Morphofunctional characteristics of erythrocytes in extracorporeal efferent detoxication

The erythrocyte morphology (scanning electronic microscope, the superficial erythrocyte charge, the lipid peroxidation rate and the blood viscosity were investigated in 78 patients, treated by use of hemodyalisis, hemosorbtion, plasmosorbtion and hyperbaric oxygenation to correct the chronic renal insufficiency and the purulent intoxication. The described erythrocyte changes reflect the features of definite kind of the efferent treatment and the program of its use, the individuality of the patient initial state. The efferent methods of treatment cause significant and mostly differently directed changes in the peripheral red blood. Morphologic and functional parameters of the erythrocytes appear to be important diagnostic criteria of the efficiency of the extracorporal methods of detoxication.     

Differentiation of renal from non-renal hematuria by microscopic examination of erythrocytes in urine

Recent studies indicate that hematuria of renal parenchymal origin can be differentiated from hematuria of other origin by the presence of dysmorphic urinary erythrocytes (cells exhibiting irregular membranes or small surface blebs). We investigated the utility of this simple screening assay in a routine clinical laboratory. Dysmorphic erythrocytes in urine from 69 patients (18 with renal-parenchymal disease) were quantified on unstained slides by medical technologists using phase-contrast microscopes. Samples stored at 4 degrees C or 23 degrees C for up to 5 h had no significant changes in percentages of dysmorphic erythrocytes (PDE). PDE was also not modified by urea nitrogen concentration, osmolality, or pH over the physiological ranges of these variables. Receiver-operating characteristic (ROC) curves indicated an optimal sensitivity of 88% and specifity of 94% at a decision level of 14% dysmorphic erythrocytes per high-power field. Thus, the presence of fewer than 14% dysmorphic cells is suggestive of extra-renal disease; more than 14% is suggestive of intra-renal disease.     

Diagnostic approach in patients with asymptomatic haematuria: efficient or not?

Many patients with asymptomatic haematuria are primarily referred to urological examination. To analyse the efficiency of this strategy, we investigated the diagnostic process in 134 patients with asymptomatic haematuria (91 macroscopic and 43 microscopic) who were referred to our urology department. The frequency of diagnostic procedures was urine culture: 91%, cystoscopy: 87%, intravenous urography: 86%, ultrasound: 73%, examination of urinary sediment: 20%. In 70 patients (52%), a urological diagnosis was made. In the remaining 64 patients, the urinary sediment was examined for the presence of dysmorphic erythrocytes and erythrocyte casts in 17 patients (27%). Signs of glomerular haematuria were found in nine of them (53%). The diagnostic strategy in these patients with asymptomatic haematuria was not discordant from several published algorithms but appeared neither efficacious nor efficient. We estimate that when examination of the urinary sediment would have been performed at the start of work-up, 25% of patients could have spared from extensive urological investigation.     

Current assessment of microhematuria and leukocyturia

Technical advances in laboratory testing such as sensitive chemical tests and standardized commercial slides have significantly altered our entire approach to urinalysis. In addition, the recognition of the association of microhematuria with urologic neoplasms and the morphologically altered red blood cells with renal parenchymal bleeding is beginning to expand our knowledge of the pathogenesis of microhematuria. Future trends may include a broader range of chemical tests as well as a better understanding of disease processes associated with microhematuria.     

UF-100尿液自动分析仪和显微镜检测RBC形态在鉴别肾性血尿中的比较

目的探讨尿液RBC形态检测的临床意义。方法采用UF-100和显微镜法对118例尿液标本进行正形(均一性)和异形(非均一性)RBC的检测,将两者结果进行比较分析。结果62例肾性血尿患者中显微镜检测有56例异形RBC增高,临床诊断符合率为90.3%;UF-100检测有58例为非均一性RBC,临床诊断符合率为93.5%。56例非肾性血尿中显微镜检测有54例正形RBC增高,临床诊断符合率为96.4%;UF-100检测有55例为均一性RBC,临床诊断符合率为98.2%。两法比较,经配对x2检验,P>0.05,结果无显著性差异。而肾性和非肾性血尿组相比,经四格表资料x2检验,P<0.05,结果显示两组有显著性差异。结论UF-100和显微镜对RBC形态的检测都可以用于鉴别诊断肾性和非肾性血尿。尤其是UF-100可为临床诊断疗效观察和判断预后起到非常重要的作用。     

