246: Absence of Fever and Elevated White Blood Count Does Not Exclude the Diagnosis of Diverticulitis as Determined by CT in the Emergency Department

2007 ◽  
Vol 50 (3) ◽  
pp. S77
Author(s):  
A.D. Mounday ◽  
C. Aubin ◽  
L. Lewis
Keyword(s):  
Emergency Department ◽  
Blood Count ◽  
White Blood Count

Identifying Targets for the Prevention of Childhood Undernutrition in a Resource-Limited Peri-Urban Ecuadorian Community

2021 ◽  
pp. 037957212098250
Author(s):  
Suzanna L. Attia ◽  
Wolf-Peter Schmidt ◽  
Janeth Ceballos Osorio ◽  
Thomas Young ◽  
Aric Schadler ◽  
...  
Keyword(s):  
Vitamin A ◽  
Blood Count ◽  
Complete Blood Count ◽  
Dietary Diversity ◽  
Demographic Data ◽  
Serum Zinc ◽  
White Blood Count ◽  
Monthly Income ◽  
Vitamin Deficiencies ◽  
Dietary Diversity Score

Background: In middle-income countries, malnutrition concentrates in marginalized populations with a lack of effective preventive strategies. Objective: Identify risk factors for undernutrition in a peri-urban Ecuadorian community of children aged 12 to 59 months. Methods: Data from a cross-sectional survey in 2011 of children 1 to 5 years were analyzed including demographic data, medical history and examination, food frequency questionnaire (FFQ), anthropometric measurements, and blood for complete blood count, C-reactive protein, vitamin A, iron, and zinc levels. Dietary Diversity Score (DDS) was calculated from FFQ. Bivariate and multivariate analysis assessed effects on primary outcome of undernutrition by DDS, vitamin deficiencies, and demographic and nutritional data. Results: N = 67, 52.2% undernourished: 49.3% stunted, 25.4% underweight, and 3% wasted; 74.6% (n = 50) were anemic and 95.1% (n = 39) had low serum zinc. Dietary Diversity Score was universally low (mean 4.91 ± 1.36, max 12). Undernutrition was associated with lower vitamin A levels (20 306, IQR: 16605.25-23973.75 vs 23665, IQR: 19292-26474 ng/mL, P = .04); underweight was associated with less parental report of illness (43.8%, n = 7 vs 80% n = 40, P = .005) and higher white blood count (13.7, IQR: 11.95-15.8 vs 10.9, IQR: 7.8-14.23 × 109/L, P = .02). In multiple regression, risk of undernutrition decreased by 4% for every $10 monthly income increase (95 CI%: 0.5%-7.4%, P = .02, n = 23); risk of underweight decreased by 0.06 for every increased DDS point (adjusted odds ratio: 0.06; 95 CI%: 0.004-0.91, P = .04, n = 23). Conclusions: In this peri-urban limited resource, mostly Indigenous Ecuadorian community, stunting exceeds national prevalence, lower monthly income is the strongest predictor of undernutrition, lower DDS can predict some forms of undernutrition, and vitamin deficiencies are associated with but not predictive of undernutrition.

Massive Eosinophilic Reaction to Desipramine in Conjunction with Pneumonia*

1984 ◽  
Vol 29 (2) ◽  
pp. 142-144 ◽  
Author(s):  
R.P. Kraus ◽  
R.J. Clarke ◽  
R.A. Remick
Keyword(s):  
Affective Disorder ◽  
Female Patient ◽  
Blood Count ◽  
Bipolar Affective Disorder ◽  
Dry Mouth ◽  
White Blood Count ◽  
Medication Change ◽  
Supportive Management

The authors report on a female patient with bipolar affective disorder who presented with marked eosinophilia in conjunction with pneumonia five days after a medication change from amitriptyline to desipramine (for intolerable dry mouth). She improved with discontinuance of medications and supportive management, and her eosinophilia normalized. Reinstitution of desipramine was followed by prompt appearance of asymptomatic eosinophilia, which resolved with discontinuation of desipramine. A subsequent depression managed with amitriptyline was followed by no abnormal white blood count findings. Eosinophilia is occasionally encountered in imipramine or desipramine therapy and, although usually asymptomatic, appears to be manageable by switching to amitriptyline or nortriptyline.

scholarly journals Cutting-Edge Technology for Rapid Bedside Assessment of Capillary Refill Time for Early Diagnosis and Resuscitation of Sepsis

2020 ◽  
Vol 7 ◽  
Author(s):  
David C. Sheridan ◽  
Robert Cloutier ◽  
Andrew Kibler ◽  
Matthew L. Hansen
Keyword(s):  
Emergency Department ◽  
Early Diagnosis ◽  
New Technology ◽  
Cutting Edge ◽  
Adult Patients ◽  
White Blood Count ◽  
Organ Perfusion ◽  
Capillary Refill ◽  
Individualized Care ◽  
Emergency Department Triage

