Alexander Kratz’s research while affiliated with Columbia University and other places

A 25-year-old woman was admitted to the hospital with relapsing fevers, headache, and dyspnea. An elective splenectomy had been performed 4 years earlier for hereditary spherocytosis. Laboratory studies showed leukocytosis, anemia, and multiple intraerythrocytic ring forms on a peripheral-blood smear. The dyspnea worsened, and hypoxemia developed. A therapeutic procedure was performed.

Technologic advances affecting analyzers used in clinical laboratories have changed the methods used to obtain many laboratory measurements, and many novel parameters are now available. The effects of specimen transport through a pneumatic tube system on laboratory results obtained with such modern instruments are unclear. To determine the effects of sample transport through a pneumatic tube system on routine and novel hematology and coagulation parameters obtained on state-of-the-art analyzers. Paired blood samples from 33 healthy volunteers were either hand delivered to the clinical laboratory or transported through a pneumatic tube system. No statistically significant differences were observed for routine complete blood cell count and white cell differential parameters or markers of platelet activation, such as the mean platelet component, or of red cell fragmentation. When 2 donors who reported aspirin intake were excluded from the analysis, there was a statistically, but not clinically, significant impact of transport through the pneumatic tube system on the mean platelet component. There were no statistically significant differences for prothrombin time, activated partial thromboplastin time, waveform slopes for prothrombin time or activated partial thromboplastin time, fibrinogen, or fibrin monomers. Although further study regarding the mean platelet component may be required, transport through a pneumatic tube system has no clinically significant effect on hematology and coagulation results obtained with certain modern instruments in blood samples from healthy volunteers.

Case reports have described detection of candidemia by examination of peripheral blood smears. It is unclear whether this method has wider applicability for early detection of fungemia. To determine the sensitivity of smear review for detecting candidemia. Normal and cytopenic blood was spiked with increasing concentrations of yeast. Smears were prepared and reviewed by a pathologist and by technical staff. Staff members blinded to the purpose of the study first performed a routine slide review and then a targeted review for yeast. The pathologist detected isolated yeast forms at a concentration of 1 to 5 x 10(5) colony-forming units (CFU)/mL. When blinded to the purpose of the study, technical staff could detect Candida in most samples when the yeast concentration was 1 to 5 x 10(7) CFU/mL, but found it in only a small fraction of samples with lower concentrations. When asked to examine the smears specifically for yeast, they could detect it in most samples containing 1 to 5 x 10(6) CFU/mL. Detection of candidemia by peripheral blood smear examination requires a yeast concentration of 1 to 5 x 10(5) CFU/mL or greater. This degree of fungemia is unusual; therefore, detection of candidemia by blood smear review will not be possible in most cases. Sensitivity of smear review for yeast detection is greatly increased if the microscopist is specifically directed to look for the presence of yeast.

Context.—Technologic advances affecting analyzers used in clinical laboratories have changed the methods used to obtain many laboratory measurements, and many novel parameters are now available. The effects of specimen transport through a pneumatic tube system on laboratory results obtained with such modern instruments are unclear. Objective.—To determine the effects of sample transport through a pneumatic tube system on routine and novel hematology and coagulation parameters obtained on state-of-the-art analyzers. Design.—Paired blood samples from 33 healthy volunteers were either hand delivered to the clinical laboratory or transported through a pneumatic tube system. Results.—No statistically significant differences were observed for routine complete blood cell count and white cell differential parameters or markers of platelet activation, such as the mean platelet component, or of red cell fragmentation. When 2 donors who reported aspirin intake were excluded from the analysis, there was a statistically, but not clinically, significant impact of transport through the pneumatic tube system on the mean platelet component. There were no statistically significant differences for prothrombin time, activated partial thromboplastin time, waveform slopes for prothrombin time or activated partial thromboplastin time, fibrinogen, or fibrin monomers. Conclusions.—Although further study regarding the mean platelet component may be required, transport through a pneumatic tube system has no clinically significant effect on hematology and coagulation results obtained with certain modern instruments in blood samples from healthy volunteers.

A 64-year-old man with a 3-year history of anemia was found to have a low serum level of high-density lipoprotein (HDL) on routine testing, with a cardiac risk ratio of 9.8. The level of HDL cholesterol had been normal 3 years earlier. A diagnostic procedure was performed.

Context.—Case reports have described detection of candidemia by examination of peripheral blood smears. It is unclear whether this method has wider applicability for early detection of fungemia. Objective.—To determine the sensitivity of smear review for detecting candidemia. Design.—Normal and cytopenic blood was spiked with increasing concentrations of yeast. Smears were prepared and reviewed by a pathologist and by technical staff. Staff members blinded to the purpose of the study first performed a routine slide review and then a targeted review for yeast. Results.—The pathologist detected isolated yeast forms at a concentration of 1 to 5 × 105 colony-forming units (CFU)/mL. When blinded to the purpose of the study, technical staff could detect Candida in most samples when the yeast concentration was 1 to 5 × 107 CFU/mL, but found it in only a small fraction of samples with lower concentrations. When asked to examine the smears specifically for yeast, they could detect it in most samples containing 1 to 5 × 106 CFU/mL. Conclusions.—Detection of candidemia by peripheral blood smear examination requires a yeast concentration of 1 to 5 × 105 CFU/mL or greater. This degree of fungemia is unusual; therefore, detection of candidemia by blood smear review will not be possible in most cases. Sensitivity of smear review for yeast detection is greatly increased if the microscopist is specifically directed to look for the presence of yeast.