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Background: Approximately 30% of stroke cases result from carotid disease. Although several risk factors for complications after carotid endarterectomy have been identified, the existence of a biomarker that can estimate postoperative risk in these patients has not yet been proven. Objectives: This study aimed to investigate correlations between the platelet-lymphocyte ratio (PLR) and the neutrophil-lymphocyte ratio (NLR) and postoperative clinical outcomes in patients undergoing carotid endarterectomy. Methods: A retrospective study was conducted, including 374 patients who underwent carotid endarterectomy between 2002 and 2019 due to moderate to high extracranial internal carotid artery stenosis. Their platelet-lymphocyte ratio and neutrophil-lymphocyte ratios were obtained from the same blood samples. Results: There was a statistically significant correlation between the PLR and the occurrence of restenosis (p < 0.01) and acute myocardial infarction (AMI) after endarterectomy (p = 0.03). Additionally, there was a statistically significant correlation between the PLR and the combined outcomes stroke and/or AMI and/or death (p = 0.03) and stroke and/or AMI and/or death and/or restenosis (p < 0.01). However, there were no significant correlations between NLR and these outcomes (p = 0.05, p = 0.16). Conclusions: The platelet-lymphocyte ratio proved to be a useful test for predicting occurrence of strokes, acute myocardial infarctions, and deaths during the postoperative period after carotid endarterectomy. It was also associated with the risk of postoperative restenosis.

Contexto: Aproximadamente 30% dos casos de acidente vascular cerebral (AVC) resultam de doença carotídea. Embora vários fatores de risco para complicações pós-endarterectomia carotídea tenham sido identificados, ainda não foi comprovada a existência de um biomarcador que possa estimar o risco pós-operatório nesses pacientes. Objetivos: Correlacionar o índice plaqueta-linfócito (IPL) e o índice neutrófilo-linfócito (INL) com os desfechos clínicos pós-operatórios em pacientes submetidos a endarterectomia carotídea. Métodos: Estudo retrospectivo que incluiu 374 pacientes submetidos a endarterectomia carotídea, entre 2009 e 2019, por estenose extracraniana da artéria carótida interna. O IPL e o INL foram calculados, tendo sido obtidos das mesmas amostras de sangue. Resultados: Houve correlação estatisticamente significativa entre IPL e presença de reestenose (p<0,01) e infarto agudo do miocárdio (IAM) após endarterectomia (p=0,03). Os desfechos combinados AVC e/ou IAM e/ou óbito e AVC e/ou IAM e/ou óbito e/ou reestenose apresentaram, respectivamente, correlação estatisticamente significativa com o IPL (p=0,03; p<0,01) e não significativa com o INL (p=0,05; p=0,16). Conclusões: O IPL mostrou-se um teste útil, capaz de predizer os desfechos de AVC e/ou IAM e/ou óbito em pacientes no pós-operatório de endarterectomia carotídea, relacionando-se também com risco de reestenose pós-operatória.

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Abstract Background Subarachnoid hemorrhage (SAH) prognosis remains poor. Vasospasm mechanism might be associated with inflammation. Neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) have been studied as inflammation markers and prognostic predictors. Objective We aimed to investigate NLR and PLR in admission as predictors of angiographic vasospasm and functional outcome at 6 months. Methods This cohort study included consecutive aneurysmal SAH patients admitted to a tertiary center. Complete blood count was recorded at admission before treatment. White blood cell count, neutrophil count, lymphocyte count, platelet count, NLR, and PLR were collected as independent variables. Vasospasm occurrence-modified Rankin scale (mRS), Glasgow outcome scale (GOS), and Hunt-Hess score at admission and at 6 months were recorded as dependent variables. Multivariable logistic regression models were used to adjust for potential confounding and to assess the independent prognostic value of NLR and PLR at admission. Results A total of 74.1% of the patients were female, with mean age of 55.6 ± 12.4 years. At admission, the median Hunt-Hess score was 2 (interquartile range [IQR] 1), and the median mFisher was 3 (IQR 1). Microsurgical clipping was the treatment for 66.2% of the patients. Angiographic vasospasm incidence was 16.5%. At 6 months, the median GOS was 4 (IQR 0.75), and the median mRS was 3 (IQR 1.5). Twenty-one patients (15.1%) died. Neutrophil-to-lymphocyte ratio and PLR levels did not differ between favorable and unfavorable (mRS > 2 or GOS < 4) functional outcomes. No variables were significantly associated with angiographic vasospasm. Conclusion Admission NLR and PLR presented no value for prediction of functional outcome or angiographic vasospasm risk. Further research is needed in this field.

