Study of automated hematology analyzer’s scatterplot patterns in white blood cell disorders

Background: Automated hematology analyzers produce scattergrams that can be used as screening tool for various hematological conditions and efficiently shorten turnaround times. Aim was to study scattergram patterns of various while blood cell disorders and assess their efficacy compared to a peripheral blood smear for diagnosis of various disorders. Methods: Scattergram findings generated by UniCel® DxH 800 automated hematology analyzer, a 5-part differential analyzer. The graphic displays have been compiled over a period of 3 months from blood samples received for CBC. Samples that the counter flagged as abnormal for white blood cell were chosen. Based on the scatterplots, a preliminary diagnosis was formed. It was compared with the peripheral blood smear (PBS) findings which were taken as the gold standard. Results: The scatterplots showed unique patterns for various disorders on the basis of location, shape, size, density of the cells and their clustering. The scattergram analyser showed 90% sensitivity and 88% specificity for diagnosing hematological disorders. A 97-100% accuracy rate was reported showing excellent correlation between PBS result and WBC parameter result in cell counter analyzers. Conclusions: Not all cases of haematological malignancy exhibit cytopenias or cytosis at initial presentation. Therefore, these scatter plots offer helpful information that prompts a hematopathologist to suspiciously screen the peripheral smear in cases with normal counts. Scattergram analysis suspects a diagnosis earlier than peripheral smear examination. Given their strong correlation with a variety of WBC disorders and confirmed by PBS, WBC scatterplots can be used as a screening tool

Empagliflozin in Patients with Chronic Kidney Disease

Background The effects of empagliflozin in patients with chronic kidney disease who are at risk for disease progression are not well understood. The EMPA-KIDNEY trial was designed to assess the effects of treatment with empagliflozin in a broad range of such patients. Methods We enrolled patients with chronic kidney disease who had an estimated glomerular filtration rate (eGFR) of at least 20 but less than 45 ml per minute per 1.73 m(2) of body-surface area, or who had an eGFR of at least 45 but less than 90 ml per minute per 1.73 m(2) with a urinary albumin-to-creatinine ratio (with albumin measured in milligrams and creatinine measured in grams) of at least 200. Patients were randomly assigned to receive empagliflozin (10 mg once daily) or matching placebo. The primary outcome was a composite of progression of kidney disease (defined as end-stage kidney disease, a sustained decrease in eGFR to < 10 ml per minute per 1.73 m(2), a sustained decrease in eGFR of & GE;40% from baseline, or death from renal causes) or death from cardiovascular causes. Results A total of 6609 patients underwent randomization. During a median of 2.0 years of follow-up, progression of kidney disease or death from cardiovascular causes occurred in 432 of 3304 patients (13.1%) in the empagliflozin group and in 558 of 3305 patients (16.9%) in the placebo group (hazard ratio, 0.72; 95% confidence interval [CI], 0.64 to 0.82; P < 0.001). Results were consistent among patients with or without diabetes and across subgroups defined according to eGFR ranges. The rate of hospitalization from any cause was lower in the empagliflozin group than in the placebo group (hazard ratio, 0.86; 95% CI, 0.78 to 0.95; P=0.003), but there were no significant between-group differences with respect to the composite outcome of hospitalization for heart failure or death from cardiovascular causes (which occurred in 4.0% in the empagliflozin group and 4.6% in the placebo group) or death from any cause (in 4.5% and 5.1%, respectively). The rates of serious adverse events were similar in the two groups. Conclusions Among a wide range of patients with chronic kidney disease who were at risk for disease progression, empagliflozin therapy led to a lower risk of progression of kidney disease or death from cardiovascular causes than placebo