Skip to main content
Top
Published in: Clinical Rheumatology 4/2021

01-04-2021 | Thrombosis | Original Article

Variation of red blood cell parameters in Behcet’s disease: association with disease severity and vascular involvement

Authors: Linlin Cheng, Liubing Li, Chenxi Liu, Songxin Yan, Haizhen Chen, Haolong Li, Fengchun Zhang, Hua Chen, Yongzhe Li

Published in: Clinical Rheumatology | Issue 4/2021

Login to get access

Abstract

Introduction/objectives

Behcet’s disease (BD) is a systemic and chronic inflammatory vasculitis with unknown etiology. Diagnosis is determined by evaluating several clinical criteria, but the lack of specific laboratory diagnostic markers makes the diagnosis of BD more difficult. Therefore, the aim of this study was to determine the changes in hematological parameters in BD patients to investigate their relationship with BD clinical features.

Method

A total of 48 BD patients and 96 healthy controls were included in this study. The severity of each BD patient was associated to a severity score according to the entire spectrum of disease manifestations. Several laboratory tests were assessed, and the difference in their results between BD patients and healthy controls was evaluated. Correlation analysis was performed to reveal the interaction of these parameters.

Results

C-reactive protein (CRP), mean corpuscular hemoglobin (MCH), mean corpuscular hemoglobin concentration (MCHC), neutrophil count, platelet count, and plateletcrit significantly increased in BD patients compared with healthy controls (P < 0.05). CRP was higher in patients with skin lesions, MCH and MCHC were lower in patients with vascular involvement, and the neutrophil count was higher in patients with skin lesions and genital ulcers. In addition, higher CRP and lower MCH and MCHC were associated with a severe condition. Besides, MCH and MCHC were negatively correlated with the platelet count, plateletcrit, and neutrophil count.