Sepsis currently affects over 30 million people globally with a mortality rate of ~30%. Prompt Emergency Department diagnosis and initiation of resuscitation improves outcomes; data has found an 8% increase in mortality for every hour delay in diagnosis. Once sepsis is recognized, the current Surviving Sepsis Guidelines for adult patients mandate the initiation of antibiotics within 3 h of emergency department triage as well as 30 milliliters per kilogram of intravenous fluids. While these are important parameters to follow, many emergency departments fail to meet these goals for a variety of reasons including turnaround on blood tests such as the serum lactate that may be delayed or require expensive laboratory equipment. However, patients routinely have vital signs assessed and measured in triage within 30 min of presentation. This creates a unique opportunity for implementation point for cutting-edge technology to significantly reduce the time to diagnosis of potentially septic patients allowing for earlier initiation of treatment. In addition to the practical and clinical difficulties with early diagnosis of sepsis, recent clinical trials have shown higher morbidity and mortality when septic patients are over-resuscitated. Technology allowing more real time monitoring of a patient's physiologic responses to resuscitation may allow for more individualized care in emergency department and critical care settings. One such measure at the bedside is capillary refill. This has shown favor in the ability to differentiate subsets of patients who may or may not need resuscitation and interpreting blood values more accurately (1, 2). This is a well-recognized measure of distal perfusion that has been correlated to sepsis outcomes. This physical exam finding is performed routinely, however, there is significant variability in the measurement based on who is performing it. Therefore, technology allowing rapid, objective, non-invasive measurement of capillary refill could improve sepsis recognition compared to algorithms that require lab tests included lactate or white blood count. This manuscript will discuss the broad application of capillary refill to resuscitation care and sepsis in particular for adult patients but much can be applied to pediatrics as well. The authors will then introduce a new technology that has been developed through a problem-based innovation approach to allow clinicians rapid assessment of end-organ perfusion at the bedside or emergency department triage and be incorporated into the electronic medical record. Future applications for identifying patient decompensation in the prehospital and home environment will also be discussed. This new technology has 3 significant advantages: [1] the use of reflected light technology for capillary refill assessment to provide deeper tissue penetration with less signal-to-noise ratio than transmitted infrared light, [2] the ability to significantly improve clinical outcomes without large changes to clinical workflow or provider practice, and [3] it can be used by individuals with minimal training and even in low resource settings to increase the utility of this technology. It should be noted that this perspective focuses on the utility of capillary refill for sepsis care, but it could be considered the next standard of care vital sign for assessment of end-organ perfusion. The ultimate goal for this sensor is to integrate it into existing monitors within the healthcare system.

P5610Inflammatory response after ExoVasc personalized external aortic root support (PEARS) procedure in patients with Marfan syndrome or non-Marfan genetic aortopathy

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
R Kockova ◽  
J Maly ◽  
A Krebsova ◽  
M Labos ◽  
J Pirk
Keyword(s):  
Aortic Root ◽  
Hospital Readmission ◽  
Blood Count ◽  
White Blood Count ◽  
Recurrent Fever ◽  
C Reactive Protein ◽  
Recurrent Pericarditis ◽  
Reactive Protein ◽  
Aortic Root Surgery ◽  
St Elevation

Abstract Background External aortic root support (PEARS) is a novel prophylactic aortic root surgery. Purpose The study aimed to determine the severity of inflammatory response after the personalized external aortic root support (PEARS) procedure in comparison to after the standard prophylactic aortic root surgery (SPARS). Materials and methods The study was a single-centre, retrospective, based on hospital record analysis of patients who underwent the PEARS procedure (PEARS group) or SPARS (SPARS group) during 1998–2017. C-reactive protein (CRP), white blood count (WBC), and echocardiography were routinely obtained. Fever was defined as body temperature ≥38°C. Diagnosis of pericarditis included a minimum of three signs from chest pain, pericardial effusion, ST elevation, elevated CRP, and body temperature. Results PEARS and SPARS groups consisted of 13 and 14 patients, respectively, scheduled for prophylactic aortic root surgery. A majority of patients in both groups had Marfan syndrome with causal mutation in the fibrillin 1 (FBN1) gene (62% vs 79%). Patient baseline characteristics were similar in the two groups, except aortic root was significantly larger in the SPARS group than in the PEARS group (60±12 mm vs 48±5 mm; P=0.003). All surgical procedures were successful and without major complications. The peak values of CRP and WBC were significantly higher in the PEARS group (264.5±84.4 mg/L vs 184.6±89.6 mg/L; P=0.034 and 15.2±3.8 109/L vs 11.9±3.3 109/L; P=0.029). Early and recurrent fever requiring hospital readmission was significantly more frequent in the PEARS group (77% vs 36%; P=0.032 and 46% vs 7%; P=0.020). Early and recurrent pericarditis requiring hospital readmission was also more frequent in the PEARS group (31% vs 0%; P=0.024 and 31% vs 0%; P=0.024). Inflammatory characteristics Postprocedural inflammatory characteristics PEARS group SPARS group P value (N=13) (N=14) Peak level of CRP (mg/L) 264.5±84.4 184.6±89.6 0.034 Peak WBC (109/L) 15.2±3.8 11.9±3.3 0.029 ST elevation (N) 11 (85) 6 (43) 0.024 Early fever (N) 10 (77) 5 (36) 0.032 Recurrent fever (N) 6 (46) 1 (7) 0.020 Early pericarditis (N) 4 (31) 0 (0) 0.024 Recurrent pericarditis (N) 4 (31) 0 (0) 0.024 CRP, C-reactive protein; WBC, white blood count. Echocardiography-signs of inflammation Conclusions The PEARS procedure is an extremely promising surgical technique, but the postoperative inflammatory response occurs frequently and more severely in comparison to SPARS. Clearly, these findings warrant further investigation.