Morphofunctional characteristics of erythrocytes in chronic kidney failure and purulent intoxication

The morphology of blood erythrocytes was examined under a scanning electron microscope and erythrocyte surface charge, lipid peroxidation on erythrocyte membranes, and blood viscosity were studied in 213 urological patients with chronic renal insufficiency (CRI) and purulent intoxication (PI) of different severity. CRI and PI were characterized by morphofunctional changes in erythrocytes, which depended on the type and severity of intoxication. Changes in erythrocyte morphology in CRI and PI were paralleled by a decrease in their negative surface charge and activation of lipid peroxidation. These parameters can serve as diagnostic tests for evaluation of the severity of intoxication.     

Release of prostacyclin after erythrocyte adhesion to cultured vascular endothelium

Endothelial cell damage is considered to be the initial step in the genesis of thrombosis and atherosclerosis. Recently, the adhesion of erythrocytes from patients with diabetes or sickle cell anemia to endothelial cells was found to be increased and correlated with the severity of vascular complications. We have measured by radioimmunoassay the release of 6-keto-prostaglandin F1 alpha (6-keto-PGF1 alpha) as an index of prostacyclin (PGI2) production, during red cell adhesion to endothelial cells in culture. The amount of 6-keto-PGF1 alpha released after incubation with normal red cells was similar to that observed with buffer (1.07 +/- 0.32 nmol/10(6) endothelial cells). However, after the adhesion of erythrocytes from patients with diabetes or sickle cell anemia, the amount of 6-keto-PGF1 alpha produced was significantly increased (P less than 0.01) and was correlated with the extent of erythrocyte adhesion (P less than 0.05). Tritium-labeled PGI2 was found to bind to erythrocytes, and the binding was time and concentration dependent. PGI2 release was inhibited by the cyclooxygenase inhibitor (flurbiprofen), whereas red cell adhesion remained unchanged. Fibrinogen potentiated erythrocyte adhesion and PGI2 production. The increase in PGI2 production after the adhesion of red cells from patients with diabetes or sickle cell anemia to endothelial cells indicates that endothelium may be damaged by abnormal erythrocyte adhesion.     

异常形态红细胞百分比法和芽孢状等特殊异常形态红细胞百分比法在小儿肾性血尿诊断中临床价值的对比观察

目的对小儿肾性血尿进行红细胞形态学分析,评价异常形态红细胞百分比法和芽孢状等特殊形态红细胞百分比法在小儿肾性血尿鉴别诊断中的临床价值。方法回顾性对来自首都医科大学附属北京友谊医院的117例非重复性小儿肾性血尿标本红细胞形态检查结果进行分析,比较尿红细胞形态检查两种判断标准的敏感性。结果在肾小球疾病组和对照组,异常形态红细胞占红细胞总数80%的标本百分比分别为62. 5%(73/117)和12. 0%(15/125),差异具有明显统计学意义(P <0. 01);芽孢状红细胞等特殊异常形态红细胞百分比≥30%标本百分比分别为83. 8%(98/117)和8. 0%(10/125),差异具有非常显著性统计学意义(P <0. 01)。明确诊断为肾小球疾病患儿,尿液异常形态红细胞占红细胞总数≥80%百分比显著低于芽孢状红细胞等特殊异常形态红细胞百分比≥30%者(62. 4%,73/117 vs.83. 8%,98/117),差异具有非常显著性统计学意义(P <0. 01)。结论以芽孢状红细胞等特殊异常形态红细胞百分比法作为判断标准对小儿肾性血尿的诊断具有较好的敏感性。     

Asymptomatic microscopic hematuria in adults: summary of the AUA best practice policy recommendations

The American Urological Association (AUA) convened the Best Practice Policy Panel on Asymptomatic Microscopic Hematuria to formulate policy statements and recommendations for the evaluation of asymptomatic microhematuria in adults. The recommended definition of microscopic hematuria is three or more red blood cells per high-power microscopic field in urinary sediment from two of three properly collected urinalysis specimens. This definition accounts for some degree of hematuria in normal patients, as well as the intermittent nature of hematuria in patients with urologic malignancies. Asymptomatic microscopic hematuria has causes ranging from minor findings that do not require treatment to highly significant, life-threatening lesions. Therefore, the AUA recommends that an appropriate renal or urologic evaluation be performed in all patients with asymptomatic microscopic hematuria who are at risk for urologic disease or primary renal disease. At this time, there is no consensus on when to test for microscopic hematuria in the primary care setting, and screening is not addressed in this report. However, the AUA report suggests that the patient's history and physical examination should help the physician decide whether testing is appropriate.     

