Hematopathology
Beuy Joob; Viroj Wiwanitkit
Abstract
Dear Editor, Dengue is an important arbovirus infection. This infection can result in an acute febrile illness. The important hematological abnormalities included hemoconcentration and thrombocytopenia (1). Due to the decreased platelet count, the patient might develop petechiae and hemorrhagic complication. ...
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Dear Editor, Dengue is an important arbovirus infection. This infection can result in an acute febrile illness. The important hematological abnormalities included hemoconcentration and thrombocytopenia (1). Due to the decreased platelet count, the patient might develop petechiae and hemorrhagic complication. In endemic area, the presumptive diagnosis of dengue is usually derived by the clinical findings (1). Sometimes, the atypical clinical presentation of dengue can be seen. The dengue without thrombocytopenia is possible and might be difficult for diagnosis (2). Here, the authors present an interesting case of dengue with platelet count and no hemocon-centration. The automated hematogram can help explain the aberrant complete blood count finding. The patient was a 13 years old female patient. The chief complaint was high fever for 4 days and petechiae for 1 day. The tourniquet test was positive. The complete blood count was done and the hemoglobin level was 12.4 g/dL and platelet count was 276,000/mm3. In the present case, there was no thrombocytopenia and no hemo-concentration. However, the autoamted hematogram (Figure 1) showed flag that platelet interpretation was possible. From history taking, the patient was a known case of beta-thalassemia/hemoglobin E disorder. The additional dengue NS1 Ag test was positive. The patient was diagnosed to have dengue and received the standard fluid replacement therapy. She got full recovery within 1 week. In the present case, the unexpected normal platelet count despite overt petechiae might be explainable by the automated hematogram. The patient had the underlying hemoglobin disorder problem that results in anisopoikilocytosis and microcytic anemia. With the underlying abnormal hematological parameter, anemia, no hemoconcentration can be explained. Regarding the platelet count, the microcytosis, anisocytosis and poikilocytosis can interfere with the platelet count in autoamted hematology analytical process. Nevertheless, the automated hematogram and flag can help explain and assist the physician in charge for further use of definitive diagnosis test for dengue.
Diagnostic Pathology
sora yaari; Viroj Wiwanitkit
Volume 13, Issue 4 , October 2018, , Pages 479-479
Abstract
Dear Editor, erythrocyte sedimentation rate (ESR) is a useful basic clinical pathology laboratory investigation. It can be helpful in diagnosis and follow-up of several diseases. At present, a new automated method with proven reliability is available for ESR test (1). Here, the authors report on ...
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Dear Editor, erythrocyte sedimentation rate (ESR) is a useful basic clinical pathology laboratory investigation. It can be helpful in diagnosis and follow-up of several diseases. At present, a new automated method with proven reliability is available for ESR test (1). Here, the authors report on observation on a laboratory experiment to test the effect of zinc nanoparticles on ESR results. The total of 100 blood samples was used in the experiment. Each sample was divided into two parts. One part was directly measured for ESR and the other part was added by 1 droplet of zinc nanoparticles solution then exposed to ESR measurement. All ESR measurements were done using the same automated ESR analyzer; MicroSed SR-system, in the same ISO15189 accredited clinical laboratory at the same time, place and condition. The ESR results showed a difference in ESR values between two groups. The ESR values for the groups with and without zinc nanoparticles were equal to 25.6 + 7.2 and 10.7 + 3.4 mm/hr, respectively. Therefore, zinc nanoparticles can interrupt the ESR test conducted by automated analyzer. This observation was similar to the recent report which showed nanoparticles can alter the result of lipid profile test (2). Therefore, due to the widely use of nanoparticle substances, practitioners must consider the effect of nanoparticles interference in the interpretation of ESR results.
Biochemistry
Beuy Joob; Viroj Wiwanitkit
Volume 13, Issue 3 , July 2018, , Pages 379-380
Abstract
Dear Editor An important problem to manage diabetes mellitus is controlling the patients` blood glucose. Fluctuation of blood glucose results in molecular biochemistry change and can result in unwanted diabetic complications (1). In clinical practice, hemoglobin A1C (HbA1C) is a common useful laboratory ...