scholarly journals Acute myeloid leukaemia: an unusual cause of biliary strictures

2019 ◽  
Vol 12 (3) ◽  
pp. e227821
Author(s):  
Adele Beck ◽  
Hannah Hunter ◽  
Simon Jackson ◽  
David Sheridan
Keyword(s):  
Bone Marrow ◽  
Obstructive Jaundice ◽  
Acute Myeloid Leukaemia ◽  
Myeloid Leukaemia ◽  
Blood Count ◽  
Extrahepatic Bile Duct ◽  
White Blood Count ◽  
Full Blood Count ◽  
Significant Past Medical History ◽  
Acute Myeloid

A 17-year-old man with no significant past medical history presented with a 2-week history of worsening jaundice, lethargy, anorexia and progressive right upper quadrant abdominal pain. There were no stigmata of chronic liver disease. Initial investigations were suggestive of cholangitis with large intrahepatic and extrahepatic bile duct strictures but otherwise normal hepatic and splenic appearances. A percutaneous transhepatic cholangiogram with the positioning of drains was performed to alleviate the obstructive jaundice. Within 2 weeks of the first presentation, full blood count revealed a significantly raised white blood count and a subsequent peripheral blood smear and bone marrow were consistent with a diagnosis of acute myeloid leukaemia. Chemotherapy was started after partial improvement of his obstructive jaundice. Complete morphological and cytogenetic remission was obtained 4 weeks after the first cycle of chemotherapy (half dose of daunorubicin and full dose of cytarabine, treated off trial) on control bone marrow. The patient remains in remission.

scholarly journals Are Fibrinogen and Complete Blood Count Parameters Predictive in Incarcerated Abdominal Hernia Repair?

2014 ◽  
Vol 99 (6) ◽  
pp. 723-728 ◽  
Author(s):  
Sahin Kahramanca ◽  
Oskay Kaya ◽  
Gulay Ozgehan ◽  
Hakan Guzel ◽  
Cem Azili ◽  
...  
Keyword(s):  
Hernia Repair ◽  
Blood Count ◽  
Complete Blood Count ◽  
Abdominal Hernia ◽  
White Blood Count ◽  
Morbidity Rate ◽  
Distribution Width ◽  
Diagnostic Role ◽  
Elective Group ◽  
Group B

Abstract Therapeutic delays in cases of external incarcerated hernias typically result in increasing morbidity, mortality, and health expenditures. We investigated the diagnostic role of blood fibrinogen level, white blood count (WBC), mean platelet volume (MPV), and platelet distribution width (PDW) in patients with incarcerated hernia. Two groups, each containing 100 patients, were studied. Group A underwent elective, and group B underwent incarcerated and urgent external hernia repair. We observed high fibrinogen and WBC levels but low MPV and PDW values for patients in group B. Contrary to our expectations, we found lower MPV and PDW values in the complicated group than in the elective group. The morbidity rate and cost burden were higher in group B, and the results were statistically significant. Early operation should be recommended for patients with incarcerated external hernias if their fibrinogen and WBC levels are high.

Comparison of G-CSF Administration Starting Day +5 Versus Based on White Blood Count Following Autologous Peripheral Blood Stem Cell Transplantation.