Resumo Antecedentes O prognóstico da hemorragia subaracnoidea (HSA) permanece ruim. Vasoespasmo pode estar associado à inflamação. Razões neutrófilo-linfócito (NLR) e plaqueta-linfócito (PLR) têm sido estudadas como marcadores de inflamação e prognóstico. Objetivo Investigar NLR e PLR na admissão como preditores de vasoespasmo angiográfico e desfecho aos 6 meses. Métodos Este estudo de coorte incluiu pacientes consecutivos com HSA aneurismática de um centro terciário. Contagem de leucócitos, neutrófilos, linfócitos e plaquetas, proporção de neutrófilos para linfócitos e de plaquetas para linfócitos foram coletados como variáveis independentes. Ocorrência de vasoespasmo, escala de Rankin modificada, escala de desfecho de Glasgow e o escore de Hunt-Hess na admissão e 6 meses após a mesma foram registradas como variáveis dependentes. Modelos de regressão logística multivariável foram usados para ajustar potenciais fatores de confusão e avaliar valor prognóstico independente de NLR e PLR. Resultados Um total de 74,1% pacientes eram do sexo feminino, com idade média de 55,6 ± 12,4 anos. Na admissão, a pontuação média de Hunt-Hess foi de 2 (IQR 1) e a mediana de mFisher foi de 3 (IQR 1). Clipagem microcirúrgica foi o tratamento escolhido para 66,2% dos pacientes. A incidência de vasoespasmo angiográfico foi de 16,5%. Aos 6 meses, a escala de desfecho de Glasgow mediana era 4 (IQR 0,75) e a escala de Rankin modificada mediana era 3 (IQR 1,5). Vinte e um pacientes (15,1%) morreram. Os níveis de NLR e PLR não diferiram entre resultados funcionais favoráveis e desfavoráveis (mRS > 2 ou GOS < 4). Nenhuma variável foi significativamente associada ao vasoespasmo angiográfico. Conclusão Razão neutrófilo-linfócito e a PLR não apresentaram valor preditivo de desfecho funcional ou risco de vasoespasmo angiográfico. Mais pesquisas são necessárias neste campo.

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INTRODUCTION: Postoperative thrombocytopenia is common in cardiac surgery with cardiopulmonary bypass, and its risk factors are unclear. METHODS: This retrospective study enrolled 3,175 adult patients undergoing valve surgeries with cardiopulmonary bypass from January 1, 2017 to December 30, 2018 in our institute. Postoperative thrombocytopenia was defined as the first postoperative platelet count below the 10th quantile in all the enrolled patients. Outcomes between patients with and without postoperative thrombocytopenia were compared. The primary outcome was in-hospital mortality. Risk factors of postoperative thrombocytopenia were assessed by logistic regression analysis. RESULTS: The 10th quantile of all enrolled patients (75×109/L) was defined as the threshold for postoperative thrombocytopenia. In-hospital mortality was comparable between thrombocytopenia and non-thrombocytopenia groups (0.9% vs. 0.6%, P=0.434). Patients in the thrombocytopenia group had higher rate of postoperative blood transfusion (5.9% vs. 3.2%, P=0.014), more chest drainage volume (735 [550-1080] vs. 560 [430-730] ml, P<0.001), and higher incidence of acute kidney injury (12.3% vs. 4.2%, P<0.001). Age > 60 years (odds ratio [OR] 2.25, 95% confidence interval [CI] 1.345-3.765, P=0.002], preoperative thrombocytopenia (OR 18.671, 95% CI 13.649-25.542, P<0.001), and cardiopulmonary bypass time (OR 1.088, 95% CI 1.059-1.117, P<0.001) were positively independently associated with postoperative thrombocytopenia. Body surface area (BSA) (OR 0.247, 95% CI 0.114-0.538, P<0.001) and isolated mitral valve surgery (OR 0.475, 95% CI 0.294-0.77) were negatively independently associated with postoperative thrombocytopenia. CONCLUSION: Positive predictors for thrombocytopenia after valve surgery included age > 60 years, small BSA, preoperative thrombocytopenia, and cardiopulmonary bypass time. BSA and isolated mitral valve surgery were negative predictors.

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Toluene is a widely used solvent whose many toxic effects include neurological and hematological damage. This study reviewed evidence about the effects of toluene exposure on platelet count in humans. Three electronic databases and a digital library of theses and dissertations were searched using a specific strategy, yielding 64 articles, of which 14 were selected. These studies assessed a total of 15,759 participants, including 13,297 exposed individuals, mainly women exposed in an environmental setting. The major findings were: (1) conflicting results (positive, inverse, or no association), (2) cross-contamination with other substances, which impaired assessment of the relationship, and (3) a lack of studies. Thus, further research is needed on this topic, especially toluene exposure in isolation from associated substances.

O tolueno é um solvente amplamente utilizado com múltiplos efeitos tóxicos, sobretudo sobre o sistema nervoso central, assim como efeitos hematológicos. Este estudo foi conduzido para revisar a evidência presente na literatura sobre a exposição humana ao tolueno e seu efeito na contagem de plaquetas. Em 3 bases de dados eletrônicas e 1 biblioteca digital de teses e dissertações foram pesquisadas utilizando uma estratégia de busca específica, da qual resultaram 64 artigos, dos quais 14 foram selecionados. Estes avaliaram 15.759 pessoas, com 13.297 indivíduos expostos, compostos principalmente de mulheres em um cenário ambiental. Foram encontrados 3 grandes resultados, os quais incluem a presença de relações conflitantes (positiva, inversa, sem associação), a presença frequente de outras substâncias afetando a análise da relação, e a falta de estudos. Portanto, nós recomendamos mais pesquisas no tópico, com ênfase na exposição ao tolueno sem substâncias associadas.