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Dear Editor An important problem to manage diabetes mellitus is controlling the patients` blood glucose. Fluctuation of blood glucose results in molecular biochemistry change and can result in unwanted diabetic complications (1). In clinical practice, hemoglobin A1C (HbA1C) is a common useful laboratory test to follow-up patients with diabetes (2). Sometimes, an unexpected laboratory result can be observed. Here, the authors presented a case of extremely low hemoglobin A1C level and discussed its clinical importance. The current study was a consultation case of an abnormally low HbA1C level. The patient was a 40-year-old male with the history of cerebral stroke and on control of diabetes mellitus. The patient was firstly diagnosed with diabetes mellitus at the time of diagnosis of stroke. The HbA1C level of this patient at the first time on the first diagnosis of diabetes mellitus was 7.2% (fasting plasma glucose 218 mg/dL). This case was on strict diet control and took oral metformin 2000 mg/day. The HbA1C levels at the 1st, 2nd, 3rd, 4th, 5th, and 6th months after the first diagnosis were 6.4%, 6.4%, 6.1%, 6.1%, 5.9%, and 5.9%, respectively. However, the aberrant result was observed on the 7th month that the HbA1C was 3.2% (the fasting blood glucose level at this time was 92 mg/dL). The laboratory already checked and validated the result. The other laboratory investigations including complete blood count, blood lipid, uric acid, liver function test, and renal function test were within normal limit. Focusing on the performance of HbA1C test, the precision and accuracy of the test, coefficient of variation (CV) was 1.2% and mean bias +0.4 %, which were according to the clinical pathology standards (3). All tests were performed at an ISO15189 certified laboratory. Therefore, the main question is “What is the cause of abnormally low HbA1C in this case?”To confirm the problem, repeated HbA1C test was performed and the fructosamine test was also performed in parallel. The low HbA1C level was still observed (3.3%). The fructosamine test was also performed and the abnormally low fructosamine level was observed. Hence, this case was consulted to a clinical pathologist expert. The expert verified and confirmed the correctness of laboratory analysis. The possible causes of the cases with abnormally low HbA1C are listed as a) extremely diet control of the patient, b) excessive use of antidiabetic drugs, and c) laboratory error. Also, hemolytic anemia or hemorrhage might be a cause of reduced HbA1c. Nevertheless, in the current case, there was no evidence of hemolytic anemia or hemorrhage (the reticulocyte count and serum bilirubin were within normal limits and the blood smear examination showed normal appearance). In the current case, laboratory error was excluded. History taking showed that the patient extremely practiced food restriction and avoided any fruit and sugar products after his onset of stroke. Also, the patient consumed only one-sixths of food amount that he did before the stroke. Under such circumstances, the patient felt fainting in the afternoon every day. He was suggested not to be too much diet restricted and the dosage of antidiabetic drug was reduced to 500 mg daily. After modification, the patient had no problem and the follow-up visits showed the normal HbA1C in the next three months and he never had the problem of extremely high or low HbA1C level to date (24th month after diagnosis of stroke).Laboratory investigation is a tool of family physician to manage primary care for common diseases. The diabetes mellitus is a very common problem. The basic practice is to monitor the glucose control. Of several laboratory tests, hemoglobin A1C is a very good test that can be useful in clinical practice. The abnormally high HbA1C level can be observed in cases with underlying hemoglobinopathy, although there is no problem of poor diabetes control (4). However, there are also some limitations in using due to the possibility of incorrect high result. The aberration of laboratory result can be observed in the area with high prevalence of hemoglobinopathy such as Southeast Asia (5).In general practice, the abnormally high HbA1C level is commonly observed in the patients with diabetes and poor diabetes control. However, the opposite case of the abnormally low HbA1C level is rarely mentioned. In the current case, an abnormally low HBA1C level was observed, which is not common in clinical practice. There are many possible causes as already mentioned, but the important concern is usually the laboratory error. Sometimes, the patients take herbal products with glucose lowering effects that can induce unwanted hypoglycemia. Nevertheless, in the current case, the patient did not take any additional herbal products, but excessively and strictly controlled intake of food. The excessive control can result in low blood glucose accumulation and low HbA1C. In the current case, although there is no clinical problem yet, the problem could exist if there were no detection of the abnormally low HbA1C level.
Beuy Joob; Viroj Wiwanitkit
Volume 11, Issue 3 , July 2016, , Pages 301-302
Abstract
Dear Editor-in-Chief The recent report on “The Adverse Effects of Pregnancies Complicated by Hemoglobin H (HBH) Disease” is very interesting (1). Rabiee et al. reported a pregnant case complicated with HBH disease. Indeed, this problem might not common in the Middle East but it is very ...
