericos con los que se construyen los ejes de lo diagramas de dispersioacuten de los leucocitos
bull Dependen de la tecnologiacutea
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
High Sensitivity New Parameters for the Detection of Vitamin B12 and Folate Deficiencies Blood 2008 1125379
B12 def vs
Normals
Mann
Withney T-Test
ROC
AUC Sens Specif Cutoff signifROC
MCV p=03156 p=09533 0577
MPV p=00001 0802 792 806 lt83 p=00001
NE Mean
Volume plt00001 0862 833 778 gt1403 p=00001
MO Mean
Volume plt00001 0829 625 889 gt1723 p=00001
MRV p=00113 0705 50 964 gt1133 p=00051
Folate def vs
Normals
Mann
Withney T-Test
ROC
AUC Sens Specif Cut-off signifROC
MCV p=00798 p=06461 0665
MPV plt00001 0832 81 806 lt83 p=00001
NE Mean
Volume p=00008 087 952 694 gt1402 p=00001
MO Mean
Volume p=00002 0801 667 833 gt1696 p=00001
MRV p=00054 0731 476 964 gt1133 p=00019
The Mean Neutrophil Volume (MNE V) and Mean Monocyte Volume (MMOV) may be used for the detection of megaloblastic neutrophils and monocytes MNEV and MMOV have significantly higher sensitivity than the previous information from the red cells (MCV) detecting B12 or folate deficiency because they are not affected by the presence at the same time of Iron deficiency or other reasons of anemia
Congreso Nacional Laboratorio Cliacutenico
2018
POSTER 733
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
CPD Sysmex XN
NE SSC complejidad
NE SFL aacutecidos nucleacuteicos
NE FSC tamantildeo
NE WX
NE WY
NE WZ
MO X
MO Y
MO Z
MO WX
MO WY
MO WZ
LY X
LY Y
LY Z
LY WX
LY WY
LY WZCongreso Nacio
nal Laboratorio Cliacutenico 2018
As MCV is the mean which is calculated it is insensitive to the presence of a small number of macrocytes
Further macrocytosis can be obscured by concomitant disorders that can cause microcytosis resulting inmasked megaloblastic anaemia (MA) for example iron deficiency hereditary elliptocytosis alpha and betathalassemia
This study was undertaken to evaluate the role of NEUT-X and NEUT-Y in detecting MA on peripheral blood andalso see whether other forms of macrocytic anaemia can be differentiated from MA
In MA the peripheral blood smear shows cytopenia with macroovalocytes and hypersegmented
neutrophils (gt5 lobes in 5 neutrophils six lobes nuclei or lobe average of gt35)
In conclusion our study shows that higher values of NEUT-X and NEUT-Y in MA patients in spite of low ornormal MCV high RDW may be used to not only reveal the masked cases of MA with concomitant irondeficiency but also separate them from the broader macrocytic anaemia group
Peripheral smear remains diagnostic however making smear for all the suspicious cases is a cumbersomeand tedious procedure Thus these parameters emerge as more reliable and stable parameters in themodern laboratories which in future may replace the older screening tools
Congreso Nacional Laboratorio Cliacutenico
2018
A favor Eficiencia Operativa
Mejora el proceso del Laboratorio
Mejor informacioacuten al Cliacutenico al mismo coste
Mejora la informacioacuten
Informa sobre la eritropoyesis deteccioacuten precoz de estados carenciales
Ayuda al cliacutenico
Estado real del paciente
En contraParaacutemetros de investigacioacuten
Dificultad de standarizar dependencia teacutecnica
Control de calidadCongreso Nacional Laboratorio Cliacutenico
2018
Caring for Those Who Share Mitigating Iron Deficiency in Regular Blood DonorsMast Alan E
bull Iron deficiency caused by regular blood donation is a problem facing blood centers Each blood donation removes 200 to 250 mg of iron from the donor Consequently many donors become iron deficient with repeated donation
bull This presents a challenge to blood centers that has become more acute in recent years with the realization that iron deficiency even in the absence of anemia is associated with adverse effects including fatigue and decreased exercise tolerance as well as neurological symptoms such as decreased cognitive function pica and restless leg syndrome
bull REDS-II investigators performed a longitudinal study investigating the iron status of blood donors over a two year period called the REDS-II Donor Iron Status Evaluation (RISE)
bull Results from the baseline analysis of regular donors (e 2 donations per year (females) or e 3 donations per year (males) revealed that over two-thirds of female donors and over one-half of male donors have iron deficiency
Congreso Nacional Laboratorio Cliacutenico
2018
Transfusion 2013 532766-2775
bull We evaluated the diagnostic sensitivity and specificity of red blood cell (RBC) hematology analyzer indices to assess iron status as a part of donor management iron deficient erythropoiesis (IDE) and absence of iron stores (AIS)
bull STUDY DESIGN AND METHODS A total of 1659 male and female donors from the Retrovirus Epidemiology Donor Study-II (REDS-II) Donor Iron Status Evaluation (RISE) study who were either first-timereactivated (FT RA no donations for 2 years) or frequent donors were recruited into a longitudinal study of regular donation of RBCs Of these 1002 donors returned 15 to 24 months later for a final assessment
Absent iron stores (AIS) was defined as plasma ferritin level of less than 12 mgL Logarithm of the ratio of soluble transferrin receptor to ferritin of at least 207 was used to define iron-deficient erythropoiesis (IDE)
bull RESULTS HYPOm and CHr detected IDE with comparable sensitivity 72 versus 69 but differed in specificity HYPOm 68 and CHr 53
For detecting AIS sensitivity was improved to 85 for HYPOm and 81 for CHr but specificity was reduced
Venous Hb had high specificity but poor sensitivity for IDE and AIS A plasma ferritin level of less than 267 mgL was a good surrogate for assessing IDE Congreso Nacio
nal Laboratorio Cliacutenico 2018
Microcytic RBC and reticulocyte mean cell hemoglobin content predicted iron depletion with
sensitivities 70 and 64
specificities of 72 and 78 respectively
When both combined
increased the sensitivity to 82
Congreso Nacional Laboratorio Cliacutenico
2018
Depending on the number of donations during the preceding12 months
Absent iron stores were detected in up to 214 of male and278 of female donors respectively
impaired hemoglobinisation IH was present in up to 64 maleand 167 female donors with 2 and 4 preceding donationsrespectively
The defined CHr cut-off value was 280 pg to detect IH infrequent whole blood donors with AIS leading to a testspecificity of 982 (positive predictive value PPV 577) inmale and of 978 (PPV 829) in female donors
It may help to prevent the development of anemia in frequentblood donors and also can help to decide whether donordeferral or even iron substitution need to be recommended
Congreso Nacional Laboratorio Cliacutenico
2018
Of the 501 blood donors sTfR and Ret-He detected Latent Iron Deficiency in 148 and 135 donors respectively
In comparison to sTfR Ret-He had sensitivity of 927 specificity of 9716 PPV of 931 and NPV of 963
Serum Ferritin TIBC and serum Iron had comparatively lower sensitivity of 8716 797 and 777 respectively
Conclusion Ret-He can be used as a routine screening test to detect LID in blood donors
This could provide an opportunity to make appropriate and timely interventions like dietary changes or drug supplementation
Congreso Nacional Laboratorio Cliacutenico
2018
Singh A Chaudhary R Pandey HC Sonker A Identification of iron status of blood donors by using low hemoglobin density and microcytic anemia factor Asian J Transfus Sci 20181246-50
The main objective of this study was to assess ifLHD and Maf could be used for assessment ofiron status in blood donors and also to establisha cut-off for these two parameters at which atentative iron deficiency could be reportedconclusively
Results LHD and Maf were able to differentiatebetween iron deficient and iron-depleteddonors from normal donorsA cutoff of 918 for LHD was able todifferentiate iron deficient and depleted statefrom normal iron statessensitivity 919 and specificity 71respectivelya cutoff of 1016 for Mafsensitivity 946 and specificity 968
MAf = (MVC Hb) 100
Congreso Nacional Laboratorio Cliacutenico
2018
Hb reticulocitaria sensible para detectar la fase inicial del deacuteficitde hierro cuando la eritropoyesis requiere maacutes cantidad que laque recibe ANTES de que la anemia se establezca
La deteccioacuten precoz del deacuteficit de hierro en la fase del balance negativo demanda aporte contribuye a reducir sus manifestaciones cliacutenicas en los pacientes afectados mejorando la salud puacuteblica
Un tratamiento menos prolongado con suplementos y menor consumo de los recursos sanitaros Contribuye a la eficiencia y sostenibilidad de los servicios sanitarios
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
Buttarello MLaboratory diagnosis of anemia are the old and new red cell parameters useful in classification and treatment howInt Jnl Lab Hem 2016 38 (Suppl 1) 123ndash132
Congreso Nacional Laboratorio Cliacutenico
2018
Buttarello MLaboratory diagnosis of anemia are the old and new red cell parameters useful in classification and treatment howInt Jnl Lab Hem 2016 38 (Suppl 1) 123ndash132
Congreso Nacional Laboratorio Cliacutenico
2018
Ralph Green amp Ananya Datta Mitra Megaloblastic Anemias Nutritional and Other CausesMed Clin N Am 2017 101 297ndash317
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
ANEMIA CARENCIAL CAUSAS
Factores alimentariosConsumir una dieta vegetariana mal planeadaAlimentacioacuten deficiente en los bebeacutesDesnutricioacuten durante el embarazo
Deacuteficit de absorcioacutenAlcoholismo croacutenicoEnfermedad de Crohn celiaquiacutea infeccioacuten otros problemas que le dificulten al cuerpo la digestioacuten de los alimentosAnemia perniciosa (factor intriacutenseco)Cirugiacuteas para extirpar ciertas partes del estoacutemago o el intestino delgado
MedicamentosB12 omeprazol metformina colchicina aminosalicilatos neomicinaFOLATO fenitoiacutena metotrexato sulfasalacina triamtereno pirimetamina trimetoprim con sulfametoxazol barbituacutericos
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
Reacciones metaboacutelicas en las que participan la vitamina B12 y el folato bull la conversioacuten de metilmalonil-CoA a succinil-CoA donde la adenosil-cobalamina actuacutea de
cofactor Por ello un deacuteficit de B12 conlleva un aumento de metilmalonil-CoA y de su producto de hidroacutelisis el aacutecido metilmaloacutenico
bull la siacutentesis de metionina a partir de homocisteina gracias a la metionina sintetasa y a la metil-cobalamina como cofactor En esta misma reaccioacuten el metiltetrahidrofolato es transformado a tetrahidrofolato que es necesario para la siacutentesis de DNA
Congreso Nacional Laboratorio Cliacutenico
2018
Anemia macrociacutetica secundaria a deficiencia de aacutecido foacutelico y de vitamina B12(cobalamina)
La deficiencia de B12 yo aacutecido foacutelico es la causa maacutes frecuente de megaloblastosis
Dentro de distintas funciones generales del metabolismo la vitamina B12 es uncofactor esencial en la siacutentesis de ADN y ARN compromete a todas las ceacutelulas delorganismo
Su deficiencia se manifiesta en oacuterganos con alto recambio celular como la meacutedulaosea y en el sistema nervioso central (SNC) a traveacutes de la siacutentesis de mielina y lareparacioacuten axonal
La deficiencia de cobalamina es responsable de alteraciones hematoloacutegicasneuroloacutegicas neurocognitivas y neuropsiquiaacutetricas
La siacutentesis defectuosa de ADN conduce a la apoptosis y a la hemoacutelisis (intra yextramedular) causantes de la hemopoyesis inefectiva
En meacutedula la siacutentesis ineficiente de DNA causa cambios megaloblaacutesticos comoconsecuencIa anemia y citopenias
Congreso Nacional Laboratorio Cliacutenico
2018
Limitaciones de los meacutetodos diagnoacutesticos claacutesicos
Volumen Corpuscular Medio (VCM) y morfologiacutea de sangre perifeacuterica En una serie de pacientes con deacuteficit de cobalamina soacutelo un 29 teniacutean anemia y soacutelo un 36 teniacutean un VCM gt 100 fL
Un VCM normal no puede ser empleado para rechazar una determinacioacuten de nivel de cobalamina ya que hasta un 25 de casos con manifestaciones neuroloacutegicas cursan con un VCM normal
Cobalamina seacuterica (nivel de B12) Es el test diagnoacutestico rutinario inicial estaacutendar Es un test ampliamente disponible de bajo coste y automatizado Sin embargo presenta algunas limitaciones
-- Existencia de varias teacutecnicas y ausencia de un gold standard por lo que hay diferentes liacutemites de referencia
-- Variacioacuten intraindividual muy alta
La OMS publicoacute en 2008 las conclusiones de un grupo teacutecnico consultado sobre el deacuteficit de cobalamina y folato
El grupo reconocioacute que no existen unos umbrales universalmente reconocidos para definir el deacuteficit de ambas vitaminas y expresaron la necesidad de un consenso
Devalia V Hamilton MS and Molloy AM on behalf of the British Committee for standards in haematology Guidelines for the diagnosis and treatment of cobalamin and folate disorders Br J Haematol 2014 166(4) 496-513
Schrier SL Diagnosis and treatment of vitamin B12 and folate deficiency UpToDate Last updated Jun 25 2014
de Benoist B Conclusions of a WHO Technical Consultation on folate and vitamin B12 deficiencies Food Nutr Bull 200829(2 Suppl)S238ndash44Congreso Nacional Laboratorio Cliacutenico
2018
Tomado de Tefferi A Li C En Atlas of Clinical Hematology Publicado por JO Armitage Philadelphia Current Medicine 2004
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
Int Jnl Lab Hem 2007 29 327ndash334
Clin Lab 201662343-347
In ourstudy mean MCVrMCV ratio of healthy controls is130 as microcytic anemia irondeficiency anemia is121 as also macrocytic anemia vitamin B12 deficiencyanemia is 115
Congreso Nacional Laboratorio Cliacutenico
2018
Sualeh Muslim Khan Muhammad Akbar Agha
Mean cell volume of reticulocytemdashA new parameter for diagnosing sub-clinical cobalamin deficiency in blood donors Int J Lab Hem 20181ndash4
The Abbott CELL-DYN Sapphire Hematology System uses multi-angle polarized scatter separation (MAPSS) and focused flow impedance technologies
Congreso Nacional Laboratorio Cliacutenico
2018
MCVr at 985 fL yielded the highest Youdenrsquos index at sensitivity of 82 specificity of 828 AUC 0847 ( 95 CI 803-891)
Khan SM Agha MA Mean cell volume of reticulocyte-A new parameter for diagnosing sub-clinical cobalamin deficiency in blood donors
Int J Lab Hem 20181ndash4 2018 Jul 13 doi 101111ijlh12899
Congreso Nacional Laboratorio Cliacutenico
2018
Role of Cell Population Data in the detection of folate and cobalamin deficiency
J Nieto et al
XXXI st International Symposium on Technological Innovations in Laboratory Hematology ISLH 2018 10-12 May 2018 Brussels Belgium
M-V-NRET and SD-VNRET are the best discriminatory single parameters to distinguish between patients with B9B12 deficiency and reference subjects M-V-NRETAUC=0823 sensitivity 78 and specificity 86
AUC=0852 sensitivity 55 and specificity 60
Conclusions The CPD parameters of Volume and Light Scatter (M and SD of LALS angle) that inform about size and intracellular structure of RBCs provided very useful information for the detection of B9B12 deficiency
Congreso Nacional Laboratorio Cliacutenico
2018
Cell Population Data
bull Paraacutemetros poblacionales de los leucocitos
bull Describen la morfologiacutea tamantildeo
estructuras citoplasmaacuteticas
nuacutecleo aacutecidos nucleacuteicos
bull Son datos numeacutericos con los que se construyen los ejes de lo diagramas de dispersioacuten de los leucocitos
bull Dependen de la tecnologiacutea
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
High Sensitivity New Parameters for the Detection of Vitamin B12 and Folate Deficiencies Blood 2008 1125379
B12 def vs
Normals
Mann
Withney T-Test
ROC
AUC Sens Specif Cutoff signifROC
MCV p=03156 p=09533 0577
MPV p=00001 0802 792 806 lt83 p=00001
NE Mean
Volume plt00001 0862 833 778 gt1403 p=00001
MO Mean
Volume plt00001 0829 625 889 gt1723 p=00001
MRV p=00113 0705 50 964 gt1133 p=00051
Folate def vs
Normals
Mann
Withney T-Test
ROC
AUC Sens Specif Cut-off signifROC
MCV p=00798 p=06461 0665
MPV plt00001 0832 81 806 lt83 p=00001
NE Mean
Volume p=00008 087 952 694 gt1402 p=00001
MO Mean
Volume p=00002 0801 667 833 gt1696 p=00001
MRV p=00054 0731 476 964 gt1133 p=00019
The Mean Neutrophil Volume (MNE V) and Mean Monocyte Volume (MMOV) may be used for the detection of megaloblastic neutrophils and monocytes MNEV and MMOV have significantly higher sensitivity than the previous information from the red cells (MCV) detecting B12 or folate deficiency because they are not affected by the presence at the same time of Iron deficiency or other reasons of anemia
Congreso Nacional Laboratorio Cliacutenico
2018
POSTER 733
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
CPD Sysmex XN
NE SSC complejidad
NE SFL aacutecidos nucleacuteicos
NE FSC tamantildeo
NE WX
NE WY
NE WZ
MO X
MO Y
MO Z
MO WX
MO WY
MO WZ
LY X
LY Y
LY Z
LY WX
LY WY
LY WZCongreso Nacio
nal Laboratorio Cliacutenico 2018
As MCV is the mean which is calculated it is insensitive to the presence of a small number of macrocytes
Further macrocytosis can be obscured by concomitant disorders that can cause microcytosis resulting inmasked megaloblastic anaemia (MA) for example iron deficiency hereditary elliptocytosis alpha and betathalassemia
This study was undertaken to evaluate the role of NEUT-X and NEUT-Y in detecting MA on peripheral blood andalso see whether other forms of macrocytic anaemia can be differentiated from MA
In MA the peripheral blood smear shows cytopenia with macroovalocytes and hypersegmented
neutrophils (gt5 lobes in 5 neutrophils six lobes nuclei or lobe average of gt35)
In conclusion our study shows that higher values of NEUT-X and NEUT-Y in MA patients in spite of low ornormal MCV high RDW may be used to not only reveal the masked cases of MA with concomitant irondeficiency but also separate them from the broader macrocytic anaemia group
Peripheral smear remains diagnostic however making smear for all the suspicious cases is a cumbersomeand tedious procedure Thus these parameters emerge as more reliable and stable parameters in themodern laboratories which in future may replace the older screening tools
Congreso Nacional Laboratorio Cliacutenico
2018
A favor Eficiencia Operativa
Mejora el proceso del Laboratorio
Mejor informacioacuten al Cliacutenico al mismo coste
Mejora la informacioacuten
Informa sobre la eritropoyesis deteccioacuten precoz de estados carenciales
Ayuda al cliacutenico
Estado real del paciente
En contraParaacutemetros de investigacioacuten
Dificultad de standarizar dependencia teacutecnica
Control de calidadCongreso Nacional Laboratorio Cliacutenico
2018
Transfusion 2013 532766-2775
bull We evaluated the diagnostic sensitivity and specificity of red blood cell (RBC) hematology analyzer indices to assess iron status as a part of donor management iron deficient erythropoiesis (IDE) and absence of iron stores (AIS)
bull STUDY DESIGN AND METHODS A total of 1659 male and female donors from the Retrovirus Epidemiology Donor Study-II (REDS-II) Donor Iron Status Evaluation (RISE) study who were either first-timereactivated (FT RA no donations for 2 years) or frequent donors were recruited into a longitudinal study of regular donation of RBCs Of these 1002 donors returned 15 to 24 months later for a final assessment
Absent iron stores (AIS) was defined as plasma ferritin level of less than 12 mgL Logarithm of the ratio of soluble transferrin receptor to ferritin of at least 207 was used to define iron-deficient erythropoiesis (IDE)
bull RESULTS HYPOm and CHr detected IDE with comparable sensitivity 72 versus 69 but differed in specificity HYPOm 68 and CHr 53
For detecting AIS sensitivity was improved to 85 for HYPOm and 81 for CHr but specificity was reduced
Venous Hb had high specificity but poor sensitivity for IDE and AIS A plasma ferritin level of less than 267 mgL was a good surrogate for assessing IDE Congreso Nacio
nal Laboratorio Cliacutenico 2018
Microcytic RBC and reticulocyte mean cell hemoglobin content predicted iron depletion with
sensitivities 70 and 64
specificities of 72 and 78 respectively
When both combined
increased the sensitivity to 82
Congreso Nacional Laboratorio Cliacutenico
2018
Depending on the number of donations during the preceding12 months
Absent iron stores were detected in up to 214 of male and278 of female donors respectively
impaired hemoglobinisation IH was present in up to 64 maleand 167 female donors with 2 and 4 preceding donationsrespectively
The defined CHr cut-off value was 280 pg to detect IH infrequent whole blood donors with AIS leading to a testspecificity of 982 (positive predictive value PPV 577) inmale and of 978 (PPV 829) in female donors
It may help to prevent the development of anemia in frequentblood donors and also can help to decide whether donordeferral or even iron substitution need to be recommended
Congreso Nacional Laboratorio Cliacutenico
2018
Of the 501 blood donors sTfR and Ret-He detected Latent Iron Deficiency in 148 and 135 donors respectively
In comparison to sTfR Ret-He had sensitivity of 927 specificity of 9716 PPV of 931 and NPV of 963
Serum Ferritin TIBC and serum Iron had comparatively lower sensitivity of 8716 797 and 777 respectively
Conclusion Ret-He can be used as a routine screening test to detect LID in blood donors
This could provide an opportunity to make appropriate and timely interventions like dietary changes or drug supplementation
Congreso Nacional Laboratorio Cliacutenico
2018
Singh A Chaudhary R Pandey HC Sonker A Identification of iron status of blood donors by using low hemoglobin density and microcytic anemia factor Asian J Transfus Sci 20181246-50
The main objective of this study was to assess ifLHD and Maf could be used for assessment ofiron status in blood donors and also to establisha cut-off for these two parameters at which atentative iron deficiency could be reportedconclusively
Results LHD and Maf were able to differentiatebetween iron deficient and iron-depleteddonors from normal donorsA cutoff of 918 for LHD was able todifferentiate iron deficient and depleted statefrom normal iron statessensitivity 919 and specificity 71respectivelya cutoff of 1016 for Mafsensitivity 946 and specificity 968
MAf = (MVC Hb) 100
Congreso Nacional Laboratorio Cliacutenico
2018
Hb reticulocitaria sensible para detectar la fase inicial del deacuteficitde hierro cuando la eritropoyesis requiere maacutes cantidad que laque recibe ANTES de que la anemia se establezca
La deteccioacuten precoz del deacuteficit de hierro en la fase del balance negativo demanda aporte contribuye a reducir sus manifestaciones cliacutenicas en los pacientes afectados mejorando la salud puacuteblica
Un tratamiento menos prolongado con suplementos y menor consumo de los recursos sanitaros Contribuye a la eficiencia y sostenibilidad de los servicios sanitarios
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
Buttarello MLaboratory diagnosis of anemia are the old and new red cell parameters useful in classification and treatment howInt Jnl Lab Hem 2016 38 (Suppl 1) 123ndash132
Congreso Nacional Laboratorio Cliacutenico
2018
Buttarello MLaboratory diagnosis of anemia are the old and new red cell parameters useful in classification and treatment howInt Jnl Lab Hem 2016 38 (Suppl 1) 123ndash132
Congreso Nacional Laboratorio Cliacutenico
2018
Ralph Green amp Ananya Datta Mitra Megaloblastic Anemias Nutritional and Other CausesMed Clin N Am 2017 101 297ndash317
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
ANEMIA CARENCIAL CAUSAS
Factores alimentariosConsumir una dieta vegetariana mal planeadaAlimentacioacuten deficiente en los bebeacutesDesnutricioacuten durante el embarazo
Deacuteficit de absorcioacutenAlcoholismo croacutenicoEnfermedad de Crohn celiaquiacutea infeccioacuten otros problemas que le dificulten al cuerpo la digestioacuten de los alimentosAnemia perniciosa (factor intriacutenseco)Cirugiacuteas para extirpar ciertas partes del estoacutemago o el intestino delgado
MedicamentosB12 omeprazol metformina colchicina aminosalicilatos neomicinaFOLATO fenitoiacutena metotrexato sulfasalacina triamtereno pirimetamina trimetoprim con sulfametoxazol barbituacutericos
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
Reacciones metaboacutelicas en las que participan la vitamina B12 y el folato bull la conversioacuten de metilmalonil-CoA a succinil-CoA donde la adenosil-cobalamina actuacutea de
cofactor Por ello un deacuteficit de B12 conlleva un aumento de metilmalonil-CoA y de su producto de hidroacutelisis el aacutecido metilmaloacutenico
bull la siacutentesis de metionina a partir de homocisteina gracias a la metionina sintetasa y a la metil-cobalamina como cofactor En esta misma reaccioacuten el metiltetrahidrofolato es transformado a tetrahidrofolato que es necesario para la siacutentesis de DNA
Congreso Nacional Laboratorio Cliacutenico
2018
Anemia macrociacutetica secundaria a deficiencia de aacutecido foacutelico y de vitamina B12(cobalamina)
La deficiencia de B12 yo aacutecido foacutelico es la causa maacutes frecuente de megaloblastosis
Dentro de distintas funciones generales del metabolismo la vitamina B12 es uncofactor esencial en la siacutentesis de ADN y ARN compromete a todas las ceacutelulas delorganismo
Su deficiencia se manifiesta en oacuterganos con alto recambio celular como la meacutedulaosea y en el sistema nervioso central (SNC) a traveacutes de la siacutentesis de mielina y lareparacioacuten axonal
La deficiencia de cobalamina es responsable de alteraciones hematoloacutegicasneuroloacutegicas neurocognitivas y neuropsiquiaacutetricas
La siacutentesis defectuosa de ADN conduce a la apoptosis y a la hemoacutelisis (intra yextramedular) causantes de la hemopoyesis inefectiva
En meacutedula la siacutentesis ineficiente de DNA causa cambios megaloblaacutesticos comoconsecuencIa anemia y citopenias
Congreso Nacional Laboratorio Cliacutenico
2018
Limitaciones de los meacutetodos diagnoacutesticos claacutesicos
Volumen Corpuscular Medio (VCM) y morfologiacutea de sangre perifeacuterica En una serie de pacientes con deacuteficit de cobalamina soacutelo un 29 teniacutean anemia y soacutelo un 36 teniacutean un VCM gt 100 fL
Un VCM normal no puede ser empleado para rechazar una determinacioacuten de nivel de cobalamina ya que hasta un 25 de casos con manifestaciones neuroloacutegicas cursan con un VCM normal
Cobalamina seacuterica (nivel de B12) Es el test diagnoacutestico rutinario inicial estaacutendar Es un test ampliamente disponible de bajo coste y automatizado Sin embargo presenta algunas limitaciones
-- Existencia de varias teacutecnicas y ausencia de un gold standard por lo que hay diferentes liacutemites de referencia
-- Variacioacuten intraindividual muy alta
La OMS publicoacute en 2008 las conclusiones de un grupo teacutecnico consultado sobre el deacuteficit de cobalamina y folato
El grupo reconocioacute que no existen unos umbrales universalmente reconocidos para definir el deacuteficit de ambas vitaminas y expresaron la necesidad de un consenso
Devalia V Hamilton MS and Molloy AM on behalf of the British Committee for standards in haematology Guidelines for the diagnosis and treatment of cobalamin and folate disorders Br J Haematol 2014 166(4) 496-513
Schrier SL Diagnosis and treatment of vitamin B12 and folate deficiency UpToDate Last updated Jun 25 2014
de Benoist B Conclusions of a WHO Technical Consultation on folate and vitamin B12 deficiencies Food Nutr Bull 200829(2 Suppl)S238ndash44Congreso Nacional Laboratorio Cliacutenico
2018
Tomado de Tefferi A Li C En Atlas of Clinical Hematology Publicado por JO Armitage Philadelphia Current Medicine 2004
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
Int Jnl Lab Hem 2007 29 327ndash334
Clin Lab 201662343-347
In ourstudy mean MCVrMCV ratio of healthy controls is130 as microcytic anemia irondeficiency anemia is121 as also macrocytic anemia vitamin B12 deficiencyanemia is 115
Congreso Nacional Laboratorio Cliacutenico
2018
Sualeh Muslim Khan Muhammad Akbar Agha
Mean cell volume of reticulocytemdashA new parameter for diagnosing sub-clinical cobalamin deficiency in blood donors Int J Lab Hem 20181ndash4
The Abbott CELL-DYN Sapphire Hematology System uses multi-angle polarized scatter separation (MAPSS) and focused flow impedance technologies
Congreso Nacional Laboratorio Cliacutenico
2018
MCVr at 985 fL yielded the highest Youdenrsquos index at sensitivity of 82 specificity of 828 AUC 0847 ( 95 CI 803-891)
Khan SM Agha MA Mean cell volume of reticulocyte-A new parameter for diagnosing sub-clinical cobalamin deficiency in blood donors
Int J Lab Hem 20181ndash4 2018 Jul 13 doi 101111ijlh12899
Congreso Nacional Laboratorio Cliacutenico
2018
Role of Cell Population Data in the detection of folate and cobalamin deficiency