Blood ◽  
2004 ◽  
Vol 104 (11) ◽  
pp. 5053-5053
Author(s):  
Michael Craig ◽  
Yuan Yao ◽  
Solveig Ericson
Keyword(s):  
Stem Cell ◽  
Stem Cell Transplantation ◽  
Hospital Stay ◽  
Cell Transplantation ◽  
Peripheral Blood ◽  
Blood Count ◽  
Peripheral Blood Stem Cell ◽  
White Blood Count ◽  
Autologous Pbsct ◽  
Blood Stem Cell Transplantation

Abstract Granulocyte colony stimulating factor (G-CSF) is commonly used following autologous peripheral blood stem cell transplantation (PBSCT) to promote bone marrow recovery. However, the optimal timing of G-CSF in this setting is unknown. We randomized 23 patients undergoing autologous PBSCT for a variety of malignant disorders to G-CSF administration 5 μg/kg/day starting day +5 (Arm A) versus when white blood count (WBC) recovered to 0.2 x 109/L or 0.1 x 109/L for 2 consecutive days (Arm B). Results: All patients engrafted. The median time to absolute neutrophil count (ANC) > 1.0 x 109/L in Arms A and B was 12.1 vs. 12.8 days (p=0.77). There was no significant difference in number of days of temperature >38.3°C (4.3 vs. 4.4 days, p=0.71) or hospital stay (23.8 vs. 22.1 days, p=0.93) between Arms A and B respectively. The mean amount of G-CSF administered was 3210 μg/patient in Arm A vs. 2384 μg/patient in Arm B, a significant reduction (p=0.035). Conclusion: Waiting for early signs of engraftment after autologous PBSCT before starting G-CSF administration is associated with a decrease in amount of G-CSF administration by 25%, with no increase in days with fever, time to neutrophil recovery, or length of hospital stay.

Automated Quantitative Assessment of Bone Marrow in Normal Samples: Correlation with the Reference Method.

Blood ◽  
2005 ◽  
Vol 106 (11) ◽  
pp. 4192-4192
Author(s):  
Gina Zini ◽  
Mariagrazia Garzia ◽  
Antonella Di Mario ◽  
Elena Rossi ◽  
Giuliana Farina ◽  
...  
Keyword(s):  
Bone Marrow ◽  
Cell Count ◽  
Blood Count ◽  
Hematopoietic Cells ◽  
Reference Method ◽  
Mean Value ◽  
White Blood Count ◽  
Quantitative Detection ◽  
Microscope Examination ◽  
Age Related

Abstract Bone marrow (BM) analysis is conventionally performed by microscope examination on films of about 0.3ml of aspirated bone marrow fluid, stained with Romanowsky dyes. Until 1996 the simple automated screening of marrow composition was made very difficult by a number of factors, mainly the lack of the erythroblasts quantitation and the fat interference. From 1996 last generation automated hematology analyzers provide accurate and precise erythroblasts counts; moreover same systems have improved their software reducing the problem of fat interference. We have analyzed data from 100 normal BM samples from patients submitted for diagnostic and/or follow up purposes in our Hematology Day Hospital. BM fluid was harvested from the superior posterior iliac crest. The first 0,3–0.5 ml were used for smears, while the next 1–2 ml of BM, collected into K3-EDTA, were analysed with Coulter LH 750, a fully automated hematology analyzer which provides Complete Blood Count, White Blood Count Differential included Nucleated Red Blood Cells (NRBC) and Reticulocytes count. We used the microscope examination conventionally performed on films stained with Romanowsky dyes as reference method. Quantitative detection BM cellularity was obtained by semi quantitative evaluation based on the evaluation of hematopoietic cells in several marrow particles: physiological differences age related were also taken in account. If hematopoietic cells occupy less than 25% or more than 85% the sample is defined respectively hypocellular or hypercellular (none of our sample was as). Differential cell count was usually performed on two different slides counting 500 cells (1000 when hypercellular, but none of our sample was as). We found a strict correlation between microscope semi-quantitative cellularity evaluation and the instrumental cell count as sum of WBC plus NRBC, the Total Nucleted Cell Count (TNCC). The mean value of the TNCC in normal PM samples was 29,48 x109/L with a range 25,9–54,9 x109/L. These results are in good agreement with normal BM cell count reported in the literature using a cytofluorimetric method, which is 34,5 x109/L (SD28.0). The instrumental mean percentage of BM granulocytes corrected for TNNC was 62% (range: 23,5–93,7) versus a mean microscope percentage of 58,42% (range: 40–72). The automated NRBC BM count corrected for TNCC was 11,38% (range: 2,7 – 39,17) versus a microscopic mean value of 28% (range: 9–45). These results, including the slight NRBC underestimation probably due to partial mature cell lysis, are in line with the data of the literature. This study confirms the feasibility of routine automated cell count using a hematology in normal BM fluid samples. Automated methods will support morphologists quickly providing accurate and precise quantitative information such as TNCC and myeloid/erythroid ratio.

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