Urine flow cytometry and detection of glomerular hematuria.

BACKGROUND: The UF-100 is a flow cytometer designed for automated cellular urinalysis. In this study, the usefulness of the UF-100 in laboratory investigation into the origin of hematuria was evaluated. METHODS: Results from flow cytometric urinalysis were used to classify urinary red blood cells (RBCs) according to glomerular and non-glomerular origin and the classification was compared to the patient's clinical diagnosis as the gold standard. In parallel, microscopic sediment analysis was carried out. RESULTS: A total of 206 urine samples from 129 patients were analyzed (127 from patients with glomerular hematuria, 79 from patients with non-glomerular hematuria). Of these, 136 samples (92 patients) showed overt hematuria (>or=20 RBC/microL). Urine flow cytometry correctly classified 61% (sediment analysis 69%) of urine samples with overt hematuria. If inconclusive results are excluded, the UF-100 correctly diagnosed 85% (sediment analysis 98%) of urine samples with overt hematuria. The UF-100 and microscopic sediment analysis both showed sensitivity of 99% for the detection of glomerular hematuria. The specificity of the UF-100 for the detection of glomerular bleeding was lower (42%) than the specificity of microscopic sediment analysis (93%). CONCLUSIONS: Owing to its low specificity, the UF-100 showed limited capacity to discriminate glomerular from non-glomerular causes of hematuria in a population with a high incidence of renal disease. Therefore, extensive microscopic urinalysis remains necessary to assess the origin of hematuria.     

Factors associated with microhematuria in asymptomatic young men

The prevalence of asymptomatic microhematuria (two to four or more erythrocytes per high-power field) in 1341 male Air Force personnel was 5.4%. The most powerful predictor of microhematuria (nearly 15-fold increased prevalence) was a history of recurrent microhematuria during the previous five years. Recurrent microscopic hematuria was present in 14.5% (8/55) of men with a history of urethritis, accounting for 26% (8/31) of the cases of recurrent microscopic hematuria. The prevalence of microhematuria was not affected by physical exercise, flight duty, or sexual intercourse during the 24 h preceding the urinalysis.     

Chronic bronchitis: participation of red cells in the pathologic process

To study characteristics of structural-metabolic status and function of erythrocytes in patients with chronic bronchitis (CB), the examination was made of 53 CB patients (39 male and 14 female). A complex study of morphofunctional state of peripheral erythron included investigation of protein and lipid composition, microviscosity of the lipid phase of erythrocyte membrane, surface architectonics, ultrastructure, reversible aggregation of red cells, concentrations of sulfhydric groups, lipoproteins and dry cell mass in erythrocytes. CB patients were found to have prominent defects in membrane structure and metabolism of mature red cells (reduced dry mass and concentration of sulfhydric groups and lipoproteins, abnormal protein composition and lipid membrane spectrum, increased viscosity of membrane lipid bilayer), alterations of surface architectonics, shape, ultrastructure of erythrocytes. Disorders in structural-metabolic status of erythrocytes in CB patients affected their functional features, the ability for reversible aggregation, in particular. Functional disturbances of erythrocytes in CB patients aggravate the course of the disease and need correction with membrane-stabilizing and membrane-repairing drugs.     