J Nieto et al
XXXI st International Symposium on Technological Innovations in Laboratory Hematology ISLH 2018 10-12 May 2018 Brussels Belgium
M-V-NRET and SD-VNRET are the best discriminatory single parameters to distinguish between patients with B9B12 deficiency and reference subjects M-V-NRETAUC=0823 sensitivity 78 and specificity 86
AUC=0852 sensitivity 55 and specificity 60
Conclusions The CPD parameters of Volume and Light Scatter (M and SD of LALS angle) that inform about size and intracellular structure of RBCs provided very useful information for the detection of B9B12 deficiency
Congreso Nacional Laboratorio Cliacutenico
2018
Cell Population Data
bull Paraacutemetros poblacionales de los leucocitos
bull Describen la morfologiacutea tamantildeo
estructuras citoplasmaacuteticas
nuacutecleo aacutecidos nucleacuteicos
bull Son datos numeacutericos con los que se construyen los ejes de lo diagramas de dispersioacuten de los leucocitos
bull Dependen de la tecnologiacutea
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
High Sensitivity New Parameters for the Detection of Vitamin B12 and Folate Deficiencies Blood 2008 1125379
B12 def vs
Normals
Mann
Withney T-Test
ROC
AUC Sens Specif Cutoff signifROC
MCV p=03156 p=09533 0577
MPV p=00001 0802 792 806 lt83 p=00001
NE Mean
Volume plt00001 0862 833 778 gt1403 p=00001
MO Mean
Volume plt00001 0829 625 889 gt1723 p=00001
MRV p=00113 0705 50 964 gt1133 p=00051
Folate def vs
Normals
Mann
Withney T-Test
ROC
AUC Sens Specif Cut-off signifROC
MCV p=00798 p=06461 0665
MPV plt00001 0832 81 806 lt83 p=00001
NE Mean
Volume p=00008 087 952 694 gt1402 p=00001
MO Mean
Volume p=00002 0801 667 833 gt1696 p=00001
MRV p=00054 0731 476 964 gt1133 p=00019
The Mean Neutrophil Volume (MNE V) and Mean Monocyte Volume (MMOV) may be used for the detection of megaloblastic neutrophils and monocytes MNEV and MMOV have significantly higher sensitivity than the previous information from the red cells (MCV) detecting B12 or folate deficiency because they are not affected by the presence at the same time of Iron deficiency or other reasons of anemia
Congreso Nacional Laboratorio Cliacutenico
2018
POSTER 733
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
CPD Sysmex XN
NE SSC complejidad
NE SFL aacutecidos nucleacuteicos
NE FSC tamantildeo
NE WX
NE WY
NE WZ
MO X
MO Y
MO Z
MO WX
MO WY
MO WZ
LY X
LY Y
LY Z
LY WX
LY WY
LY WZCongreso Nacio
nal Laboratorio Cliacutenico 2018
As MCV is the mean which is calculated it is insensitive to the presence of a small number of macrocytes
Further macrocytosis can be obscured by concomitant disorders that can cause microcytosis resulting inmasked megaloblastic anaemia (MA) for example iron deficiency hereditary elliptocytosis alpha and betathalassemia
This study was undertaken to evaluate the role of NEUT-X and NEUT-Y in detecting MA on peripheral blood andalso see whether other forms of macrocytic anaemia can be differentiated from MA
In MA the peripheral blood smear shows cytopenia with macroovalocytes and hypersegmented
neutrophils (gt5 lobes in 5 neutrophils six lobes nuclei or lobe average of gt35)
In conclusion our study shows that higher values of NEUT-X and NEUT-Y in MA patients in spite of low ornormal MCV high RDW may be used to not only reveal the masked cases of MA with concomitant irondeficiency but also separate them from the broader macrocytic anaemia group
Peripheral smear remains diagnostic however making smear for all the suspicious cases is a cumbersomeand tedious procedure Thus these parameters emerge as more reliable and stable parameters in themodern laboratories which in future may replace the older screening tools
Congreso Nacional Laboratorio Cliacutenico
2018
A favor Eficiencia Operativa
Mejora el proceso del Laboratorio
Mejor informacioacuten al Cliacutenico al mismo coste
Mejora la informacioacuten
Informa sobre la eritropoyesis deteccioacuten precoz de estados carenciales
Ayuda al cliacutenico
Estado real del paciente
En contraParaacutemetros de investigacioacuten
Dificultad de standarizar dependencia teacutecnica
Control de calidadCongreso Nacional Laboratorio Cliacutenico
2018
Microcytic RBC and reticulocyte mean cell hemoglobin content predicted iron depletion with
sensitivities 70 and 64
specificities of 72 and 78 respectively
When both combined
increased the sensitivity to 82
Congreso Nacional Laboratorio Cliacutenico
2018
Depending on the number of donations during the preceding12 months
Absent iron stores were detected in up to 214 of male and278 of female donors respectively
impaired hemoglobinisation IH was present in up to 64 maleand 167 female donors with 2 and 4 preceding donationsrespectively
The defined CHr cut-off value was 280 pg to detect IH infrequent whole blood donors with AIS leading to a testspecificity of 982 (positive predictive value PPV 577) inmale and of 978 (PPV 829) in female donors
It may help to prevent the development of anemia in frequentblood donors and also can help to decide whether donordeferral or even iron substitution need to be recommended
Congreso Nacional Laboratorio Cliacutenico
2018
Of the 501 blood donors sTfR and Ret-He detected Latent Iron Deficiency in 148 and 135 donors respectively
In comparison to sTfR Ret-He had sensitivity of 927 specificity of 9716 PPV of 931 and NPV of 963
Serum Ferritin TIBC and serum Iron had comparatively lower sensitivity of 8716 797 and 777 respectively
Conclusion Ret-He can be used as a routine screening test to detect LID in blood donors
This could provide an opportunity to make appropriate and timely interventions like dietary changes or drug supplementation
Congreso Nacional Laboratorio Cliacutenico
2018
Singh A Chaudhary R Pandey HC Sonker A Identification of iron status of blood donors by using low hemoglobin density and microcytic anemia factor Asian J Transfus Sci 20181246-50
The main objective of this study was to assess ifLHD and Maf could be used for assessment ofiron status in blood donors and also to establisha cut-off for these two parameters at which atentative iron deficiency could be reportedconclusively
Results LHD and Maf were able to differentiatebetween iron deficient and iron-depleteddonors from normal donorsA cutoff of 918 for LHD was able todifferentiate iron deficient and depleted statefrom normal iron statessensitivity 919 and specificity 71respectivelya cutoff of 1016 for Mafsensitivity 946 and specificity 968
MAf = (MVC Hb) 100
Congreso Nacional Laboratorio Cliacutenico
2018
Hb reticulocitaria sensible para detectar la fase inicial del deacuteficitde hierro cuando la eritropoyesis requiere maacutes cantidad que laque recibe ANTES de que la anemia se establezca
La deteccioacuten precoz del deacuteficit de hierro en la fase del balance negativo demanda aporte contribuye a reducir sus manifestaciones cliacutenicas en los pacientes afectados mejorando la salud puacuteblica
Un tratamiento menos prolongado con suplementos y menor consumo de los recursos sanitaros Contribuye a la eficiencia y sostenibilidad de los servicios sanitarios
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
Buttarello MLaboratory diagnosis of anemia are the old and new red cell parameters useful in classification and treatment howInt Jnl Lab Hem 2016 38 (Suppl 1) 123ndash132
Congreso Nacional Laboratorio Cliacutenico
2018
Buttarello MLaboratory diagnosis of anemia are the old and new red cell parameters useful in classification and treatment howInt Jnl Lab Hem 2016 38 (Suppl 1) 123ndash132
Congreso Nacional Laboratorio Cliacutenico
2018
Ralph Green amp Ananya Datta Mitra Megaloblastic Anemias Nutritional and Other CausesMed Clin N Am 2017 101 297ndash317
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
ANEMIA CARENCIAL CAUSAS
Factores alimentariosConsumir una dieta vegetariana mal planeadaAlimentacioacuten deficiente en los bebeacutesDesnutricioacuten durante el embarazo
Deacuteficit de absorcioacutenAlcoholismo croacutenicoEnfermedad de Crohn celiaquiacutea infeccioacuten otros problemas que le dificulten al cuerpo la digestioacuten de los alimentosAnemia perniciosa (factor intriacutenseco)Cirugiacuteas para extirpar ciertas partes del estoacutemago o el intestino delgado
MedicamentosB12 omeprazol metformina colchicina aminosalicilatos neomicinaFOLATO fenitoiacutena metotrexato sulfasalacina triamtereno pirimetamina trimetoprim con sulfametoxazol barbituacutericos
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
Reacciones metaboacutelicas en las que participan la vitamina B12 y el folato bull la conversioacuten de metilmalonil-CoA a succinil-CoA donde la adenosil-cobalamina actuacutea de
cofactor Por ello un deacuteficit de B12 conlleva un aumento de metilmalonil-CoA y de su producto de hidroacutelisis el aacutecido metilmaloacutenico
bull la siacutentesis de metionina a partir de homocisteina gracias a la metionina sintetasa y a la metil-cobalamina como cofactor En esta misma reaccioacuten el metiltetrahidrofolato es transformado a tetrahidrofolato que es necesario para la siacutentesis de DNA
Congreso Nacional Laboratorio Cliacutenico
2018
Anemia macrociacutetica secundaria a deficiencia de aacutecido foacutelico y de vitamina B12(cobalamina)
La deficiencia de B12 yo aacutecido foacutelico es la causa maacutes frecuente de megaloblastosis
Dentro de distintas funciones generales del metabolismo la vitamina B12 es uncofactor esencial en la siacutentesis de ADN y ARN compromete a todas las ceacutelulas delorganismo
Su deficiencia se manifiesta en oacuterganos con alto recambio celular como la meacutedulaosea y en el sistema nervioso central (SNC) a traveacutes de la siacutentesis de mielina y lareparacioacuten axonal
La deficiencia de cobalamina es responsable de alteraciones hematoloacutegicasneuroloacutegicas neurocognitivas y neuropsiquiaacutetricas
La siacutentesis defectuosa de ADN conduce a la apoptosis y a la hemoacutelisis (intra yextramedular) causantes de la hemopoyesis inefectiva
En meacutedula la siacutentesis ineficiente de DNA causa cambios megaloblaacutesticos comoconsecuencIa anemia y citopenias
Congreso Nacional Laboratorio Cliacutenico
2018
Limitaciones de los meacutetodos diagnoacutesticos claacutesicos
Volumen Corpuscular Medio (VCM) y morfologiacutea de sangre perifeacuterica En una serie de pacientes con deacuteficit de cobalamina soacutelo un 29 teniacutean anemia y soacutelo un 36 teniacutean un VCM gt 100 fL
Un VCM normal no puede ser empleado para rechazar una determinacioacuten de nivel de cobalamina ya que hasta un 25 de casos con manifestaciones neuroloacutegicas cursan con un VCM normal
Cobalamina seacuterica (nivel de B12) Es el test diagnoacutestico rutinario inicial estaacutendar Es un test ampliamente disponible de bajo coste y automatizado Sin embargo presenta algunas limitaciones
-- Existencia de varias teacutecnicas y ausencia de un gold standard por lo que hay diferentes liacutemites de referencia
-- Variacioacuten intraindividual muy alta
La OMS publicoacute en 2008 las conclusiones de un grupo teacutecnico consultado sobre el deacuteficit de cobalamina y folato
El grupo reconocioacute que no existen unos umbrales universalmente reconocidos para definir el deacuteficit de ambas vitaminas y expresaron la necesidad de un consenso
Devalia V Hamilton MS and Molloy AM on behalf of the British Committee for standards in haematology Guidelines for the diagnosis and treatment of cobalamin and folate disorders Br J Haematol 2014 166(4) 496-513
Schrier SL Diagnosis and treatment of vitamin B12 and folate deficiency UpToDate Last updated Jun 25 2014
de Benoist B Conclusions of a WHO Technical Consultation on folate and vitamin B12 deficiencies Food Nutr Bull 200829(2 Suppl)S238ndash44Congreso Nacional Laboratorio Cliacutenico
2018
Tomado de Tefferi A Li C En Atlas of Clinical Hematology Publicado por JO Armitage Philadelphia Current Medicine 2004
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
Int Jnl Lab Hem 2007 29 327ndash334
Clin Lab 201662343-347
In ourstudy mean MCVrMCV ratio of healthy controls is130 as microcytic anemia irondeficiency anemia is121 as also macrocytic anemia vitamin B12 deficiencyanemia is 115
Congreso Nacional Laboratorio Cliacutenico
2018
Sualeh Muslim Khan Muhammad Akbar Agha
Mean cell volume of reticulocytemdashA new parameter for diagnosing sub-clinical cobalamin deficiency in blood donors Int J Lab Hem 20181ndash4
The Abbott CELL-DYN Sapphire Hematology System uses multi-angle polarized scatter separation (MAPSS) and focused flow impedance technologies
Congreso Nacional Laboratorio Cliacutenico
2018
MCVr at 985 fL yielded the highest Youdenrsquos index at sensitivity of 82 specificity of 828 AUC 0847 ( 95 CI 803-891)
Khan SM Agha MA Mean cell volume of reticulocyte-A new parameter for diagnosing sub-clinical cobalamin deficiency in blood donors
Int J Lab Hem 20181ndash4 2018 Jul 13 doi 101111ijlh12899
Congreso Nacional Laboratorio Cliacutenico
2018
Role of Cell Population Data in the detection of folate and cobalamin deficiency
J Nieto et al
XXXI st International Symposium on Technological Innovations in Laboratory Hematology ISLH 2018 10-12 May 2018 Brussels Belgium
M-V-NRET and SD-VNRET are the best discriminatory single parameters to distinguish between patients with B9B12 deficiency and reference subjects M-V-NRETAUC=0823 sensitivity 78 and specificity 86
AUC=0852 sensitivity 55 and specificity 60
Conclusions The CPD parameters of Volume and Light Scatter (M and SD of LALS angle) that inform about size and intracellular structure of RBCs provided very useful information for the detection of B9B12 deficiency
Congreso Nacional Laboratorio Cliacutenico
2018
Cell Population Data
bull Paraacutemetros poblacionales de los leucocitos
bull Describen la morfologiacutea tamantildeo
estructuras citoplasmaacuteticas
nuacutecleo aacutecidos nucleacuteicos
bull Son datos numeacutericos con los que se construyen los ejes de lo diagramas de dispersioacuten de los leucocitos
bull Dependen de la tecnologiacutea
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
High Sensitivity New Parameters for the Detection of Vitamin B12 and Folate Deficiencies Blood 2008 1125379
B12 def vs
Normals
Mann
Withney T-Test
ROC
AUC Sens Specif Cutoff signifROC
MCV p=03156 p=09533 0577
MPV p=00001 0802 792 806 lt83 p=00001
NE Mean
Volume plt00001 0862 833 778 gt1403 p=00001
MO Mean
Volume plt00001 0829 625 889 gt1723 p=00001
MRV p=00113 0705 50 964 gt1133 p=00051
Folate def vs
Normals
Mann
Withney T-Test
ROC
AUC Sens Specif Cut-off signifROC
MCV p=00798 p=06461 0665
MPV plt00001 0832 81 806 lt83 p=00001
NE Mean
Volume p=00008 087 952 694 gt1402 p=00001
MO Mean
Volume p=00002 0801 667 833 gt1696 p=00001
MRV p=00054 0731 476 964 gt1133 p=00019
The Mean Neutrophil Volume (MNE V) and Mean Monocyte Volume (MMOV) may be used for the detection of megaloblastic neutrophils and monocytes MNEV and MMOV have significantly higher sensitivity than the previous information from the red cells (MCV) detecting B12 or folate deficiency because they are not affected by the presence at the same time of Iron deficiency or other reasons of anemia
Congreso Nacional Laboratorio Cliacutenico
2018
POSTER 733
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
CPD Sysmex XN
NE SSC complejidad
NE SFL aacutecidos nucleacuteicos
NE FSC tamantildeo
NE WX
NE WY
NE WZ
MO X
MO Y
MO Z
MO WX
MO WY
MO WZ
LY X
LY Y
LY Z
LY WX
LY WY
LY WZCongreso Nacio
nal Laboratorio Cliacutenico 2018
As MCV is the mean which is calculated it is insensitive to the presence of a small number of macrocytes
Further macrocytosis can be obscured by concomitant disorders that can cause microcytosis resulting inmasked megaloblastic anaemia (MA) for example iron deficiency hereditary elliptocytosis alpha and betathalassemia
This study was undertaken to evaluate the role of NEUT-X and NEUT-Y in detecting MA on peripheral blood andalso see whether other forms of macrocytic anaemia can be differentiated from MA
In MA the peripheral blood smear shows cytopenia with macroovalocytes and hypersegmented
neutrophils (gt5 lobes in 5 neutrophils six lobes nuclei or lobe average of gt35)
In conclusion our study shows that higher values of NEUT-X and NEUT-Y in MA patients in spite of low ornormal MCV high RDW may be used to not only reveal the masked cases of MA with concomitant irondeficiency but also separate them from the broader macrocytic anaemia group
Peripheral smear remains diagnostic however making smear for all the suspicious cases is a cumbersomeand tedious procedure Thus these parameters emerge as more reliable and stable parameters in themodern laboratories which in future may replace the older screening tools
Congreso Nacional Laboratorio Cliacutenico
2018
A favor Eficiencia Operativa
Mejora el proceso del Laboratorio
Mejor informacioacuten al Cliacutenico al mismo coste
Mejora la informacioacuten
Informa sobre la eritropoyesis deteccioacuten precoz de estados carenciales
Ayuda al cliacutenico
Estado real del paciente
En contraParaacutemetros de investigacioacuten
Dificultad de standarizar dependencia teacutecnica
Control de calidadCongreso Nacional Laboratorio Cliacutenico
2018
Depending on the number of donations during the preceding12 months
Absent iron stores were detected in up to 214 of male and278 of female donors respectively
impaired hemoglobinisation IH was present in up to 64 maleand 167 female donors with 2 and 4 preceding donationsrespectively
The defined CHr cut-off value was 280 pg to detect IH infrequent whole blood donors with AIS leading to a testspecificity of 982 (positive predictive value PPV 577) inmale and of 978 (PPV 829) in female donors
It may help to prevent the development of anemia in frequentblood donors and also can help to decide whether donordeferral or even iron substitution need to be recommended
Congreso Nacional Laboratorio Cliacutenico
2018
Of the 501 blood donors sTfR and Ret-He detected Latent Iron Deficiency in 148 and 135 donors respectively
In comparison to sTfR Ret-He had sensitivity of 927 specificity of 9716 PPV of 931 and NPV of 963
Serum Ferritin TIBC and serum Iron had comparatively lower sensitivity of 8716 797 and 777 respectively
Conclusion Ret-He can be used as a routine screening test to detect LID in blood donors
This could provide an opportunity to make appropriate and timely interventions like dietary changes or drug supplementation
Congreso Nacional Laboratorio Cliacutenico
2018
Singh A Chaudhary R Pandey HC Sonker A Identification of iron status of blood donors by using low hemoglobin density and microcytic anemia factor Asian J Transfus Sci 20181246-50
The main objective of this study was to assess ifLHD and Maf could be used for assessment ofiron status in blood donors and also to establisha cut-off for these two parameters at which atentative iron deficiency could be reportedconclusively
Results LHD and Maf were able to differentiatebetween iron deficient and iron-depleteddonors from normal donorsA cutoff of 918 for LHD was able todifferentiate iron deficient and depleted statefrom normal iron statessensitivity 919 and specificity 71respectivelya cutoff of 1016 for Mafsensitivity 946 and specificity 968
MAf = (MVC Hb) 100
Congreso Nacional Laboratorio Cliacutenico
2018
Hb reticulocitaria sensible para detectar la fase inicial del deacuteficitde hierro cuando la eritropoyesis requiere maacutes cantidad que laque recibe ANTES de que la anemia se establezca
La deteccioacuten precoz del deacuteficit de hierro en la fase del balance negativo demanda aporte contribuye a reducir sus manifestaciones cliacutenicas en los pacientes afectados mejorando la salud puacuteblica
Un tratamiento menos prolongado con suplementos y menor consumo de los recursos sanitaros Contribuye a la eficiencia y sostenibilidad de los servicios sanitarios
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
Buttarello MLaboratory diagnosis of anemia are the old and new red cell parameters useful in classification and treatment howInt Jnl Lab Hem 2016 38 (Suppl 1) 123ndash132
Congreso Nacional Laboratorio Cliacutenico
2018
Buttarello MLaboratory diagnosis of anemia are the old and new red cell parameters useful in classification and treatment howInt Jnl Lab Hem 2016 38 (Suppl 1) 123ndash132
Congreso Nacional Laboratorio Cliacutenico
2018
Ralph Green amp Ananya Datta Mitra Megaloblastic Anemias Nutritional and Other CausesMed Clin N Am 2017 101 297ndash317
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
ANEMIA CARENCIAL CAUSAS
Factores alimentariosConsumir una dieta vegetariana mal planeadaAlimentacioacuten deficiente en los bebeacutesDesnutricioacuten durante el embarazo
Deacuteficit de absorcioacutenAlcoholismo croacutenicoEnfermedad de Crohn celiaquiacutea infeccioacuten otros problemas que le dificulten al cuerpo la digestioacuten de los alimentosAnemia perniciosa (factor intriacutenseco)Cirugiacuteas para extirpar ciertas partes del estoacutemago o el intestino delgado
MedicamentosB12 omeprazol metformina colchicina aminosalicilatos neomicinaFOLATO fenitoiacutena metotrexato sulfasalacina triamtereno pirimetamina trimetoprim con sulfametoxazol barbituacutericos
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
Reacciones metaboacutelicas en las que participan la vitamina B12 y el folato bull la conversioacuten de metilmalonil-CoA a succinil-CoA donde la adenosil-cobalamina actuacutea de
cofactor Por ello un deacuteficit de B12 conlleva un aumento de metilmalonil-CoA y de su producto de hidroacutelisis el aacutecido metilmaloacutenico
bull la siacutentesis de metionina a partir de homocisteina gracias a la metionina sintetasa y a la metil-cobalamina como cofactor En esta misma reaccioacuten el metiltetrahidrofolato es transformado a tetrahidrofolato que es necesario para la siacutentesis de DNA
Congreso Nacional Laboratorio Cliacutenico
2018
Anemia macrociacutetica secundaria a deficiencia de aacutecido foacutelico y de vitamina B12(cobalamina)
La deficiencia de B12 yo aacutecido foacutelico es la causa maacutes frecuente de megaloblastosis
Dentro de distintas funciones generales del metabolismo la vitamina B12 es uncofactor esencial en la siacutentesis de ADN y ARN compromete a todas las ceacutelulas delorganismo
Su deficiencia se manifiesta en oacuterganos con alto recambio celular como la meacutedulaosea y en el sistema nervioso central (SNC) a traveacutes de la siacutentesis de mielina y lareparacioacuten axonal
La deficiencia de cobalamina es responsable de alteraciones hematoloacutegicasneuroloacutegicas neurocognitivas y neuropsiquiaacutetricas
La siacutentesis defectuosa de ADN conduce a la apoptosis y a la hemoacutelisis (intra yextramedular) causantes de la hemopoyesis inefectiva
En meacutedula la siacutentesis ineficiente de DNA causa cambios megaloblaacutesticos comoconsecuencIa anemia y citopenias
Congreso Nacional Laboratorio Cliacutenico
2018
Limitaciones de los meacutetodos diagnoacutesticos claacutesicos
Volumen Corpuscular Medio (VCM) y morfologiacutea de sangre perifeacuterica En una serie de pacientes con deacuteficit de cobalamina soacutelo un 29 teniacutean anemia y soacutelo un 36 teniacutean un VCM gt 100 fL
Un VCM normal no puede ser empleado para rechazar una determinacioacuten de nivel de cobalamina ya que hasta un 25 de casos con manifestaciones neuroloacutegicas cursan con un VCM normal
Cobalamina seacuterica (nivel de B12) Es el test diagnoacutestico rutinario inicial estaacutendar Es un test ampliamente disponible de bajo coste y automatizado Sin embargo presenta algunas limitaciones
-- Existencia de varias teacutecnicas y ausencia de un gold standard por lo que hay diferentes liacutemites de referencia
-- Variacioacuten intraindividual muy alta
La OMS publicoacute en 2008 las conclusiones de un grupo teacutecnico consultado sobre el deacuteficit de cobalamina y folato
El grupo reconocioacute que no existen unos umbrales universalmente reconocidos para definir el deacuteficit de ambas vitaminas y expresaron la necesidad de un consenso
Devalia V Hamilton MS and Molloy AM on behalf of the British Committee for standards in haematology Guidelines for the diagnosis and treatment of cobalamin and folate disorders Br J Haematol 2014 166(4) 496-513
Schrier SL Diagnosis and treatment of vitamin B12 and folate deficiency UpToDate Last updated Jun 25 2014
de Benoist B Conclusions of a WHO Technical Consultation on folate and vitamin B12 deficiencies Food Nutr Bull 200829(2 Suppl)S238ndash44Congreso Nacional Laboratorio Cliacutenico
2018
Tomado de Tefferi A Li C En Atlas of Clinical Hematology Publicado por JO Armitage Philadelphia Current Medicine 2004
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
Int Jnl Lab Hem 2007 29 327ndash334
Clin Lab 201662343-347
In ourstudy mean MCVrMCV ratio of healthy controls is130 as microcytic anemia irondeficiency anemia is121 as also macrocytic anemia vitamin B12 deficiencyanemia is 115
Congreso Nacional Laboratorio Cliacutenico
2018
Sualeh Muslim Khan Muhammad Akbar Agha
Mean cell volume of reticulocytemdashA new parameter for diagnosing sub-clinical cobalamin deficiency in blood donors Int J Lab Hem 20181ndash4
The Abbott CELL-DYN Sapphire Hematology System uses multi-angle polarized scatter separation (MAPSS) and focused flow impedance technologies
Congreso Nacional Laboratorio Cliacutenico
2018
MCVr at 985 fL yielded the highest Youdenrsquos index at sensitivity of 82 specificity of 828 AUC 0847 ( 95 CI 803-891)
Khan SM Agha MA Mean cell volume of reticulocyte-A new parameter for diagnosing sub-clinical cobalamin deficiency in blood donors
Int J Lab Hem 20181ndash4 2018 Jul 13 doi 101111ijlh12899
Congreso Nacional Laboratorio Cliacutenico
2018
Role of Cell Population Data in the detection of folate and cobalamin deficiency
J Nieto et al
XXXI st International Symposium on Technological Innovations in Laboratory Hematology ISLH 2018 10-12 May 2018 Brussels Belgium
M-V-NRET and SD-VNRET are the best discriminatory single parameters to distinguish between patients with B9B12 deficiency and reference subjects M-V-NRETAUC=0823 sensitivity 78 and specificity 86
AUC=0852 sensitivity 55 and specificity 60
Conclusions The CPD parameters of Volume and Light Scatter (M and SD of LALS angle) that inform about size and intracellular structure of RBCs provided very useful information for the detection of B9B12 deficiency
Congreso Nacional Laboratorio Cliacutenico
2018
Cell Population Data
bull Paraacutemetros poblacionales de los leucocitos
bull Describen la morfologiacutea tamantildeo
estructuras citoplasmaacuteticas
nuacutecleo aacutecidos nucleacuteicos
bull Son datos numeacutericos con los que se construyen los ejes de lo diagramas de dispersioacuten de los leucocitos
bull Dependen de la tecnologiacutea
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
High Sensitivity New Parameters for the Detection of Vitamin B12 and Folate Deficiencies Blood 2008 1125379
B12 def vs
Normals
Mann
Withney T-Test
ROC
AUC Sens Specif Cutoff signifROC
MCV p=03156 p=09533 0577
MPV p=00001 0802 792 806 lt83 p=00001
NE Mean
Volume plt00001 0862 833 778 gt1403 p=00001
MO Mean
Volume plt00001 0829 625 889 gt1723 p=00001
MRV p=00113 0705 50 964 gt1133 p=00051
Folate def vs
Normals
Mann
Withney T-Test
ROC
AUC Sens Specif Cut-off signifROC
MCV p=00798 p=06461 0665
MPV plt00001 0832 81 806 lt83 p=00001
NE Mean
Volume p=00008 087 952 694 gt1402 p=00001
MO Mean
Volume p=00002 0801 667 833 gt1696 p=00001
MRV p=00054 0731 476 964 gt1133 p=00019
The Mean Neutrophil Volume (MNE V) and Mean Monocyte Volume (MMOV) may be used for the detection of megaloblastic neutrophils and monocytes MNEV and MMOV have significantly higher sensitivity than the previous information from the red cells (MCV) detecting B12 or folate deficiency because they are not affected by the presence at the same time of Iron deficiency or other reasons of anemia
Congreso Nacional Laboratorio Cliacutenico
2018
POSTER 733
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
CPD Sysmex XN
NE SSC complejidad
NE SFL aacutecidos nucleacuteicos
NE FSC tamantildeo
NE WX
NE WY
NE WZ
MO X
MO Y
MO Z
MO WX
MO WY
MO WZ
LY X
LY Y
LY Z
LY WX
LY WY
LY WZCongreso Nacio
nal Laboratorio Cliacutenico 2018
As MCV is the mean which is calculated it is insensitive to the presence of a small number of macrocytes
Further macrocytosis can be obscured by concomitant disorders that can cause microcytosis resulting inmasked megaloblastic anaemia (MA) for example iron deficiency hereditary elliptocytosis alpha and betathalassemia
This study was undertaken to evaluate the role of NEUT-X and NEUT-Y in detecting MA on peripheral blood andalso see whether other forms of macrocytic anaemia can be differentiated from MA
In MA the peripheral blood smear shows cytopenia with macroovalocytes and hypersegmented
neutrophils (gt5 lobes in 5 neutrophils six lobes nuclei or lobe average of gt35)