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Dear Editor-in-Chief The recent report on “The Adverse Effects of Pregnancies Complicated by Hemoglobin H (HBH) Disease” is very interesting (1). Rabiee et al. reported a pregnant case complicated with HBH disease. Indeed, this problem might not common in the Middle East but it is very common in Southeast Asia. The authors hereby would like to share the experience on this topic. In the recent report by Tongsong et al. (2), the maternal outcomes of normal mothers and those with HBH disease were not different. The common identified problems are fetal growth restriction, preterm birth and low birth weight (2).
beuy joob; viroj wiwanitkit
Volume 11, Issue 2 , April 2016, , Pages 189-190
Abstract
Ebola virus disease is the important emerging disease in Africa. This infection is deadly and has the main clinical feature as an acute hemorrhagic fever. The main hematological alteration in this infection is the platelet change. However, the change in other hematological parameters should be mentioned.
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Ebola virus disease is the important emerging disease in Africa. This infection is deadly and has the main clinical feature as an acute hemorrhagic fever. The main hematological alteration in this infection is the platelet change. However, the change in other hematological parameters should be mentioned.
Sora Yasri; Viroj Wiwanitkit
Volume 11, Issue 2 , April 2016, , Pages 191-193
Abstract
Diabetes mellitus is the common endocrine problem that affects millions of world population. The disease can be seen in every country around the world. It is recorded as one of the most common noninfectious disease at present. In the era of the new emerging diseases, the concern on the effect of new ...
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Diabetes mellitus is the common endocrine problem that affects millions of world population. The disease can be seen in every country around the world. It is recorded as one of the most common noninfectious disease at present. In the era of the new emerging diseases, the concern on the effect of new diseases on diabetes should be discussed. For example, in the case of new emerging zoonotic influenza infections, the effect of the new diseases on the clinical course of diabetes mellitus is mentioned (1). In addition, the interesting observation of the prevalence and severity of new emerging infections in the cases that has diabetes mellitus, as a concomitant disorder is also available in the literatures.
Beuy Joob; Viroj Wiwanitkit
Abstract
Dear Editor-in-Chief
The present global consideration is on the recent outbreak of 2014 Western Ebola virus in West Africa (1 – 3). This viral hemorrhagic fever wide spreads to several countries in West Africa and remote countries (1 - 3). With high death rate, the disease is presently on the ...
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Dear Editor-in-Chief
The present global consideration is on the recent outbreak of 2014 Western Ebola virus in West Africa (1 – 3). This viral hemorrhagic fever wide spreads to several countries in West Africa and remote countries (1 - 3). With high death rate, the disease is presently on the list of public health threatens. The main problem for management of the infection is the limited knowledge on its clinical presentation.
An interesting concern is on the gastroenterology presentation of this new disease. In fact, some new viral diseases such as atypical influenza virus infection can have an important clinical presentation as diarrhea (4). Here, the authors try to summarize on the magnitude of diarrhea in clinical presentation of this new disease. From information reported from 15 confirmed cases from Guinea (1 – 3, 5), 73.3% of the cases primarily present with diarrhea. This rate is considerable high comparing to those observed in other viral hemorrhagic disease such as dengue (rate of diarrhea at presentation < 5% (6).
This calls for the attention that it is necessary to think about new Ebola disease in any febrile illness patient with diarrhea who has history of visiting to outbreak area.
Viroj Wiwanitkit
Volume 7, Issue 3 , July 2012, , Pages 207-208
Viroj Wiwanitkit
Volume 7, Issue 1 , January 2012, , Pages 1-2
Viroj Wiwanitkit
Volume 6, Issue 4 , September 2011, , Pages 229-229
Viroj Wiwanitkit
Volume 6, Issue 3 , June 2011, , Pages 164-164
Viroj Wiwanitkit
Volume 6, Issue 2 , April 2011, , Pages 106-106
Viroj Wiwanitkit
Volume 6, Issue 1 , January 2011, , Pages 51-52
Viroj Wiwanitkit
Volume 5, Issue 3 , June 2010, , Pages 163-164
Viroj Wiwantikit
Volume 5, Issue 1 , January 2010, , Pages 51-51