Summary Introduction In daily practice in haematology laboratories, spurious increased MCHC induces an analytical alarm and needs prompt corrective action to ensure delivery of the right results to the clinicians. The aim of this study was to establish a ‘decision tree’ using the new parameters red blood cells (RBC‐O) and haemoglobin (HGB‐O) from the Sysmex XN‐10 RET obtained by flow cytometry to deliver appropriate results. Methods From 128 unknown patients with MCHC > 365 g/L, all erythrocyte parameters including reticulocyte parameters were measured and analysed in parallel with blood smears, chemistry index and osmolarity. Differences between optical parameters (RBC‐O, HGB‐O) and usual parameters (RBC, HGB) obtained by impedance and photometry were reported also. Results Four groups were defined from observations: ‐RBC agglutination (n = 22); ‐optical interference (n = 17); ‐RBC disease (n = 18); and ‐others (n = 71). The use of RBC‐O and HGB‐O permitted efficient correction of the abnormalities when RBC agglutination and/or optical interference were present in 36 of 39 patients. Reticulocyte parameters permitted to elaborate an RBC score that allowed a highly sensitive detection of RBC disease patients (17/18). Conclusion Based on new parameters, we propose a ‘decision tree’ that delivers time savings and supports biological interpretation in case of elevated MCHC.
Background-Thirty children operated on for Crohn's disease (CD) were reviewed (1975-1994). The aim of the study was to assess their postoperative outcome. Patients-19 boys and 11 girls, aged 15.3 (2) years (range 11.3-20) at surgery were studied. Results-Surgical indications were acute complications of CD and chronic intestinal illness. Six months after surgery, 11 of 12 patients had been weaned oV steroids, and 22 of 23 patients were weaned oV nutritional support; 17 patients without recurrrence had a mean (SD) weight gain of 2.1 (8) kg and a height gain of 3.36 (3) cm. During 3.1 (2.7) years follow up, 12 patients (40%) had a recurrence of the disease after 19.4 (14) months (means (SD)): supra-anastomotic recurrence (six), severe perianal disease (two), and chronic illness (four). Six of 14 patients who were treated with mesalazine (13) or azathioprine (one) had recurrences. The postoperative recurrence rate was 50% at two years. Conclusion-Surgical treatment modifies the immediate outcome of severe or complicated CD, but does not prevent recurrence, despite localised resection or prophylactic postoperative treatment. Extension of the disease before surgery seems to be a major risk factor for postoperative recurrence in children. (Gut 1998;43:634-638) Keywords: Crohn's disease; surgery; children Twenty years ago, 80% of patients with Crohn's disease (CD) underwent surgery within five years of onset, 1 but today the figure is under 50%.2 Surgery does not cure CD by resection of pathological segments, but transiently relieves the chronic abdominal illness. Postoperative endoscopic studies of adult CD have shown a high frequency of early recurrence (80% at one year 2 ). In contrast with the adult disease, old 3 4 and recent data 5-8 suggest that the prognosis for paediatric CD after surgery is fairly good, with prolonged remission and normal growth, particularly in cases of localised ileocaecal involvement. We report a retrospective study of 30 children operated on for CD, focusing on their postoperative outcome. Patients and methodsFrom 1975 to 1994, 119 children and adolescents were treated for CD in our department. Local surgery was performed for perianal disease in 29 cases (abscesses and fistula drainage, dilation of stenosis). Diagnostic laparotomies (n = 2) were excluded from the study as the diagnosis of CD was not known. So, 36 patients (30%) with CD underwent major surgery such as curative resection and/or strictureplasties in the Paediatric Surgery Department. The data for six of the patients were not available for analysis. The remaining 30 patients comprised 19 boys and 11 girls (sex ratio 1.7); the mean (SD) age at CD diagnosis was 12.2 (2) years (range 7.5-16.5) and the mean (SD) age at surgery was 15.3 (2) years (range 11.3-20). The mean number of flare ups before surgery was 2 (0.9) (range 0-4). The severity of CD before surgery was estimated by a paediatric CD activity index (>30 indicates severe disease). The sites of CD lesions were determined by radiology, upper gastrointestinal tr...
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