Benign ethnic neutropenia: What is a normal absolute neutrophil count?

Objective: To find diagnostic accuracy of increased total leucocyte count (TLC) and decreased absolute neutrophil count (ANC) for diagnosis of neonatal sepsis taking culture and sensitivity as gold standard.Methodology: Samples was collected from all the neonates with suspicion of sepsis admitted to neonatal due to severe bad health condition in the Children Hospital, Lahore. Parents were informed for consent. Total 3.5 cc sample was drawn by venipuncture.2.0 cc in CBC voil containing trisodium citrate, this sample was sent to CBC lab for automated CBC on sysmex KX-21 analyzer and peripheral smear. 1.5 cc was taken in specialized containers for blood culture and was sent to microbiology lab. Neonatal sepsis on TLC, ANC and blood count were be recorded. Patients of sepsis was managed as per hospital protocol. Data was analyzed using SPSS.Results: Neonates in this study was at mean age of 3.86±1.81 days. There was almost equal number of males and females neonates. Male were 155(51.7%) and female babies 145(48.3%). It was noted that 182(60.7%) babies were on term while 118(39.3%) were preterm neonates in this study. Neonatal sepsis was positive on TLC in 101(33.7%) cases. in 115(38.3%) on ANC.It was noted that sensitivity of the TLC was 71% while specificity was 66% with a diagnostic accuracy of 68%. On the other and, ANC sowed a sensitivity as 65%, specificity as 56% and diagnostic accuracy of 65%.Conclusion: Conclusively, TLC and ANC is not a good marker for the taking a neonate for the consideration of neonatal sepsis.

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Feasibility and patient-reported satisfaction using a novel point-of-care novel fingerstick method for monitoring absolute neutrophil count (ANC) monitoring for clozapine at the point of care

10.12788/acp.0029 ◽

2021 ◽

Author(s):

Deanna L. Kelly

Keyword(s):

Absolute Neutrophil Count ◽

Neutrophil Count ◽

Point Of Care ◽

Patient Reported

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Reflections on the value of the adjective absolute in reference to hematologic indices like absolute neutrophil count

International Journal of Laboratory Hematology ◽

10.1111/ijlh.13297 ◽

2020 ◽

Vol 42 (6) ◽

Author(s):

Elapulli Sankaranarayanan Prakash

Keyword(s):

Absolute Neutrophil Count ◽

Neutrophil Count

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1740. Title: Outcomes of a Clinical Algorithm for the Early Diagnosis and Treatment of Invasive Fungal Sinusitis among Children with Hematologic Malignancy or Prior Hematopoietic Stem Cell Transplantation

Open Forum Infectious Diseases ◽

10.1093/ofid/ofz360.1603 ◽

2019 ◽

Vol 6 (Supplement_2) ◽

pp. S637-S637

Author(s):

Gohar Warraich ◽

Naomi Winick ◽

Tamra Slone ◽

Victor M Aquino ◽

Kimberly Donner ◽

...

Keyword(s):

Stem Cell ◽

Absolute Neutrophil Count ◽

Neutrophil Count ◽

Hematologic Malignancy ◽

Morbidity And Mortality ◽

Fungal Sinusitis ◽

Significant Morbidity ◽

Hematopoietic Stem ◽

Clinical Algorithm ◽

Invasive Fungal Sinusitis

Abstract Background Invasive fungal sinusitis (IFS) is a cause of significant morbidity and mortality among children with hematologic malignancy and hematopoietic stem cell transplant (HSCT) recipients, with an estimated mortality of 18–80%. Since 2007, our center has employed a clinical algorithm for the early detection and treatment of IFS among children with prolonged febrile neutropenia. Methods We reviewed all EORTC defined cases of proven IFS among children with underlying hematologic malignancy or prior HSCT admitted to our institution between July 1, 2004 and December 31, 2018, and compared clinical characteristics and outcomes (including underlying malignancy, chemotherapy regimen at the time of viremia, absolute neutrophil count, absolute lymphocyte count, treatment regimens, and 6 month mortality) between the pre (July 1, 2004–December 31, 2006) and post-protocol (January 1, /2007–December 31, 2018) periods. Results We identified 33 cases of proven IFS during the study period, with 6 in the pre-protocol and 27 in the post-protocol period. The most common underlying primary diagnosis was acute lymphoblastic leukemia (ALL) at > 50% with 8% of individuals with prior HSCT. Twenty-five cases (92%) during the protocol period were diagnosed via nasal endoscopy per protocol, with 17 (63%) reporting no clinical complaints of sinusitis. Median absolute neutrophil count (ANC) at the time of IFS diagnosis was 155/mm3 (IQR 0 – 375/ mm3; n = 12) with median duration of neutropenia 16.5 days (IQR 10.5–18.25, n = 12) at the time of diagnosis. Most individuals required one definitive debridement. Isolated fungal specimens included Bipolaris spp. (24%), Aspergillus spp. (20%), Curvularia spp. (20%), with Fusarium and Exserohilum spp. each at 12%, and Rhizopus spp. At least one patient had a co-infection with more than one fungal species. Pre-protocol cause-specific mortality at 6 months was 33.3% compared with 14.8% (P = 0.29) in the post- protocol period. Conclusion IFS is a cause of significant morbidity and mortality among children with hematologic malignancy or prior HSCT. An aggressive protocol with early nasal endoscopy and targeted debridement may help decrease morbidity and mortality associated with this entity. Additional well-designed studies are needed to assess the potential benefits of this approach in the diagnosis and management of IFS among high-risk children. Disclosures All authors: No reported disclosures.