In conclusion our study shows that higher values of NEUT-X and NEUT-Y in MA patients in spite of low ornormal MCV high RDW may be used to not only reveal the masked cases of MA with concomitant irondeficiency but also separate them from the broader macrocytic anaemia group
Peripheral smear remains diagnostic however making smear for all the suspicious cases is a cumbersomeand tedious procedure Thus these parameters emerge as more reliable and stable parameters in themodern laboratories which in future may replace the older screening tools
Congreso Nacional Laboratorio Cliacutenico
2018
A favor Eficiencia Operativa
Mejora el proceso del Laboratorio
Mejor informacioacuten al Cliacutenico al mismo coste
Mejora la informacioacuten
Informa sobre la eritropoyesis deteccioacuten precoz de estados carenciales
Ayuda al cliacutenico
Estado real del paciente
En contraParaacutemetros de investigacioacuten
Dificultad de standarizar dependencia teacutecnica
Control de calidadCongreso Nacional Laboratorio Cliacutenico
2018
Of the 501 blood donors sTfR and Ret-He detected Latent Iron Deficiency in 148 and 135 donors respectively
In comparison to sTfR Ret-He had sensitivity of 927 specificity of 9716 PPV of 931 and NPV of 963
Serum Ferritin TIBC and serum Iron had comparatively lower sensitivity of 8716 797 and 777 respectively
Conclusion Ret-He can be used as a routine screening test to detect LID in blood donors
This could provide an opportunity to make appropriate and timely interventions like dietary changes or drug supplementation
Congreso Nacional Laboratorio Cliacutenico
2018
Singh A Chaudhary R Pandey HC Sonker A Identification of iron status of blood donors by using low hemoglobin density and microcytic anemia factor Asian J Transfus Sci 20181246-50
The main objective of this study was to assess ifLHD and Maf could be used for assessment ofiron status in blood donors and also to establisha cut-off for these two parameters at which atentative iron deficiency could be reportedconclusively
Results LHD and Maf were able to differentiatebetween iron deficient and iron-depleteddonors from normal donorsA cutoff of 918 for LHD was able todifferentiate iron deficient and depleted statefrom normal iron statessensitivity 919 and specificity 71respectivelya cutoff of 1016 for Mafsensitivity 946 and specificity 968
MAf = (MVC Hb) 100
Congreso Nacional Laboratorio Cliacutenico
2018
Hb reticulocitaria sensible para detectar la fase inicial del deacuteficitde hierro cuando la eritropoyesis requiere maacutes cantidad que laque recibe ANTES de que la anemia se establezca
La deteccioacuten precoz del deacuteficit de hierro en la fase del balance negativo demanda aporte contribuye a reducir sus manifestaciones cliacutenicas en los pacientes afectados mejorando la salud puacuteblica
Un tratamiento menos prolongado con suplementos y menor consumo de los recursos sanitaros Contribuye a la eficiencia y sostenibilidad de los servicios sanitarios
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
Buttarello MLaboratory diagnosis of anemia are the old and new red cell parameters useful in classification and treatment howInt Jnl Lab Hem 2016 38 (Suppl 1) 123ndash132
Congreso Nacional Laboratorio Cliacutenico
2018
Buttarello MLaboratory diagnosis of anemia are the old and new red cell parameters useful in classification and treatment howInt Jnl Lab Hem 2016 38 (Suppl 1) 123ndash132
Congreso Nacional Laboratorio Cliacutenico
2018
Ralph Green amp Ananya Datta Mitra Megaloblastic Anemias Nutritional and Other CausesMed Clin N Am 2017 101 297ndash317
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
ANEMIA CARENCIAL CAUSAS
Factores alimentariosConsumir una dieta vegetariana mal planeadaAlimentacioacuten deficiente en los bebeacutesDesnutricioacuten durante el embarazo
Deacuteficit de absorcioacutenAlcoholismo croacutenicoEnfermedad de Crohn celiaquiacutea infeccioacuten otros problemas que le dificulten al cuerpo la digestioacuten de los alimentosAnemia perniciosa (factor intriacutenseco)Cirugiacuteas para extirpar ciertas partes del estoacutemago o el intestino delgado
MedicamentosB12 omeprazol metformina colchicina aminosalicilatos neomicinaFOLATO fenitoiacutena metotrexato sulfasalacina triamtereno pirimetamina trimetoprim con sulfametoxazol barbituacutericos
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
Reacciones metaboacutelicas en las que participan la vitamina B12 y el folato bull la conversioacuten de metilmalonil-CoA a succinil-CoA donde la adenosil-cobalamina actuacutea de
cofactor Por ello un deacuteficit de B12 conlleva un aumento de metilmalonil-CoA y de su producto de hidroacutelisis el aacutecido metilmaloacutenico
bull la siacutentesis de metionina a partir de homocisteina gracias a la metionina sintetasa y a la metil-cobalamina como cofactor En esta misma reaccioacuten el metiltetrahidrofolato es transformado a tetrahidrofolato que es necesario para la siacutentesis de DNA
Congreso Nacional Laboratorio Cliacutenico
2018
Anemia macrociacutetica secundaria a deficiencia de aacutecido foacutelico y de vitamina B12(cobalamina)
La deficiencia de B12 yo aacutecido foacutelico es la causa maacutes frecuente de megaloblastosis
Dentro de distintas funciones generales del metabolismo la vitamina B12 es uncofactor esencial en la siacutentesis de ADN y ARN compromete a todas las ceacutelulas delorganismo
Su deficiencia se manifiesta en oacuterganos con alto recambio celular como la meacutedulaosea y en el sistema nervioso central (SNC) a traveacutes de la siacutentesis de mielina y lareparacioacuten axonal
La deficiencia de cobalamina es responsable de alteraciones hematoloacutegicasneuroloacutegicas neurocognitivas y neuropsiquiaacutetricas
La siacutentesis defectuosa de ADN conduce a la apoptosis y a la hemoacutelisis (intra yextramedular) causantes de la hemopoyesis inefectiva
En meacutedula la siacutentesis ineficiente de DNA causa cambios megaloblaacutesticos comoconsecuencIa anemia y citopenias
Congreso Nacional Laboratorio Cliacutenico
2018
Limitaciones de los meacutetodos diagnoacutesticos claacutesicos
Volumen Corpuscular Medio (VCM) y morfologiacutea de sangre perifeacuterica En una serie de pacientes con deacuteficit de cobalamina soacutelo un 29 teniacutean anemia y soacutelo un 36 teniacutean un VCM gt 100 fL
Un VCM normal no puede ser empleado para rechazar una determinacioacuten de nivel de cobalamina ya que hasta un 25 de casos con manifestaciones neuroloacutegicas cursan con un VCM normal
Cobalamina seacuterica (nivel de B12) Es el test diagnoacutestico rutinario inicial estaacutendar Es un test ampliamente disponible de bajo coste y automatizado Sin embargo presenta algunas limitaciones
-- Existencia de varias teacutecnicas y ausencia de un gold standard por lo que hay diferentes liacutemites de referencia
-- Variacioacuten intraindividual muy alta
La OMS publicoacute en 2008 las conclusiones de un grupo teacutecnico consultado sobre el deacuteficit de cobalamina y folato
El grupo reconocioacute que no existen unos umbrales universalmente reconocidos para definir el deacuteficit de ambas vitaminas y expresaron la necesidad de un consenso
Devalia V Hamilton MS and Molloy AM on behalf of the British Committee for standards in haematology Guidelines for the diagnosis and treatment of cobalamin and folate disorders Br J Haematol 2014 166(4) 496-513
Schrier SL Diagnosis and treatment of vitamin B12 and folate deficiency UpToDate Last updated Jun 25 2014
de Benoist B Conclusions of a WHO Technical Consultation on folate and vitamin B12 deficiencies Food Nutr Bull 200829(2 Suppl)S238ndash44Congreso Nacional Laboratorio Cliacutenico
2018
Tomado de Tefferi A Li C En Atlas of Clinical Hematology Publicado por JO Armitage Philadelphia Current Medicine 2004
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
Int Jnl Lab Hem 2007 29 327ndash334
Clin Lab 201662343-347
In ourstudy mean MCVrMCV ratio of healthy controls is130 as microcytic anemia irondeficiency anemia is121 as also macrocytic anemia vitamin B12 deficiencyanemia is 115
Congreso Nacional Laboratorio Cliacutenico
2018
Sualeh Muslim Khan Muhammad Akbar Agha
Mean cell volume of reticulocytemdashA new parameter for diagnosing sub-clinical cobalamin deficiency in blood donors Int J Lab Hem 20181ndash4
The Abbott CELL-DYN Sapphire Hematology System uses multi-angle polarized scatter separation (MAPSS) and focused flow impedance technologies
Congreso Nacional Laboratorio Cliacutenico
2018
MCVr at 985 fL yielded the highest Youdenrsquos index at sensitivity of 82 specificity of 828 AUC 0847 ( 95 CI 803-891)
Khan SM Agha MA Mean cell volume of reticulocyte-A new parameter for diagnosing sub-clinical cobalamin deficiency in blood donors
Int J Lab Hem 20181ndash4 2018 Jul 13 doi 101111ijlh12899
Congreso Nacional Laboratorio Cliacutenico
2018
Role of Cell Population Data in the detection of folate and cobalamin deficiency
J Nieto et al
XXXI st International Symposium on Technological Innovations in Laboratory Hematology ISLH 2018 10-12 May 2018 Brussels Belgium
M-V-NRET and SD-VNRET are the best discriminatory single parameters to distinguish between patients with B9B12 deficiency and reference subjects M-V-NRETAUC=0823 sensitivity 78 and specificity 86
AUC=0852 sensitivity 55 and specificity 60
Conclusions The CPD parameters of Volume and Light Scatter (M and SD of LALS angle) that inform about size and intracellular structure of RBCs provided very useful information for the detection of B9B12 deficiency
Congreso Nacional Laboratorio Cliacutenico
2018
Cell Population Data
bull Paraacutemetros poblacionales de los leucocitos
bull Describen la morfologiacutea tamantildeo
estructuras citoplasmaacuteticas
nuacutecleo aacutecidos nucleacuteicos
bull Son datos numeacutericos con los que se construyen los ejes de lo diagramas de dispersioacuten de los leucocitos
bull Dependen de la tecnologiacutea
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
High Sensitivity New Parameters for the Detection of Vitamin B12 and Folate Deficiencies Blood 2008 1125379
B12 def vs
Normals
Mann
Withney T-Test
ROC
AUC Sens Specif Cutoff signifROC
MCV p=03156 p=09533 0577
MPV p=00001 0802 792 806 lt83 p=00001
NE Mean
Volume plt00001 0862 833 778 gt1403 p=00001
MO Mean
Volume plt00001 0829 625 889 gt1723 p=00001
MRV p=00113 0705 50 964 gt1133 p=00051
Folate def vs
Normals
Mann
Withney T-Test
ROC
AUC Sens Specif Cut-off signifROC
MCV p=00798 p=06461 0665
MPV plt00001 0832 81 806 lt83 p=00001
NE Mean
Volume p=00008 087 952 694 gt1402 p=00001
MO Mean
Volume p=00002 0801 667 833 gt1696 p=00001
MRV p=00054 0731 476 964 gt1133 p=00019
The Mean Neutrophil Volume (MNE V) and Mean Monocyte Volume (MMOV) may be used for the detection of megaloblastic neutrophils and monocytes MNEV and MMOV have significantly higher sensitivity than the previous information from the red cells (MCV) detecting B12 or folate deficiency because they are not affected by the presence at the same time of Iron deficiency or other reasons of anemia
Congreso Nacional Laboratorio Cliacutenico
2018
POSTER 733
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
CPD Sysmex XN
NE SSC complejidad
NE SFL aacutecidos nucleacuteicos
NE FSC tamantildeo
NE WX
NE WY
NE WZ
MO X
MO Y
MO Z
MO WX
MO WY
MO WZ
LY X
LY Y
LY Z
LY WX
LY WY
LY WZCongreso Nacio
nal Laboratorio Cliacutenico 2018
As MCV is the mean which is calculated it is insensitive to the presence of a small number of macrocytes
Further macrocytosis can be obscured by concomitant disorders that can cause microcytosis resulting inmasked megaloblastic anaemia (MA) for example iron deficiency hereditary elliptocytosis alpha and betathalassemia
This study was undertaken to evaluate the role of NEUT-X and NEUT-Y in detecting MA on peripheral blood andalso see whether other forms of macrocytic anaemia can be differentiated from MA
In MA the peripheral blood smear shows cytopenia with macroovalocytes and hypersegmented
neutrophils (gt5 lobes in 5 neutrophils six lobes nuclei or lobe average of gt35)
In conclusion our study shows that higher values of NEUT-X and NEUT-Y in MA patients in spite of low ornormal MCV high RDW may be used to not only reveal the masked cases of MA with concomitant irondeficiency but also separate them from the broader macrocytic anaemia group
Peripheral smear remains diagnostic however making smear for all the suspicious cases is a cumbersomeand tedious procedure Thus these parameters emerge as more reliable and stable parameters in themodern laboratories which in future may replace the older screening tools
Congreso Nacional Laboratorio Cliacutenico
2018
A favor Eficiencia Operativa
Mejora el proceso del Laboratorio
Mejor informacioacuten al Cliacutenico al mismo coste
Mejora la informacioacuten
Informa sobre la eritropoyesis deteccioacuten precoz de estados carenciales
Ayuda al cliacutenico
Estado real del paciente
En contraParaacutemetros de investigacioacuten
Dificultad de standarizar dependencia teacutecnica
Control de calidadCongreso Nacional Laboratorio Cliacutenico
2018
Singh A Chaudhary R Pandey HC Sonker A Identification of iron status of blood donors by using low hemoglobin density and microcytic anemia factor Asian J Transfus Sci 20181246-50
The main objective of this study was to assess ifLHD and Maf could be used for assessment ofiron status in blood donors and also to establisha cut-off for these two parameters at which atentative iron deficiency could be reportedconclusively
Results LHD and Maf were able to differentiatebetween iron deficient and iron-depleteddonors from normal donorsA cutoff of 918 for LHD was able todifferentiate iron deficient and depleted statefrom normal iron statessensitivity 919 and specificity 71respectivelya cutoff of 1016 for Mafsensitivity 946 and specificity 968
MAf = (MVC Hb) 100
Congreso Nacional Laboratorio Cliacutenico
2018
Hb reticulocitaria sensible para detectar la fase inicial del deacuteficitde hierro cuando la eritropoyesis requiere maacutes cantidad que laque recibe ANTES de que la anemia se establezca
La deteccioacuten precoz del deacuteficit de hierro en la fase del balance negativo demanda aporte contribuye a reducir sus manifestaciones cliacutenicas en los pacientes afectados mejorando la salud puacuteblica
Un tratamiento menos prolongado con suplementos y menor consumo de los recursos sanitaros Contribuye a la eficiencia y sostenibilidad de los servicios sanitarios
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
Buttarello MLaboratory diagnosis of anemia are the old and new red cell parameters useful in classification and treatment howInt Jnl Lab Hem 2016 38 (Suppl 1) 123ndash132
Congreso Nacional Laboratorio Cliacutenico
2018
Buttarello MLaboratory diagnosis of anemia are the old and new red cell parameters useful in classification and treatment howInt Jnl Lab Hem 2016 38 (Suppl 1) 123ndash132
Congreso Nacional Laboratorio Cliacutenico
2018
Ralph Green amp Ananya Datta Mitra Megaloblastic Anemias Nutritional and Other CausesMed Clin N Am 2017 101 297ndash317
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
ANEMIA CARENCIAL CAUSAS
Factores alimentariosConsumir una dieta vegetariana mal planeadaAlimentacioacuten deficiente en los bebeacutesDesnutricioacuten durante el embarazo
Deacuteficit de absorcioacutenAlcoholismo croacutenicoEnfermedad de Crohn celiaquiacutea infeccioacuten otros problemas que le dificulten al cuerpo la digestioacuten de los alimentosAnemia perniciosa (factor intriacutenseco)Cirugiacuteas para extirpar ciertas partes del estoacutemago o el intestino delgado
MedicamentosB12 omeprazol metformina colchicina aminosalicilatos neomicinaFOLATO fenitoiacutena metotrexato sulfasalacina triamtereno pirimetamina trimetoprim con sulfametoxazol barbituacutericos
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
Reacciones metaboacutelicas en las que participan la vitamina B12 y el folato bull la conversioacuten de metilmalonil-CoA a succinil-CoA donde la adenosil-cobalamina actuacutea de
cofactor Por ello un deacuteficit de B12 conlleva un aumento de metilmalonil-CoA y de su producto de hidroacutelisis el aacutecido metilmaloacutenico
bull la siacutentesis de metionina a partir de homocisteina gracias a la metionina sintetasa y a la metil-cobalamina como cofactor En esta misma reaccioacuten el metiltetrahidrofolato es transformado a tetrahidrofolato que es necesario para la siacutentesis de DNA
Congreso Nacional Laboratorio Cliacutenico
2018
Anemia macrociacutetica secundaria a deficiencia de aacutecido foacutelico y de vitamina B12(cobalamina)
La deficiencia de B12 yo aacutecido foacutelico es la causa maacutes frecuente de megaloblastosis
Dentro de distintas funciones generales del metabolismo la vitamina B12 es uncofactor esencial en la siacutentesis de ADN y ARN compromete a todas las ceacutelulas delorganismo
Su deficiencia se manifiesta en oacuterganos con alto recambio celular como la meacutedulaosea y en el sistema nervioso central (SNC) a traveacutes de la siacutentesis de mielina y lareparacioacuten axonal
La deficiencia de cobalamina es responsable de alteraciones hematoloacutegicasneuroloacutegicas neurocognitivas y neuropsiquiaacutetricas
La siacutentesis defectuosa de ADN conduce a la apoptosis y a la hemoacutelisis (intra yextramedular) causantes de la hemopoyesis inefectiva
En meacutedula la siacutentesis ineficiente de DNA causa cambios megaloblaacutesticos comoconsecuencIa anemia y citopenias
Congreso Nacional Laboratorio Cliacutenico
2018
Limitaciones de los meacutetodos diagnoacutesticos claacutesicos
Volumen Corpuscular Medio (VCM) y morfologiacutea de sangre perifeacuterica En una serie de pacientes con deacuteficit de cobalamina soacutelo un 29 teniacutean anemia y soacutelo un 36 teniacutean un VCM gt 100 fL
Un VCM normal no puede ser empleado para rechazar una determinacioacuten de nivel de cobalamina ya que hasta un 25 de casos con manifestaciones neuroloacutegicas cursan con un VCM normal
Cobalamina seacuterica (nivel de B12) Es el test diagnoacutestico rutinario inicial estaacutendar Es un test ampliamente disponible de bajo coste y automatizado Sin embargo presenta algunas limitaciones
-- Existencia de varias teacutecnicas y ausencia de un gold standard por lo que hay diferentes liacutemites de referencia
-- Variacioacuten intraindividual muy alta
La OMS publicoacute en 2008 las conclusiones de un grupo teacutecnico consultado sobre el deacuteficit de cobalamina y folato
El grupo reconocioacute que no existen unos umbrales universalmente reconocidos para definir el deacuteficit de ambas vitaminas y expresaron la necesidad de un consenso
Devalia V Hamilton MS and Molloy AM on behalf of the British Committee for standards in haematology Guidelines for the diagnosis and treatment of cobalamin and folate disorders Br J Haematol 2014 166(4) 496-513
Schrier SL Diagnosis and treatment of vitamin B12 and folate deficiency UpToDate Last updated Jun 25 2014
de Benoist B Conclusions of a WHO Technical Consultation on folate and vitamin B12 deficiencies Food Nutr Bull 200829(2 Suppl)S238ndash44Congreso Nacional Laboratorio Cliacutenico
2018
Tomado de Tefferi A Li C En Atlas of Clinical Hematology Publicado por JO Armitage Philadelphia Current Medicine 2004
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
Int Jnl Lab Hem 2007 29 327ndash334
Clin Lab 201662343-347
In ourstudy mean MCVrMCV ratio of healthy controls is130 as microcytic anemia irondeficiency anemia is121 as also macrocytic anemia vitamin B12 deficiencyanemia is 115
Congreso Nacional Laboratorio Cliacutenico
2018
Sualeh Muslim Khan Muhammad Akbar Agha
Mean cell volume of reticulocytemdashA new parameter for diagnosing sub-clinical cobalamin deficiency in blood donors Int J Lab Hem 20181ndash4
The Abbott CELL-DYN Sapphire Hematology System uses multi-angle polarized scatter separation (MAPSS) and focused flow impedance technologies
Congreso Nacional Laboratorio Cliacutenico
2018
MCVr at 985 fL yielded the highest Youdenrsquos index at sensitivity of 82 specificity of 828 AUC 0847 ( 95 CI 803-891)
Khan SM Agha MA Mean cell volume of reticulocyte-A new parameter for diagnosing sub-clinical cobalamin deficiency in blood donors
Int J Lab Hem 20181ndash4 2018 Jul 13 doi 101111ijlh12899
Congreso Nacional Laboratorio Cliacutenico
2018
Role of Cell Population Data in the detection of folate and cobalamin deficiency
J Nieto et al
XXXI st International Symposium on Technological Innovations in Laboratory Hematology ISLH 2018 10-12 May 2018 Brussels Belgium
M-V-NRET and SD-VNRET are the best discriminatory single parameters to distinguish between patients with B9B12 deficiency and reference subjects M-V-NRETAUC=0823 sensitivity 78 and specificity 86
AUC=0852 sensitivity 55 and specificity 60
Conclusions The CPD parameters of Volume and Light Scatter (M and SD of LALS angle) that inform about size and intracellular structure of RBCs provided very useful information for the detection of B9B12 deficiency
Congreso Nacional Laboratorio Cliacutenico
2018
Cell Population Data
bull Paraacutemetros poblacionales de los leucocitos
bull Describen la morfologiacutea tamantildeo
estructuras citoplasmaacuteticas
nuacutecleo aacutecidos nucleacuteicos
bull Son datos numeacutericos con los que se construyen los ejes de lo diagramas de dispersioacuten de los leucocitos
bull Dependen de la tecnologiacutea
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
High Sensitivity New Parameters for the Detection of Vitamin B12 and Folate Deficiencies Blood 2008 1125379
B12 def vs
Normals
Mann
Withney T-Test
ROC
AUC Sens Specif Cutoff signifROC
MCV p=03156 p=09533 0577
MPV p=00001 0802 792 806 lt83 p=00001
NE Mean
Volume plt00001 0862 833 778 gt1403 p=00001
MO Mean
Volume plt00001 0829 625 889 gt1723 p=00001
MRV p=00113 0705 50 964 gt1133 p=00051
Folate def vs
Normals
Mann
Withney T-Test
ROC
AUC Sens Specif Cut-off signifROC
MCV p=00798 p=06461 0665
MPV plt00001 0832 81 806 lt83 p=00001
NE Mean
Volume p=00008 087 952 694 gt1402 p=00001
MO Mean
Volume p=00002 0801 667 833 gt1696 p=00001
MRV p=00054 0731 476 964 gt1133 p=00019
The Mean Neutrophil Volume (MNE V) and Mean Monocyte Volume (MMOV) may be used for the detection of megaloblastic neutrophils and monocytes MNEV and MMOV have significantly higher sensitivity than the previous information from the red cells (MCV) detecting B12 or folate deficiency because they are not affected by the presence at the same time of Iron deficiency or other reasons of anemia
Congreso Nacional Laboratorio Cliacutenico
2018
POSTER 733
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
CPD Sysmex XN
NE SSC complejidad
NE SFL aacutecidos nucleacuteicos
NE FSC tamantildeo
NE WX
NE WY
NE WZ
MO X
MO Y
MO Z
MO WX
MO WY
MO WZ
LY X
LY Y
LY Z
LY WX
LY WY
LY WZCongreso Nacio
nal Laboratorio Cliacutenico 2018
As MCV is the mean which is calculated it is insensitive to the presence of a small number of macrocytes
Further macrocytosis can be obscured by concomitant disorders that can cause microcytosis resulting inmasked megaloblastic anaemia (MA) for example iron deficiency hereditary elliptocytosis alpha and betathalassemia
This study was undertaken to evaluate the role of NEUT-X and NEUT-Y in detecting MA on peripheral blood andalso see whether other forms of macrocytic anaemia can be differentiated from MA
In MA the peripheral blood smear shows cytopenia with macroovalocytes and hypersegmented
neutrophils (gt5 lobes in 5 neutrophils six lobes nuclei or lobe average of gt35)
In conclusion our study shows that higher values of NEUT-X and NEUT-Y in MA patients in spite of low ornormal MCV high RDW may be used to not only reveal the masked cases of MA with concomitant irondeficiency but also separate them from the broader macrocytic anaemia group
Peripheral smear remains diagnostic however making smear for all the suspicious cases is a cumbersomeand tedious procedure Thus these parameters emerge as more reliable and stable parameters in themodern laboratories which in future may replace the older screening tools
Congreso Nacional Laboratorio Cliacutenico
2018
A favor Eficiencia Operativa
Mejora el proceso del Laboratorio
Mejor informacioacuten al Cliacutenico al mismo coste
Mejora la informacioacuten
Informa sobre la eritropoyesis deteccioacuten precoz de estados carenciales
Ayuda al cliacutenico
Estado real del paciente
En contraParaacutemetros de investigacioacuten
Dificultad de standarizar dependencia teacutecnica
Control de calidadCongreso Nacional Laboratorio Cliacutenico
2018
Hb reticulocitaria sensible para detectar la fase inicial del deacuteficitde hierro cuando la eritropoyesis requiere maacutes cantidad que laque recibe ANTES de que la anemia se establezca
La deteccioacuten precoz del deacuteficit de hierro en la fase del balance negativo demanda aporte contribuye a reducir sus manifestaciones cliacutenicas en los pacientes afectados mejorando la salud puacuteblica
Un tratamiento menos prolongado con suplementos y menor consumo de los recursos sanitaros Contribuye a la eficiencia y sostenibilidad de los servicios sanitarios
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
Buttarello MLaboratory diagnosis of anemia are the old and new red cell parameters useful in classification and treatment howInt Jnl Lab Hem 2016 38 (Suppl 1) 123ndash132
Congreso Nacional Laboratorio Cliacutenico
2018
Buttarello MLaboratory diagnosis of anemia are the old and new red cell parameters useful in classification and treatment howInt Jnl Lab Hem 2016 38 (Suppl 1) 123ndash132
Congreso Nacional Laboratorio Cliacutenico
2018
Ralph Green amp Ananya Datta Mitra Megaloblastic Anemias Nutritional and Other CausesMed Clin N Am 2017 101 297ndash317
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
ANEMIA CARENCIAL CAUSAS
Factores alimentariosConsumir una dieta vegetariana mal planeadaAlimentacioacuten deficiente en los bebeacutesDesnutricioacuten durante el embarazo
Deacuteficit de absorcioacutenAlcoholismo croacutenicoEnfermedad de Crohn celiaquiacutea infeccioacuten otros problemas que le dificulten al cuerpo la digestioacuten de los alimentosAnemia perniciosa (factor intriacutenseco)Cirugiacuteas para extirpar ciertas partes del estoacutemago o el intestino delgado
MedicamentosB12 omeprazol metformina colchicina aminosalicilatos neomicinaFOLATO fenitoiacutena metotrexato sulfasalacina triamtereno pirimetamina trimetoprim con sulfametoxazol barbituacutericos
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
Reacciones metaboacutelicas en las que participan la vitamina B12 y el folato bull la conversioacuten de metilmalonil-CoA a succinil-CoA donde la adenosil-cobalamina actuacutea de
cofactor Por ello un deacuteficit de B12 conlleva un aumento de metilmalonil-CoA y de su producto de hidroacutelisis el aacutecido metilmaloacutenico
bull la siacutentesis de metionina a partir de homocisteina gracias a la metionina sintetasa y a la metil-cobalamina como cofactor En esta misma reaccioacuten el metiltetrahidrofolato es transformado a tetrahidrofolato que es necesario para la siacutentesis de DNA
Congreso Nacional Laboratorio Cliacutenico
2018
Anemia macrociacutetica secundaria a deficiencia de aacutecido foacutelico y de vitamina B12(cobalamina)
La deficiencia de B12 yo aacutecido foacutelico es la causa maacutes frecuente de megaloblastosis
Dentro de distintas funciones generales del metabolismo la vitamina B12 es uncofactor esencial en la siacutentesis de ADN y ARN compromete a todas las ceacutelulas delorganismo
Su deficiencia se manifiesta en oacuterganos con alto recambio celular como la meacutedulaosea y en el sistema nervioso central (SNC) a traveacutes de la siacutentesis de mielina y lareparacioacuten axonal
La deficiencia de cobalamina es responsable de alteraciones hematoloacutegicasneuroloacutegicas neurocognitivas y neuropsiquiaacutetricas
La siacutentesis defectuosa de ADN conduce a la apoptosis y a la hemoacutelisis (intra yextramedular) causantes de la hemopoyesis inefectiva
En meacutedula la siacutentesis ineficiente de DNA causa cambios megaloblaacutesticos comoconsecuencIa anemia y citopenias
Congreso Nacional Laboratorio Cliacutenico
2018
Limitaciones de los meacutetodos diagnoacutesticos claacutesicos
Volumen Corpuscular Medio (VCM) y morfologiacutea de sangre perifeacuterica En una serie de pacientes con deacuteficit de cobalamina soacutelo un 29 teniacutean anemia y soacutelo un 36 teniacutean un VCM gt 100 fL
Un VCM normal no puede ser empleado para rechazar una determinacioacuten de nivel de cobalamina ya que hasta un 25 de casos con manifestaciones neuroloacutegicas cursan con un VCM normal
Cobalamina seacuterica (nivel de B12) Es el test diagnoacutestico rutinario inicial estaacutendar Es un test ampliamente disponible de bajo coste y automatizado Sin embargo presenta algunas limitaciones
-- Existencia de varias teacutecnicas y ausencia de un gold standard por lo que hay diferentes liacutemites de referencia
