**1. Introduction**

104 Basic Nephrology and Acute Kidney Injury

Zelikovic, I., Szargel, R., Hawash, A., Labay, V., Hatib, I., Cohen, N. & Nakhoul, F. (2003) A

2538 (Linking).

novel mutation in the chloride channel gene, clcnkb, as a cause of gitelman and bartter syndromes. *Kidney Int*, Vol. 63, No. 1, (Jan), pp. (24-32), 0085-2538 (Print) 0085-

> Epidemiologic studies have suggested that anemia may be associated with poorer outcomes in a variety of disorders. The WHO criteria define anemia by hemoglobin (HGB) concentration of < 130 g/L for adult men and<120 g/L for adult females. [1]

> Nonetheless, recent evidence indicates that even mild anemia is independently associated with increased risk of recurrent falls, poorer physical function, hospitalization, and mortality in older adults. [2, 3]

> A number of studies have reported differential distributions of anemia by age and sex, but less attention has been devoted to disparities in anemia by race. According to NHANES III estimates, older non-Hispanic blacks were 3 times more likely to have anemia compared to older non-Hispanic whites (27.8% vs 9.0%). [1]

> Similar disparities in anemia prevalence have been observed in other population-based studies of older blacks and whites [4, 5]. These observations have led some to consider racespecific criteria for defining anemia. [6]

> A recent study in Iceland defined mild anemia as a hemoglobin concentration between 10.0 and 11.9 g/dL in women and between 10.0 and 12.9 g/dL in men [7]. This cross sectional analysis provides evidence of anemia in 36.7% of hospitalized patients, and shows an association among anemia, poor nutritional status, and inflammation [8].

> Future research on anemia in the elderly should focus on the age-related physiologic changes underlying this condition and whether anemia correction can reduce anemiaassociated risks, and improve quality of life [9, 10].

> Erythrocytes indices, derivatives from value of HGB and numbers of erythrocytes was used in correlation with serum iron to establish grades and types of anemia and was pathological results of these indices was noted as first signals of latent anemia in hematological diseases. Mean corpuscular volume (MCV) measures the mean or average size of individual red blood cells. To obtain the MCV, the hematocrit is divided by the total RBC count.

Variability of Biological Parameters in Blood Samples

days in peripheral blood**)** was considered 1 day

of 0.2mm². [12].

decreased red cell survival (bleeding, hemolysis) [11].

cells/μL or cells/μL • 10³μL /L = cells x 109/L).

thrombocytopenia while >40 indicates thrombocythemia. [13].

analyzer Vitros 700(Ortho Diagnostics), Johnson \$ Johnson.

Between Two Consecutive Schedules of Hemodialysis 107

specific biochemical parameters in chronic renal failure as serum iron, total iron binding capacity, and index saturation transferrin ( IST), usually and specific biochemical tests: Glucose, Urea nitrogen, Creatinine, Sodium, Potassium, E CO2, was used a dry chemistry

Reticulocyte count (RET %) was calculated after microscopic analysis of brilliant cresyl blue stained slides, (normal ranges adult: 0.5 - 1.5%). To evaluate rate of erythropoiesis, the Reticulocyte Production Index (RPI) was calculated using the formula: [RPI = RET% x HCT patient /45 /reticulocyte time maturation], where maturation time (reticulocytes survival

for HCT 36-45%, 1.5 days for HCT 26-35%, 2 days for HCT 16- 25% and 2.5 days for HCT < 15%. Reference interval for RPI in healthy individuals is 1.0-2.0; and RPI < 2 in a person with anemia indicates ineffective erythropoiesis, while values > 2 indicate compensation for

Three methods were used to assess platelet counts of hemodialysis patients: optical microscopy, peripheral blood smear and user of the cytometry principle with impedance principle (VIC) by Coulter HNX hematological analysis. For to avoid systematic errors during platelets count by optical microscopy, a method of direct counting in the Burker-Turk chamber( hemacytometer) has been recommended for use in parallel with determination of the number of platelets counted on peripheral blood smear, ( by optical microscopy). Calculation of the platelets counted in the Burker-Turk chamber considers the height of the chamber and the surface of the middle square of the chamber to yield a value

The calculation formula for hemacytometer cell counts determines the number of cells within 1μL (1 mm³) of blood. To make this determination, the total number of cells counted must be corrected for the initial dilution of blood and the volume of diluted blood used. The standard dilution of blood for platelet counts is 1:100; therefore the dilution factor is 100. The volume of diluted blood used is based on the area and depth of the counting area. The area counted is 2 mm² and the depth is 0.1 mm; therefore the volume factor is 0.2 mm³. Total number of cells counted • dilution factor • 1/volume factor = cells/mm3 (cells/mm³=

Direct microscopy of the blood smear yields the number of thrombocytes count by counting those found between 1000 erythrocytes (5 microscopic fields of 200 red cells) multiplied by the number of erythrocytes/mm.³ and then divided /1000) with the results expressed as platelets/ mm³. The estimate of platelet count from slides uses a semiquantitative method, whereby 1 platelet / oil immersion field is equivalent with 20.000 plt/mm³. Figure 1 In optical microscopy, one assesses a panoptic colored blood smear under the immersion objective(100 X). Most platelets have a dendritic aspect and fringe-like extension. Normal platelets have diameter of 2-4 microns on the blood smear with 70% alone, 20% in groups of 2 or 3 and 10% in larger groups or "big pools". Correctly executed blood smear reveal microscopic fields on the oil-immersion objective with an average of 10 platelets;as either isolated or grouped. Visualization of <5 platelets on the microscopic field connotes

Platelets are typically disk-shaped with a more dense central (granular) area and a peripheral (crystalline) area with functional dendritic fringes [14]. If activated by toxic metabolic factors, platelets become more spherical, which can yield a decrease in the intensity of the image in the microscopic lenses, due to light transmission and diffusion through samples. When platelets are activated, they become spherical with a hypogranular

The MCV is an indicator of the size of red blood cells. MCV is measured in cubic micrometers or fento-liters (Reference values: adult men: 80-94 fl, women: 81-99 fl).

Mean corpuscular hemoglobin (MCH) measures the amount, or the mass, of hemoglobin present in one RBC. The weight of hemoglobin in an average cell is obtained by dividing the hemoglobin by the total RBC count.

MCH is expressed in picograms of hemoglobin per cell (pg/L, 1 pg = 10-12 g). (Reference values: adult men; MCH = 27 - 31 pg, women = 27-30 pg). Mean corpuscular hemoglobin concentration (MCHC) measures the proportion of each cell taken up by hemoglobin.

The results are reported in percentages, reflecting the proportion of hemoglobin in the RBC. The hemoglobin is divided by the hematocrit and multiplied by 100 to obtain the MCHC. (Reference values: adults: MCHC = 32- 36 %}

RDW (red cell distribution width) reflects the size distribution of the erythrocyte population. The hematological instrument calculates it as a coefficient of variation (CV),

(Reference values: adults RDW = 11.5 - 15.5)

The aim of this study was to identify the values and changes of hematological and biochemical parameters in blood samples between two consecutive schedules of hemodialysis and assesses the effect of plasma osmolality on errors of platelets count, to the hospitalized patients admitted in hospital with diagnosis chronic renal diseases complicated with chronic renal failure.