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Abstract Background Approximately 30% of stroke cases result from carotid disease. Although several risk factors for complications after carotid endarterectomy have been identified, the existence of a biomarker that can estimate postoperative risk in these patients has not yet been proven. Objectives This study aimed to investigate correlations between the platelet-lymphocyte ratio (PLR) and the neutrophil-lymphocyte ratio (NLR) and postoperative clinical outcomes in patients undergoing carotid endarterectomy. Methods A retrospective study was conducted, including 374 patients who underwent carotid endarterectomy between 2002 and 2019 due to moderate to high extracranial internal carotid artery stenosis. Their platelet-lymphocyte ratio and neutrophil-lymphocyte ratios were obtained from the same blood samples. Results There was a statistically significant correlation between the PLR and the occurrence of restenosis (p < 0.01) and acute myocardial infarction (AMI) after endarterectomy (p = 0.03). Additionally, there was a statistically significant correlation between the PLR and the combined outcomes stroke and/or AMI and/or death (p = 0.03) and stroke and/or AMI and/or death and/or restenosis (p < 0.01). However, there were no significant correlations between NLR and these outcomes (p = 0.05, p = 0.16). Conclusions The platelet-lymphocyte ratio proved to be a useful test for predicting occurrence of strokes, acute myocardial infarctions, and deaths during the postoperative period after carotid endarterectomy. It was also associated with the risk of postoperative restenosis.

Resumo Contexto Aproximadamente 30% dos casos de acidente vascular cerebral (AVC) resultam de doença carotídea. Embora vários fatores de risco para complicações pós-endarterectomia carotídea tenham sido identificados, ainda não foi comprovada a existência de um biomarcador que possa estimar o risco pós-operatório nesses pacientes. Objetivos Correlacionar o índice plaqueta-linfócito (IPL) e o índice neutrófilo-linfócito (INL) com os desfechos clínicos pós-operatórios em pacientes submetidos a endarterectomia carotídea. Métodos Estudo retrospectivo que incluiu 374 pacientes submetidos a endarterectomia carotídea, entre 2009 e 2019, por estenose extracraniana da artéria carótida interna. O IPL e o INL foram calculados, tendo sido obtidos das mesmas amostras de sangue. Resultados Houve correlação estatisticamente significativa entre IPL e presença de reestenose (p<0,01) e infarto agudo do miocárdio (IAM) após endarterectomia (p=0,03). Os desfechos combinados AVC e/ou IAM e/ou óbito e AVC e/ou IAM e/ou óbito e/ou reestenose apresentaram, respectivamente, correlação estatisticamente significativa com o IPL (p=0,03; p<0,01) e não significativa com o INL (p=0,05; p=0,16). Conclusões O IPL mostrou-se um teste útil, capaz de predizer os desfechos de AVC e/ou IAM e/ou óbito em pacientes no pós-operatório de endarterectomia carotídea, relacionando-se também com risco de reestenose pós-operatória.

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ABSTRACT Introduction: Postoperative thrombocytopenia is common in cardiac surgery with cardiopulmonary bypass, and its risk factors are unclear. Methods: This retrospective study enrolled 3,175 adult patients undergoing valve surgeries with cardiopulmonary bypass from January 1, 2017 to December 30, 2018 in our institute. Postoperative thrombocytopenia was defined as the first postoperative platelet count below the 10th quantile in all the enrolled patients. Outcomes between patients with and without postoperative thrombocytopenia were compared. The primary outcome was in-hospital mortality. Risk factors of postoperative thrombocytopenia were assessed by logistic regression analysis. Results: The 10th quantile of all enrolled patients (75×109/L) was defined as the threshold for postoperative thrombocytopenia. In-hospital mortality was comparable between thrombocytopenia and non-thrombocytopenia groups (0.9% vs. 0.6%, P=0.434). Patients in the thrombocytopenia group had higher rate of postoperative blood transfusion (5.9% vs. 3.2%, P=0.014), more chest drainage volume (735 [550-1080] vs. 560 [430-730] ml, P<0.001), and higher incidence of acute kidney injury (12.3% vs. 4.2%, P<0.001). Age > 60 years (odds ratio [OR] 2.25, 95% confidence interval [CI] 1.345-3.765, P=0.002], preoperative thrombocytopenia (OR 18.671, 95% CI 13.649-25.542, P<0.001), and cardiopulmonary bypass time (OR 1.088, 95% CI 1.059-1.117, P<0.001) were positively independently associated with postoperative thrombocytopenia. Body surface area (BSA) (OR 0.247, 95% CI 0.114-0.538, P<0.001) and isolated mitral valve surgery (OR 0.475, 95% CI 0.294-0.77) were negatively independently associated with postoperative thrombocytopenia. Conclusion: Positive predictors for thrombocytopenia after valve surgery included age > 60 years, small BSA, preoperative thrombocytopenia, and cardiopulmonary bypass time. BSA and isolated mitral valve surgery were negative predictors.