-- Variacioacuten intraindividual muy alta
La OMS publicoacute en 2008 las conclusiones de un grupo teacutecnico consultado sobre el deacuteficit de cobalamina y folato
El grupo reconocioacute que no existen unos umbrales universalmente reconocidos para definir el deacuteficit de ambas vitaminas y expresaron la necesidad de un consenso
Devalia V Hamilton MS and Molloy AM on behalf of the British Committee for standards in haematology Guidelines for the diagnosis and treatment of cobalamin and folate disorders Br J Haematol 2014 166(4) 496-513
Schrier SL Diagnosis and treatment of vitamin B12 and folate deficiency UpToDate Last updated Jun 25 2014
de Benoist B Conclusions of a WHO Technical Consultation on folate and vitamin B12 deficiencies Food Nutr Bull 200829(2 Suppl)S238ndash44Congreso Nacional Laboratorio Cliacutenico
2018
Tomado de Tefferi A Li C En Atlas of Clinical Hematology Publicado por JO Armitage Philadelphia Current Medicine 2004
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
Int Jnl Lab Hem 2007 29 327ndash334
Clin Lab 201662343-347
In ourstudy mean MCVrMCV ratio of healthy controls is130 as microcytic anemia irondeficiency anemia is121 as also macrocytic anemia vitamin B12 deficiencyanemia is 115
Congreso Nacional Laboratorio Cliacutenico
2018
Sualeh Muslim Khan Muhammad Akbar Agha
Mean cell volume of reticulocytemdashA new parameter for diagnosing sub-clinical cobalamin deficiency in blood donors Int J Lab Hem 20181ndash4
The Abbott CELL-DYN Sapphire Hematology System uses multi-angle polarized scatter separation (MAPSS) and focused flow impedance technologies
Congreso Nacional Laboratorio Cliacutenico
2018
MCVr at 985 fL yielded the highest Youdenrsquos index at sensitivity of 82 specificity of 828 AUC 0847 ( 95 CI 803-891)
Khan SM Agha MA Mean cell volume of reticulocyte-A new parameter for diagnosing sub-clinical cobalamin deficiency in blood donors
Int J Lab Hem 20181ndash4 2018 Jul 13 doi 101111ijlh12899
Congreso Nacional Laboratorio Cliacutenico
2018
Role of Cell Population Data in the detection of folate and cobalamin deficiency
J Nieto et al
XXXI st International Symposium on Technological Innovations in Laboratory Hematology ISLH 2018 10-12 May 2018 Brussels Belgium
M-V-NRET and SD-VNRET are the best discriminatory single parameters to distinguish between patients with B9B12 deficiency and reference subjects M-V-NRETAUC=0823 sensitivity 78 and specificity 86
AUC=0852 sensitivity 55 and specificity 60
Conclusions The CPD parameters of Volume and Light Scatter (M and SD of LALS angle) that inform about size and intracellular structure of RBCs provided very useful information for the detection of B9B12 deficiency
Congreso Nacional Laboratorio Cliacutenico
2018
Cell Population Data
bull Paraacutemetros poblacionales de los leucocitos
bull Describen la morfologiacutea tamantildeo
estructuras citoplasmaacuteticas
nuacutecleo aacutecidos nucleacuteicos
bull Son datos numeacutericos con los que se construyen los ejes de lo diagramas de dispersioacuten de los leucocitos
bull Dependen de la tecnologiacutea
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
High Sensitivity New Parameters for the Detection of Vitamin B12 and Folate Deficiencies Blood 2008 1125379
B12 def vs
Normals
Mann
Withney T-Test
ROC
AUC Sens Specif Cutoff signifROC
MCV p=03156 p=09533 0577
MPV p=00001 0802 792 806 lt83 p=00001
NE Mean
Volume plt00001 0862 833 778 gt1403 p=00001
MO Mean
Volume plt00001 0829 625 889 gt1723 p=00001
MRV p=00113 0705 50 964 gt1133 p=00051
Folate def vs
Normals
Mann
Withney T-Test
ROC
AUC Sens Specif Cut-off signifROC
MCV p=00798 p=06461 0665
MPV plt00001 0832 81 806 lt83 p=00001
NE Mean
Volume p=00008 087 952 694 gt1402 p=00001
MO Mean
Volume p=00002 0801 667 833 gt1696 p=00001
MRV p=00054 0731 476 964 gt1133 p=00019
The Mean Neutrophil Volume (MNE V) and Mean Monocyte Volume (MMOV) may be used for the detection of megaloblastic neutrophils and monocytes MNEV and MMOV have significantly higher sensitivity than the previous information from the red cells (MCV) detecting B12 or folate deficiency because they are not affected by the presence at the same time of Iron deficiency or other reasons of anemia
Congreso Nacional Laboratorio Cliacutenico
2018
POSTER 733
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
CPD Sysmex XN
NE SSC complejidad
NE SFL aacutecidos nucleacuteicos
NE FSC tamantildeo
NE WX
NE WY
NE WZ
MO X
MO Y
MO Z
MO WX
MO WY
MO WZ
LY X
LY Y
LY Z
LY WX
LY WY
LY WZCongreso Nacio
nal Laboratorio Cliacutenico 2018
As MCV is the mean which is calculated it is insensitive to the presence of a small number of macrocytes
Further macrocytosis can be obscured by concomitant disorders that can cause microcytosis resulting inmasked megaloblastic anaemia (MA) for example iron deficiency hereditary elliptocytosis alpha and betathalassemia
This study was undertaken to evaluate the role of NEUT-X and NEUT-Y in detecting MA on peripheral blood andalso see whether other forms of macrocytic anaemia can be differentiated from MA
In MA the peripheral blood smear shows cytopenia with macroovalocytes and hypersegmented
neutrophils (gt5 lobes in 5 neutrophils six lobes nuclei or lobe average of gt35)
In conclusion our study shows that higher values of NEUT-X and NEUT-Y in MA patients in spite of low ornormal MCV high RDW may be used to not only reveal the masked cases of MA with concomitant irondeficiency but also separate them from the broader macrocytic anaemia group
Peripheral smear remains diagnostic however making smear for all the suspicious cases is a cumbersomeand tedious procedure Thus these parameters emerge as more reliable and stable parameters in themodern laboratories which in future may replace the older screening tools
Congreso Nacional Laboratorio Cliacutenico
2018
A favor Eficiencia Operativa
Mejora el proceso del Laboratorio
Mejor informacioacuten al Cliacutenico al mismo coste
Mejora la informacioacuten
Informa sobre la eritropoyesis deteccioacuten precoz de estados carenciales
Ayuda al cliacutenico
Estado real del paciente
En contraParaacutemetros de investigacioacuten
Dificultad de standarizar dependencia teacutecnica
Control de calidadCongreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
Buttarello MLaboratory diagnosis of anemia are the old and new red cell parameters useful in classification and treatment howInt Jnl Lab Hem 2016 38 (Suppl 1) 123ndash132
Congreso Nacional Laboratorio Cliacutenico
2018
Buttarello MLaboratory diagnosis of anemia are the old and new red cell parameters useful in classification and treatment howInt Jnl Lab Hem 2016 38 (Suppl 1) 123ndash132
Congreso Nacional Laboratorio Cliacutenico
2018
Ralph Green amp Ananya Datta Mitra Megaloblastic Anemias Nutritional and Other CausesMed Clin N Am 2017 101 297ndash317
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
ANEMIA CARENCIAL CAUSAS
Factores alimentariosConsumir una dieta vegetariana mal planeadaAlimentacioacuten deficiente en los bebeacutesDesnutricioacuten durante el embarazo
Deacuteficit de absorcioacutenAlcoholismo croacutenicoEnfermedad de Crohn celiaquiacutea infeccioacuten otros problemas que le dificulten al cuerpo la digestioacuten de los alimentosAnemia perniciosa (factor intriacutenseco)Cirugiacuteas para extirpar ciertas partes del estoacutemago o el intestino delgado
MedicamentosB12 omeprazol metformina colchicina aminosalicilatos neomicinaFOLATO fenitoiacutena metotrexato sulfasalacina triamtereno pirimetamina trimetoprim con sulfametoxazol barbituacutericos
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
Reacciones metaboacutelicas en las que participan la vitamina B12 y el folato bull la conversioacuten de metilmalonil-CoA a succinil-CoA donde la adenosil-cobalamina actuacutea de
cofactor Por ello un deacuteficit de B12 conlleva un aumento de metilmalonil-CoA y de su producto de hidroacutelisis el aacutecido metilmaloacutenico
bull la siacutentesis de metionina a partir de homocisteina gracias a la metionina sintetasa y a la metil-cobalamina como cofactor En esta misma reaccioacuten el metiltetrahidrofolato es transformado a tetrahidrofolato que es necesario para la siacutentesis de DNA
Congreso Nacional Laboratorio Cliacutenico
2018
Anemia macrociacutetica secundaria a deficiencia de aacutecido foacutelico y de vitamina B12(cobalamina)
La deficiencia de B12 yo aacutecido foacutelico es la causa maacutes frecuente de megaloblastosis
Dentro de distintas funciones generales del metabolismo la vitamina B12 es uncofactor esencial en la siacutentesis de ADN y ARN compromete a todas las ceacutelulas delorganismo
Su deficiencia se manifiesta en oacuterganos con alto recambio celular como la meacutedulaosea y en el sistema nervioso central (SNC) a traveacutes de la siacutentesis de mielina y lareparacioacuten axonal
La deficiencia de cobalamina es responsable de alteraciones hematoloacutegicasneuroloacutegicas neurocognitivas y neuropsiquiaacutetricas
La siacutentesis defectuosa de ADN conduce a la apoptosis y a la hemoacutelisis (intra yextramedular) causantes de la hemopoyesis inefectiva
En meacutedula la siacutentesis ineficiente de DNA causa cambios megaloblaacutesticos comoconsecuencIa anemia y citopenias
Congreso Nacional Laboratorio Cliacutenico
2018
Limitaciones de los meacutetodos diagnoacutesticos claacutesicos
Volumen Corpuscular Medio (VCM) y morfologiacutea de sangre perifeacuterica En una serie de pacientes con deacuteficit de cobalamina soacutelo un 29 teniacutean anemia y soacutelo un 36 teniacutean un VCM gt 100 fL
Un VCM normal no puede ser empleado para rechazar una determinacioacuten de nivel de cobalamina ya que hasta un 25 de casos con manifestaciones neuroloacutegicas cursan con un VCM normal
Cobalamina seacuterica (nivel de B12) Es el test diagnoacutestico rutinario inicial estaacutendar Es un test ampliamente disponible de bajo coste y automatizado Sin embargo presenta algunas limitaciones
-- Existencia de varias teacutecnicas y ausencia de un gold standard por lo que hay diferentes liacutemites de referencia
-- Variacioacuten intraindividual muy alta
La OMS publicoacute en 2008 las conclusiones de un grupo teacutecnico consultado sobre el deacuteficit de cobalamina y folato
El grupo reconocioacute que no existen unos umbrales universalmente reconocidos para definir el deacuteficit de ambas vitaminas y expresaron la necesidad de un consenso
Devalia V Hamilton MS and Molloy AM on behalf of the British Committee for standards in haematology Guidelines for the diagnosis and treatment of cobalamin and folate disorders Br J Haematol 2014 166(4) 496-513
Schrier SL Diagnosis and treatment of vitamin B12 and folate deficiency UpToDate Last updated Jun 25 2014
de Benoist B Conclusions of a WHO Technical Consultation on folate and vitamin B12 deficiencies Food Nutr Bull 200829(2 Suppl)S238ndash44Congreso Nacional Laboratorio Cliacutenico
2018
Tomado de Tefferi A Li C En Atlas of Clinical Hematology Publicado por JO Armitage Philadelphia Current Medicine 2004
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
Int Jnl Lab Hem 2007 29 327ndash334
Clin Lab 201662343-347
In ourstudy mean MCVrMCV ratio of healthy controls is130 as microcytic anemia irondeficiency anemia is121 as also macrocytic anemia vitamin B12 deficiencyanemia is 115
Congreso Nacional Laboratorio Cliacutenico
2018
Sualeh Muslim Khan Muhammad Akbar Agha
Mean cell volume of reticulocytemdashA new parameter for diagnosing sub-clinical cobalamin deficiency in blood donors Int J Lab Hem 20181ndash4
The Abbott CELL-DYN Sapphire Hematology System uses multi-angle polarized scatter separation (MAPSS) and focused flow impedance technologies
Congreso Nacional Laboratorio Cliacutenico
2018
MCVr at 985 fL yielded the highest Youdenrsquos index at sensitivity of 82 specificity of 828 AUC 0847 ( 95 CI 803-891)
Khan SM Agha MA Mean cell volume of reticulocyte-A new parameter for diagnosing sub-clinical cobalamin deficiency in blood donors
Int J Lab Hem 20181ndash4 2018 Jul 13 doi 101111ijlh12899
Congreso Nacional Laboratorio Cliacutenico
2018
Role of Cell Population Data in the detection of folate and cobalamin deficiency
J Nieto et al
XXXI st International Symposium on Technological Innovations in Laboratory Hematology ISLH 2018 10-12 May 2018 Brussels Belgium
M-V-NRET and SD-VNRET are the best discriminatory single parameters to distinguish between patients with B9B12 deficiency and reference subjects M-V-NRETAUC=0823 sensitivity 78 and specificity 86
AUC=0852 sensitivity 55 and specificity 60
Conclusions The CPD parameters of Volume and Light Scatter (M and SD of LALS angle) that inform about size and intracellular structure of RBCs provided very useful information for the detection of B9B12 deficiency
Congreso Nacional Laboratorio Cliacutenico
2018
Cell Population Data
bull Paraacutemetros poblacionales de los leucocitos
bull Describen la morfologiacutea tamantildeo
estructuras citoplasmaacuteticas
nuacutecleo aacutecidos nucleacuteicos
bull Son datos numeacutericos con los que se construyen los ejes de lo diagramas de dispersioacuten de los leucocitos
bull Dependen de la tecnologiacutea
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
High Sensitivity New Parameters for the Detection of Vitamin B12 and Folate Deficiencies Blood 2008 1125379
B12 def vs
Normals
Mann
Withney T-Test
ROC
AUC Sens Specif Cutoff signifROC
MCV p=03156 p=09533 0577
MPV p=00001 0802 792 806 lt83 p=00001
NE Mean
Volume plt00001 0862 833 778 gt1403 p=00001
MO Mean
Volume plt00001 0829 625 889 gt1723 p=00001
MRV p=00113 0705 50 964 gt1133 p=00051
Folate def vs
Normals
Mann
Withney T-Test
ROC
AUC Sens Specif Cut-off signifROC
MCV p=00798 p=06461 0665
MPV plt00001 0832 81 806 lt83 p=00001
NE Mean
Volume p=00008 087 952 694 gt1402 p=00001
MO Mean
Volume p=00002 0801 667 833 gt1696 p=00001
MRV p=00054 0731 476 964 gt1133 p=00019
The Mean Neutrophil Volume (MNE V) and Mean Monocyte Volume (MMOV) may be used for the detection of megaloblastic neutrophils and monocytes MNEV and MMOV have significantly higher sensitivity than the previous information from the red cells (MCV) detecting B12 or folate deficiency because they are not affected by the presence at the same time of Iron deficiency or other reasons of anemia
Congreso Nacional Laboratorio Cliacutenico
2018
POSTER 733
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
CPD Sysmex XN
NE SSC complejidad
NE SFL aacutecidos nucleacuteicos
NE FSC tamantildeo
NE WX
NE WY
NE WZ
MO X
MO Y
MO Z
MO WX
MO WY
MO WZ
LY X
LY Y
LY Z
LY WX
LY WY
LY WZCongreso Nacio
nal Laboratorio Cliacutenico 2018
As MCV is the mean which is calculated it is insensitive to the presence of a small number of macrocytes
Further macrocytosis can be obscured by concomitant disorders that can cause microcytosis resulting inmasked megaloblastic anaemia (MA) for example iron deficiency hereditary elliptocytosis alpha and betathalassemia
This study was undertaken to evaluate the role of NEUT-X and NEUT-Y in detecting MA on peripheral blood andalso see whether other forms of macrocytic anaemia can be differentiated from MA
In MA the peripheral blood smear shows cytopenia with macroovalocytes and hypersegmented
neutrophils (gt5 lobes in 5 neutrophils six lobes nuclei or lobe average of gt35)
In conclusion our study shows that higher values of NEUT-X and NEUT-Y in MA patients in spite of low ornormal MCV high RDW may be used to not only reveal the masked cases of MA with concomitant irondeficiency but also separate them from the broader macrocytic anaemia group
Peripheral smear remains diagnostic however making smear for all the suspicious cases is a cumbersomeand tedious procedure Thus these parameters emerge as more reliable and stable parameters in themodern laboratories which in future may replace the older screening tools
Congreso Nacional Laboratorio Cliacutenico
2018
A favor Eficiencia Operativa
Mejora el proceso del Laboratorio
Mejor informacioacuten al Cliacutenico al mismo coste
Mejora la informacioacuten
Informa sobre la eritropoyesis deteccioacuten precoz de estados carenciales
Ayuda al cliacutenico
Estado real del paciente
En contraParaacutemetros de investigacioacuten
Dificultad de standarizar dependencia teacutecnica
Control de calidadCongreso Nacional Laboratorio Cliacutenico
2018
Buttarello MLaboratory diagnosis of anemia are the old and new red cell parameters useful in classification and treatment howInt Jnl Lab Hem 2016 38 (Suppl 1) 123ndash132
Congreso Nacional Laboratorio Cliacutenico
2018
Buttarello MLaboratory diagnosis of anemia are the old and new red cell parameters useful in classification and treatment howInt Jnl Lab Hem 2016 38 (Suppl 1) 123ndash132
Congreso Nacional Laboratorio Cliacutenico
2018
Ralph Green amp Ananya Datta Mitra Megaloblastic Anemias Nutritional and Other CausesMed Clin N Am 2017 101 297ndash317
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
ANEMIA CARENCIAL CAUSAS
Factores alimentariosConsumir una dieta vegetariana mal planeadaAlimentacioacuten deficiente en los bebeacutesDesnutricioacuten durante el embarazo
Deacuteficit de absorcioacutenAlcoholismo croacutenicoEnfermedad de Crohn celiaquiacutea infeccioacuten otros problemas que le dificulten al cuerpo la digestioacuten de los alimentosAnemia perniciosa (factor intriacutenseco)Cirugiacuteas para extirpar ciertas partes del estoacutemago o el intestino delgado
MedicamentosB12 omeprazol metformina colchicina aminosalicilatos neomicinaFOLATO fenitoiacutena metotrexato sulfasalacina triamtereno pirimetamina trimetoprim con sulfametoxazol barbituacutericos
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
Reacciones metaboacutelicas en las que participan la vitamina B12 y el folato bull la conversioacuten de metilmalonil-CoA a succinil-CoA donde la adenosil-cobalamina actuacutea de
cofactor Por ello un deacuteficit de B12 conlleva un aumento de metilmalonil-CoA y de su producto de hidroacutelisis el aacutecido metilmaloacutenico
bull la siacutentesis de metionina a partir de homocisteina gracias a la metionina sintetasa y a la metil-cobalamina como cofactor En esta misma reaccioacuten el metiltetrahidrofolato es transformado a tetrahidrofolato que es necesario para la siacutentesis de DNA
Congreso Nacional Laboratorio Cliacutenico
2018
Anemia macrociacutetica secundaria a deficiencia de aacutecido foacutelico y de vitamina B12(cobalamina)
La deficiencia de B12 yo aacutecido foacutelico es la causa maacutes frecuente de megaloblastosis
Dentro de distintas funciones generales del metabolismo la vitamina B12 es uncofactor esencial en la siacutentesis de ADN y ARN compromete a todas las ceacutelulas delorganismo
Su deficiencia se manifiesta en oacuterganos con alto recambio celular como la meacutedulaosea y en el sistema nervioso central (SNC) a traveacutes de la siacutentesis de mielina y lareparacioacuten axonal
La deficiencia de cobalamina es responsable de alteraciones hematoloacutegicasneuroloacutegicas neurocognitivas y neuropsiquiaacutetricas
La siacutentesis defectuosa de ADN conduce a la apoptosis y a la hemoacutelisis (intra yextramedular) causantes de la hemopoyesis inefectiva
En meacutedula la siacutentesis ineficiente de DNA causa cambios megaloblaacutesticos comoconsecuencIa anemia y citopenias
Congreso Nacional Laboratorio Cliacutenico
2018
Limitaciones de los meacutetodos diagnoacutesticos claacutesicos
Volumen Corpuscular Medio (VCM) y morfologiacutea de sangre perifeacuterica En una serie de pacientes con deacuteficit de cobalamina soacutelo un 29 teniacutean anemia y soacutelo un 36 teniacutean un VCM gt 100 fL
Un VCM normal no puede ser empleado para rechazar una determinacioacuten de nivel de cobalamina ya que hasta un 25 de casos con manifestaciones neuroloacutegicas cursan con un VCM normal
Cobalamina seacuterica (nivel de B12) Es el test diagnoacutestico rutinario inicial estaacutendar Es un test ampliamente disponible de bajo coste y automatizado Sin embargo presenta algunas limitaciones
-- Existencia de varias teacutecnicas y ausencia de un gold standard por lo que hay diferentes liacutemites de referencia
-- Variacioacuten intraindividual muy alta
La OMS publicoacute en 2008 las conclusiones de un grupo teacutecnico consultado sobre el deacuteficit de cobalamina y folato
El grupo reconocioacute que no existen unos umbrales universalmente reconocidos para definir el deacuteficit de ambas vitaminas y expresaron la necesidad de un consenso
Devalia V Hamilton MS and Molloy AM on behalf of the British Committee for standards in haematology Guidelines for the diagnosis and treatment of cobalamin and folate disorders Br J Haematol 2014 166(4) 496-513
Schrier SL Diagnosis and treatment of vitamin B12 and folate deficiency UpToDate Last updated Jun 25 2014
de Benoist B Conclusions of a WHO Technical Consultation on folate and vitamin B12 deficiencies Food Nutr Bull 200829(2 Suppl)S238ndash44Congreso Nacional Laboratorio Cliacutenico
2018
Tomado de Tefferi A Li C En Atlas of Clinical Hematology Publicado por JO Armitage Philadelphia Current Medicine 2004
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
Int Jnl Lab Hem 2007 29 327ndash334
Clin Lab 201662343-347
In ourstudy mean MCVrMCV ratio of healthy controls is130 as microcytic anemia irondeficiency anemia is121 as also macrocytic anemia vitamin B12 deficiencyanemia is 115
Congreso Nacional Laboratorio Cliacutenico
2018
Sualeh Muslim Khan Muhammad Akbar Agha
Mean cell volume of reticulocytemdashA new parameter for diagnosing sub-clinical cobalamin deficiency in blood donors Int J Lab Hem 20181ndash4
The Abbott CELL-DYN Sapphire Hematology System uses multi-angle polarized scatter separation (MAPSS) and focused flow impedance technologies
Congreso Nacional Laboratorio Cliacutenico
2018
MCVr at 985 fL yielded the highest Youdenrsquos index at sensitivity of 82 specificity of 828 AUC 0847 ( 95 CI 803-891)
Khan SM Agha MA Mean cell volume of reticulocyte-A new parameter for diagnosing sub-clinical cobalamin deficiency in blood donors
Int J Lab Hem 20181ndash4 2018 Jul 13 doi 101111ijlh12899
Congreso Nacional Laboratorio Cliacutenico
2018
Role of Cell Population Data in the detection of folate and cobalamin deficiency
J Nieto et al
XXXI st International Symposium on Technological Innovations in Laboratory Hematology ISLH 2018 10-12 May 2018 Brussels Belgium
M-V-NRET and SD-VNRET are the best discriminatory single parameters to distinguish between patients with B9B12 deficiency and reference subjects M-V-NRETAUC=0823 sensitivity 78 and specificity 86
AUC=0852 sensitivity 55 and specificity 60
Conclusions The CPD parameters of Volume and Light Scatter (M and SD of LALS angle) that inform about size and intracellular structure of RBCs provided very useful information for the detection of B9B12 deficiency
Congreso Nacional Laboratorio Cliacutenico
2018
Cell Population Data
bull Paraacutemetros poblacionales de los leucocitos
bull Describen la morfologiacutea tamantildeo
estructuras citoplasmaacuteticas
nuacutecleo aacutecidos nucleacuteicos
bull Son datos numeacutericos con los que se construyen los ejes de lo diagramas de dispersioacuten de los leucocitos
bull Dependen de la tecnologiacutea
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
High Sensitivity New Parameters for the Detection of Vitamin B12 and Folate Deficiencies Blood 2008 1125379
B12 def vs
Normals
Mann
Withney T-Test
ROC
AUC Sens Specif Cutoff signifROC
MCV p=03156 p=09533 0577
MPV p=00001 0802 792 806 lt83 p=00001
NE Mean
Volume plt00001 0862 833 778 gt1403 p=00001
MO Mean
Volume plt00001 0829 625 889 gt1723 p=00001
MRV p=00113 0705 50 964 gt1133 p=00051
Folate def vs
Normals
Mann
Withney T-Test
ROC
AUC Sens Specif Cut-off signifROC
MCV p=00798 p=06461 0665
MPV plt00001 0832 81 806 lt83 p=00001
NE Mean
Volume p=00008 087 952 694 gt1402 p=00001
MO Mean
Volume p=00002 0801 667 833 gt1696 p=00001
MRV p=00054 0731 476 964 gt1133 p=00019
The Mean Neutrophil Volume (MNE V) and Mean Monocyte Volume (MMOV) may be used for the detection of megaloblastic neutrophils and monocytes MNEV and MMOV have significantly higher sensitivity than the previous information from the red cells (MCV) detecting B12 or folate deficiency because they are not affected by the presence at the same time of Iron deficiency or other reasons of anemia
Congreso Nacional Laboratorio Cliacutenico
2018
POSTER 733
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
CPD Sysmex XN
NE SSC complejidad
NE SFL aacutecidos nucleacuteicos
NE FSC tamantildeo
NE WX
NE WY
NE WZ
MO X
MO Y
MO Z
MO WX
MO WY
MO WZ
LY X
LY Y
LY Z
LY WX
LY WY
LY WZCongreso Nacio
nal Laboratorio Cliacutenico 2018
As MCV is the mean which is calculated it is insensitive to the presence of a small number of macrocytes
Further macrocytosis can be obscured by concomitant disorders that can cause microcytosis resulting inmasked megaloblastic anaemia (MA) for example iron deficiency hereditary elliptocytosis alpha and betathalassemia
This study was undertaken to evaluate the role of NEUT-X and NEUT-Y in detecting MA on peripheral blood andalso see whether other forms of macrocytic anaemia can be differentiated from MA
In MA the peripheral blood smear shows cytopenia with macroovalocytes and hypersegmented
neutrophils (gt5 lobes in 5 neutrophils six lobes nuclei or lobe average of gt35)
In conclusion our study shows that higher values of NEUT-X and NEUT-Y in MA patients in spite of low ornormal MCV high RDW may be used to not only reveal the masked cases of MA with concomitant irondeficiency but also separate them from the broader macrocytic anaemia group
Peripheral smear remains diagnostic however making smear for all the suspicious cases is a cumbersomeand tedious procedure Thus these parameters emerge as more reliable and stable parameters in themodern laboratories which in future may replace the older screening tools
Congreso Nacional Laboratorio Cliacutenico
2018
A favor Eficiencia Operativa
Mejora el proceso del Laboratorio
Mejor informacioacuten al Cliacutenico al mismo coste
Mejora la informacioacuten
Informa sobre la eritropoyesis deteccioacuten precoz de estados carenciales
Ayuda al cliacutenico
Estado real del paciente
En contraParaacutemetros de investigacioacuten
Dificultad de standarizar dependencia teacutecnica
Control de calidadCongreso Nacional Laboratorio Cliacutenico
2018
Buttarello MLaboratory diagnosis of anemia are the old and new red cell parameters useful in classification and treatment howInt Jnl Lab Hem 2016 38 (Suppl 1) 123ndash132
Congreso Nacional Laboratorio Cliacutenico
2018
Ralph Green amp Ananya Datta Mitra Megaloblastic Anemias Nutritional and Other CausesMed Clin N Am 2017 101 297ndash317
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
ANEMIA CARENCIAL CAUSAS
Factores alimentariosConsumir una dieta vegetariana mal planeadaAlimentacioacuten deficiente en los bebeacutesDesnutricioacuten durante el embarazo
Deacuteficit de absorcioacutenAlcoholismo croacutenicoEnfermedad de Crohn celiaquiacutea infeccioacuten otros problemas que le dificulten al cuerpo la digestioacuten de los alimentosAnemia perniciosa (factor intriacutenseco)Cirugiacuteas para extirpar ciertas partes del estoacutemago o el intestino delgado
MedicamentosB12 omeprazol metformina colchicina aminosalicilatos neomicinaFOLATO fenitoiacutena metotrexato sulfasalacina triamtereno pirimetamina trimetoprim con sulfametoxazol barbituacutericos
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
Reacciones metaboacutelicas en las que participan la vitamina B12 y el folato bull la conversioacuten de metilmalonil-CoA a succinil-CoA donde la adenosil-cobalamina actuacutea de
cofactor Por ello un deacuteficit de B12 conlleva un aumento de metilmalonil-CoA y de su producto de hidroacutelisis el aacutecido metilmaloacutenico
bull la siacutentesis de metionina a partir de homocisteina gracias a la metionina sintetasa y a la metil-cobalamina como cofactor En esta misma reaccioacuten el metiltetrahidrofolato es transformado a tetrahidrofolato que es necesario para la siacutentesis de DNA
Congreso Nacional Laboratorio Cliacutenico
2018
Anemia macrociacutetica secundaria a deficiencia de aacutecido foacutelico y de vitamina B12(cobalamina)
La deficiencia de B12 yo aacutecido foacutelico es la causa maacutes frecuente de megaloblastosis
Dentro de distintas funciones generales del metabolismo la vitamina B12 es uncofactor esencial en la siacutentesis de ADN y ARN compromete a todas las ceacutelulas delorganismo
Su deficiencia se manifiesta en oacuterganos con alto recambio celular como la meacutedulaosea y en el sistema nervioso central (SNC) a traveacutes de la siacutentesis de mielina y lareparacioacuten axonal
La deficiencia de cobalamina es responsable de alteraciones hematoloacutegicasneuroloacutegicas neurocognitivas y neuropsiquiaacutetricas