Morphological characteristics of peripheral blood erythrocytes in elderly, senile, and long-living persons (according to the data of a computer study)

The paper presents the results of a study of the morphometry of peripheral blood erythrocytes in elderly, senile, and long-living persons on an ASPEK Russian computer cell image analyzer, by applying the programs to measure the sizes of the cells and their hemoglobin count. By examining large amounts of erythrocytes, the use of a current technology provides objective characteristics of not only cell sizes, but also fundamentally new information on hemoglobin count in an individual erythrocyte and on the structure of red blood cells in terms of this indicator. The average diameter and area of a red blood cell population were ascertained to correspond to the generally accepted adult upper normal ranges manually calculated. The composition of a red blood cell population was determined by the distribution of cells containing different hemoglobin levels. The use of the results of the investigation optimizes the detection of patients with impaired hemoglobin formation.     

Survival of gentamicin-loaded carrier erythrocytes in healthy human volunteers

Resealed erythrocytes are potential slow release carriers for drugs and enzymes. We have investigated carrier erythrocyte survival in human volunteers using gentamicin (G) as encapsulated cell marker; G was readily incorporated into red cells by hypo-osmotic dialysis (87% efficiency of incorporation) and did not exit from carrier cells in vitro. Six healthy young volunteers were injected with 59 +/- 7 ml carrier erythrocytes containing 56 +/- 13 mg G. G levels were measured in plasma and haemolysed whole blood by RIA. After an initial phase of cell loss (up to 4.5 h post-injection) the carrier erythrocytes survived in circulation with a half-life of 22 days, as was indicated by intracellular G concentration. G levels were detectable in plasma during the first 90 min after injection. This indicates haemolysis of some carrier cells. In conclusion, carrier erythrocytes appear to circulate longer than any other drug carrier under investigation and may well serve as innocuous slow release system.     

Renal insufficiency in community patients with mild asymptomatic microhematuria

Primary-care physicians often must decide when patients with asymptomatic microhematuria warrant further testing for renal parenchymal disease. Because previous data had shown a greater frequency of elevated serum creatinine concentration in a population with asymptomatic microhematuria than in control subjects without hematuria, we reviewed the records of 125 patients with isolated asymptomatic microhematuria and elevated serum creatinine (AM/EC) and 83 comparison patients with no hematuria and elevated serum creatinine (NH/EC) from a previous population-based study to determine the relationship between renal parenchymal disease and isolated asymptomatic microhematuria. Serum creatinine was often elevated transiently because of volume depletion or shock, or elevations occurred in relationship to a terminal illness. Thus, only 63 AM/EC patients and 45 NH/EC control subjects had primary renal parenchymal disease or systemic disorders that caused an elevated serum creatinine. The patients selected from the asymptomatic microhematuria population because of elevated serum creatinine most often had low-grade hematuria and were typically 75 years of age or older. No disease was consistently found more frequently in the AM/EC patients than in the NH/EC group. Intervention at the time of the detection of hematuria might have altered the prognosis in 8% and probably would not have altered the prognosis in 78%. Therefore, exhaustive diagnostic testing to detect renal parenchymal diseases cannot be advised in asymptomatic elderly patients with low-grade (grade 1) microhematuria unless more specific indications are present.     

Fragility of abnormal erythrocytes evaluated by response to shear stress.

Shear stress is a potential cause of erythrocyte fragmentation and hemolysis in flowing blood. In this study, the response of abnormal human erythrocytes to shear stress in virto was evaluated using a concentric cylinder viscometer. Compared to normal red cells, deoxygenated erythrocytes from persons with sicle cell anemia were particularly susceptible to fragmentation and hemolysis by shear stress. Oxygenation of sicke cell blood improved the resistance of those red cells to shear stress; they remain, however, more susceptible to shear stress than normal erythrocytes. Erythrocytes from patients with iron deficiency, thalassemia minor, and erythrocyte pyruvate kinase deficiency showed fragmentation and hemolysis at threshold shear stresses intermediate between those ovserved for blood from patients with sickle cell anemia and normal persons. Blood samples from patients with hereditary spherocytosis were more resistant to shear stress than normal blood. These results indicate that there are important differences in the response of various red cells to shear stress.     