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Fatal Neutropenia and Thrombocytopenia Associated with Ticlopidine

Annals of Pharmacotherapy ◽

10.1177/106002809402801103 ◽

1994 ◽

Vol 28 (11) ◽

pp. 1236-1238 ◽

Cited By ~ 13

Author(s):

James A. Carlson ◽

Jon E. Maesner

Keyword(s):

Renal Function ◽

Absolute Neutrophil Count ◽

Neutrophil Count ◽

Impaired Renal Function ◽

Healthcare Professionals ◽

Severe Neutropenia ◽

Gram Negative ◽

Case Summary ◽

First Case

OBJECTIVE: To report the first case of ticlopidine-associated neutropenia resulting in sepsis and death. CASE SUMMARY: An 83-year-old Filipino man was started on ticlopidine 250 mg bid. By the seventh week of therapy his absolute neutrophil count (ANC) had dropped to 2700 from 7600 × 106 cells/L. The ticlopidine was stopped. Six days later, he was admitted to the hospital. He died 18 hours later of gram-negative sepsis. DISCUSSION: Although ticlopidine therapy was discontinued four days after the patient's ANC was 2700 × 106 cells/L, the ANC dropped to and remained at 0 until his death eight days later. This may be associated with the patient's decreased clearance of ticlopidine given his age and impaired renal function. This is the first reported case of moderate or severe neutropenia in a nonwhite patient and the first reported case of sepsis and death caused by ticlopidine CONCLUSIONS: Healthcare professionals must be aware of the possibility of severe neutropenia and death caused by ticlopidine, even when the manufacturers' monitoring guidelines are followed.

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O9.1. SATISFACTION WITH USING A NOVEL FINGERSTICK FOR ABSOLUTE NEUTROPHIL COUNT (ANC) AT THE POINT OF TREATMENT IN PATIENTS TREATED WITH CLOZAPINE

Schizophrenia Bulletin ◽

10.1093/schbul/sbaa028.048 ◽

2020 ◽

Vol 46 (Supplement_1) ◽

pp. S20-S21

Author(s):

Deanna Kelly ◽

Matthew Glassman ◽

Marie Mackowick ◽

Jae Park ◽

Myriam Navarro-De La Vega ◽

...

Keyword(s):

Absolute Neutrophil Count ◽

Neutrophil Count ◽

Venous Blood ◽

Test Strip ◽

Significant Advance ◽

Clinical Team ◽

Blood Draw ◽

Team Members ◽

Blood Drawing ◽

Finger Stick

Abstract Background Clozapine is an effective antipsychotic for treatment-resistant schizophrenia that requires monitoring of the Absolute Neutrophil Count (ANC) due to the potential of clozapine induced neutropenia. Standard monitoring requires a routine venous draw which is considered one of the most significant barriers to patients starting or continuing the medication. This project assesses the feasibility, patient and clinician satisfaction with both venous blood drawing for ANC monitoring and a novel method for measuring ANC with a fingerstick using capillary blood. Methods During an open-label clinical trial of clozapine, participants with schizophrenia received both a venous blood draw and a capillary finger stick at baseline, week 2 and week 4. Capillary testing was done onsite using the newly FDA Class II cleared automated diagnostic device. This device performs tests on capillary finger stick samples collected directly into the provided test strip. This works by using a microfluidic test strip channel that creates a stained monolayer of white blood cells. Multiple images are taken of the monolayer and the cells are counted and classified by computer vision-based image analysis on a cloud server. This device offers technology that provides ANC results within 5 minutes using a small drop of blood drawn in the clinic and has been found to have a correlation to reference lab results of >0.94 in over 30, 000 testings. We measured patient satisfaction using a questionnaire with a 5-point Likert Scale rating domain of pain, worry, concern about blood volume, concern for where blood is sent and irritation with blood drawing and we anonymously measured clinical team members satisfaction with an anonymous survey. The study was conducted at two sites (one inpatient hospital and one research clinic) and approved by the Institutional Review Board at the University of Maryland and respective research committees. Results We enrolled 20 participants and 20 clinical team members for the surveys. Most patients believe the doctor is able to provide better care given immediate results. They also feel the elimination of unknown people touching the blood is a benefit of fingerstick monitoring. Patients indicated that they are more likely to remain on clozapine with fingerstick testing versus venous testing. There was a trend for higher agreement that using the venous blood draw negatively impacts their health (3.2 vs 2.8, p=0.068). In terms of pain, patients indicated that venous blood monitoring was slightly painful and more worrisome than fingerstick monitoring. Clinician ratings are high with mean scores >4 for satisfaction with device, satisfaction with immediate results, advancement in treatment, and improved patient care. Discussion The device is very user friendly and technology appears to be a significant advance for clinicians. Patients do not appear to worry about having venous blood draws or fingersticks but rate their most significant concern with venous blood draws is its negative effect on their health. However, patients strongly feel the fingerstick helps their doctors and their care. The use of POC devices may decrease or eliminate a significant barrier and may help improve the use of this underused evidence-based medication. Funding: This project was funded by NIMH R01MH102215 (Kelly PI). Athelas provided the Athelas One devices for two locations but provided no funding for the project.

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