La siacutentesis defectuosa de ADN conduce a la apoptosis y a la hemoacutelisis (intra yextramedular) causantes de la hemopoyesis inefectiva
En meacutedula la siacutentesis ineficiente de DNA causa cambios megaloblaacutesticos comoconsecuencIa anemia y citopenias
Congreso Nacional Laboratorio Cliacutenico
2018
Limitaciones de los meacutetodos diagnoacutesticos claacutesicos
Volumen Corpuscular Medio (VCM) y morfologiacutea de sangre perifeacuterica En una serie de pacientes con deacuteficit de cobalamina soacutelo un 29 teniacutean anemia y soacutelo un 36 teniacutean un VCM gt 100 fL
Un VCM normal no puede ser empleado para rechazar una determinacioacuten de nivel de cobalamina ya que hasta un 25 de casos con manifestaciones neuroloacutegicas cursan con un VCM normal
Cobalamina seacuterica (nivel de B12) Es el test diagnoacutestico rutinario inicial estaacutendar Es un test ampliamente disponible de bajo coste y automatizado Sin embargo presenta algunas limitaciones
-- Existencia de varias teacutecnicas y ausencia de un gold standard por lo que hay diferentes liacutemites de referencia
-- Variacioacuten intraindividual muy alta
La OMS publicoacute en 2008 las conclusiones de un grupo teacutecnico consultado sobre el deacuteficit de cobalamina y folato
El grupo reconocioacute que no existen unos umbrales universalmente reconocidos para definir el deacuteficit de ambas vitaminas y expresaron la necesidad de un consenso
Devalia V Hamilton MS and Molloy AM on behalf of the British Committee for standards in haematology Guidelines for the diagnosis and treatment of cobalamin and folate disorders Br J Haematol 2014 166(4) 496-513
Schrier SL Diagnosis and treatment of vitamin B12 and folate deficiency UpToDate Last updated Jun 25 2014
de Benoist B Conclusions of a WHO Technical Consultation on folate and vitamin B12 deficiencies Food Nutr Bull 200829(2 Suppl)S238ndash44Congreso Nacional Laboratorio Cliacutenico
2018
Tomado de Tefferi A Li C En Atlas of Clinical Hematology Publicado por JO Armitage Philadelphia Current Medicine 2004
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
Int Jnl Lab Hem 2007 29 327ndash334
Clin Lab 201662343-347
In ourstudy mean MCVrMCV ratio of healthy controls is130 as microcytic anemia irondeficiency anemia is121 as also macrocytic anemia vitamin B12 deficiencyanemia is 115
Congreso Nacional Laboratorio Cliacutenico
2018
Sualeh Muslim Khan Muhammad Akbar Agha
Mean cell volume of reticulocytemdashA new parameter for diagnosing sub-clinical cobalamin deficiency in blood donors Int J Lab Hem 20181ndash4
The Abbott CELL-DYN Sapphire Hematology System uses multi-angle polarized scatter separation (MAPSS) and focused flow impedance technologies
Congreso Nacional Laboratorio Cliacutenico
2018
MCVr at 985 fL yielded the highest Youdenrsquos index at sensitivity of 82 specificity of 828 AUC 0847 ( 95 CI 803-891)
Khan SM Agha MA Mean cell volume of reticulocyte-A new parameter for diagnosing sub-clinical cobalamin deficiency in blood donors
Int J Lab Hem 20181ndash4 2018 Jul 13 doi 101111ijlh12899
Congreso Nacional Laboratorio Cliacutenico
2018
Role of Cell Population Data in the detection of folate and cobalamin deficiency
J Nieto et al
XXXI st International Symposium on Technological Innovations in Laboratory Hematology ISLH 2018 10-12 May 2018 Brussels Belgium
M-V-NRET and SD-VNRET are the best discriminatory single parameters to distinguish between patients with B9B12 deficiency and reference subjects M-V-NRETAUC=0823 sensitivity 78 and specificity 86
AUC=0852 sensitivity 55 and specificity 60
Conclusions The CPD parameters of Volume and Light Scatter (M and SD of LALS angle) that inform about size and intracellular structure of RBCs provided very useful information for the detection of B9B12 deficiency
Congreso Nacional Laboratorio Cliacutenico
2018
Cell Population Data
bull Paraacutemetros poblacionales de los leucocitos
bull Describen la morfologiacutea tamantildeo
estructuras citoplasmaacuteticas
nuacutecleo aacutecidos nucleacuteicos
bull Son datos numeacutericos con los que se construyen los ejes de lo diagramas de dispersioacuten de los leucocitos
bull Dependen de la tecnologiacutea
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
High Sensitivity New Parameters for the Detection of Vitamin B12 and Folate Deficiencies Blood 2008 1125379
B12 def vs
Normals
Mann
Withney T-Test
ROC
AUC Sens Specif Cutoff signifROC
MCV p=03156 p=09533 0577
MPV p=00001 0802 792 806 lt83 p=00001
NE Mean
Volume plt00001 0862 833 778 gt1403 p=00001
MO Mean
Volume plt00001 0829 625 889 gt1723 p=00001
MRV p=00113 0705 50 964 gt1133 p=00051
Folate def vs
Normals
Mann
Withney T-Test
ROC
AUC Sens Specif Cut-off signifROC
MCV p=00798 p=06461 0665
MPV plt00001 0832 81 806 lt83 p=00001
NE Mean
Volume p=00008 087 952 694 gt1402 p=00001
MO Mean
Volume p=00002 0801 667 833 gt1696 p=00001
MRV p=00054 0731 476 964 gt1133 p=00019
The Mean Neutrophil Volume (MNE V) and Mean Monocyte Volume (MMOV) may be used for the detection of megaloblastic neutrophils and monocytes MNEV and MMOV have significantly higher sensitivity than the previous information from the red cells (MCV) detecting B12 or folate deficiency because they are not affected by the presence at the same time of Iron deficiency or other reasons of anemia
Congreso Nacional Laboratorio Cliacutenico
2018
POSTER 733
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
CPD Sysmex XN
NE SSC complejidad
NE SFL aacutecidos nucleacuteicos
NE FSC tamantildeo
NE WX
NE WY
NE WZ
MO X
MO Y
MO Z
MO WX
MO WY
MO WZ
LY X
LY Y
LY Z
LY WX
LY WY
LY WZCongreso Nacio
nal Laboratorio Cliacutenico 2018
As MCV is the mean which is calculated it is insensitive to the presence of a small number of macrocytes
Further macrocytosis can be obscured by concomitant disorders that can cause microcytosis resulting inmasked megaloblastic anaemia (MA) for example iron deficiency hereditary elliptocytosis alpha and betathalassemia
This study was undertaken to evaluate the role of NEUT-X and NEUT-Y in detecting MA on peripheral blood andalso see whether other forms of macrocytic anaemia can be differentiated from MA
In MA the peripheral blood smear shows cytopenia with macroovalocytes and hypersegmented
neutrophils (gt5 lobes in 5 neutrophils six lobes nuclei or lobe average of gt35)
In conclusion our study shows that higher values of NEUT-X and NEUT-Y in MA patients in spite of low ornormal MCV high RDW may be used to not only reveal the masked cases of MA with concomitant irondeficiency but also separate them from the broader macrocytic anaemia group
Peripheral smear remains diagnostic however making smear for all the suspicious cases is a cumbersomeand tedious procedure Thus these parameters emerge as more reliable and stable parameters in themodern laboratories which in future may replace the older screening tools
Congreso Nacional Laboratorio Cliacutenico
2018
A favor Eficiencia Operativa
Mejora el proceso del Laboratorio
Mejor informacioacuten al Cliacutenico al mismo coste
Mejora la informacioacuten
Informa sobre la eritropoyesis deteccioacuten precoz de estados carenciales
Ayuda al cliacutenico
Estado real del paciente
En contraParaacutemetros de investigacioacuten
Dificultad de standarizar dependencia teacutecnica
Control de calidadCongreso Nacional Laboratorio Cliacutenico
2018
Ralph Green amp Ananya Datta Mitra Megaloblastic Anemias Nutritional and Other CausesMed Clin N Am 2017 101 297ndash317
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
ANEMIA CARENCIAL CAUSAS
Factores alimentariosConsumir una dieta vegetariana mal planeadaAlimentacioacuten deficiente en los bebeacutesDesnutricioacuten durante el embarazo
Deacuteficit de absorcioacutenAlcoholismo croacutenicoEnfermedad de Crohn celiaquiacutea infeccioacuten otros problemas que le dificulten al cuerpo la digestioacuten de los alimentosAnemia perniciosa (factor intriacutenseco)Cirugiacuteas para extirpar ciertas partes del estoacutemago o el intestino delgado
MedicamentosB12 omeprazol metformina colchicina aminosalicilatos neomicinaFOLATO fenitoiacutena metotrexato sulfasalacina triamtereno pirimetamina trimetoprim con sulfametoxazol barbituacutericos
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
Reacciones metaboacutelicas en las que participan la vitamina B12 y el folato bull la conversioacuten de metilmalonil-CoA a succinil-CoA donde la adenosil-cobalamina actuacutea de
cofactor Por ello un deacuteficit de B12 conlleva un aumento de metilmalonil-CoA y de su producto de hidroacutelisis el aacutecido metilmaloacutenico
bull la siacutentesis de metionina a partir de homocisteina gracias a la metionina sintetasa y a la metil-cobalamina como cofactor En esta misma reaccioacuten el metiltetrahidrofolato es transformado a tetrahidrofolato que es necesario para la siacutentesis de DNA
Congreso Nacional Laboratorio Cliacutenico
2018
Anemia macrociacutetica secundaria a deficiencia de aacutecido foacutelico y de vitamina B12(cobalamina)
La deficiencia de B12 yo aacutecido foacutelico es la causa maacutes frecuente de megaloblastosis
Dentro de distintas funciones generales del metabolismo la vitamina B12 es uncofactor esencial en la siacutentesis de ADN y ARN compromete a todas las ceacutelulas delorganismo
Su deficiencia se manifiesta en oacuterganos con alto recambio celular como la meacutedulaosea y en el sistema nervioso central (SNC) a traveacutes de la siacutentesis de mielina y lareparacioacuten axonal
La deficiencia de cobalamina es responsable de alteraciones hematoloacutegicasneuroloacutegicas neurocognitivas y neuropsiquiaacutetricas
La siacutentesis defectuosa de ADN conduce a la apoptosis y a la hemoacutelisis (intra yextramedular) causantes de la hemopoyesis inefectiva
En meacutedula la siacutentesis ineficiente de DNA causa cambios megaloblaacutesticos comoconsecuencIa anemia y citopenias
Congreso Nacional Laboratorio Cliacutenico
2018
Limitaciones de los meacutetodos diagnoacutesticos claacutesicos
Volumen Corpuscular Medio (VCM) y morfologiacutea de sangre perifeacuterica En una serie de pacientes con deacuteficit de cobalamina soacutelo un 29 teniacutean anemia y soacutelo un 36 teniacutean un VCM gt 100 fL
Un VCM normal no puede ser empleado para rechazar una determinacioacuten de nivel de cobalamina ya que hasta un 25 de casos con manifestaciones neuroloacutegicas cursan con un VCM normal
Cobalamina seacuterica (nivel de B12) Es el test diagnoacutestico rutinario inicial estaacutendar Es un test ampliamente disponible de bajo coste y automatizado Sin embargo presenta algunas limitaciones
-- Existencia de varias teacutecnicas y ausencia de un gold standard por lo que hay diferentes liacutemites de referencia
-- Variacioacuten intraindividual muy alta
La OMS publicoacute en 2008 las conclusiones de un grupo teacutecnico consultado sobre el deacuteficit de cobalamina y folato
El grupo reconocioacute que no existen unos umbrales universalmente reconocidos para definir el deacuteficit de ambas vitaminas y expresaron la necesidad de un consenso
Devalia V Hamilton MS and Molloy AM on behalf of the British Committee for standards in haematology Guidelines for the diagnosis and treatment of cobalamin and folate disorders Br J Haematol 2014 166(4) 496-513
Schrier SL Diagnosis and treatment of vitamin B12 and folate deficiency UpToDate Last updated Jun 25 2014
de Benoist B Conclusions of a WHO Technical Consultation on folate and vitamin B12 deficiencies Food Nutr Bull 200829(2 Suppl)S238ndash44Congreso Nacional Laboratorio Cliacutenico
2018
Tomado de Tefferi A Li C En Atlas of Clinical Hematology Publicado por JO Armitage Philadelphia Current Medicine 2004
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
Int Jnl Lab Hem 2007 29 327ndash334
Clin Lab 201662343-347
In ourstudy mean MCVrMCV ratio of healthy controls is130 as microcytic anemia irondeficiency anemia is121 as also macrocytic anemia vitamin B12 deficiencyanemia is 115
Congreso Nacional Laboratorio Cliacutenico
2018
Sualeh Muslim Khan Muhammad Akbar Agha
Mean cell volume of reticulocytemdashA new parameter for diagnosing sub-clinical cobalamin deficiency in blood donors Int J Lab Hem 20181ndash4
The Abbott CELL-DYN Sapphire Hematology System uses multi-angle polarized scatter separation (MAPSS) and focused flow impedance technologies
Congreso Nacional Laboratorio Cliacutenico
2018
MCVr at 985 fL yielded the highest Youdenrsquos index at sensitivity of 82 specificity of 828 AUC 0847 ( 95 CI 803-891)
Khan SM Agha MA Mean cell volume of reticulocyte-A new parameter for diagnosing sub-clinical cobalamin deficiency in blood donors
Int J Lab Hem 20181ndash4 2018 Jul 13 doi 101111ijlh12899
Congreso Nacional Laboratorio Cliacutenico
2018
Role of Cell Population Data in the detection of folate and cobalamin deficiency
J Nieto et al
XXXI st International Symposium on Technological Innovations in Laboratory Hematology ISLH 2018 10-12 May 2018 Brussels Belgium
M-V-NRET and SD-VNRET are the best discriminatory single parameters to distinguish between patients with B9B12 deficiency and reference subjects M-V-NRETAUC=0823 sensitivity 78 and specificity 86
AUC=0852 sensitivity 55 and specificity 60
Conclusions The CPD parameters of Volume and Light Scatter (M and SD of LALS angle) that inform about size and intracellular structure of RBCs provided very useful information for the detection of B9B12 deficiency
Congreso Nacional Laboratorio Cliacutenico
2018
Cell Population Data
bull Paraacutemetros poblacionales de los leucocitos
bull Describen la morfologiacutea tamantildeo
estructuras citoplasmaacuteticas
nuacutecleo aacutecidos nucleacuteicos
bull Son datos numeacutericos con los que se construyen los ejes de lo diagramas de dispersioacuten de los leucocitos
bull Dependen de la tecnologiacutea
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
High Sensitivity New Parameters for the Detection of Vitamin B12 and Folate Deficiencies Blood 2008 1125379
B12 def vs
Normals
Mann
Withney T-Test
ROC
AUC Sens Specif Cutoff signifROC
MCV p=03156 p=09533 0577
MPV p=00001 0802 792 806 lt83 p=00001
NE Mean
Volume plt00001 0862 833 778 gt1403 p=00001
MO Mean
Volume plt00001 0829 625 889 gt1723 p=00001
MRV p=00113 0705 50 964 gt1133 p=00051
Folate def vs
Normals
Mann
Withney T-Test
ROC
AUC Sens Specif Cut-off signifROC
MCV p=00798 p=06461 0665
MPV plt00001 0832 81 806 lt83 p=00001
NE Mean
Volume p=00008 087 952 694 gt1402 p=00001
MO Mean
Volume p=00002 0801 667 833 gt1696 p=00001
MRV p=00054 0731 476 964 gt1133 p=00019
The Mean Neutrophil Volume (MNE V) and Mean Monocyte Volume (MMOV) may be used for the detection of megaloblastic neutrophils and monocytes MNEV and MMOV have significantly higher sensitivity than the previous information from the red cells (MCV) detecting B12 or folate deficiency because they are not affected by the presence at the same time of Iron deficiency or other reasons of anemia
Congreso Nacional Laboratorio Cliacutenico
2018
POSTER 733
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
CPD Sysmex XN
NE SSC complejidad
NE SFL aacutecidos nucleacuteicos
NE FSC tamantildeo
NE WX
NE WY
NE WZ
MO X
MO Y
MO Z
MO WX
MO WY
MO WZ
LY X
LY Y
LY Z
LY WX
LY WY
LY WZCongreso Nacio
nal Laboratorio Cliacutenico 2018
As MCV is the mean which is calculated it is insensitive to the presence of a small number of macrocytes
Further macrocytosis can be obscured by concomitant disorders that can cause microcytosis resulting inmasked megaloblastic anaemia (MA) for example iron deficiency hereditary elliptocytosis alpha and betathalassemia
This study was undertaken to evaluate the role of NEUT-X and NEUT-Y in detecting MA on peripheral blood andalso see whether other forms of macrocytic anaemia can be differentiated from MA
In MA the peripheral blood smear shows cytopenia with macroovalocytes and hypersegmented
neutrophils (gt5 lobes in 5 neutrophils six lobes nuclei or lobe average of gt35)
In conclusion our study shows that higher values of NEUT-X and NEUT-Y in MA patients in spite of low ornormal MCV high RDW may be used to not only reveal the masked cases of MA with concomitant irondeficiency but also separate them from the broader macrocytic anaemia group
Peripheral smear remains diagnostic however making smear for all the suspicious cases is a cumbersomeand tedious procedure Thus these parameters emerge as more reliable and stable parameters in themodern laboratories which in future may replace the older screening tools
Congreso Nacional Laboratorio Cliacutenico
2018
A favor Eficiencia Operativa
Mejora el proceso del Laboratorio
Mejor informacioacuten al Cliacutenico al mismo coste
Mejora la informacioacuten
Informa sobre la eritropoyesis deteccioacuten precoz de estados carenciales
Ayuda al cliacutenico
Estado real del paciente
En contraParaacutemetros de investigacioacuten
Dificultad de standarizar dependencia teacutecnica
Control de calidadCongreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
ANEMIA CARENCIAL CAUSAS
Factores alimentariosConsumir una dieta vegetariana mal planeadaAlimentacioacuten deficiente en los bebeacutesDesnutricioacuten durante el embarazo
Deacuteficit de absorcioacutenAlcoholismo croacutenicoEnfermedad de Crohn celiaquiacutea infeccioacuten otros problemas que le dificulten al cuerpo la digestioacuten de los alimentosAnemia perniciosa (factor intriacutenseco)Cirugiacuteas para extirpar ciertas partes del estoacutemago o el intestino delgado
MedicamentosB12 omeprazol metformina colchicina aminosalicilatos neomicinaFOLATO fenitoiacutena metotrexato sulfasalacina triamtereno pirimetamina trimetoprim con sulfametoxazol barbituacutericos
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
Reacciones metaboacutelicas en las que participan la vitamina B12 y el folato bull la conversioacuten de metilmalonil-CoA a succinil-CoA donde la adenosil-cobalamina actuacutea de
cofactor Por ello un deacuteficit de B12 conlleva un aumento de metilmalonil-CoA y de su producto de hidroacutelisis el aacutecido metilmaloacutenico
bull la siacutentesis de metionina a partir de homocisteina gracias a la metionina sintetasa y a la metil-cobalamina como cofactor En esta misma reaccioacuten el metiltetrahidrofolato es transformado a tetrahidrofolato que es necesario para la siacutentesis de DNA
Congreso Nacional Laboratorio Cliacutenico
2018
Anemia macrociacutetica secundaria a deficiencia de aacutecido foacutelico y de vitamina B12(cobalamina)
La deficiencia de B12 yo aacutecido foacutelico es la causa maacutes frecuente de megaloblastosis
Dentro de distintas funciones generales del metabolismo la vitamina B12 es uncofactor esencial en la siacutentesis de ADN y ARN compromete a todas las ceacutelulas delorganismo
Su deficiencia se manifiesta en oacuterganos con alto recambio celular como la meacutedulaosea y en el sistema nervioso central (SNC) a traveacutes de la siacutentesis de mielina y lareparacioacuten axonal
La deficiencia de cobalamina es responsable de alteraciones hematoloacutegicasneuroloacutegicas neurocognitivas y neuropsiquiaacutetricas
La siacutentesis defectuosa de ADN conduce a la apoptosis y a la hemoacutelisis (intra yextramedular) causantes de la hemopoyesis inefectiva
En meacutedula la siacutentesis ineficiente de DNA causa cambios megaloblaacutesticos comoconsecuencIa anemia y citopenias
Congreso Nacional Laboratorio Cliacutenico
2018
Limitaciones de los meacutetodos diagnoacutesticos claacutesicos
Volumen Corpuscular Medio (VCM) y morfologiacutea de sangre perifeacuterica En una serie de pacientes con deacuteficit de cobalamina soacutelo un 29 teniacutean anemia y soacutelo un 36 teniacutean un VCM gt 100 fL
Un VCM normal no puede ser empleado para rechazar una determinacioacuten de nivel de cobalamina ya que hasta un 25 de casos con manifestaciones neuroloacutegicas cursan con un VCM normal
Cobalamina seacuterica (nivel de B12) Es el test diagnoacutestico rutinario inicial estaacutendar Es un test ampliamente disponible de bajo coste y automatizado Sin embargo presenta algunas limitaciones
-- Existencia de varias teacutecnicas y ausencia de un gold standard por lo que hay diferentes liacutemites de referencia
-- Variacioacuten intraindividual muy alta
La OMS publicoacute en 2008 las conclusiones de un grupo teacutecnico consultado sobre el deacuteficit de cobalamina y folato
El grupo reconocioacute que no existen unos umbrales universalmente reconocidos para definir el deacuteficit de ambas vitaminas y expresaron la necesidad de un consenso
Devalia V Hamilton MS and Molloy AM on behalf of the British Committee for standards in haematology Guidelines for the diagnosis and treatment of cobalamin and folate disorders Br J Haematol 2014 166(4) 496-513
Schrier SL Diagnosis and treatment of vitamin B12 and folate deficiency UpToDate Last updated Jun 25 2014
de Benoist B Conclusions of a WHO Technical Consultation on folate and vitamin B12 deficiencies Food Nutr Bull 200829(2 Suppl)S238ndash44Congreso Nacional Laboratorio Cliacutenico
2018
Tomado de Tefferi A Li C En Atlas of Clinical Hematology Publicado por JO Armitage Philadelphia Current Medicine 2004
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
Int Jnl Lab Hem 2007 29 327ndash334
Clin Lab 201662343-347
In ourstudy mean MCVrMCV ratio of healthy controls is130 as microcytic anemia irondeficiency anemia is121 as also macrocytic anemia vitamin B12 deficiencyanemia is 115
Congreso Nacional Laboratorio Cliacutenico
2018
Sualeh Muslim Khan Muhammad Akbar Agha
Mean cell volume of reticulocytemdashA new parameter for diagnosing sub-clinical cobalamin deficiency in blood donors Int J Lab Hem 20181ndash4
The Abbott CELL-DYN Sapphire Hematology System uses multi-angle polarized scatter separation (MAPSS) and focused flow impedance technologies
Congreso Nacional Laboratorio Cliacutenico
2018
MCVr at 985 fL yielded the highest Youdenrsquos index at sensitivity of 82 specificity of 828 AUC 0847 ( 95 CI 803-891)
Khan SM Agha MA Mean cell volume of reticulocyte-A new parameter for diagnosing sub-clinical cobalamin deficiency in blood donors
Int J Lab Hem 20181ndash4 2018 Jul 13 doi 101111ijlh12899
Congreso Nacional Laboratorio Cliacutenico
2018
Role of Cell Population Data in the detection of folate and cobalamin deficiency
J Nieto et al
XXXI st International Symposium on Technological Innovations in Laboratory Hematology ISLH 2018 10-12 May 2018 Brussels Belgium
M-V-NRET and SD-VNRET are the best discriminatory single parameters to distinguish between patients with B9B12 deficiency and reference subjects M-V-NRETAUC=0823 sensitivity 78 and specificity 86
AUC=0852 sensitivity 55 and specificity 60
Conclusions The CPD parameters of Volume and Light Scatter (M and SD of LALS angle) that inform about size and intracellular structure of RBCs provided very useful information for the detection of B9B12 deficiency
Congreso Nacional Laboratorio Cliacutenico
2018
Cell Population Data
bull Paraacutemetros poblacionales de los leucocitos
bull Describen la morfologiacutea tamantildeo
estructuras citoplasmaacuteticas
nuacutecleo aacutecidos nucleacuteicos
bull Son datos numeacutericos con los que se construyen los ejes de lo diagramas de dispersioacuten de los leucocitos
bull Dependen de la tecnologiacutea
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
High Sensitivity New Parameters for the Detection of Vitamin B12 and Folate Deficiencies Blood 2008 1125379
B12 def vs
Normals
Mann
Withney T-Test
ROC
AUC Sens Specif Cutoff signifROC
MCV p=03156 p=09533 0577
MPV p=00001 0802 792 806 lt83 p=00001
NE Mean
Volume plt00001 0862 833 778 gt1403 p=00001
MO Mean
Volume plt00001 0829 625 889 gt1723 p=00001
MRV p=00113 0705 50 964 gt1133 p=00051
Folate def vs
Normals
Mann
Withney T-Test
ROC
AUC Sens Specif Cut-off signifROC
MCV p=00798 p=06461 0665
MPV plt00001 0832 81 806 lt83 p=00001
NE Mean
Volume p=00008 087 952 694 gt1402 p=00001
MO Mean
Volume p=00002 0801 667 833 gt1696 p=00001
MRV p=00054 0731 476 964 gt1133 p=00019
The Mean Neutrophil Volume (MNE V) and Mean Monocyte Volume (MMOV) may be used for the detection of megaloblastic neutrophils and monocytes MNEV and MMOV have significantly higher sensitivity than the previous information from the red cells (MCV) detecting B12 or folate deficiency because they are not affected by the presence at the same time of Iron deficiency or other reasons of anemia
Congreso Nacional Laboratorio Cliacutenico
2018
POSTER 733
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
CPD Sysmex XN
NE SSC complejidad
NE SFL aacutecidos nucleacuteicos
NE FSC tamantildeo
NE WX
NE WY
NE WZ
MO X
MO Y
MO Z
MO WX
MO WY
MO WZ
LY X
LY Y
LY Z
LY WX
LY WY
LY WZCongreso Nacio
nal Laboratorio Cliacutenico 2018
As MCV is the mean which is calculated it is insensitive to the presence of a small number of macrocytes
Further macrocytosis can be obscured by concomitant disorders that can cause microcytosis resulting inmasked megaloblastic anaemia (MA) for example iron deficiency hereditary elliptocytosis alpha and betathalassemia
This study was undertaken to evaluate the role of NEUT-X and NEUT-Y in detecting MA on peripheral blood andalso see whether other forms of macrocytic anaemia can be differentiated from MA
In MA the peripheral blood smear shows cytopenia with macroovalocytes and hypersegmented
neutrophils (gt5 lobes in 5 neutrophils six lobes nuclei or lobe average of gt35)
In conclusion our study shows that higher values of NEUT-X and NEUT-Y in MA patients in spite of low ornormal MCV high RDW may be used to not only reveal the masked cases of MA with concomitant irondeficiency but also separate them from the broader macrocytic anaemia group
Peripheral smear remains diagnostic however making smear for all the suspicious cases is a cumbersomeand tedious procedure Thus these parameters emerge as more reliable and stable parameters in themodern laboratories which in future may replace the older screening tools
Congreso Nacional Laboratorio Cliacutenico
2018
A favor Eficiencia Operativa
Mejora el proceso del Laboratorio
Mejor informacioacuten al Cliacutenico al mismo coste
Mejora la informacioacuten
Informa sobre la eritropoyesis deteccioacuten precoz de estados carenciales
Ayuda al cliacutenico
Estado real del paciente
En contraParaacutemetros de investigacioacuten
Dificultad de standarizar dependencia teacutecnica
Control de calidadCongreso Nacional Laboratorio Cliacutenico
2018
ANEMIA CARENCIAL CAUSAS
Factores alimentariosConsumir una dieta vegetariana mal planeadaAlimentacioacuten deficiente en los bebeacutesDesnutricioacuten durante el embarazo
Deacuteficit de absorcioacutenAlcoholismo croacutenicoEnfermedad de Crohn celiaquiacutea infeccioacuten otros problemas que le dificulten al cuerpo la digestioacuten de los alimentosAnemia perniciosa (factor intriacutenseco)Cirugiacuteas para extirpar ciertas partes del estoacutemago o el intestino delgado
MedicamentosB12 omeprazol metformina colchicina aminosalicilatos neomicinaFOLATO fenitoiacutena metotrexato sulfasalacina triamtereno pirimetamina trimetoprim con sulfametoxazol barbituacutericos
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
Reacciones metaboacutelicas en las que participan la vitamina B12 y el folato bull la conversioacuten de metilmalonil-CoA a succinil-CoA donde la adenosil-cobalamina actuacutea de
cofactor Por ello un deacuteficit de B12 conlleva un aumento de metilmalonil-CoA y de su producto de hidroacutelisis el aacutecido metilmaloacutenico
bull la siacutentesis de metionina a partir de homocisteina gracias a la metionina sintetasa y a la metil-cobalamina como cofactor En esta misma reaccioacuten el metiltetrahidrofolato es transformado a tetrahidrofolato que es necesario para la siacutentesis de DNA
Congreso Nacional Laboratorio Cliacutenico
2018
Anemia macrociacutetica secundaria a deficiencia de aacutecido foacutelico y de vitamina B12(cobalamina)
La deficiencia de B12 yo aacutecido foacutelico es la causa maacutes frecuente de megaloblastosis
Dentro de distintas funciones generales del metabolismo la vitamina B12 es uncofactor esencial en la siacutentesis de ADN y ARN compromete a todas las ceacutelulas delorganismo
Su deficiencia se manifiesta en oacuterganos con alto recambio celular como la meacutedulaosea y en el sistema nervioso central (SNC) a traveacutes de la siacutentesis de mielina y lareparacioacuten axonal
La deficiencia de cobalamina es responsable de alteraciones hematoloacutegicasneuroloacutegicas neurocognitivas y neuropsiquiaacutetricas
La siacutentesis defectuosa de ADN conduce a la apoptosis y a la hemoacutelisis (intra yextramedular) causantes de la hemopoyesis inefectiva
En meacutedula la siacutentesis ineficiente de DNA causa cambios megaloblaacutesticos comoconsecuencIa anemia y citopenias
Congreso Nacional Laboratorio Cliacutenico
2018
Limitaciones de los meacutetodos diagnoacutesticos claacutesicos
Volumen Corpuscular Medio (VCM) y morfologiacutea de sangre perifeacuterica En una serie de pacientes con deacuteficit de cobalamina soacutelo un 29 teniacutean anemia y soacutelo un 36 teniacutean un VCM gt 100 fL