Conclusions

This study revealed that MCH and MCHC are valuable parameters for BD. Their levels help assess the disease severity and indicate the vascular involvement in BD.
Key Points
This is the first study reporting MCH and MCHC as important biomarkers in BD.
BD patients with vascular involvement and thrombosis potential have lower levels of MCH and MCHC.
MCH and MCHC are negatively correlated with platelet count, plateletcrit, and neutrophil count.
Lower MCH and MCHC are associated with a severe condition.
Appendix
Available only for authorised users
Literature
1.
go back to reference Yazici H, Seyahi E, Hatemi G, Yazici Y (2018) Behçet syndrome: a contemporary view. Nat Rev Rheumatol 14(2):107–119CrossRef Yazici H, Seyahi E, Hatemi G, Yazici Y (2018) Behçet syndrome: a contemporary view. Nat Rev Rheumatol 14(2):107–119CrossRef
2.
go back to reference (1990) Criteria for diagnosis of Behcet’s disease. International study group for Behcet’s disease. Lancet 335(8697):1078–1080 (1990) Criteria for diagnosis of Behcet’s disease. International study group for Behcet’s disease. Lancet 335(8697):1078–1080
3.
go back to reference Davatchi F, Assaad-Khalil S, Calamia KT et al (2014) The international criteria for Behçet’s disease (ICBD): a collaborative study of 27 countries on the sensitivity and specificity of the new criteria. J Eur Acad Dermatol Venereol 28(3):338–347CrossRef Davatchi F, Assaad-Khalil S, Calamia KT et al (2014) The international criteria for Behçet’s disease (ICBD): a collaborative study of 27 countries on the sensitivity and specificity of the new criteria. J Eur Acad Dermatol Venereol 28(3):338–347CrossRef
4.
go back to reference Gasparyan AY, Ayvazyan L, Mukanova U, Yessirkepov M, Kitas GD (2019) The platelet-to-lymphocyte ratio as an inflammatory marker in rheumatic diseases. Ann Lab Med 39(4):345–357CrossRef Gasparyan AY, Ayvazyan L, Mukanova U, Yessirkepov M, Kitas GD (2019) The platelet-to-lymphocyte ratio as an inflammatory marker in rheumatic diseases. Ann Lab Med 39(4):345–357CrossRef
5.
go back to reference Yolbas S, Yildirim A, Gozel N, Uz B, Koca SS (2016) Hematological indices may be useful in the diagnosis of systemic lupus erythematosus and in determining disease activity in Behcet’s disease. Med Princ Pract 25(6):510–516CrossRef Yolbas S, Yildirim A, Gozel N, Uz B, Koca SS (2016) Hematological indices may be useful in the diagnosis of systemic lupus erythematosus and in determining disease activity in Behcet’s disease. Med Princ Pract 25(6):510–516CrossRef
6.
go back to reference Soydinc S, Turkbeyler IH, Pehlivan Y, Soylu G, Goktepe MF, Bilici M, Zengin O, Kisacik B, Onat AM (2014) Mean platelet volume seems to be a valuable marker in patients with systemic sclerosis. Inflammation. 37(1):100–106CrossRef Soydinc S, Turkbeyler IH, Pehlivan Y, Soylu G, Goktepe MF, Bilici M, Zengin O, Kisacik B, Onat AM (2014) Mean platelet volume seems to be a valuable marker in patients with systemic sclerosis. Inflammation. 37(1):100–106CrossRef
7.
go back to reference Qin B, Ma N, Tang Q, Wei T, Yang M, Fu H, Hu Z, Liang Y, Yang Z, Zhong R (2016) Neutrophil to lymphocyte ratio (NLR) and platelet to lymphocyte ratio (PLR) were useful markers in assessment of inflammatory response and disease activity in SLE patients. Mod Rheumatol 26(3):372–376CrossRef Qin B, Ma N, Tang Q, Wei T, Yang M, Fu H, Hu Z, Liang Y, Yang Z, Zhong R (2016) Neutrophil to lymphocyte ratio (NLR) and platelet to lymphocyte ratio (PLR) were useful markers in assessment of inflammatory response and disease activity in SLE patients. Mod Rheumatol 26(3):372–376CrossRef
8.
go back to reference Gheita TA, Sakr BR, Rabea RE, Abd ElHamid SM (2019) Value of hematological indices versus VEGF as biomarkers of activity in Behcet’s disease. Clin Rheumatol 38(8):2201–2210CrossRef Gheita TA, Sakr BR, Rabea RE, Abd ElHamid SM (2019) Value of hematological indices versus VEGF as biomarkers of activity in Behcet’s disease. Clin Rheumatol 38(8):2201–2210CrossRef
9.