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Introduction: The pre-analytical phase directly influences the laboratory result, such as the method of collection, transport, and storage of biological samples. Therefore, the stability of the biological sample is a crucial and determinant aspect of the quality of results in a clinical laboratory. Studies show that some platelet parameters may suffer alterations in the presence of altered blood/anticoagulant ratio, with increased storage time and/or variations in storage temperature, possibly leading to unrepresentative results. This study aimed to investigate the reliability of platelet parameters regarding the effect of the anticoagulant/blood ratio and storage temperature in samples stored for up to 24 hours after collection using the Cell Dyn Ruby® equipment.Methodology: A total of 351 blood samples were evaluated under different analysis periods: 2, 5, 12, and 24 hours and storage methods: at room temperature (25 °C) and 4 °C, in addition to the analysis of anticoagulant/blood ratio. The Platelet parameters selected were: PLT (total platelet count), MPV (mean platelet volume), PDW (Platelet Distribution Width) and PCT (plateletcrit). The imprecision of the results was evaluated by the CVa (%) within the maximum allowed analytical variation, as well as by the mean difference of the results concerning the baseline sample (2 hours). Results: The total platelet count was the only parameter evaluated that showed reproducibility of results in all conditions analyzed. Regarding the other platelet parameters, it could be observed an imprecision of results emitted by Cell Dyn Ruby® after five hours of storage, both at room and refrigerated temperature. Conclusion: This study demonstrates that pre-analytical factors, such as storage temperature and storage time, can affect the variability of platelet parameters, which may produce erroneous results. Thus, the correct blood/anticoagulant ratio must be respected to avoid the late processing of the sample (AU)

Introdução: O resultado laboratorial é diretamente influenciado por etapas da fase pré-analítica, como método de coleta, transporte e armazenamento das amostras biológicas. Desta forma, a estabilidade da amostra biológica é um aspecto crucial e determinante para a qualidade dos resultados de um laboratório clínico. Estudos demonstram que alguns parâmetros plaquetários podem sofrer modificações na presença da relação sangue/anticoagulante alterada, com aumento do tempo de estocagem e/ou alterações na temperatura de armazenamento, podendo levar a resultados não representativos. Portanto, o objetivo desse estudo foi investigar a confiabilidade dos parâmetros plaquetários com relação ao efeito da relação anticoagulante/sangue e da temperatura de armazenamento, em amostras estocadas por até 24 horas após a coleta, utilizando o equipamento Cell Dyn Ruby®. Métodos: Foram avaliados 351 hemogramas, em diferentes tempos de análise: 2, 5, 12 e 24 horas e formas de estocagem: à temperatura ambiente (25°C) e à 4°C, além da relação anticoagulante/sangue. Foram selecionados os seguintes parâmetros plaquetários: PLT (contagem total de plaquetas), VPM (volume plaquetário médio), PDW (amplitude de variação do tamanho das plaquetas) e PCT (plaquetócrito). A confiabilidade dos resultados foi avaliada pelo CVa (%), dentro da variação analítica máxima permitida, assim como pela diferença de média dos resultados em relação à amostra de base (2 horas). Resultados: A contagem total de plaquetas foi o único parâmetro avaliado que apresentou reprodutibilidade de resultados em todas as condições analisadas. Em relação aos demais parâmetros plaquetários, foi observado imprecisão dos resultados emitidos pelo Cell Dyn Ruby®, a partir de 5 horas de estocagem, tanto em temperatura ambiente quanto refrigerada. Conclusão: Este estudo demonstra que fatores pré-analíticos, como a temperatura de armazenamento e o tempo de estocagem, podem afetar a variabilidade dos parâmetros plaquetários, podendo produzir resultados equivocados. Deste modo, deve-se respeitar a correta relação sangue/anticoagulante e evitar o processamento tardio da amostra (AU)

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SUMMARY OBJECTIVE: This study aimed to compare neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio of overweight children and adolescents with the eutrophic ratios and to verify whether these ratios are associated with age, inflammation, Z-score of body mass index, and waist-to-height ratio. METHODS: This is a cross-sectional study involving 64 overweight and 106 eutrophic children and adolescents. Data on weight, height, and waist circumference (body mass index and waist-to-height ratio), blood count (neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio), and high-sensitivity C-reactive protein were collected. RESULTS: The mean age of participants was 8.4±3.2 years. The ratios did not differ between the overweight and non-overweight groups. The platelet-to-lymphocyte ratio has shown a direct and independent association with body mass index (p=0.031) and waist-to-height ratio (p=0.018), a fact not observed for neutrophil-to-lymphocyte ratio. The ultrasensitive C-reactive protein level was higher in the obesity group (p=0.003). Both ratios had a direct and independent association with age. CONCLUSION: The ratios did not differ between the overweight and non-overweight groups. There was a direct and independent association of platelet-to-lymphocyte ratio with overweight, not observed in neutrophil-to-lymphocyte ratio. The ratios have significantly increased according to the age of the participants.