Un VCM normal no puede ser empleado para rechazar una determinacioacuten de nivel de cobalamina ya que hasta un 25 de casos con manifestaciones neuroloacutegicas cursan con un VCM normal
Cobalamina seacuterica (nivel de B12) Es el test diagnoacutestico rutinario inicial estaacutendar Es un test ampliamente disponible de bajo coste y automatizado Sin embargo presenta algunas limitaciones
-- Existencia de varias teacutecnicas y ausencia de un gold standard por lo que hay diferentes liacutemites de referencia
-- Variacioacuten intraindividual muy alta
La OMS publicoacute en 2008 las conclusiones de un grupo teacutecnico consultado sobre el deacuteficit de cobalamina y folato
El grupo reconocioacute que no existen unos umbrales universalmente reconocidos para definir el deacuteficit de ambas vitaminas y expresaron la necesidad de un consenso
Devalia V Hamilton MS and Molloy AM on behalf of the British Committee for standards in haematology Guidelines for the diagnosis and treatment of cobalamin and folate disorders Br J Haematol 2014 166(4) 496-513
Schrier SL Diagnosis and treatment of vitamin B12 and folate deficiency UpToDate Last updated Jun 25 2014
de Benoist B Conclusions of a WHO Technical Consultation on folate and vitamin B12 deficiencies Food Nutr Bull 200829(2 Suppl)S238ndash44Congreso Nacional Laboratorio Cliacutenico
2018
Tomado de Tefferi A Li C En Atlas of Clinical Hematology Publicado por JO Armitage Philadelphia Current Medicine 2004
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
Int Jnl Lab Hem 2007 29 327ndash334
Clin Lab 201662343-347
In ourstudy mean MCVrMCV ratio of healthy controls is130 as microcytic anemia irondeficiency anemia is121 as also macrocytic anemia vitamin B12 deficiencyanemia is 115
Congreso Nacional Laboratorio Cliacutenico
2018
Sualeh Muslim Khan Muhammad Akbar Agha
Mean cell volume of reticulocytemdashA new parameter for diagnosing sub-clinical cobalamin deficiency in blood donors Int J Lab Hem 20181ndash4
The Abbott CELL-DYN Sapphire Hematology System uses multi-angle polarized scatter separation (MAPSS) and focused flow impedance technologies
Congreso Nacional Laboratorio Cliacutenico
2018
MCVr at 985 fL yielded the highest Youdenrsquos index at sensitivity of 82 specificity of 828 AUC 0847 ( 95 CI 803-891)
Khan SM Agha MA Mean cell volume of reticulocyte-A new parameter for diagnosing sub-clinical cobalamin deficiency in blood donors
Int J Lab Hem 20181ndash4 2018 Jul 13 doi 101111ijlh12899
Congreso Nacional Laboratorio Cliacutenico
2018
Role of Cell Population Data in the detection of folate and cobalamin deficiency
J Nieto et al
XXXI st International Symposium on Technological Innovations in Laboratory Hematology ISLH 2018 10-12 May 2018 Brussels Belgium
M-V-NRET and SD-VNRET are the best discriminatory single parameters to distinguish between patients with B9B12 deficiency and reference subjects M-V-NRETAUC=0823 sensitivity 78 and specificity 86
AUC=0852 sensitivity 55 and specificity 60
Conclusions The CPD parameters of Volume and Light Scatter (M and SD of LALS angle) that inform about size and intracellular structure of RBCs provided very useful information for the detection of B9B12 deficiency
Congreso Nacional Laboratorio Cliacutenico
2018
Cell Population Data
bull Paraacutemetros poblacionales de los leucocitos
bull Describen la morfologiacutea tamantildeo
estructuras citoplasmaacuteticas
nuacutecleo aacutecidos nucleacuteicos
bull Son datos numeacutericos con los que se construyen los ejes de lo diagramas de dispersioacuten de los leucocitos
bull Dependen de la tecnologiacutea
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
High Sensitivity New Parameters for the Detection of Vitamin B12 and Folate Deficiencies Blood 2008 1125379
B12 def vs
Normals
Mann
Withney T-Test
ROC
AUC Sens Specif Cutoff signifROC
MCV p=03156 p=09533 0577
MPV p=00001 0802 792 806 lt83 p=00001
NE Mean
Volume plt00001 0862 833 778 gt1403 p=00001
MO Mean
Volume plt00001 0829 625 889 gt1723 p=00001
MRV p=00113 0705 50 964 gt1133 p=00051
Folate def vs
Normals
Mann
Withney T-Test
ROC
AUC Sens Specif Cut-off signifROC
MCV p=00798 p=06461 0665
MPV plt00001 0832 81 806 lt83 p=00001
NE Mean
Volume p=00008 087 952 694 gt1402 p=00001
MO Mean
Volume p=00002 0801 667 833 gt1696 p=00001
MRV p=00054 0731 476 964 gt1133 p=00019
The Mean Neutrophil Volume (MNE V) and Mean Monocyte Volume (MMOV) may be used for the detection of megaloblastic neutrophils and monocytes MNEV and MMOV have significantly higher sensitivity than the previous information from the red cells (MCV) detecting B12 or folate deficiency because they are not affected by the presence at the same time of Iron deficiency or other reasons of anemia
Congreso Nacional Laboratorio Cliacutenico
2018
POSTER 733
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
CPD Sysmex XN
NE SSC complejidad
NE SFL aacutecidos nucleacuteicos
NE FSC tamantildeo
NE WX
NE WY
NE WZ
MO X
MO Y
MO Z
MO WX
MO WY
MO WZ
LY X
LY Y
LY Z
LY WX
LY WY
LY WZCongreso Nacio
nal Laboratorio Cliacutenico 2018
As MCV is the mean which is calculated it is insensitive to the presence of a small number of macrocytes
Further macrocytosis can be obscured by concomitant disorders that can cause microcytosis resulting inmasked megaloblastic anaemia (MA) for example iron deficiency hereditary elliptocytosis alpha and betathalassemia
This study was undertaken to evaluate the role of NEUT-X and NEUT-Y in detecting MA on peripheral blood andalso see whether other forms of macrocytic anaemia can be differentiated from MA
In MA the peripheral blood smear shows cytopenia with macroovalocytes and hypersegmented
neutrophils (gt5 lobes in 5 neutrophils six lobes nuclei or lobe average of gt35)
In conclusion our study shows that higher values of NEUT-X and NEUT-Y in MA patients in spite of low ornormal MCV high RDW may be used to not only reveal the masked cases of MA with concomitant irondeficiency but also separate them from the broader macrocytic anaemia group
Peripheral smear remains diagnostic however making smear for all the suspicious cases is a cumbersomeand tedious procedure Thus these parameters emerge as more reliable and stable parameters in themodern laboratories which in future may replace the older screening tools
Congreso Nacional Laboratorio Cliacutenico
2018
A favor Eficiencia Operativa
Mejora el proceso del Laboratorio
Mejor informacioacuten al Cliacutenico al mismo coste
Mejora la informacioacuten
Informa sobre la eritropoyesis deteccioacuten precoz de estados carenciales
Ayuda al cliacutenico
Estado real del paciente
En contraParaacutemetros de investigacioacuten
Dificultad de standarizar dependencia teacutecnica
Control de calidadCongreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
Reacciones metaboacutelicas en las que participan la vitamina B12 y el folato bull la conversioacuten de metilmalonil-CoA a succinil-CoA donde la adenosil-cobalamina actuacutea de
cofactor Por ello un deacuteficit de B12 conlleva un aumento de metilmalonil-CoA y de su producto de hidroacutelisis el aacutecido metilmaloacutenico
bull la siacutentesis de metionina a partir de homocisteina gracias a la metionina sintetasa y a la metil-cobalamina como cofactor En esta misma reaccioacuten el metiltetrahidrofolato es transformado a tetrahidrofolato que es necesario para la siacutentesis de DNA
Congreso Nacional Laboratorio Cliacutenico
2018
Anemia macrociacutetica secundaria a deficiencia de aacutecido foacutelico y de vitamina B12(cobalamina)
La deficiencia de B12 yo aacutecido foacutelico es la causa maacutes frecuente de megaloblastosis
Dentro de distintas funciones generales del metabolismo la vitamina B12 es uncofactor esencial en la siacutentesis de ADN y ARN compromete a todas las ceacutelulas delorganismo
Su deficiencia se manifiesta en oacuterganos con alto recambio celular como la meacutedulaosea y en el sistema nervioso central (SNC) a traveacutes de la siacutentesis de mielina y lareparacioacuten axonal
La deficiencia de cobalamina es responsable de alteraciones hematoloacutegicasneuroloacutegicas neurocognitivas y neuropsiquiaacutetricas
La siacutentesis defectuosa de ADN conduce a la apoptosis y a la hemoacutelisis (intra yextramedular) causantes de la hemopoyesis inefectiva
En meacutedula la siacutentesis ineficiente de DNA causa cambios megaloblaacutesticos comoconsecuencIa anemia y citopenias
Congreso Nacional Laboratorio Cliacutenico
2018
Limitaciones de los meacutetodos diagnoacutesticos claacutesicos
Volumen Corpuscular Medio (VCM) y morfologiacutea de sangre perifeacuterica En una serie de pacientes con deacuteficit de cobalamina soacutelo un 29 teniacutean anemia y soacutelo un 36 teniacutean un VCM gt 100 fL
Un VCM normal no puede ser empleado para rechazar una determinacioacuten de nivel de cobalamina ya que hasta un 25 de casos con manifestaciones neuroloacutegicas cursan con un VCM normal
Cobalamina seacuterica (nivel de B12) Es el test diagnoacutestico rutinario inicial estaacutendar Es un test ampliamente disponible de bajo coste y automatizado Sin embargo presenta algunas limitaciones
-- Existencia de varias teacutecnicas y ausencia de un gold standard por lo que hay diferentes liacutemites de referencia
-- Variacioacuten intraindividual muy alta
La OMS publicoacute en 2008 las conclusiones de un grupo teacutecnico consultado sobre el deacuteficit de cobalamina y folato
El grupo reconocioacute que no existen unos umbrales universalmente reconocidos para definir el deacuteficit de ambas vitaminas y expresaron la necesidad de un consenso
Devalia V Hamilton MS and Molloy AM on behalf of the British Committee for standards in haematology Guidelines for the diagnosis and treatment of cobalamin and folate disorders Br J Haematol 2014 166(4) 496-513
Schrier SL Diagnosis and treatment of vitamin B12 and folate deficiency UpToDate Last updated Jun 25 2014
de Benoist B Conclusions of a WHO Technical Consultation on folate and vitamin B12 deficiencies Food Nutr Bull 200829(2 Suppl)S238ndash44Congreso Nacional Laboratorio Cliacutenico
2018
Tomado de Tefferi A Li C En Atlas of Clinical Hematology Publicado por JO Armitage Philadelphia Current Medicine 2004
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
Int Jnl Lab Hem 2007 29 327ndash334
Clin Lab 201662343-347
In ourstudy mean MCVrMCV ratio of healthy controls is130 as microcytic anemia irondeficiency anemia is121 as also macrocytic anemia vitamin B12 deficiencyanemia is 115
Congreso Nacional Laboratorio Cliacutenico
2018
Sualeh Muslim Khan Muhammad Akbar Agha
Mean cell volume of reticulocytemdashA new parameter for diagnosing sub-clinical cobalamin deficiency in blood donors Int J Lab Hem 20181ndash4
The Abbott CELL-DYN Sapphire Hematology System uses multi-angle polarized scatter separation (MAPSS) and focused flow impedance technologies
Congreso Nacional Laboratorio Cliacutenico
2018
MCVr at 985 fL yielded the highest Youdenrsquos index at sensitivity of 82 specificity of 828 AUC 0847 ( 95 CI 803-891)
Khan SM Agha MA Mean cell volume of reticulocyte-A new parameter for diagnosing sub-clinical cobalamin deficiency in blood donors
Int J Lab Hem 20181ndash4 2018 Jul 13 doi 101111ijlh12899
Congreso Nacional Laboratorio Cliacutenico
2018
Role of Cell Population Data in the detection of folate and cobalamin deficiency
J Nieto et al
XXXI st International Symposium on Technological Innovations in Laboratory Hematology ISLH 2018 10-12 May 2018 Brussels Belgium
M-V-NRET and SD-VNRET are the best discriminatory single parameters to distinguish between patients with B9B12 deficiency and reference subjects M-V-NRETAUC=0823 sensitivity 78 and specificity 86
AUC=0852 sensitivity 55 and specificity 60
Conclusions The CPD parameters of Volume and Light Scatter (M and SD of LALS angle) that inform about size and intracellular structure of RBCs provided very useful information for the detection of B9B12 deficiency
Congreso Nacional Laboratorio Cliacutenico
2018
Cell Population Data
bull Paraacutemetros poblacionales de los leucocitos
bull Describen la morfologiacutea tamantildeo
estructuras citoplasmaacuteticas
nuacutecleo aacutecidos nucleacuteicos
bull Son datos numeacutericos con los que se construyen los ejes de lo diagramas de dispersioacuten de los leucocitos
bull Dependen de la tecnologiacutea
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
High Sensitivity New Parameters for the Detection of Vitamin B12 and Folate Deficiencies Blood 2008 1125379
B12 def vs
Normals
Mann
Withney T-Test
ROC
AUC Sens Specif Cutoff signifROC
MCV p=03156 p=09533 0577
MPV p=00001 0802 792 806 lt83 p=00001
NE Mean
Volume plt00001 0862 833 778 gt1403 p=00001
MO Mean
Volume plt00001 0829 625 889 gt1723 p=00001
MRV p=00113 0705 50 964 gt1133 p=00051
Folate def vs
Normals
Mann
Withney T-Test
ROC
AUC Sens Specif Cut-off signifROC
MCV p=00798 p=06461 0665
MPV plt00001 0832 81 806 lt83 p=00001
NE Mean
Volume p=00008 087 952 694 gt1402 p=00001
MO Mean
Volume p=00002 0801 667 833 gt1696 p=00001
MRV p=00054 0731 476 964 gt1133 p=00019
The Mean Neutrophil Volume (MNE V) and Mean Monocyte Volume (MMOV) may be used for the detection of megaloblastic neutrophils and monocytes MNEV and MMOV have significantly higher sensitivity than the previous information from the red cells (MCV) detecting B12 or folate deficiency because they are not affected by the presence at the same time of Iron deficiency or other reasons of anemia
Congreso Nacional Laboratorio Cliacutenico
2018
POSTER 733
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
CPD Sysmex XN
NE SSC complejidad
NE SFL aacutecidos nucleacuteicos
NE FSC tamantildeo
NE WX
NE WY
NE WZ
MO X
MO Y
MO Z
MO WX
MO WY
MO WZ
LY X
LY Y
LY Z
LY WX
LY WY
LY WZCongreso Nacio
nal Laboratorio Cliacutenico 2018
As MCV is the mean which is calculated it is insensitive to the presence of a small number of macrocytes
Further macrocytosis can be obscured by concomitant disorders that can cause microcytosis resulting inmasked megaloblastic anaemia (MA) for example iron deficiency hereditary elliptocytosis alpha and betathalassemia
This study was undertaken to evaluate the role of NEUT-X and NEUT-Y in detecting MA on peripheral blood andalso see whether other forms of macrocytic anaemia can be differentiated from MA
In MA the peripheral blood smear shows cytopenia with macroovalocytes and hypersegmented
neutrophils (gt5 lobes in 5 neutrophils six lobes nuclei or lobe average of gt35)
In conclusion our study shows that higher values of NEUT-X and NEUT-Y in MA patients in spite of low ornormal MCV high RDW may be used to not only reveal the masked cases of MA with concomitant irondeficiency but also separate them from the broader macrocytic anaemia group
Peripheral smear remains diagnostic however making smear for all the suspicious cases is a cumbersomeand tedious procedure Thus these parameters emerge as more reliable and stable parameters in themodern laboratories which in future may replace the older screening tools
Congreso Nacional Laboratorio Cliacutenico
2018
A favor Eficiencia Operativa
Mejora el proceso del Laboratorio
Mejor informacioacuten al Cliacutenico al mismo coste
Mejora la informacioacuten
Informa sobre la eritropoyesis deteccioacuten precoz de estados carenciales
Ayuda al cliacutenico
Estado real del paciente
En contraParaacutemetros de investigacioacuten
Dificultad de standarizar dependencia teacutecnica
Control de calidadCongreso Nacional Laboratorio Cliacutenico
2018
Reacciones metaboacutelicas en las que participan la vitamina B12 y el folato bull la conversioacuten de metilmalonil-CoA a succinil-CoA donde la adenosil-cobalamina actuacutea de
cofactor Por ello un deacuteficit de B12 conlleva un aumento de metilmalonil-CoA y de su producto de hidroacutelisis el aacutecido metilmaloacutenico
bull la siacutentesis de metionina a partir de homocisteina gracias a la metionina sintetasa y a la metil-cobalamina como cofactor En esta misma reaccioacuten el metiltetrahidrofolato es transformado a tetrahidrofolato que es necesario para la siacutentesis de DNA
Congreso Nacional Laboratorio Cliacutenico
2018
Anemia macrociacutetica secundaria a deficiencia de aacutecido foacutelico y de vitamina B12(cobalamina)
La deficiencia de B12 yo aacutecido foacutelico es la causa maacutes frecuente de megaloblastosis
Dentro de distintas funciones generales del metabolismo la vitamina B12 es uncofactor esencial en la siacutentesis de ADN y ARN compromete a todas las ceacutelulas delorganismo
Su deficiencia se manifiesta en oacuterganos con alto recambio celular como la meacutedulaosea y en el sistema nervioso central (SNC) a traveacutes de la siacutentesis de mielina y lareparacioacuten axonal
La deficiencia de cobalamina es responsable de alteraciones hematoloacutegicasneuroloacutegicas neurocognitivas y neuropsiquiaacutetricas
La siacutentesis defectuosa de ADN conduce a la apoptosis y a la hemoacutelisis (intra yextramedular) causantes de la hemopoyesis inefectiva
En meacutedula la siacutentesis ineficiente de DNA causa cambios megaloblaacutesticos comoconsecuencIa anemia y citopenias
Congreso Nacional Laboratorio Cliacutenico
2018
Limitaciones de los meacutetodos diagnoacutesticos claacutesicos
Volumen Corpuscular Medio (VCM) y morfologiacutea de sangre perifeacuterica En una serie de pacientes con deacuteficit de cobalamina soacutelo un 29 teniacutean anemia y soacutelo un 36 teniacutean un VCM gt 100 fL
Un VCM normal no puede ser empleado para rechazar una determinacioacuten de nivel de cobalamina ya que hasta un 25 de casos con manifestaciones neuroloacutegicas cursan con un VCM normal
Cobalamina seacuterica (nivel de B12) Es el test diagnoacutestico rutinario inicial estaacutendar Es un test ampliamente disponible de bajo coste y automatizado Sin embargo presenta algunas limitaciones
-- Existencia de varias teacutecnicas y ausencia de un gold standard por lo que hay diferentes liacutemites de referencia
-- Variacioacuten intraindividual muy alta
La OMS publicoacute en 2008 las conclusiones de un grupo teacutecnico consultado sobre el deacuteficit de cobalamina y folato
El grupo reconocioacute que no existen unos umbrales universalmente reconocidos para definir el deacuteficit de ambas vitaminas y expresaron la necesidad de un consenso
Devalia V Hamilton MS and Molloy AM on behalf of the British Committee for standards in haematology Guidelines for the diagnosis and treatment of cobalamin and folate disorders Br J Haematol 2014 166(4) 496-513
Schrier SL Diagnosis and treatment of vitamin B12 and folate deficiency UpToDate Last updated Jun 25 2014
de Benoist B Conclusions of a WHO Technical Consultation on folate and vitamin B12 deficiencies Food Nutr Bull 200829(2 Suppl)S238ndash44Congreso Nacional Laboratorio Cliacutenico
2018
Tomado de Tefferi A Li C En Atlas of Clinical Hematology Publicado por JO Armitage Philadelphia Current Medicine 2004
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
Int Jnl Lab Hem 2007 29 327ndash334
Clin Lab 201662343-347
In ourstudy mean MCVrMCV ratio of healthy controls is130 as microcytic anemia irondeficiency anemia is121 as also macrocytic anemia vitamin B12 deficiencyanemia is 115
Congreso Nacional Laboratorio Cliacutenico
2018
Sualeh Muslim Khan Muhammad Akbar Agha
Mean cell volume of reticulocytemdashA new parameter for diagnosing sub-clinical cobalamin deficiency in blood donors Int J Lab Hem 20181ndash4
The Abbott CELL-DYN Sapphire Hematology System uses multi-angle polarized scatter separation (MAPSS) and focused flow impedance technologies
Congreso Nacional Laboratorio Cliacutenico
2018
MCVr at 985 fL yielded the highest Youdenrsquos index at sensitivity of 82 specificity of 828 AUC 0847 ( 95 CI 803-891)
Khan SM Agha MA Mean cell volume of reticulocyte-A new parameter for diagnosing sub-clinical cobalamin deficiency in blood donors
Int J Lab Hem 20181ndash4 2018 Jul 13 doi 101111ijlh12899
Congreso Nacional Laboratorio Cliacutenico
2018
Role of Cell Population Data in the detection of folate and cobalamin deficiency
J Nieto et al
XXXI st International Symposium on Technological Innovations in Laboratory Hematology ISLH 2018 10-12 May 2018 Brussels Belgium
M-V-NRET and SD-VNRET are the best discriminatory single parameters to distinguish between patients with B9B12 deficiency and reference subjects M-V-NRETAUC=0823 sensitivity 78 and specificity 86
AUC=0852 sensitivity 55 and specificity 60
Conclusions The CPD parameters of Volume and Light Scatter (M and SD of LALS angle) that inform about size and intracellular structure of RBCs provided very useful information for the detection of B9B12 deficiency
Congreso Nacional Laboratorio Cliacutenico
2018
Cell Population Data
bull Paraacutemetros poblacionales de los leucocitos
bull Describen la morfologiacutea tamantildeo
estructuras citoplasmaacuteticas
nuacutecleo aacutecidos nucleacuteicos
bull Son datos numeacutericos con los que se construyen los ejes de lo diagramas de dispersioacuten de los leucocitos
bull Dependen de la tecnologiacutea
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
High Sensitivity New Parameters for the Detection of Vitamin B12 and Folate Deficiencies Blood 2008 1125379
B12 def vs
Normals
Mann
Withney T-Test
ROC
AUC Sens Specif Cutoff signifROC
MCV p=03156 p=09533 0577
MPV p=00001 0802 792 806 lt83 p=00001
NE Mean
Volume plt00001 0862 833 778 gt1403 p=00001
MO Mean
Volume plt00001 0829 625 889 gt1723 p=00001
MRV p=00113 0705 50 964 gt1133 p=00051
Folate def vs
Normals
Mann
Withney T-Test
ROC
AUC Sens Specif Cut-off signifROC
MCV p=00798 p=06461 0665
MPV plt00001 0832 81 806 lt83 p=00001
NE Mean
Volume p=00008 087 952 694 gt1402 p=00001
MO Mean
Volume p=00002 0801 667 833 gt1696 p=00001
MRV p=00054 0731 476 964 gt1133 p=00019
The Mean Neutrophil Volume (MNE V) and Mean Monocyte Volume (MMOV) may be used for the detection of megaloblastic neutrophils and monocytes MNEV and MMOV have significantly higher sensitivity than the previous information from the red cells (MCV) detecting B12 or folate deficiency because they are not affected by the presence at the same time of Iron deficiency or other reasons of anemia
Congreso Nacional Laboratorio Cliacutenico
2018
POSTER 733
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
CPD Sysmex XN
NE SSC complejidad
NE SFL aacutecidos nucleacuteicos
NE FSC tamantildeo
NE WX
NE WY
NE WZ
MO X
MO Y
MO Z
MO WX
MO WY
MO WZ
LY X
LY Y
LY Z
LY WX
LY WY
LY WZCongreso Nacio
nal Laboratorio Cliacutenico 2018
As MCV is the mean which is calculated it is insensitive to the presence of a small number of macrocytes
Further macrocytosis can be obscured by concomitant disorders that can cause microcytosis resulting inmasked megaloblastic anaemia (MA) for example iron deficiency hereditary elliptocytosis alpha and betathalassemia
This study was undertaken to evaluate the role of NEUT-X and NEUT-Y in detecting MA on peripheral blood andalso see whether other forms of macrocytic anaemia can be differentiated from MA
In MA the peripheral blood smear shows cytopenia with macroovalocytes and hypersegmented
neutrophils (gt5 lobes in 5 neutrophils six lobes nuclei or lobe average of gt35)
In conclusion our study shows that higher values of NEUT-X and NEUT-Y in MA patients in spite of low ornormal MCV high RDW may be used to not only reveal the masked cases of MA with concomitant irondeficiency but also separate them from the broader macrocytic anaemia group
Peripheral smear remains diagnostic however making smear for all the suspicious cases is a cumbersomeand tedious procedure Thus these parameters emerge as more reliable and stable parameters in themodern laboratories which in future may replace the older screening tools
Congreso Nacional Laboratorio Cliacutenico
2018
A favor Eficiencia Operativa
Mejora el proceso del Laboratorio
Mejor informacioacuten al Cliacutenico al mismo coste
Mejora la informacioacuten
Informa sobre la eritropoyesis deteccioacuten precoz de estados carenciales
Ayuda al cliacutenico
Estado real del paciente
En contraParaacutemetros de investigacioacuten
Dificultad de standarizar dependencia teacutecnica
Control de calidadCongreso Nacional Laboratorio Cliacutenico
2018
Anemia macrociacutetica secundaria a deficiencia de aacutecido foacutelico y de vitamina B12(cobalamina)
La deficiencia de B12 yo aacutecido foacutelico es la causa maacutes frecuente de megaloblastosis
Dentro de distintas funciones generales del metabolismo la vitamina B12 es uncofactor esencial en la siacutentesis de ADN y ARN compromete a todas las ceacutelulas delorganismo
Su deficiencia se manifiesta en oacuterganos con alto recambio celular como la meacutedulaosea y en el sistema nervioso central (SNC) a traveacutes de la siacutentesis de mielina y lareparacioacuten axonal
La deficiencia de cobalamina es responsable de alteraciones hematoloacutegicasneuroloacutegicas neurocognitivas y neuropsiquiaacutetricas
La siacutentesis defectuosa de ADN conduce a la apoptosis y a la hemoacutelisis (intra yextramedular) causantes de la hemopoyesis inefectiva
En meacutedula la siacutentesis ineficiente de DNA causa cambios megaloblaacutesticos comoconsecuencIa anemia y citopenias
Congreso Nacional Laboratorio Cliacutenico
2018
Limitaciones de los meacutetodos diagnoacutesticos claacutesicos
Volumen Corpuscular Medio (VCM) y morfologiacutea de sangre perifeacuterica En una serie de pacientes con deacuteficit de cobalamina soacutelo un 29 teniacutean anemia y soacutelo un 36 teniacutean un VCM gt 100 fL
Un VCM normal no puede ser empleado para rechazar una determinacioacuten de nivel de cobalamina ya que hasta un 25 de casos con manifestaciones neuroloacutegicas cursan con un VCM normal
Cobalamina seacuterica (nivel de B12) Es el test diagnoacutestico rutinario inicial estaacutendar Es un test ampliamente disponible de bajo coste y automatizado Sin embargo presenta algunas limitaciones
-- Existencia de varias teacutecnicas y ausencia de un gold standard por lo que hay diferentes liacutemites de referencia
-- Variacioacuten intraindividual muy alta
La OMS publicoacute en 2008 las conclusiones de un grupo teacutecnico consultado sobre el deacuteficit de cobalamina y folato
El grupo reconocioacute que no existen unos umbrales universalmente reconocidos para definir el deacuteficit de ambas vitaminas y expresaron la necesidad de un consenso
Devalia V Hamilton MS and Molloy AM on behalf of the British Committee for standards in haematology Guidelines for the diagnosis and treatment of cobalamin and folate disorders Br J Haematol 2014 166(4) 496-513
Schrier SL Diagnosis and treatment of vitamin B12 and folate deficiency UpToDate Last updated Jun 25 2014
de Benoist B Conclusions of a WHO Technical Consultation on folate and vitamin B12 deficiencies Food Nutr Bull 200829(2 Suppl)S238ndash44Congreso Nacional Laboratorio Cliacutenico
2018
Tomado de Tefferi A Li C En Atlas of Clinical Hematology Publicado por JO Armitage Philadelphia Current Medicine 2004
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
Int Jnl Lab Hem 2007 29 327ndash334
Clin Lab 201662343-347
In ourstudy mean MCVrMCV ratio of healthy controls is130 as microcytic anemia irondeficiency anemia is121 as also macrocytic anemia vitamin B12 deficiencyanemia is 115
Congreso Nacional Laboratorio Cliacutenico
2018
Sualeh Muslim Khan Muhammad Akbar Agha
Mean cell volume of reticulocytemdashA new parameter for diagnosing sub-clinical cobalamin deficiency in blood donors Int J Lab Hem 20181ndash4
The Abbott CELL-DYN Sapphire Hematology System uses multi-angle polarized scatter separation (MAPSS) and focused flow impedance technologies
Congreso Nacional Laboratorio Cliacutenico
2018
MCVr at 985 fL yielded the highest Youdenrsquos index at sensitivity of 82 specificity of 828 AUC 0847 ( 95 CI 803-891)
Khan SM Agha MA Mean cell volume of reticulocyte-A new parameter for diagnosing sub-clinical cobalamin deficiency in blood donors
Int J Lab Hem 20181ndash4 2018 Jul 13 doi 101111ijlh12899
Congreso Nacional Laboratorio Cliacutenico
2018
Role of Cell Population Data in the detection of folate and cobalamin deficiency
J Nieto et al
XXXI st International Symposium on Technological Innovations in Laboratory Hematology ISLH 2018 10-12 May 2018 Brussels Belgium
M-V-NRET and SD-VNRET are the best discriminatory single parameters to distinguish between patients with B9B12 deficiency and reference subjects M-V-NRETAUC=0823 sensitivity 78 and specificity 86
AUC=0852 sensitivity 55 and specificity 60
Conclusions The CPD parameters of Volume and Light Scatter (M and SD of LALS angle) that inform about size and intracellular structure of RBCs provided very useful information for the detection of B9B12 deficiency
Congreso Nacional Laboratorio Cliacutenico
2018
Cell Population Data
bull Paraacutemetros poblacionales de los leucocitos