go back to reference Dong Z, Shi J, Dorhoi A, Zhang J, Soodeen-Lalloo AK, Tan WL, Yin H, Sha W, Li W, Zheng R, Liu Z, Yang H, Qin L, Wang J, Huang X, Wu C, Kaufmann SHE, Feng Y (2018) Hemostasis and lipoprotein indices signify exacerbated lung injury in TB with diabetes comorbidity. Chest. 153(5):1187–1200CrossRef Dong Z, Shi J, Dorhoi A, Zhang J, Soodeen-Lalloo AK, Tan WL, Yin H, Sha W, Li W, Zheng R, Liu Z, Yang H, Qin L, Wang J, Huang X, Wu C, Kaufmann SHE, Feng Y (2018) Hemostasis and lipoprotein indices signify exacerbated lung injury in TB with diabetes comorbidity. Chest. 153(5):1187–1200CrossRef
10.
go back to reference Atas H, Canpolat F, Eskioglu F (2018) Evaluation of mean platelet volume in patients with Behcet’s disease as an indicator of vascular thrombosis. Arch Iran Med 21(6):234–239PubMed Atas H, Canpolat F, Eskioglu F (2018) Evaluation of mean platelet volume in patients with Behcet’s disease as an indicator of vascular thrombosis. Arch Iran Med 21(6):234–239PubMed
11.
go back to reference Ataş H, Canpolat F, Eskioglu F (2018) Evaluation of mean platelet volume in patients with Behcet’s disease as an indicator of vascular thrombosis. Arch Iran Med 21(6):234–239PubMed Ataş H, Canpolat F, Eskioglu F (2018) Evaluation of mean platelet volume in patients with Behcet’s disease as an indicator of vascular thrombosis. Arch Iran Med 21(6):234–239PubMed
12.
go back to reference Jiang Y, Zang M, Li S (2017) Serum PLR and LMR in Behcet’s disease: can they show the disease activity? Medicine (Baltimore) 96(21):e6981CrossRef Jiang Y, Zang M, Li S (2017) Serum PLR and LMR in Behcet’s disease: can they show the disease activity? Medicine (Baltimore) 96(21):e6981CrossRef
13.
go back to reference Olumuyiwa-Akeredolu OO, Pretorius E (2015) Platelet and red blood cell interactions and their role in rheumatoid arthritis. Rheumatol Int 35(12):1955–1964CrossRef Olumuyiwa-Akeredolu OO, Pretorius E (2015) Platelet and red blood cell interactions and their role in rheumatoid arthritis. Rheumatol Int 35(12):1955–1964CrossRef
14.
go back to reference Krause I, Mader R, Sulkes J, Paul M, Uziel Y, Adawi M, Weinberger A (2001) Behcet’s disease in Israel: the influence of ethnic origin on disease expression and severity. J Rheumatol 28(5):1033–1036PubMed Krause I, Mader R, Sulkes J, Paul M, Uziel Y, Adawi M, Weinberger A (2001) Behcet’s disease in Israel: the influence of ethnic origin on disease expression and severity. J Rheumatol 28(5):1033–1036PubMed
15.
go back to reference Mumcu G, Ergun T, Inanc N, Fresko I, Atalay T, Hayran O, Direskeneli H (2004) Oral health is impaired in Behcet’s disease and is associated with disease severity. Rheumatology (Oxford) 43(8):1028–1033CrossRef Mumcu G, Ergun T, Inanc N, Fresko I, Atalay T, Hayran O, Direskeneli H (2004) Oral health is impaired in Behcet’s disease and is associated with disease severity. Rheumatology (Oxford) 43(8):1028–1033CrossRef
16.
go back to reference Latger-Cannard V, Hoarau M, Salignac S, Baumgart D, Nurden P, Lecompte T (2012) Mean platelet volume: comparison of three analysers towards standardization of platelet morphological phenotype. Int J Lab Hematol 34(3):300–310CrossRef Latger-Cannard V, Hoarau M, Salignac S, Baumgart D, Nurden P, Lecompte T (2012) Mean platelet volume: comparison of three analysers towards standardization of platelet morphological phenotype. Int J Lab Hematol 34(3):300–310CrossRef
17.
go back to reference Trowbridge EA, Reardon DM, Hutchinson D, Pickering C (1985) The routine measurement of platelet volume: a comparison of light-scattering and aperture-impedance technologies. Clin Phys Physiol Meas 6(3):221–238CrossRef Trowbridge EA, Reardon DM, Hutchinson D, Pickering C (1985) The routine measurement of platelet volume: a comparison of light-scattering and aperture-impedance technologies. Clin Phys Physiol Meas 6(3):221–238CrossRef
18.
go back to reference Maugeri N, Manfredi AA (2015) Tissue factor expressed by neutrophils: another piece in the vascular inflammation puzzle. Semin Thromb Hemost 41(7):728–736CrossRef Maugeri N, Manfredi AA (2015) Tissue factor expressed by neutrophils: another piece in the vascular inflammation puzzle. Semin Thromb Hemost 41(7):728–736CrossRef
19.
go back to reference Seyahi E (2016) Behçet’s disease: how to diagnose and treat vascular involvement. Best Pract Res Clin Rheumatol 30(2):279–295CrossRef Seyahi E (2016) Behçet’s disease: how to diagnose and treat vascular involvement. Best Pract Res Clin Rheumatol 30(2):279–295CrossRef