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RESUMEN El hemograma, el frotis de sangre periférica, el conteo de reticulocitos y el conteo de plaquetas en el período neonatal son exámenes fundamentales en el diagnóstico y seguimiento de algunas enfermedades más frecuentes en esta fase de la vida como la anemia y las infecciones, las cuales, en ocasiones, pueden causar gran morbilidad y mortalidad en el neonato. Se efectúa una revisión bibliográfica de los resultados del hemograma, lámina periférica, conteo de reticulocitos y conteo de plaquetas en el neonato a término y pretérmino describiendo las variaciones de estos parámetros en el síndrome anémico y la sepsis del recién nacido.

ABSTRACT The complete blood count, the peripheral blood smear, the reticulocyte count and the platelet count in the pathological neonatal period are fundamental tests in the diagnosis and follow-up of some of the most frequent diseases in this phase of life, such as anemia and infections, which can sometimes cause great morbidity and mortality in the newborn. A bibliographic review of the results of the hemogram, peripheral lamina, reticulocyte count and platelet count in term and preterm neonates is carried out, describing the variations of these parameters in the anemia syndrome and sepsis of the newborn.

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BACKGROUND: Thrombocytopenia is a marker of severity in dengue, and its resolution predicts clinical improvement. The objective was to evaluate mean platelet volume (MPV) trajectories as a predictor of platelet count (PC) recovery in dengue patients. METHODS: An observational, longitudinal and analytical study was conducted at Fundación Valle del Lili (Cali, Colombia). Patients diagnosed with dengue during 2016-2020 were included. The association between PC and the covariates was evaluated using simple linear, quadratic and non-parametric spline smoothing regression models. A longitudinal linear mixed model was adjusted and then validated for PC measurements. RESULTS: A total of 71 patients were included. The median age was 27 y, 38.5% were women and half had dengue with warning signs. A statistically significant PC decrease was observed when MPV was 13.87 fL and 4.46 d from the onset of symptoms, while PC displayed a significant constant increase with neutrophils count. Then, PC recovery was achieved with an MPV of 13.58 fL, 4.5 d from the onset of symptoms and a minimum neutrophils count of 150 µL. CONCLUSION: MPV may be a predictor of PC recovery in dengue patients. PC recovery is expected when a patient has an MPV of 13.58 fL, an onset time of 4.5 d and a neutrophils count of 150 µL.

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RESUMEN Se define recién nacido normal a aquel niño con peso superior a 2500 gramos e inferior a 4000 gramos, a término, y que no presenta afección ni presente ni probable en el momento del nacimiento. Los valores del hemograma, la morfología del frotis de sangre periférica, el conteo de reticulocitos y de plaquetas en el recién nacido normal varían según su tiempo de vida y son efecto de diferentes causas fisiológicas; aunque también existen numerosas alteraciones patológicas en estos exámenes de laboratorio en caso de determinadas enfermedades que pueden aparecer en esta etapa de la vida. En los recién nacidos pre término estas cambios son más evidentes. Se realizó una revisión bibliográfica sobre el hemograma, lámina periférica, conteo de plaquetas y conteo de reticulocitos en el recién nacido normal donde se exponen los resultados de estos estudios según su tiempo de nacimiento. Se realizan conclusiones.

ABSTRACT A normal newborn is defined as a child weighing more than 2500 grams and less than 4000 grams, at term, and who does not present affection or possible affection at the time of birth. The values of the hemogram, the morphology of the peripheral blood smear, the reticulocyte and platelet count in the normal newborn vary according to their life span and are the effect of different physiological causes; although there are also numerous pathological alterations in these laboratory tests in the case of certain diseases that may appear at this stage of life. In preterm newborns these changes are more evident. A bibliographic review was carried out on the hemogram, peripheral lamina, platelet count and reticulocyte count in the normal newborn where the results of these studies are presented according to their time of birth. Conclusions are made.