bull Describen la morfologiacutea tamantildeo
estructuras citoplasmaacuteticas
nuacutecleo aacutecidos nucleacuteicos
bull Son datos numeacutericos con los que se construyen los ejes de lo diagramas de dispersioacuten de los leucocitos
bull Dependen de la tecnologiacutea
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
High Sensitivity New Parameters for the Detection of Vitamin B12 and Folate Deficiencies Blood 2008 1125379
B12 def vs
Normals
Mann
Withney T-Test
ROC
AUC Sens Specif Cutoff signifROC
MCV p=03156 p=09533 0577
MPV p=00001 0802 792 806 lt83 p=00001
NE Mean
Volume plt00001 0862 833 778 gt1403 p=00001
MO Mean
Volume plt00001 0829 625 889 gt1723 p=00001
MRV p=00113 0705 50 964 gt1133 p=00051
Folate def vs
Normals
Mann
Withney T-Test
ROC
AUC Sens Specif Cut-off signifROC
MCV p=00798 p=06461 0665
MPV plt00001 0832 81 806 lt83 p=00001
NE Mean
Volume p=00008 087 952 694 gt1402 p=00001
MO Mean
Volume p=00002 0801 667 833 gt1696 p=00001
MRV p=00054 0731 476 964 gt1133 p=00019
The Mean Neutrophil Volume (MNE V) and Mean Monocyte Volume (MMOV) may be used for the detection of megaloblastic neutrophils and monocytes MNEV and MMOV have significantly higher sensitivity than the previous information from the red cells (MCV) detecting B12 or folate deficiency because they are not affected by the presence at the same time of Iron deficiency or other reasons of anemia
Congreso Nacional Laboratorio Cliacutenico
2018
POSTER 733
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
CPD Sysmex XN
NE SSC complejidad
NE SFL aacutecidos nucleacuteicos
NE FSC tamantildeo
NE WX
NE WY
NE WZ
MO X
MO Y
MO Z
MO WX
MO WY
MO WZ
LY X
LY Y
LY Z
LY WX
LY WY
LY WZCongreso Nacio
nal Laboratorio Cliacutenico 2018
As MCV is the mean which is calculated it is insensitive to the presence of a small number of macrocytes
Further macrocytosis can be obscured by concomitant disorders that can cause microcytosis resulting inmasked megaloblastic anaemia (MA) for example iron deficiency hereditary elliptocytosis alpha and betathalassemia
This study was undertaken to evaluate the role of NEUT-X and NEUT-Y in detecting MA on peripheral blood andalso see whether other forms of macrocytic anaemia can be differentiated from MA
In MA the peripheral blood smear shows cytopenia with macroovalocytes and hypersegmented
neutrophils (gt5 lobes in 5 neutrophils six lobes nuclei or lobe average of gt35)
In conclusion our study shows that higher values of NEUT-X and NEUT-Y in MA patients in spite of low ornormal MCV high RDW may be used to not only reveal the masked cases of MA with concomitant irondeficiency but also separate them from the broader macrocytic anaemia group
Peripheral smear remains diagnostic however making smear for all the suspicious cases is a cumbersomeand tedious procedure Thus these parameters emerge as more reliable and stable parameters in themodern laboratories which in future may replace the older screening tools
Congreso Nacional Laboratorio Cliacutenico
2018
A favor Eficiencia Operativa
Mejora el proceso del Laboratorio
Mejor informacioacuten al Cliacutenico al mismo coste
Mejora la informacioacuten
Informa sobre la eritropoyesis deteccioacuten precoz de estados carenciales
Ayuda al cliacutenico
Estado real del paciente
En contraParaacutemetros de investigacioacuten
Dificultad de standarizar dependencia teacutecnica
Control de calidadCongreso Nacional Laboratorio Cliacutenico
2018
Limitaciones de los meacutetodos diagnoacutesticos claacutesicos
Volumen Corpuscular Medio (VCM) y morfologiacutea de sangre perifeacuterica En una serie de pacientes con deacuteficit de cobalamina soacutelo un 29 teniacutean anemia y soacutelo un 36 teniacutean un VCM gt 100 fL
Un VCM normal no puede ser empleado para rechazar una determinacioacuten de nivel de cobalamina ya que hasta un 25 de casos con manifestaciones neuroloacutegicas cursan con un VCM normal
Cobalamina seacuterica (nivel de B12) Es el test diagnoacutestico rutinario inicial estaacutendar Es un test ampliamente disponible de bajo coste y automatizado Sin embargo presenta algunas limitaciones
-- Existencia de varias teacutecnicas y ausencia de un gold standard por lo que hay diferentes liacutemites de referencia
-- Variacioacuten intraindividual muy alta
La OMS publicoacute en 2008 las conclusiones de un grupo teacutecnico consultado sobre el deacuteficit de cobalamina y folato
El grupo reconocioacute que no existen unos umbrales universalmente reconocidos para definir el deacuteficit de ambas vitaminas y expresaron la necesidad de un consenso
Devalia V Hamilton MS and Molloy AM on behalf of the British Committee for standards in haematology Guidelines for the diagnosis and treatment of cobalamin and folate disorders Br J Haematol 2014 166(4) 496-513
Schrier SL Diagnosis and treatment of vitamin B12 and folate deficiency UpToDate Last updated Jun 25 2014
de Benoist B Conclusions of a WHO Technical Consultation on folate and vitamin B12 deficiencies Food Nutr Bull 200829(2 Suppl)S238ndash44Congreso Nacional Laboratorio Cliacutenico
2018
Tomado de Tefferi A Li C En Atlas of Clinical Hematology Publicado por JO Armitage Philadelphia Current Medicine 2004
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
Int Jnl Lab Hem 2007 29 327ndash334
Clin Lab 201662343-347
In ourstudy mean MCVrMCV ratio of healthy controls is130 as microcytic anemia irondeficiency anemia is121 as also macrocytic anemia vitamin B12 deficiencyanemia is 115
Congreso Nacional Laboratorio Cliacutenico
2018
Sualeh Muslim Khan Muhammad Akbar Agha
Mean cell volume of reticulocytemdashA new parameter for diagnosing sub-clinical cobalamin deficiency in blood donors Int J Lab Hem 20181ndash4
The Abbott CELL-DYN Sapphire Hematology System uses multi-angle polarized scatter separation (MAPSS) and focused flow impedance technologies
Congreso Nacional Laboratorio Cliacutenico
2018
MCVr at 985 fL yielded the highest Youdenrsquos index at sensitivity of 82 specificity of 828 AUC 0847 ( 95 CI 803-891)
Khan SM Agha MA Mean cell volume of reticulocyte-A new parameter for diagnosing sub-clinical cobalamin deficiency in blood donors
Int J Lab Hem 20181ndash4 2018 Jul 13 doi 101111ijlh12899
Congreso Nacional Laboratorio Cliacutenico
2018
Role of Cell Population Data in the detection of folate and cobalamin deficiency
J Nieto et al
XXXI st International Symposium on Technological Innovations in Laboratory Hematology ISLH 2018 10-12 May 2018 Brussels Belgium
M-V-NRET and SD-VNRET are the best discriminatory single parameters to distinguish between patients with B9B12 deficiency and reference subjects M-V-NRETAUC=0823 sensitivity 78 and specificity 86
AUC=0852 sensitivity 55 and specificity 60
Conclusions The CPD parameters of Volume and Light Scatter (M and SD of LALS angle) that inform about size and intracellular structure of RBCs provided very useful information for the detection of B9B12 deficiency
Congreso Nacional Laboratorio Cliacutenico
2018
Cell Population Data
bull Paraacutemetros poblacionales de los leucocitos
bull Describen la morfologiacutea tamantildeo
estructuras citoplasmaacuteticas
nuacutecleo aacutecidos nucleacuteicos
bull Son datos numeacutericos con los que se construyen los ejes de lo diagramas de dispersioacuten de los leucocitos
bull Dependen de la tecnologiacutea
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
High Sensitivity New Parameters for the Detection of Vitamin B12 and Folate Deficiencies Blood 2008 1125379
B12 def vs
Normals
Mann
Withney T-Test
ROC
AUC Sens Specif Cutoff signifROC
MCV p=03156 p=09533 0577
MPV p=00001 0802 792 806 lt83 p=00001
NE Mean
Volume plt00001 0862 833 778 gt1403 p=00001
MO Mean
Volume plt00001 0829 625 889 gt1723 p=00001
MRV p=00113 0705 50 964 gt1133 p=00051
Folate def vs
Normals
Mann
Withney T-Test
ROC
AUC Sens Specif Cut-off signifROC
MCV p=00798 p=06461 0665
MPV plt00001 0832 81 806 lt83 p=00001
NE Mean
Volume p=00008 087 952 694 gt1402 p=00001
MO Mean
Volume p=00002 0801 667 833 gt1696 p=00001
MRV p=00054 0731 476 964 gt1133 p=00019
The Mean Neutrophil Volume (MNE V) and Mean Monocyte Volume (MMOV) may be used for the detection of megaloblastic neutrophils and monocytes MNEV and MMOV have significantly higher sensitivity than the previous information from the red cells (MCV) detecting B12 or folate deficiency because they are not affected by the presence at the same time of Iron deficiency or other reasons of anemia
Congreso Nacional Laboratorio Cliacutenico
2018
POSTER 733
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
CPD Sysmex XN
NE SSC complejidad
NE SFL aacutecidos nucleacuteicos
NE FSC tamantildeo
NE WX
NE WY
NE WZ
MO X
MO Y
MO Z
MO WX
MO WY
MO WZ
LY X
LY Y
LY Z
LY WX
LY WY
LY WZCongreso Nacio
nal Laboratorio Cliacutenico 2018
As MCV is the mean which is calculated it is insensitive to the presence of a small number of macrocytes
Further macrocytosis can be obscured by concomitant disorders that can cause microcytosis resulting inmasked megaloblastic anaemia (MA) for example iron deficiency hereditary elliptocytosis alpha and betathalassemia
This study was undertaken to evaluate the role of NEUT-X and NEUT-Y in detecting MA on peripheral blood andalso see whether other forms of macrocytic anaemia can be differentiated from MA
In MA the peripheral blood smear shows cytopenia with macroovalocytes and hypersegmented
neutrophils (gt5 lobes in 5 neutrophils six lobes nuclei or lobe average of gt35)
In conclusion our study shows that higher values of NEUT-X and NEUT-Y in MA patients in spite of low ornormal MCV high RDW may be used to not only reveal the masked cases of MA with concomitant irondeficiency but also separate them from the broader macrocytic anaemia group
Peripheral smear remains diagnostic however making smear for all the suspicious cases is a cumbersomeand tedious procedure Thus these parameters emerge as more reliable and stable parameters in themodern laboratories which in future may replace the older screening tools
Congreso Nacional Laboratorio Cliacutenico
2018
A favor Eficiencia Operativa
Mejora el proceso del Laboratorio
Mejor informacioacuten al Cliacutenico al mismo coste
Mejora la informacioacuten
Informa sobre la eritropoyesis deteccioacuten precoz de estados carenciales
Ayuda al cliacutenico
Estado real del paciente
En contraParaacutemetros de investigacioacuten
Dificultad de standarizar dependencia teacutecnica
Control de calidadCongreso Nacional Laboratorio Cliacutenico
2018
Tomado de Tefferi A Li C En Atlas of Clinical Hematology Publicado por JO Armitage Philadelphia Current Medicine 2004
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
Int Jnl Lab Hem 2007 29 327ndash334
Clin Lab 201662343-347
In ourstudy mean MCVrMCV ratio of healthy controls is130 as microcytic anemia irondeficiency anemia is121 as also macrocytic anemia vitamin B12 deficiencyanemia is 115
Congreso Nacional Laboratorio Cliacutenico
2018
Sualeh Muslim Khan Muhammad Akbar Agha
Mean cell volume of reticulocytemdashA new parameter for diagnosing sub-clinical cobalamin deficiency in blood donors Int J Lab Hem 20181ndash4
The Abbott CELL-DYN Sapphire Hematology System uses multi-angle polarized scatter separation (MAPSS) and focused flow impedance technologies
Congreso Nacional Laboratorio Cliacutenico
2018
MCVr at 985 fL yielded the highest Youdenrsquos index at sensitivity of 82 specificity of 828 AUC 0847 ( 95 CI 803-891)
Khan SM Agha MA Mean cell volume of reticulocyte-A new parameter for diagnosing sub-clinical cobalamin deficiency in blood donors
Int J Lab Hem 20181ndash4 2018 Jul 13 doi 101111ijlh12899
Congreso Nacional Laboratorio Cliacutenico
2018
Role of Cell Population Data in the detection of folate and cobalamin deficiency
J Nieto et al
XXXI st International Symposium on Technological Innovations in Laboratory Hematology ISLH 2018 10-12 May 2018 Brussels Belgium
M-V-NRET and SD-VNRET are the best discriminatory single parameters to distinguish between patients with B9B12 deficiency and reference subjects M-V-NRETAUC=0823 sensitivity 78 and specificity 86
AUC=0852 sensitivity 55 and specificity 60
Conclusions The CPD parameters of Volume and Light Scatter (M and SD of LALS angle) that inform about size and intracellular structure of RBCs provided very useful information for the detection of B9B12 deficiency
Congreso Nacional Laboratorio Cliacutenico
2018
Cell Population Data
bull Paraacutemetros poblacionales de los leucocitos
bull Describen la morfologiacutea tamantildeo
estructuras citoplasmaacuteticas
nuacutecleo aacutecidos nucleacuteicos
bull Son datos numeacutericos con los que se construyen los ejes de lo diagramas de dispersioacuten de los leucocitos
bull Dependen de la tecnologiacutea
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
High Sensitivity New Parameters for the Detection of Vitamin B12 and Folate Deficiencies Blood 2008 1125379
B12 def vs
Normals
Mann
Withney T-Test
ROC
AUC Sens Specif Cutoff signifROC
MCV p=03156 p=09533 0577
MPV p=00001 0802 792 806 lt83 p=00001
NE Mean
Volume plt00001 0862 833 778 gt1403 p=00001
MO Mean
Volume plt00001 0829 625 889 gt1723 p=00001
MRV p=00113 0705 50 964 gt1133 p=00051
Folate def vs
Normals
Mann
Withney T-Test
ROC
AUC Sens Specif Cut-off signifROC
MCV p=00798 p=06461 0665
MPV plt00001 0832 81 806 lt83 p=00001
NE Mean
Volume p=00008 087 952 694 gt1402 p=00001
MO Mean
Volume p=00002 0801 667 833 gt1696 p=00001
MRV p=00054 0731 476 964 gt1133 p=00019
The Mean Neutrophil Volume (MNE V) and Mean Monocyte Volume (MMOV) may be used for the detection of megaloblastic neutrophils and monocytes MNEV and MMOV have significantly higher sensitivity than the previous information from the red cells (MCV) detecting B12 or folate deficiency because they are not affected by the presence at the same time of Iron deficiency or other reasons of anemia
Congreso Nacional Laboratorio Cliacutenico
2018
POSTER 733
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
CPD Sysmex XN
NE SSC complejidad
NE SFL aacutecidos nucleacuteicos
NE FSC tamantildeo
NE WX
NE WY
NE WZ
MO X
MO Y
MO Z
MO WX
MO WY
MO WZ
LY X
LY Y
LY Z
LY WX
LY WY
LY WZCongreso Nacio
nal Laboratorio Cliacutenico 2018
As MCV is the mean which is calculated it is insensitive to the presence of a small number of macrocytes
Further macrocytosis can be obscured by concomitant disorders that can cause microcytosis resulting inmasked megaloblastic anaemia (MA) for example iron deficiency hereditary elliptocytosis alpha and betathalassemia
This study was undertaken to evaluate the role of NEUT-X and NEUT-Y in detecting MA on peripheral blood andalso see whether other forms of macrocytic anaemia can be differentiated from MA
In MA the peripheral blood smear shows cytopenia with macroovalocytes and hypersegmented
neutrophils (gt5 lobes in 5 neutrophils six lobes nuclei or lobe average of gt35)
In conclusion our study shows that higher values of NEUT-X and NEUT-Y in MA patients in spite of low ornormal MCV high RDW may be used to not only reveal the masked cases of MA with concomitant irondeficiency but also separate them from the broader macrocytic anaemia group
Peripheral smear remains diagnostic however making smear for all the suspicious cases is a cumbersomeand tedious procedure Thus these parameters emerge as more reliable and stable parameters in themodern laboratories which in future may replace the older screening tools
Congreso Nacional Laboratorio Cliacutenico
2018
A favor Eficiencia Operativa
Mejora el proceso del Laboratorio
Mejor informacioacuten al Cliacutenico al mismo coste
Mejora la informacioacuten
Informa sobre la eritropoyesis deteccioacuten precoz de estados carenciales
Ayuda al cliacutenico
Estado real del paciente
En contraParaacutemetros de investigacioacuten
Dificultad de standarizar dependencia teacutecnica
Control de calidadCongreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
Int Jnl Lab Hem 2007 29 327ndash334
Clin Lab 201662343-347
In ourstudy mean MCVrMCV ratio of healthy controls is130 as microcytic anemia irondeficiency anemia is121 as also macrocytic anemia vitamin B12 deficiencyanemia is 115
Congreso Nacional Laboratorio Cliacutenico
2018
Sualeh Muslim Khan Muhammad Akbar Agha
Mean cell volume of reticulocytemdashA new parameter for diagnosing sub-clinical cobalamin deficiency in blood donors Int J Lab Hem 20181ndash4
The Abbott CELL-DYN Sapphire Hematology System uses multi-angle polarized scatter separation (MAPSS) and focused flow impedance technologies
Congreso Nacional Laboratorio Cliacutenico
2018
MCVr at 985 fL yielded the highest Youdenrsquos index at sensitivity of 82 specificity of 828 AUC 0847 ( 95 CI 803-891)
Khan SM Agha MA Mean cell volume of reticulocyte-A new parameter for diagnosing sub-clinical cobalamin deficiency in blood donors
Int J Lab Hem 20181ndash4 2018 Jul 13 doi 101111ijlh12899
Congreso Nacional Laboratorio Cliacutenico
2018
Role of Cell Population Data in the detection of folate and cobalamin deficiency
J Nieto et al
XXXI st International Symposium on Technological Innovations in Laboratory Hematology ISLH 2018 10-12 May 2018 Brussels Belgium
M-V-NRET and SD-VNRET are the best discriminatory single parameters to distinguish between patients with B9B12 deficiency and reference subjects M-V-NRETAUC=0823 sensitivity 78 and specificity 86
AUC=0852 sensitivity 55 and specificity 60
Conclusions The CPD parameters of Volume and Light Scatter (M and SD of LALS angle) that inform about size and intracellular structure of RBCs provided very useful information for the detection of B9B12 deficiency
Congreso Nacional Laboratorio Cliacutenico
2018
Cell Population Data
bull Paraacutemetros poblacionales de los leucocitos
bull Describen la morfologiacutea tamantildeo
estructuras citoplasmaacuteticas
nuacutecleo aacutecidos nucleacuteicos
bull Son datos numeacutericos con los que se construyen los ejes de lo diagramas de dispersioacuten de los leucocitos
bull Dependen de la tecnologiacutea
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
High Sensitivity New Parameters for the Detection of Vitamin B12 and Folate Deficiencies Blood 2008 1125379
B12 def vs
Normals
Mann
Withney T-Test
ROC
AUC Sens Specif Cutoff signifROC
MCV p=03156 p=09533 0577
MPV p=00001 0802 792 806 lt83 p=00001
NE Mean
Volume plt00001 0862 833 778 gt1403 p=00001
MO Mean
Volume plt00001 0829 625 889 gt1723 p=00001
MRV p=00113 0705 50 964 gt1133 p=00051
Folate def vs
Normals
Mann
Withney T-Test
ROC
AUC Sens Specif Cut-off signifROC
MCV p=00798 p=06461 0665
MPV plt00001 0832 81 806 lt83 p=00001
NE Mean
Volume p=00008 087 952 694 gt1402 p=00001
MO Mean
Volume p=00002 0801 667 833 gt1696 p=00001
MRV p=00054 0731 476 964 gt1133 p=00019
The Mean Neutrophil Volume (MNE V) and Mean Monocyte Volume (MMOV) may be used for the detection of megaloblastic neutrophils and monocytes MNEV and MMOV have significantly higher sensitivity than the previous information from the red cells (MCV) detecting B12 or folate deficiency because they are not affected by the presence at the same time of Iron deficiency or other reasons of anemia
Congreso Nacional Laboratorio Cliacutenico
2018
POSTER 733
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
CPD Sysmex XN
NE SSC complejidad
NE SFL aacutecidos nucleacuteicos
NE FSC tamantildeo
NE WX
NE WY
NE WZ
MO X
MO Y
MO Z
MO WX
MO WY
MO WZ
LY X
LY Y
LY Z
LY WX
LY WY
LY WZCongreso Nacio
nal Laboratorio Cliacutenico 2018
As MCV is the mean which is calculated it is insensitive to the presence of a small number of macrocytes
Further macrocytosis can be obscured by concomitant disorders that can cause microcytosis resulting inmasked megaloblastic anaemia (MA) for example iron deficiency hereditary elliptocytosis alpha and betathalassemia
This study was undertaken to evaluate the role of NEUT-X and NEUT-Y in detecting MA on peripheral blood andalso see whether other forms of macrocytic anaemia can be differentiated from MA
In MA the peripheral blood smear shows cytopenia with macroovalocytes and hypersegmented
neutrophils (gt5 lobes in 5 neutrophils six lobes nuclei or lobe average of gt35)
In conclusion our study shows that higher values of NEUT-X and NEUT-Y in MA patients in spite of low ornormal MCV high RDW may be used to not only reveal the masked cases of MA with concomitant irondeficiency but also separate them from the broader macrocytic anaemia group
Peripheral smear remains diagnostic however making smear for all the suspicious cases is a cumbersomeand tedious procedure Thus these parameters emerge as more reliable and stable parameters in themodern laboratories which in future may replace the older screening tools
Congreso Nacional Laboratorio Cliacutenico
2018
A favor Eficiencia Operativa
Mejora el proceso del Laboratorio
Mejor informacioacuten al Cliacutenico al mismo coste
Mejora la informacioacuten
Informa sobre la eritropoyesis deteccioacuten precoz de estados carenciales
Ayuda al cliacutenico
Estado real del paciente
En contraParaacutemetros de investigacioacuten
Dificultad de standarizar dependencia teacutecnica
Control de calidadCongreso Nacional Laboratorio Cliacutenico
2018
Int Jnl Lab Hem 2007 29 327ndash334
Clin Lab 201662343-347
In ourstudy mean MCVrMCV ratio of healthy controls is130 as microcytic anemia irondeficiency anemia is121 as also macrocytic anemia vitamin B12 deficiencyanemia is 115
Congreso Nacional Laboratorio Cliacutenico
2018
Sualeh Muslim Khan Muhammad Akbar Agha
Mean cell volume of reticulocytemdashA new parameter for diagnosing sub-clinical cobalamin deficiency in blood donors Int J Lab Hem 20181ndash4
The Abbott CELL-DYN Sapphire Hematology System uses multi-angle polarized scatter separation (MAPSS) and focused flow impedance technologies
Congreso Nacional Laboratorio Cliacutenico
2018
MCVr at 985 fL yielded the highest Youdenrsquos index at sensitivity of 82 specificity of 828 AUC 0847 ( 95 CI 803-891)
Khan SM Agha MA Mean cell volume of reticulocyte-A new parameter for diagnosing sub-clinical cobalamin deficiency in blood donors
Int J Lab Hem 20181ndash4 2018 Jul 13 doi 101111ijlh12899
Congreso Nacional Laboratorio Cliacutenico
2018
Role of Cell Population Data in the detection of folate and cobalamin deficiency
J Nieto et al
XXXI st International Symposium on Technological Innovations in Laboratory Hematology ISLH 2018 10-12 May 2018 Brussels Belgium
M-V-NRET and SD-VNRET are the best discriminatory single parameters to distinguish between patients with B9B12 deficiency and reference subjects M-V-NRETAUC=0823 sensitivity 78 and specificity 86
AUC=0852 sensitivity 55 and specificity 60
Conclusions The CPD parameters of Volume and Light Scatter (M and SD of LALS angle) that inform about size and intracellular structure of RBCs provided very useful information for the detection of B9B12 deficiency
Congreso Nacional Laboratorio Cliacutenico
2018
Cell Population Data
bull Paraacutemetros poblacionales de los leucocitos
bull Describen la morfologiacutea tamantildeo
estructuras citoplasmaacuteticas
nuacutecleo aacutecidos nucleacuteicos
bull Son datos numeacutericos con los que se construyen los ejes de lo diagramas de dispersioacuten de los leucocitos
bull Dependen de la tecnologiacutea
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
High Sensitivity New Parameters for the Detection of Vitamin B12 and Folate Deficiencies Blood 2008 1125379
B12 def vs
Normals
Mann
Withney T-Test
ROC
AUC Sens Specif Cutoff signifROC
MCV p=03156 p=09533 0577
MPV p=00001 0802 792 806 lt83 p=00001
NE Mean
Volume plt00001 0862 833 778 gt1403 p=00001
MO Mean
Volume plt00001 0829 625 889 gt1723 p=00001
MRV p=00113 0705 50 964 gt1133 p=00051
Folate def vs
Normals
Mann
Withney T-Test
ROC
AUC Sens Specif Cut-off signifROC
MCV p=00798 p=06461 0665
MPV plt00001 0832 81 806 lt83 p=00001
NE Mean
Volume p=00008 087 952 694 gt1402 p=00001
MO Mean
Volume p=00002 0801 667 833 gt1696 p=00001
MRV p=00054 0731 476 964 gt1133 p=00019
The Mean Neutrophil Volume (MNE V) and Mean Monocyte Volume (MMOV) may be used for the detection of megaloblastic neutrophils and monocytes MNEV and MMOV have significantly higher sensitivity than the previous information from the red cells (MCV) detecting B12 or folate deficiency because they are not affected by the presence at the same time of Iron deficiency or other reasons of anemia
Congreso Nacional Laboratorio Cliacutenico
2018
POSTER 733
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
CPD Sysmex XN
NE SSC complejidad
NE SFL aacutecidos nucleacuteicos
NE FSC tamantildeo
NE WX
NE WY
NE WZ
MO X
MO Y
MO Z
MO WX
MO WY
MO WZ
LY X
LY Y
LY Z
LY WX
LY WY
LY WZCongreso Nacio
nal Laboratorio Cliacutenico 2018
As MCV is the mean which is calculated it is insensitive to the presence of a small number of macrocytes
Further macrocytosis can be obscured by concomitant disorders that can cause microcytosis resulting inmasked megaloblastic anaemia (MA) for example iron deficiency hereditary elliptocytosis alpha and betathalassemia
This study was undertaken to evaluate the role of NEUT-X and NEUT-Y in detecting MA on peripheral blood andalso see whether other forms of macrocytic anaemia can be differentiated from MA
In MA the peripheral blood smear shows cytopenia with macroovalocytes and hypersegmented
neutrophils (gt5 lobes in 5 neutrophils six lobes nuclei or lobe average of gt35)
In conclusion our study shows that higher values of NEUT-X and NEUT-Y in MA patients in spite of low ornormal MCV high RDW may be used to not only reveal the masked cases of MA with concomitant irondeficiency but also separate them from the broader macrocytic anaemia group
Peripheral smear remains diagnostic however making smear for all the suspicious cases is a cumbersomeand tedious procedure Thus these parameters emerge as more reliable and stable parameters in themodern laboratories which in future may replace the older screening tools
Congreso Nacional Laboratorio Cliacutenico
2018
A favor Eficiencia Operativa
Mejora el proceso del Laboratorio
Mejor informacioacuten al Cliacutenico al mismo coste
Mejora la informacioacuten
Informa sobre la eritropoyesis deteccioacuten precoz de estados carenciales
Ayuda al cliacutenico
Estado real del paciente
En contraParaacutemetros de investigacioacuten
Dificultad de standarizar dependencia teacutecnica
Control de calidadCongreso Nacional Laboratorio Cliacutenico
2018
Sualeh Muslim Khan Muhammad Akbar Agha
Mean cell volume of reticulocytemdashA new parameter for diagnosing sub-clinical cobalamin deficiency in blood donors Int J Lab Hem 20181ndash4
The Abbott CELL-DYN Sapphire Hematology System uses multi-angle polarized scatter separation (MAPSS) and focused flow impedance technologies
Congreso Nacional Laboratorio Cliacutenico
2018
MCVr at 985 fL yielded the highest Youdenrsquos index at sensitivity of 82 specificity of 828 AUC 0847 ( 95 CI 803-891)
Khan SM Agha MA Mean cell volume of reticulocyte-A new parameter for diagnosing sub-clinical cobalamin deficiency in blood donors
Int J Lab Hem 20181ndash4 2018 Jul 13 doi 101111ijlh12899
Congreso Nacional Laboratorio Cliacutenico
2018
Role of Cell Population Data in the detection of folate and cobalamin deficiency
J Nieto et al
XXXI st International Symposium on Technological Innovations in Laboratory Hematology ISLH 2018 10-12 May 2018 Brussels Belgium
M-V-NRET and SD-VNRET are the best discriminatory single parameters to distinguish between patients with B9B12 deficiency and reference subjects M-V-NRETAUC=0823 sensitivity 78 and specificity 86
AUC=0852 sensitivity 55 and specificity 60
Conclusions The CPD parameters of Volume and Light Scatter (M and SD of LALS angle) that inform about size and intracellular structure of RBCs provided very useful information for the detection of B9B12 deficiency
Congreso Nacional Laboratorio Cliacutenico
2018
Cell Population Data
bull Paraacutemetros poblacionales de los leucocitos
bull Describen la morfologiacutea tamantildeo
estructuras citoplasmaacuteticas
nuacutecleo aacutecidos nucleacuteicos
bull Son datos numeacutericos con los que se construyen los ejes de lo diagramas de dispersioacuten de los leucocitos
bull Dependen de la tecnologiacutea
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
High Sensitivity New Parameters for the Detection of Vitamin B12 and Folate Deficiencies Blood 2008 1125379
B12 def vs
Normals
Mann
Withney T-Test
ROC
AUC Sens Specif Cutoff signifROC
MCV p=03156 p=09533 0577
MPV p=00001 0802 792 806 lt83 p=00001
NE Mean
Volume plt00001 0862 833 778 gt1403 p=00001
MO Mean
Volume plt00001 0829 625 889 gt1723 p=00001
MRV p=00113 0705 50 964 gt1133 p=00051
Folate def vs
Normals
Mann
Withney T-Test
ROC
AUC Sens Specif Cut-off signifROC
MCV p=00798 p=06461 0665
MPV plt00001 0832 81 806 lt83 p=00001
NE Mean
Volume p=00008 087 952 694 gt1402 p=00001
MO Mean
Volume p=00002 0801 667 833 gt1696 p=00001
MRV p=00054 0731 476 964 gt1133 p=00019