20.
go back to reference Rezende SM, Lijfering WM, Rosendaal FR, Cannegieter SC (2014) Hematologic variables and venous thrombosis: red cell distribution width and blood monocyte count are associated with an increased risk. Haematologica. 99(1):194–200CrossRef Rezende SM, Lijfering WM, Rosendaal FR, Cannegieter SC (2014) Hematologic variables and venous thrombosis: red cell distribution width and blood monocyte count are associated with an increased risk. Haematologica. 99(1):194–200CrossRef
21.
go back to reference Khorana AA, Kuderer NM, Culakova E, Lyman GH, Francis CW (2008) Development and validation of a predictive model for chemotherapy-associated thrombosis. Blood. 111(10):4902–4907CrossRef Khorana AA, Kuderer NM, Culakova E, Lyman GH, Francis CW (2008) Development and validation of a predictive model for chemotherapy-associated thrombosis. Blood. 111(10):4902–4907CrossRef
22.
go back to reference Aksoy ŞN, Savaş E, Sucu M, Kisacik B, Kul S, Zengin O (2015) Association between red blood cell distribution width and disease activity in patients with Behçet’s disease. J Int Med Res 43(6):765–773CrossRef Aksoy ŞN, Savaş E, Sucu M, Kisacik B, Kul S, Zengin O (2015) Association between red blood cell distribution width and disease activity in patients with Behçet’s disease. J Int Med Res 43(6):765–773CrossRef
23.
go back to reference Vayá A, Rivera L, Todolí J, Hernandez JL, Laiz B, Ricart JM (2014) Haematological, biochemical and inflammatory parameters in inactive Behçet’s disease. Its association with red blood cell distribution width. Clin Hemorheol Microcirc 56(4):319–324CrossRef Vayá A, Rivera L, Todolí J, Hernandez JL, Laiz B, Ricart JM (2014) Haematological, biochemical and inflammatory parameters in inactive Behçet’s disease. Its association with red blood cell distribution width. Clin Hemorheol Microcirc 56(4):319–324CrossRef
24.
go back to reference Mohandas N, Clark MR, Jacobs MS, Shohet SB (1980) Analysis of factors regulating erythrocyte deformability. J Clin Invest 66(3):563–573CrossRef Mohandas N, Clark MR, Jacobs MS, Shohet SB (1980) Analysis of factors regulating erythrocyte deformability. J Clin Invest 66(3):563–573CrossRef
25.
go back to reference Shiga T, Maeda N, Kon K (1990) Erythrocyte rheology. Crit Rev Oncol Hematol 10(1):9–48CrossRef Shiga T, Maeda N, Kon K (1990) Erythrocyte rheology. Crit Rev Oncol Hematol 10(1):9–48CrossRef
26.
go back to reference Aarts PA, Heethaar RM, Sixma JJ (1984) Red blood cell deformability influences platelets--vessel wall interaction in flowing blood. Blood. 64(6):1228–1233CrossRef Aarts PA, Heethaar RM, Sixma JJ (1984) Red blood cell deformability influences platelets--vessel wall interaction in flowing blood. Blood. 64(6):1228–1233CrossRef
27.
go back to reference Yedgar S, Koshkaryev A, Barshtein G (2002) The red blood cell in vascular occlusion. Pathophysiol Haemost Thromb 32(5-6):263–268CrossRef Yedgar S, Koshkaryev A, Barshtein G (2002) The red blood cell in vascular occlusion. Pathophysiol Haemost Thromb 32(5-6):263–268CrossRef
28.
go back to reference Saadoun D, Wechsler B, Desseaux K, Huong DLT, Amoura Z, Resche-Rigon M, Cacoub P (2010) Mortality in Behçet’s disease. Arthritis Rheum 62(9):2806–2812CrossRef Saadoun D, Wechsler B, Desseaux K, Huong DLT, Amoura Z, Resche-Rigon M, Cacoub P (2010) Mortality in Behçet’s disease. Arthritis Rheum 62(9):2806–2812CrossRef
29.
go back to reference Ye J-F, Chen Y, Cai J-F, Shen Y, Zou J, Guan J-L (2019) Incidence and risk factors for anemia among newly-diagnosed intestinal Behcet's disease patients. J Natl Med Assoc 111(4):407–412CrossRef Ye J-F, Chen Y, Cai J-F, Shen Y, Zou J, Guan J-L (2019) Incidence and risk factors for anemia among newly-diagnosed intestinal Behcet's disease patients. J Natl Med Assoc 111(4):407–412CrossRef
30.
go back to reference «iÁek D, Kandi Ba, lhan N, Bakar Dertlio·lu S, Demir Bl (2007) Frequency of anemia of chronic disease in patients with Behcetís disease. TURKDERM - Turkish Archives of Dermatology and Venereology 41(4):121–124 «iÁek D, Kandi Ba, lhan N, Bakar Dertlio·lu S, Demir Bl (2007) Frequency of anemia of chronic disease in patients with Behcetís disease. TURKDERM - Turkish Archives of Dermatology and Venereology 41(4):121–124