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La trombocitemia esencial forma parte del grupo de neoplasias mieloproliferativas. Se caracteriza por síntomas microvasculares y vasomotores, recuento plaquetario superior a 450 x 109/l, proliferación megacariocítica con morfología grande y madura, ausencia de proliferación eritroide y granulocítica, demostración de JAK2V617F u otro marcador clonal y ausencia de evidencia de trombocitosis reactiva. Se reporta el manejo anestésico en una paciente donde las principales consideraciones están relacionadas con la prevención de eventos hemorrágicos y trombóticos. La suspensión de la aspirina, el mantenimiento del tratamiento con hidroxiurea, la preparación con ácido tranexámico, el uso pre y posoperatorio de fraxiparina, hidratación adecuada, uso de medias elásticas en miembros inferiores, deambulación precoz, buena hemostasia quirúrgica y disponibilidad de concentrados de plaquetas son los elementos fundamentales en la conducción anestésica de esta paciente(AU)

Essential thrombocythemia is part of the group of myeloproliferative neoplasms. It is characterized by microvascular and vasomotor symptoms, platelet count over 450x109/L, megakaryocytic proliferation with large and mature morphology, absence of erythroid and granulocytic proliferation, demonstration of JAK2V617F or other clonal marker, and absence of evidence of reactive thrombocytosis. Anesthetic management is reported in a patient, whose case's main considerations are related to the prevention of hemorrhagic and thrombotic events. Aspirin suspension, maintenance of hydroxyurea treatment, preparation with tranexamic acid, pre- and post-operative use of fraxiparin, adequate hydration, use of elastic stockings in lower limbs, early ambulation, good surgical hemostasis, as well as availability of platelet concentrates are the fundamental elements in the anesthetic management of this patient(AU)

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INTRODUCTION: This study investigated the role of the neutrophil-lymphocyte ratio (NLR), the perioperative changes in NLR (delta-NLR), the platelet-lymphocyte ratio (PLR), and the platelet count in predicting acute kidney injury (AKI) following coronary artery bypass grafting (CABG) during hospital stay. METHODS: The records of 396 patients with preoperative creatinine < 1.5 mg/dl undergoing isolated CABG between October 2015 and October 2019 were reviewed retrospectively. Diagnosis of AKI was based on the Kidney Disease Improving Global Outcomes definition. Demographic data, operative data, in-hospital mortality, preoperative NLR, PLR, and platelet counts were compared between patients with (AKI group) and without (non-AKI group) postoperative AKI. Additionally, NLR, delta-NLR, and PLR values were calculated daily for the first four postoperative days. A "subsequent AKI group" was formed for the first four postoperative days by excluding patients diagnosed with AKI. The daily and overall predictivity of the markers for AKI are investigated. RESULTS: AKI was present in 86 patients during the postoperative period, while 310 patients had normal postoperative renal functions. NLR, delta-NLR, and PLR on the first four postoperative days (P<0.001 for all) were significantly associated with the development of AKI in subsequent days. Multivariate analysis identified postoperative NLR (odds ratio 1.17, 95% confidence interval 1.11-1.23; P<0.001) as an independent predictor of AKI. PLR lost its significant association with AKI at the values measured at discharge from hospital (P>0.05). CONCLUSION: NLR values measured on the first four days postoperatively are a useful tool in predicting AKI during hospital stay following CABG.

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Abstract Introduction: This study investigated the role of the neutrophil-lymphocyte ratio (NLR), the perioperative changes in NLR (delta-NLR), the platelet-lymphocyte ratio (PLR), and the platelet count in predicting acute kidney injury (AKI) following coronary artery bypass grafting (CABG) during hospital stay. Methods: The records of 396 patients with preoperative creatinine < 1.5 mg/dl undergoing isolated CABG between October 2015 and October 2019 were reviewed retrospectively. Diagnosis of AKI was based on the Kidney Disease Improving Global Outcomes definition. Demographic data, operative data, in-hospital mortality, preoperative NLR, PLR, and platelet counts were compared between patients with (AKI group) and without (non-AKI group) postoperative AKI. Additionally, NLR, delta-NLR, and PLR values were calculated daily for the first four postoperative days. A "subsequent AKI group" was formed for the first four postoperative days by excluding patients diagnosed with AKI. The daily and overall predictivity of the markers for AKI are investigated. Results: AKI was present in 86 patients during the postoperative period, while 310 patients had normal postoperative renal functions. NLR, delta-NLR, and PLR on the first four postoperative days (P<0.001 for all) were significantly associated with the development of AKI in subsequent days. Multivariate analysis identified postoperative NLR (odds ratio 1.17, 95% confidence interval 1.11-1.23; P<0.001) as an independent predictor of AKI. PLR lost its significant association with AKI at the values measured at discharge from hospital (P>0.05). Conclusion: NLR values measured on the first four days postoperatively are a useful tool in predicting AKI during hospital stay following CABG.