The Mean Neutrophil Volume (MNE V) and Mean Monocyte Volume (MMOV) may be used for the detection of megaloblastic neutrophils and monocytes MNEV and MMOV have significantly higher sensitivity than the previous information from the red cells (MCV) detecting B12 or folate deficiency because they are not affected by the presence at the same time of Iron deficiency or other reasons of anemia
Congreso Nacional Laboratorio Cliacutenico
2018
POSTER 733
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
CPD Sysmex XN
NE SSC complejidad
NE SFL aacutecidos nucleacuteicos
NE FSC tamantildeo
NE WX
NE WY
NE WZ
MO X
MO Y
MO Z
MO WX
MO WY
MO WZ
LY X
LY Y
LY Z
LY WX
LY WY
LY WZCongreso Nacio
nal Laboratorio Cliacutenico 2018
As MCV is the mean which is calculated it is insensitive to the presence of a small number of macrocytes
Further macrocytosis can be obscured by concomitant disorders that can cause microcytosis resulting inmasked megaloblastic anaemia (MA) for example iron deficiency hereditary elliptocytosis alpha and betathalassemia
This study was undertaken to evaluate the role of NEUT-X and NEUT-Y in detecting MA on peripheral blood andalso see whether other forms of macrocytic anaemia can be differentiated from MA
In MA the peripheral blood smear shows cytopenia with macroovalocytes and hypersegmented
neutrophils (gt5 lobes in 5 neutrophils six lobes nuclei or lobe average of gt35)
In conclusion our study shows that higher values of NEUT-X and NEUT-Y in MA patients in spite of low ornormal MCV high RDW may be used to not only reveal the masked cases of MA with concomitant irondeficiency but also separate them from the broader macrocytic anaemia group
Peripheral smear remains diagnostic however making smear for all the suspicious cases is a cumbersomeand tedious procedure Thus these parameters emerge as more reliable and stable parameters in themodern laboratories which in future may replace the older screening tools
Congreso Nacional Laboratorio Cliacutenico
2018
A favor Eficiencia Operativa
Mejora el proceso del Laboratorio
Mejor informacioacuten al Cliacutenico al mismo coste
Mejora la informacioacuten
Informa sobre la eritropoyesis deteccioacuten precoz de estados carenciales
Ayuda al cliacutenico
Estado real del paciente
En contraParaacutemetros de investigacioacuten
Dificultad de standarizar dependencia teacutecnica
Control de calidadCongreso Nacional Laboratorio Cliacutenico
2018
MCVr at 985 fL yielded the highest Youdenrsquos index at sensitivity of 82 specificity of 828 AUC 0847 ( 95 CI 803-891)
Khan SM Agha MA Mean cell volume of reticulocyte-A new parameter for diagnosing sub-clinical cobalamin deficiency in blood donors
Int J Lab Hem 20181ndash4 2018 Jul 13 doi 101111ijlh12899
Congreso Nacional Laboratorio Cliacutenico
2018
Role of Cell Population Data in the detection of folate and cobalamin deficiency
J Nieto et al
XXXI st International Symposium on Technological Innovations in Laboratory Hematology ISLH 2018 10-12 May 2018 Brussels Belgium
M-V-NRET and SD-VNRET are the best discriminatory single parameters to distinguish between patients with B9B12 deficiency and reference subjects M-V-NRETAUC=0823 sensitivity 78 and specificity 86
AUC=0852 sensitivity 55 and specificity 60
Conclusions The CPD parameters of Volume and Light Scatter (M and SD of LALS angle) that inform about size and intracellular structure of RBCs provided very useful information for the detection of B9B12 deficiency
Congreso Nacional Laboratorio Cliacutenico
2018
Cell Population Data
bull Paraacutemetros poblacionales de los leucocitos
bull Describen la morfologiacutea tamantildeo
estructuras citoplasmaacuteticas
nuacutecleo aacutecidos nucleacuteicos
bull Son datos numeacutericos con los que se construyen los ejes de lo diagramas de dispersioacuten de los leucocitos
bull Dependen de la tecnologiacutea
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
High Sensitivity New Parameters for the Detection of Vitamin B12 and Folate Deficiencies Blood 2008 1125379
B12 def vs
Normals
Mann
Withney T-Test
ROC
AUC Sens Specif Cutoff signifROC
MCV p=03156 p=09533 0577
MPV p=00001 0802 792 806 lt83 p=00001
NE Mean
Volume plt00001 0862 833 778 gt1403 p=00001
MO Mean
Volume plt00001 0829 625 889 gt1723 p=00001
MRV p=00113 0705 50 964 gt1133 p=00051
Folate def vs
Normals
Mann
Withney T-Test
ROC
AUC Sens Specif Cut-off signifROC
MCV p=00798 p=06461 0665
MPV plt00001 0832 81 806 lt83 p=00001
NE Mean
Volume p=00008 087 952 694 gt1402 p=00001
MO Mean
Volume p=00002 0801 667 833 gt1696 p=00001
MRV p=00054 0731 476 964 gt1133 p=00019
The Mean Neutrophil Volume (MNE V) and Mean Monocyte Volume (MMOV) may be used for the detection of megaloblastic neutrophils and monocytes MNEV and MMOV have significantly higher sensitivity than the previous information from the red cells (MCV) detecting B12 or folate deficiency because they are not affected by the presence at the same time of Iron deficiency or other reasons of anemia
Congreso Nacional Laboratorio Cliacutenico
2018
POSTER 733
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
CPD Sysmex XN
NE SSC complejidad
NE SFL aacutecidos nucleacuteicos
NE FSC tamantildeo
NE WX
NE WY
NE WZ
MO X
MO Y
MO Z
MO WX
MO WY
MO WZ
LY X
LY Y
LY Z
LY WX
LY WY
LY WZCongreso Nacio
nal Laboratorio Cliacutenico 2018
As MCV is the mean which is calculated it is insensitive to the presence of a small number of macrocytes
Further macrocytosis can be obscured by concomitant disorders that can cause microcytosis resulting inmasked megaloblastic anaemia (MA) for example iron deficiency hereditary elliptocytosis alpha and betathalassemia
This study was undertaken to evaluate the role of NEUT-X and NEUT-Y in detecting MA on peripheral blood andalso see whether other forms of macrocytic anaemia can be differentiated from MA
In MA the peripheral blood smear shows cytopenia with macroovalocytes and hypersegmented
neutrophils (gt5 lobes in 5 neutrophils six lobes nuclei or lobe average of gt35)
In conclusion our study shows that higher values of NEUT-X and NEUT-Y in MA patients in spite of low ornormal MCV high RDW may be used to not only reveal the masked cases of MA with concomitant irondeficiency but also separate them from the broader macrocytic anaemia group
Peripheral smear remains diagnostic however making smear for all the suspicious cases is a cumbersomeand tedious procedure Thus these parameters emerge as more reliable and stable parameters in themodern laboratories which in future may replace the older screening tools
Congreso Nacional Laboratorio Cliacutenico
2018
A favor Eficiencia Operativa
Mejora el proceso del Laboratorio
Mejor informacioacuten al Cliacutenico al mismo coste
Mejora la informacioacuten
Informa sobre la eritropoyesis deteccioacuten precoz de estados carenciales
Ayuda al cliacutenico
Estado real del paciente
En contraParaacutemetros de investigacioacuten
Dificultad de standarizar dependencia teacutecnica
Control de calidadCongreso Nacional Laboratorio Cliacutenico
2018
Role of Cell Population Data in the detection of folate and cobalamin deficiency
J Nieto et al
XXXI st International Symposium on Technological Innovations in Laboratory Hematology ISLH 2018 10-12 May 2018 Brussels Belgium
M-V-NRET and SD-VNRET are the best discriminatory single parameters to distinguish between patients with B9B12 deficiency and reference subjects M-V-NRETAUC=0823 sensitivity 78 and specificity 86
AUC=0852 sensitivity 55 and specificity 60
Conclusions The CPD parameters of Volume and Light Scatter (M and SD of LALS angle) that inform about size and intracellular structure of RBCs provided very useful information for the detection of B9B12 deficiency
Congreso Nacional Laboratorio Cliacutenico
2018
Cell Population Data
bull Paraacutemetros poblacionales de los leucocitos
bull Describen la morfologiacutea tamantildeo
estructuras citoplasmaacuteticas
nuacutecleo aacutecidos nucleacuteicos
bull Son datos numeacutericos con los que se construyen los ejes de lo diagramas de dispersioacuten de los leucocitos
bull Dependen de la tecnologiacutea
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
High Sensitivity New Parameters for the Detection of Vitamin B12 and Folate Deficiencies Blood 2008 1125379
B12 def vs
Normals
Mann
Withney T-Test
ROC
AUC Sens Specif Cutoff signifROC
MCV p=03156 p=09533 0577
MPV p=00001 0802 792 806 lt83 p=00001
NE Mean
Volume plt00001 0862 833 778 gt1403 p=00001
MO Mean
Volume plt00001 0829 625 889 gt1723 p=00001
MRV p=00113 0705 50 964 gt1133 p=00051
Folate def vs
Normals
Mann
Withney T-Test
ROC
AUC Sens Specif Cut-off signifROC
MCV p=00798 p=06461 0665
MPV plt00001 0832 81 806 lt83 p=00001
NE Mean
Volume p=00008 087 952 694 gt1402 p=00001
MO Mean
Volume p=00002 0801 667 833 gt1696 p=00001
MRV p=00054 0731 476 964 gt1133 p=00019
The Mean Neutrophil Volume (MNE V) and Mean Monocyte Volume (MMOV) may be used for the detection of megaloblastic neutrophils and monocytes MNEV and MMOV have significantly higher sensitivity than the previous information from the red cells (MCV) detecting B12 or folate deficiency because they are not affected by the presence at the same time of Iron deficiency or other reasons of anemia
Congreso Nacional Laboratorio Cliacutenico
2018
POSTER 733
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
CPD Sysmex XN
NE SSC complejidad
NE SFL aacutecidos nucleacuteicos
NE FSC tamantildeo
NE WX
NE WY
NE WZ
MO X
MO Y
MO Z
MO WX
MO WY
MO WZ
LY X
LY Y
LY Z
LY WX
LY WY
LY WZCongreso Nacio
nal Laboratorio Cliacutenico 2018
As MCV is the mean which is calculated it is insensitive to the presence of a small number of macrocytes
Further macrocytosis can be obscured by concomitant disorders that can cause microcytosis resulting inmasked megaloblastic anaemia (MA) for example iron deficiency hereditary elliptocytosis alpha and betathalassemia
This study was undertaken to evaluate the role of NEUT-X and NEUT-Y in detecting MA on peripheral blood andalso see whether other forms of macrocytic anaemia can be differentiated from MA
In MA the peripheral blood smear shows cytopenia with macroovalocytes and hypersegmented
neutrophils (gt5 lobes in 5 neutrophils six lobes nuclei or lobe average of gt35)
In conclusion our study shows that higher values of NEUT-X and NEUT-Y in MA patients in spite of low ornormal MCV high RDW may be used to not only reveal the masked cases of MA with concomitant irondeficiency but also separate them from the broader macrocytic anaemia group
Peripheral smear remains diagnostic however making smear for all the suspicious cases is a cumbersomeand tedious procedure Thus these parameters emerge as more reliable and stable parameters in themodern laboratories which in future may replace the older screening tools
Congreso Nacional Laboratorio Cliacutenico
2018
A favor Eficiencia Operativa
Mejora el proceso del Laboratorio
Mejor informacioacuten al Cliacutenico al mismo coste
Mejora la informacioacuten
Informa sobre la eritropoyesis deteccioacuten precoz de estados carenciales
Ayuda al cliacutenico
Estado real del paciente
En contraParaacutemetros de investigacioacuten
Dificultad de standarizar dependencia teacutecnica
Control de calidadCongreso Nacional Laboratorio Cliacutenico
2018
Cell Population Data
bull Paraacutemetros poblacionales de los leucocitos
bull Describen la morfologiacutea tamantildeo
estructuras citoplasmaacuteticas
nuacutecleo aacutecidos nucleacuteicos
bull Son datos numeacutericos con los que se construyen los ejes de lo diagramas de dispersioacuten de los leucocitos
bull Dependen de la tecnologiacutea
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
High Sensitivity New Parameters for the Detection of Vitamin B12 and Folate Deficiencies Blood 2008 1125379
B12 def vs
Normals
Mann
Withney T-Test
ROC
AUC Sens Specif Cutoff signifROC
MCV p=03156 p=09533 0577
MPV p=00001 0802 792 806 lt83 p=00001
NE Mean
Volume plt00001 0862 833 778 gt1403 p=00001
MO Mean
Volume plt00001 0829 625 889 gt1723 p=00001
MRV p=00113 0705 50 964 gt1133 p=00051
Folate def vs
Normals
Mann
Withney T-Test
ROC
AUC Sens Specif Cut-off signifROC
MCV p=00798 p=06461 0665
MPV plt00001 0832 81 806 lt83 p=00001
NE Mean
Volume p=00008 087 952 694 gt1402 p=00001
MO Mean
Volume p=00002 0801 667 833 gt1696 p=00001
MRV p=00054 0731 476 964 gt1133 p=00019
The Mean Neutrophil Volume (MNE V) and Mean Monocyte Volume (MMOV) may be used for the detection of megaloblastic neutrophils and monocytes MNEV and MMOV have significantly higher sensitivity than the previous information from the red cells (MCV) detecting B12 or folate deficiency because they are not affected by the presence at the same time of Iron deficiency or other reasons of anemia
Congreso Nacional Laboratorio Cliacutenico
2018
POSTER 733
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
CPD Sysmex XN
NE SSC complejidad
NE SFL aacutecidos nucleacuteicos
NE FSC tamantildeo
NE WX
NE WY
NE WZ
MO X
MO Y
MO Z
MO WX
MO WY
MO WZ
LY X
LY Y
LY Z
LY WX
LY WY
LY WZCongreso Nacio
nal Laboratorio Cliacutenico 2018
As MCV is the mean which is calculated it is insensitive to the presence of a small number of macrocytes
Further macrocytosis can be obscured by concomitant disorders that can cause microcytosis resulting inmasked megaloblastic anaemia (MA) for example iron deficiency hereditary elliptocytosis alpha and betathalassemia
This study was undertaken to evaluate the role of NEUT-X and NEUT-Y in detecting MA on peripheral blood andalso see whether other forms of macrocytic anaemia can be differentiated from MA
In MA the peripheral blood smear shows cytopenia with macroovalocytes and hypersegmented
neutrophils (gt5 lobes in 5 neutrophils six lobes nuclei or lobe average of gt35)
In conclusion our study shows that higher values of NEUT-X and NEUT-Y in MA patients in spite of low ornormal MCV high RDW may be used to not only reveal the masked cases of MA with concomitant irondeficiency but also separate them from the broader macrocytic anaemia group
Peripheral smear remains diagnostic however making smear for all the suspicious cases is a cumbersomeand tedious procedure Thus these parameters emerge as more reliable and stable parameters in themodern laboratories which in future may replace the older screening tools
Congreso Nacional Laboratorio Cliacutenico
2018
A favor Eficiencia Operativa
Mejora el proceso del Laboratorio
Mejor informacioacuten al Cliacutenico al mismo coste
Mejora la informacioacuten
Informa sobre la eritropoyesis deteccioacuten precoz de estados carenciales
Ayuda al cliacutenico
Estado real del paciente
En contraParaacutemetros de investigacioacuten
Dificultad de standarizar dependencia teacutecnica
Control de calidadCongreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
High Sensitivity New Parameters for the Detection of Vitamin B12 and Folate Deficiencies Blood 2008 1125379
B12 def vs
Normals
Mann
Withney T-Test
ROC
AUC Sens Specif Cutoff signifROC
MCV p=03156 p=09533 0577
MPV p=00001 0802 792 806 lt83 p=00001
NE Mean
Volume plt00001 0862 833 778 gt1403 p=00001
MO Mean
Volume plt00001 0829 625 889 gt1723 p=00001
MRV p=00113 0705 50 964 gt1133 p=00051
Folate def vs
Normals
Mann
Withney T-Test
ROC
AUC Sens Specif Cut-off signifROC
MCV p=00798 p=06461 0665
MPV plt00001 0832 81 806 lt83 p=00001
NE Mean
Volume p=00008 087 952 694 gt1402 p=00001
MO Mean
Volume p=00002 0801 667 833 gt1696 p=00001
MRV p=00054 0731 476 964 gt1133 p=00019
The Mean Neutrophil Volume (MNE V) and Mean Monocyte Volume (MMOV) may be used for the detection of megaloblastic neutrophils and monocytes MNEV and MMOV have significantly higher sensitivity than the previous information from the red cells (MCV) detecting B12 or folate deficiency because they are not affected by the presence at the same time of Iron deficiency or other reasons of anemia
Congreso Nacional Laboratorio Cliacutenico
2018
POSTER 733
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
CPD Sysmex XN
NE SSC complejidad
NE SFL aacutecidos nucleacuteicos
NE FSC tamantildeo
NE WX
NE WY
NE WZ
MO X
MO Y
MO Z
MO WX
MO WY
MO WZ
LY X
LY Y
LY Z
LY WX
LY WY
LY WZCongreso Nacio
nal Laboratorio Cliacutenico 2018
As MCV is the mean which is calculated it is insensitive to the presence of a small number of macrocytes
Further macrocytosis can be obscured by concomitant disorders that can cause microcytosis resulting inmasked megaloblastic anaemia (MA) for example iron deficiency hereditary elliptocytosis alpha and betathalassemia
This study was undertaken to evaluate the role of NEUT-X and NEUT-Y in detecting MA on peripheral blood andalso see whether other forms of macrocytic anaemia can be differentiated from MA
In MA the peripheral blood smear shows cytopenia with macroovalocytes and hypersegmented
neutrophils (gt5 lobes in 5 neutrophils six lobes nuclei or lobe average of gt35)
In conclusion our study shows that higher values of NEUT-X and NEUT-Y in MA patients in spite of low ornormal MCV high RDW may be used to not only reveal the masked cases of MA with concomitant irondeficiency but also separate them from the broader macrocytic anaemia group
Peripheral smear remains diagnostic however making smear for all the suspicious cases is a cumbersomeand tedious procedure Thus these parameters emerge as more reliable and stable parameters in themodern laboratories which in future may replace the older screening tools
Congreso Nacional Laboratorio Cliacutenico
2018
A favor Eficiencia Operativa
Mejora el proceso del Laboratorio
Mejor informacioacuten al Cliacutenico al mismo coste
Mejora la informacioacuten
Informa sobre la eritropoyesis deteccioacuten precoz de estados carenciales
Ayuda al cliacutenico
Estado real del paciente
En contraParaacutemetros de investigacioacuten
Dificultad de standarizar dependencia teacutecnica
Control de calidadCongreso Nacional Laboratorio Cliacutenico
2018
High Sensitivity New Parameters for the Detection of Vitamin B12 and Folate Deficiencies Blood 2008 1125379
B12 def vs
Normals
Mann
Withney T-Test
ROC
AUC Sens Specif Cutoff signifROC
MCV p=03156 p=09533 0577
MPV p=00001 0802 792 806 lt83 p=00001
NE Mean
Volume plt00001 0862 833 778 gt1403 p=00001
MO Mean
Volume plt00001 0829 625 889 gt1723 p=00001
MRV p=00113 0705 50 964 gt1133 p=00051
Folate def vs
Normals
Mann
Withney T-Test
ROC
AUC Sens Specif Cut-off signifROC
MCV p=00798 p=06461 0665
MPV plt00001 0832 81 806 lt83 p=00001
NE Mean
Volume p=00008 087 952 694 gt1402 p=00001
MO Mean
Volume p=00002 0801 667 833 gt1696 p=00001
MRV p=00054 0731 476 964 gt1133 p=00019
The Mean Neutrophil Volume (MNE V) and Mean Monocyte Volume (MMOV) may be used for the detection of megaloblastic neutrophils and monocytes MNEV and MMOV have significantly higher sensitivity than the previous information from the red cells (MCV) detecting B12 or folate deficiency because they are not affected by the presence at the same time of Iron deficiency or other reasons of anemia
Congreso Nacional Laboratorio Cliacutenico
2018
POSTER 733
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
CPD Sysmex XN
NE SSC complejidad
NE SFL aacutecidos nucleacuteicos
NE FSC tamantildeo
NE WX
NE WY
NE WZ
MO X
MO Y
MO Z
MO WX
MO WY
MO WZ
LY X
LY Y
LY Z
LY WX
LY WY
LY WZCongreso Nacio
nal Laboratorio Cliacutenico 2018
As MCV is the mean which is calculated it is insensitive to the presence of a small number of macrocytes
Further macrocytosis can be obscured by concomitant disorders that can cause microcytosis resulting inmasked megaloblastic anaemia (MA) for example iron deficiency hereditary elliptocytosis alpha and betathalassemia
This study was undertaken to evaluate the role of NEUT-X and NEUT-Y in detecting MA on peripheral blood andalso see whether other forms of macrocytic anaemia can be differentiated from MA
In MA the peripheral blood smear shows cytopenia with macroovalocytes and hypersegmented
neutrophils (gt5 lobes in 5 neutrophils six lobes nuclei or lobe average of gt35)
In conclusion our study shows that higher values of NEUT-X and NEUT-Y in MA patients in spite of low ornormal MCV high RDW may be used to not only reveal the masked cases of MA with concomitant irondeficiency but also separate them from the broader macrocytic anaemia group
Peripheral smear remains diagnostic however making smear for all the suspicious cases is a cumbersomeand tedious procedure Thus these parameters emerge as more reliable and stable parameters in themodern laboratories which in future may replace the older screening tools
Congreso Nacional Laboratorio Cliacutenico
2018
A favor Eficiencia Operativa
Mejora el proceso del Laboratorio
Mejor informacioacuten al Cliacutenico al mismo coste
Mejora la informacioacuten
Informa sobre la eritropoyesis deteccioacuten precoz de estados carenciales
Ayuda al cliacutenico
Estado real del paciente
En contraParaacutemetros de investigacioacuten
Dificultad de standarizar dependencia teacutecnica
Control de calidadCongreso Nacional Laboratorio Cliacutenico
2018
POSTER 733
Congreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
CPD Sysmex XN
NE SSC complejidad
NE SFL aacutecidos nucleacuteicos
NE FSC tamantildeo
NE WX
NE WY
NE WZ
MO X
MO Y
MO Z
MO WX
MO WY
MO WZ
LY X
LY Y
LY Z
LY WX
LY WY
LY WZCongreso Nacio
nal Laboratorio Cliacutenico 2018
As MCV is the mean which is calculated it is insensitive to the presence of a small number of macrocytes
Further macrocytosis can be obscured by concomitant disorders that can cause microcytosis resulting inmasked megaloblastic anaemia (MA) for example iron deficiency hereditary elliptocytosis alpha and betathalassemia
This study was undertaken to evaluate the role of NEUT-X and NEUT-Y in detecting MA on peripheral blood andalso see whether other forms of macrocytic anaemia can be differentiated from MA
In MA the peripheral blood smear shows cytopenia with macroovalocytes and hypersegmented
neutrophils (gt5 lobes in 5 neutrophils six lobes nuclei or lobe average of gt35)
In conclusion our study shows that higher values of NEUT-X and NEUT-Y in MA patients in spite of low ornormal MCV high RDW may be used to not only reveal the masked cases of MA with concomitant irondeficiency but also separate them from the broader macrocytic anaemia group
Peripheral smear remains diagnostic however making smear for all the suspicious cases is a cumbersomeand tedious procedure Thus these parameters emerge as more reliable and stable parameters in themodern laboratories which in future may replace the older screening tools
Congreso Nacional Laboratorio Cliacutenico
2018
A favor Eficiencia Operativa
Mejora el proceso del Laboratorio
Mejor informacioacuten al Cliacutenico al mismo coste
Mejora la informacioacuten
Informa sobre la eritropoyesis deteccioacuten precoz de estados carenciales
Ayuda al cliacutenico
Estado real del paciente
En contraParaacutemetros de investigacioacuten
Dificultad de standarizar dependencia teacutecnica
Control de calidadCongreso Nacional Laboratorio Cliacutenico
2018
Congreso Nacional Laboratorio Cliacutenico
2018
CPD Sysmex XN
NE SSC complejidad
NE SFL aacutecidos nucleacuteicos
NE FSC tamantildeo
NE WX
NE WY
NE WZ
MO X
MO Y
MO Z
MO WX
MO WY
MO WZ
LY X
LY Y
LY Z
LY WX
LY WY
LY WZCongreso Nacio
nal Laboratorio Cliacutenico 2018
As MCV is the mean which is calculated it is insensitive to the presence of a small number of macrocytes
Further macrocytosis can be obscured by concomitant disorders that can cause microcytosis resulting inmasked megaloblastic anaemia (MA) for example iron deficiency hereditary elliptocytosis alpha and betathalassemia
This study was undertaken to evaluate the role of NEUT-X and NEUT-Y in detecting MA on peripheral blood andalso see whether other forms of macrocytic anaemia can be differentiated from MA
In MA the peripheral blood smear shows cytopenia with macroovalocytes and hypersegmented
neutrophils (gt5 lobes in 5 neutrophils six lobes nuclei or lobe average of gt35)
In conclusion our study shows that higher values of NEUT-X and NEUT-Y in MA patients in spite of low ornormal MCV high RDW may be used to not only reveal the masked cases of MA with concomitant irondeficiency but also separate them from the broader macrocytic anaemia group
Peripheral smear remains diagnostic however making smear for all the suspicious cases is a cumbersomeand tedious procedure Thus these parameters emerge as more reliable and stable parameters in themodern laboratories which in future may replace the older screening tools
Congreso Nacional Laboratorio Cliacutenico
2018
A favor Eficiencia Operativa
Mejora el proceso del Laboratorio
Mejor informacioacuten al Cliacutenico al mismo coste
Mejora la informacioacuten
Informa sobre la eritropoyesis deteccioacuten precoz de estados carenciales
Ayuda al cliacutenico
Estado real del paciente
En contraParaacutemetros de investigacioacuten
Dificultad de standarizar dependencia teacutecnica
Control de calidadCongreso Nacional Laboratorio Cliacutenico
2018
CPD Sysmex XN
NE SSC complejidad
NE SFL aacutecidos nucleacuteicos
NE FSC tamantildeo
NE WX
NE WY
NE WZ
MO X
MO Y
MO Z
MO WX
MO WY
MO WZ
LY X
LY Y
LY Z
LY WX
LY WY
LY WZCongreso Nacio
nal Laboratorio Cliacutenico 2018
As MCV is the mean which is calculated it is insensitive to the presence of a small number of macrocytes
Further macrocytosis can be obscured by concomitant disorders that can cause microcytosis resulting inmasked megaloblastic anaemia (MA) for example iron deficiency hereditary elliptocytosis alpha and betathalassemia
This study was undertaken to evaluate the role of NEUT-X and NEUT-Y in detecting MA on peripheral blood andalso see whether other forms of macrocytic anaemia can be differentiated from MA
In MA the peripheral blood smear shows cytopenia with macroovalocytes and hypersegmented
neutrophils (gt5 lobes in 5 neutrophils six lobes nuclei or lobe average of gt35)
In conclusion our study shows that higher values of NEUT-X and NEUT-Y in MA patients in spite of low ornormal MCV high RDW may be used to not only reveal the masked cases of MA with concomitant irondeficiency but also separate them from the broader macrocytic anaemia group
Peripheral smear remains diagnostic however making smear for all the suspicious cases is a cumbersomeand tedious procedure Thus these parameters emerge as more reliable and stable parameters in themodern laboratories which in future may replace the older screening tools
Congreso Nacional Laboratorio Cliacutenico
2018
A favor Eficiencia Operativa
Mejora el proceso del Laboratorio
Mejor informacioacuten al Cliacutenico al mismo coste
Mejora la informacioacuten
Informa sobre la eritropoyesis deteccioacuten precoz de estados carenciales
Ayuda al cliacutenico
Estado real del paciente
En contraParaacutemetros de investigacioacuten
Dificultad de standarizar dependencia teacutecnica
Control de calidadCongreso Nacional Laboratorio Cliacutenico
2018
As MCV is the mean which is calculated it is insensitive to the presence of a small number of macrocytes
Further macrocytosis can be obscured by concomitant disorders that can cause microcytosis resulting inmasked megaloblastic anaemia (MA) for example iron deficiency hereditary elliptocytosis alpha and betathalassemia
This study was undertaken to evaluate the role of NEUT-X and NEUT-Y in detecting MA on peripheral blood andalso see whether other forms of macrocytic anaemia can be differentiated from MA
In MA the peripheral blood smear shows cytopenia with macroovalocytes and hypersegmented
neutrophils (gt5 lobes in 5 neutrophils six lobes nuclei or lobe average of gt35)
In conclusion our study shows that higher values of NEUT-X and NEUT-Y in MA patients in spite of low ornormal MCV high RDW may be used to not only reveal the masked cases of MA with concomitant irondeficiency but also separate them from the broader macrocytic anaemia group
Peripheral smear remains diagnostic however making smear for all the suspicious cases is a cumbersomeand tedious procedure Thus these parameters emerge as more reliable and stable parameters in themodern laboratories which in future may replace the older screening tools
Congreso Nacional Laboratorio Cliacutenico
2018
A favor Eficiencia Operativa
Mejora el proceso del Laboratorio
Mejor informacioacuten al Cliacutenico al mismo coste
Mejora la informacioacuten
Informa sobre la eritropoyesis deteccioacuten precoz de estados carenciales
Ayuda al cliacutenico
Estado real del paciente
En contraParaacutemetros de investigacioacuten
Dificultad de standarizar dependencia teacutecnica
Control de calidadCongreso Nacional Laboratorio Cliacutenico
2018
A favor Eficiencia Operativa
Mejora el proceso del Laboratorio
Mejor informacioacuten al Cliacutenico al mismo coste
Mejora la informacioacuten
Informa sobre la eritropoyesis deteccioacuten precoz de estados carenciales
Ayuda al cliacutenico
Estado real del paciente
En contraParaacutemetros de investigacioacuten
Dificultad de standarizar dependencia teacutecnica
Control de calidadCongreso Nacional Laboratorio Cliacutenico
2018
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