31.
go back to reference Daglı M, Yilmaz S, Sivrikaya A, Celik G (2012) The role of prohepcidin and hepcidin in anemia associated with Behçet’s disease. UHOD-Uluslar Hematol-Onkol De 22(2):94–98 Daglı M, Yilmaz S, Sivrikaya A, Celik G (2012) The role of prohepcidin and hepcidin in anemia associated with Behçet’s disease. UHOD-Uluslar Hematol-Onkol De 22(2):94–98
32.
go back to reference Emmi G, Becatti M, Bettiol A, Hatemi G, Prisco D, Fiorillo C (2019) Behçet’s syndrome as a model of thrombo-inflammation: the role of neutrophils. Front Immunol 10:1085 Emmi G, Becatti M, Bettiol A, Hatemi G, Prisco D, Fiorillo C (2019) Behçet’s syndrome as a model of thrombo-inflammation: the role of neutrophils. Front Immunol 10:1085
33.
go back to reference Hammad M, Shehata OZ, Abdel-Latif SM, El-Din AMM (2018) Neutrophil/lymphocyte ratio and platelet/lymphocyte ratio in Behcet’s disease: which and when to use? Clin Rheumatol 37(10):2811–2817CrossRef Hammad M, Shehata OZ, Abdel-Latif SM, El-Din AMM (2018) Neutrophil/lymphocyte ratio and platelet/lymphocyte ratio in Behcet’s disease: which and when to use? Clin Rheumatol 37(10):2811–2817CrossRef
34.
go back to reference Maugeri N, Campana L, Gavina M, Covino C, de Metrio M, Panciroli C, Maiuri L, Maseri A, D'Angelo A, Bianchi ME, Rovere-Querini P, Manfredi AA (2014) Activated platelets present high mobility group box 1 to neutrophils, inducing autophagy and promoting the extrusion of neutrophil extracellular traps. J Thromb Haemost 12(12):2074–2088CrossRef Maugeri N, Campana L, Gavina M, Covino C, de Metrio M, Panciroli C, Maiuri L, Maseri A, D'Angelo A, Bianchi ME, Rovere-Querini P, Manfredi AA (2014) Activated platelets present high mobility group box 1 to neutrophils, inducing autophagy and promoting the extrusion of neutrophil extracellular traps. J Thromb Haemost 12(12):2074–2088CrossRef
35.
go back to reference Acikgoz N, Karincaoglu Y, Ermis N, Yagmur J, Atas H, Kurtoglu E, Cansel M, Barutcu I, Pekdemir H, &Ouml;zdemir R (2010) Increased mean platelet volume in Behcet’s disease with thrombotic tendency. Tohoku J Exp Med 221(2):119–123CrossRef Acikgoz N, Karincaoglu Y, Ermis N, Yagmur J, Atas H, Kurtoglu E, Cansel M, Barutcu I, Pekdemir H, &Ouml;zdemir R (2010) Increased mean platelet volume in Behcet’s disease with thrombotic tendency. Tohoku J Exp Med 221(2):119–123CrossRef
36.
go back to reference Jagroop IA, Tsiara S, Mikhailidis DP (2003) Mean platelet volume as an indicator of platelet activation: methodological issues. Platelets. 14(5):335–336CrossRef Jagroop IA, Tsiara S, Mikhailidis DP (2003) Mean platelet volume as an indicator of platelet activation: methodological issues. Platelets. 14(5):335–336CrossRef
37.
go back to reference Tang J, Gao X, Zhi M, Zhou HM, Zhang M, Chen HW, Yang QF, Liang ZZ (2015) Plateletcrit: a sensitive biomarker for evaluating disease activity in Crohn’s disease with low hs-CRP. J Dig Dis 16(3):118–124CrossRef Tang J, Gao X, Zhi M, Zhou HM, Zhang M, Chen HW, Yang QF, Liang ZZ (2015) Plateletcrit: a sensitive biomarker for evaluating disease activity in Crohn’s disease with low hs-CRP. J Dig Dis 16(3):118–124CrossRef
38.
go back to reference Demir Pektas S, Alatas E, Yilmaz N (2016) Plateletcrit is potential biomarker for presence and severity of psoriasis vulgaris. Acta Medica Mediterr 32:1785 Demir Pektas S, Alatas E, Yilmaz N (2016) Plateletcrit is potential biomarker for presence and severity of psoriasis vulgaris. Acta Medica Mediterr 32:1785
Metadata
Title
Variation of red blood cell parameters in Behcet’s disease: association with disease severity and vascular involvement
Authors
Linlin Cheng
Liubing Li
Chenxi Liu
Songxin Yan
Haizhen Chen
Haolong Li
Fengchun Zhang
Hua Chen
Yongzhe Li
Publication date
01-04-2021
Publisher
Springer International Publishing
Keyword
Thrombosis
Published in
Clinical Rheumatology / Issue 4/2021
Print ISSN: 0770-3198
Electronic ISSN: 1434-9949
DOI
https://doi.org/10.1007/s10067-020-05397-6

Other articles of this Issue 4/2021

Clinical Rheumatology 4/2021 Go to the issue