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OBJECTIVE: To determine the outcomes of chronic hepatitis B virus (HBV) infection in a large, prospectively studied cohort of children in the US and Canada. STUDY DESIGN: This was a prospective, observational study of children with chronic HBV enrolled in 7 clinical centers and evaluated at baseline, weeks 24 and 48, and annually thereafter, with analysis of demographic, clinical, physical examination, and blood test data. RESULTS: Among 362 children followed for a median of 4.2 years, elevated alanine aminotransferase (ALT) levels (>1 upper limit of normal) were present in 72% at last evaluation, including in 60% of children with loss of hepatitis B e antigen during follow-up and 70% of those who were hepatitis B e antigen negative at baseline. Significant ALT flares (male patients ≥400 U/L, female patients ≥350 U/L) occurred in 13 children. Of 129 children who fulfilled the American Association for the Study of Liver Diseases treatment criteria during follow-up, anti-HBV treatment was initiated in only 25. One child died (unrelated to liver disease), 1 developed cirrhosis, but no episodes of cirrhotic decompensation or hepatocellular carcinoma were observed. Decline in platelet count was inversely associated with ALT elevations. CONCLUSIONS: In a cohort of children with chronic HBV infection in the US and Canada, many children remained at risk of progressive liver disease due to active hepatitis, but major clinical outcomes such as cirrhosis, cancer, and death were rare. Many children who met criteria for treatment remained untreated.

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BACKGROUND: Hepatosplenic schistosomiasis mansoni (HS) is associated with thrombocytopenia. Accurate platelet counts are required for identification and management of HS patients. EDTA-dependent pseudothrombocytopenia (EDTA-PTCP) is an in vitro phenomenon of anticoagulant-activated platelet agglutination resulting in low platelet counts by automated methods. The prevalence of EDTA-PCTP in schistosomiasis is unknown and only one case has been described. Our aims were to determine the prevalence of EDTA-PTCP in HS and evaluate alternative methods to overcome this analytical error. METHODS: Blood samples from 56 HS patients and 56 healthy volunteers were collected, and platelet counts were obtained using standard microscopy and automated (electric impedance) methods. Automated platelet counts and the presence of platelet clumps in blood smears were evaluated in samples collected in EDTA or sodium citrate tubes 20 and 180 min after blood collection. RESULTS: EDTA-PTCP was more frequent in HS patients than healthy volunteers (8.92% vs 0.00%, p<0.0285). Platelet clumps and PTCP were also observed in samples collected in sodium citrate tubes, refuting its use as an alternative method. CONCLUSIONS: Automated platelet counts in blood samples from HS patients should be performed right after blood collection in EDTA tubes and verified by manual counts in blood smears.

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Abstract Introduction: The platelet count/spleen diameter (PC/SD) ratio is a noninvasive method for the diagnosis of esophageal varices (EV) used as an alternative to endoscopy in patients with cirrhosis. Objective: To evaluate the diagnostic performance of the PC/SD ratio (cut-off point <909) to detect EV in patients with cirrhosis treated at a tertiary referral hospital in Bogotá D.C., Colombia. Materials and methods: A prospective diagnostic test accuracy study was conducted in 66 patients with cirrhosis treated at the Hospital Universitario de La Samaritana between July and December 2018. A descriptive analysis of the data was performed. In addition, the diagnostic performance of the PC/SD ratio (cut-off point <909) for the detection of EV was compared with the findings reported in the esophagogastroduodenoscopy (gold standard), calculating its sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), positive likelihood ratio (LR+), and negative likelihood ratio (LR-). A significance level of p<0.05 was considered. Results: The mean age of the participants was 65.5 years, 53.03% were female, and the most common causes of cirrhosis were alcohol consumption (40.90%) and autoimmune hepatitis (22.72%). EV was diagnosed in 48 patients (72.72%). The PC/SC ratio showed sensitivity of 60%, specificity of 78%, PPV of 0.88, NPV of 0.42, LR+ of 2.73, and LR- of 0.51. Conclusion: The low sensitivity, specificity, and NPV found in the present study suggest that the PC/SD ratio (cut-off point <909) may not be a useful diagnostic test for detecting EV in patients with cirrhosis.

Resumen Introducción. El índice de recuento de plaquetas/diámetro del bazo (RP/DB) es un método no invasivo para el diagnóstico de varices esofágicas (VE) que se usa como alternativa a la endoscopia en pacientes con cirrosis. Objetivo. Evaluar el rendimiento diagnóstico del índice RP/DM (punto de corte <909) para detectar VE en pacientes cirróticos atendidos en un hospital de tercer nivel de Bogotá D.C., Colombia. Materiales y métodos. Estudio prospectivo de validez de prueba diagnóstica realizado en 66 pacientes cirróticos atendidos en el Hospital Universitario de La Samaritana entre julio y diciembre de 2018. Se realizó un análisis descriptivo de los datos. Además, el rendimiento diagnóstico del índice RP/DM (punto de corte <909) para la detección de VE se comparó con los hallazgos de la esofagogastroduodenoscopia (prueba de oro), calculándose su sensibilidad, especificidad, valor predictivo positivo (VPP), valor predictivo negativo (VPN), razón de probabilidad positiva (LR+) y razón de probabilidad negativa (LR-). Se consideró un nivel de significancia de p<0.05. Resultados. La edad promedio de los participantes fue 65.5 años, 53.03% eran mujeres y las causas más comunes de cirrosis fueron consumo de alcohol (40.90%) y hepatitis autoinmune (22.72%). Las VE fueron diagnosticadas en 48 pacientes (72.72%). El índice RP/DM tuvo una sensibilidad de 60%, una especificidad de 78%, un VPP de 0.88, un VPN de 0.42, una LR+ de 2.73 y una LR- de 0.51. Conclusión. La baja sensibilidad, especificidad y VPN encontrados en el presente estudio sugieren que el índice RP/DM (punto de corte <909) podría no ser una prueba diagnóstica útil para detectar VE en pacientes cirróticos.