Changes in fatty acid profiles of plasma, erythrocytes and polymorphonuclear leukocytes in induced hypothyroidism in man: indirect evidence for altered delta 6 desaturase activity

Thirteen patients who were athyreotic as a consequence of ablation treatment for well-differentiated thyroid cancer were studied during triiodothyronine supplementation, and subsequently at the end of a two weeks withdrawal of this medication. Serum and plasma lipid concentrations, erythrocyte cholesterol content and plasma and erythrocyte total fatty acid patterns were measured. In addition, total fatty acid profiles of polymorphonuclear leukocytes of eight patients and scanning electron microscopic studies of erythrocytes of nine patients were made. We observed an increase of the serum concentrations of total and unesterified cholesterol and phospholipids in all patients. Except for two, all patients showed an increase in the serum triglyceride concentration. The relative amounts of 18:2c,omega 6 rose and those of 20:3c,omega 6 fell in all studied compartments. In addition, the relative amounts of all other omega 6 fatty acids, 22:6c,omega 3, 20:3c,omega 9, 16:0, 18:0, and total saturated fatty acids decreased in plasma, whereas the levels of all monounsaturated fatty acids increased in the erythrocytes. The level of 20:3c,omega 9 rose in the erythrocytes and the 20:3c,omega 9/20:4c,omega 6 ratio rose in the polymorphonuclear leukocytes. The erythrocyte total fatty acids and cholesterol content and their ratio did not change, nor was any alteration seen in the red cell morphology by scanning electron microscopy. This study reveals that the induction of hypothyroidism in man changes fatty acid patterns of plasma, erythrocytes and polymorphonuclear leukocytes. The nature of these alterations suggests especially a disturbance in the delta 6 desaturase activity. The data point to the possibility of a derangement of eicosanoid synthesis in hypothyroidism.     

尿红细胞Tamm-Horsfall蛋白检测在儿童血尿诊断中的意义探讨

目的 :探讨尿红细胞Tamm Horsfall蛋白 (THP)检测在确定血尿来源上的诊断意义。方法 :对诊断明确的 86例肾小球性血尿和 2 6例非肾小球性血尿患儿尿样本同时进行尿红细胞THP间接免疫荧光法检测和尿红细胞的形态检测 ,比较这两种确定血尿来源方法的差异。结果 :在 86例肾小球性血尿中 ,红细胞THP检测法确定肾小球性血尿 79例 ,7例与诊断不符 ,在 2 6例非肾小球性血尿中 ,红细胞THP检测法确定为非肾小球性血尿 2 4例 ,2例与诊断不符 ,灵敏度为 91 9% ,特异性为 92 3 % ,准确性为 92 0 % ,漏诊率为 8 1% ,误诊率为 7 7% ,尿红细胞的形态检测法敏感性为 77 9% ,特异性为 69 2 % ,准确性为 76 7% ,漏诊率为 2 2 1% ,误诊率为 2 2 1% ,两者在灵敏性、准确性和漏诊率上的差异有极显著意义 (P <0 0 1) ,在特异性及误诊率上的差异有显著意义 (P <0 0 5 )。结论 :尿红细胞THP检测法确定血尿来源优于红细胞形态检查法 ,值得临床上推广应用。     

尿棘形红细胞在肾性和非肾性血尿鉴别中的意义

本文用相差显微镜对结晶紫－沙黄染色的２４例肾性出血和２１例非肾性出血尿沉渣各种形态红细胞进行观察和分类计数。结果,棘形红细胞在肾性出血红细胞总数中所占的比率（５．５％）远高于非肾性出血（０．６％）。表明棘形红细胞是区别肾性出血和非肾性出血有用的特征性标志物。     

Enzymatic erythrocyte creatine determinations as an index for cell age

Creatine concentration in red blood cells was determined after ammoniumsulfate precipitation on a clear hemoglobin-free filtrate with a new enzymatic assay making use of bacterial creatinase. The method described is more specific than Griffiths' method and can easily be mechanised and adapted for use in a routine laboratory using classical automated equipment. By contrast with Griffiths' method no significant interferences of amino acids and creatine-like molecules were found. Reference values for this method were 0.379 +/- 0.076 mmol/l. In patients with high turnover of erythrocytes, e.g. haemodialysis patients (0.529 +/- 0.122 mmol/l), and renal insufficiency patients (0.565 +/- 0.145 mmol/l), significantly increased creatine concentration in erythrocytes were observed. Low erythrocyte creatine concentrations were found in chronic ambulatory dialysis patients (0.311 +/- 0.042 mmol/l).