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INTRODUCTION: Algorithms have been developed to predict the platelet yield after apheresis from the donor's data, as well as the effect on the blood cell count, to extract an acceptable platelet number without affecting the donor. However, the evaluation of these algorithms has not been widely reported. This study aimed to assess the accuracy of the predictive algorithms of the Trima Accel v. 6 blood collection system. METHODS: Platelet concentrates (PCs) obtained by apheresis were analyzed. Platelet count and hematocrit were compared pre- and post-apheresis. Calculated post-apheresis platelet count (CPAPC), hematocrit (CPAH), and platelet yield (CPY), and their actual values were correlated. The bias of the algorithms was assessed with Bland-Altman plots, and the prediction of the extraction of single or double platelet products was evaluated. RESULTS: Two hundred and seventy-nine PCs were analyzed. Post-apheresis platelet count (PAPC) and hematocrit were decreased. A moderate correlation was observed between CPY and the actual yield, with a negative bias, and a trend to increase alongside the magnitude of the measurements. CPAPC and CPAH were strongly correlated with their actual values without bias. Prediction of single or double platelet product extraction showed a significant agreement with the actual outcomes. CONCLUSIONS: The predictive algorithm for the platelet yield showed bias, and a trend to underestimate the actual platelet yields when they are higher. The algorithms for the prediction of the PAPC and hematocrit did not show bias, proving their accuracy. Prediction of a single or double platelet product extraction has a strong agreement with the APY.

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Abstract INTRODUCTION: Dengue presents with a variable clinical course, ranging from mild illness to potentially fatal hemorrhage and shock. We aimed to evaluate the capabilities of various hematological parameters observed early in the course of illness for predicting the clinical outcomes of illness. METHODS: We retrospectively analyzed the records of children admitted in the pediatric inpatient services of the institute with dengue between 2017 and 2019. We determined the relationships between the hematological parameters observed during the first evaluation and the various clinical outcomes. RESULTS: We evaluated data from 613 patients (age range, 26 days to 17 years). Of these, 29.85% exhibited fever with warning signs, and 8.97% had severe dengue. Lower values of hemoglobin, platelet count, mean corpuscular volume, mean corpuscular hemoglobin concentration, and mean platelet volume, and higher values of total leukocyte count (TLC), hematocrit, and red cell distribution width variably correlated with numerous clinical outcomes-duration of hospital stay, development of complications, requirement of blood component transfusion, inotropic support, and mortality. Among the parameters, TLC ≥20,000/mL and initial platelet count ≤20,000/mL significantly associated with mortality, with odds ratios (95% confidence interval) of 11.81 (4.21-33.80) and 5.53 (1.90-16.09), respectively. CONCLUSIONS: Hematological parameters observed early during dengue infection may predict its clinical outcomes in infected children. Initial high TLC and low platelet count are potential predictors of fatal outcomes in the course of disease.

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OBJECTIVE: Currently, there are discrepancies in the reports on the extent of the reduction in platelet count after platelet donation by apheresis, and its impact on mean platelet volume (MPV). This study was conducted to meta-analyze the effect of plateletpheresis on platelet count and on mean platelet volume, based on studies published between 1980 and 2018. METHODS: Medline-Pubmed, Scielo, ScienceDirect, and Scopus databases were searched from inception to December 31 2019. The PRISMA guidelines, reproducibility, and evaluation of the methodological quality were guaranteed. Heterogeneity was evaluated with DerSimonian-Laird's, publication bias with a Begg's test. Sensitivity analysis and cumulative meta-analysis were also conducted, as well as a forest plot. RESULTS: Twenty-five studies with 3769 donors were systematized to analyze platelet count, and seven studies with 1176 donors to observe MPV. Most studies were published in India and the United States. There was a postprocedure reduction in both variables. The reduction in platelet count was 14.3 × 103 /µL (95% CI 11.4 to 17.1 × 103 /µL). The reduction in MPV was 1.43 fL (95% CI 0.3 to 2.5 fL). The analysis of subgroups showed that, in the case of platelet count, the reduction is not statistically significant two weeks after donation. CONCLUSION: Platelet donation by apheresis reduces platelet count and MPV in donors, which is detrimental to the purposes of the procedure; although the decrease is not clinically significant for the donor or the recipient. This demonstrates the need for subsequent studies to evaluate variables, such as donation frequency and donation intervals, should be considered to evaluate if the reported decrease is easily compensated, without adverse consequences for donors, or if modifications in donor selection criteria are required.

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