Neutrophil and Monocyte Counts in Heparin-Induced Thrombocytopenia

2019 ◽  
Vol 119 (06) ◽  
pp. 941-951 ◽  
Author(s):  
Madeleine Hui ◽  
Jo-Ann I. Sheppard ◽  
Na Li ◽  
Theodore E. Warkentin
Keyword(s):  
Cardiac Surgery ◽  
Blood Cell ◽  
White Blood Cell ◽  
Monocyte Count ◽  
Heparin Induced Thrombocytopenia ◽  
Post Surgery ◽  
Leukocyte Counts ◽  
Wbc Count ◽  
Diagnosis Of Infection ◽  
Post Cardiac Surgery

Background Heparin-induced thrombocytopenia (HIT) antibodies activate platelets, monocytes and neutrophils. Despite these findings, it is unknown whether white blood cell (WBC) counts, including neutrophils and monocytes, are altered during HIT. Materials and Methods We evaluated changes in total WBC counts (including WBC subsets), in 50 post-cardiac surgery patients with serologically confirmed HIT (30 patients with HIT-associated thrombosis). Daily leukocyte counts were compared with those measured one day prior to HIT onset; WBC increases were classified as mild (20.0–49.9%), moderate (50.0–99.9%) or major (≥ 100% increase). We also compared changes in WBC counts in HIT patients with and without HIT-associated thrombosis, and non-HIT patients with thrombosis. Results Most (34/50 [68.0%]) patients with HIT developed WBC count increases (mild, 35.3%; moderate, 44.1%; major, 20.6%). The peak WBC count occurred on day 4 (median) of HIT, which corresponded to day 10 (median) post-surgery. Absolute neutrophil counts increased in most patients (38/50 [76.0%]); whereas absolute monocyte counts rose in some patients, the overall tendency was for the monocyte count to decrease during HIT. Unexpectedly, we found that the increase in total WBC counts, as well as in neutrophils, was seen mainly in patients who developed HIT-associated or non-HIT-associated thrombosis; in contrast, no difference in monocyte levels was seen in patients with or without thrombosis. Conclusion Leukocytosis and neutrophilia are commonly observed in patients with HIT, particularly in patients with HIT-associated thrombosis, as well as non-HIT patients with thrombosis. Thus, leukocytosis/neutrophilia should not infer automatically a diagnosis of infection or inflammation, when evaluating thrombocytopenia in heparin-exposed patients.

scholarly journals Preoperative White Blood Cell Count and Risk of 30-Day Readmission after Cardiac Surgery

2013 ◽  
Vol 2013 ◽  
pp. 1-7 ◽  
Author(s):  
Jeremiah R. Brown ◽  
R. Clive Landis ◽  
Kristine Chaisson ◽  
Cathy S. Ross ◽  
Lawrence J. Dacey ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Blood Cell ◽  
White Blood Cell ◽  
Chronic Obstructive ◽  
Obstructive Pulmonary Disease ◽  
Gastrointestinal Complications ◽  
Disease States ◽  
Inflammatory State ◽  
Independent Association ◽  
Wbc Count

Approximately 1 in 5 patients undergoing cardiac surgery are readmitted within 30 days of discharge. Among the primary causes of readmission are infection and disease states susceptible to the inflammatory cascade, such as diabetes, chronic obstructive pulmonary disease, and gastrointestinal complications. Currently, it is not known if a patient’s baseline inflammatory state measured by crude white blood cell (WBC) counts could predict 30-day readmission. We collected data from 2,176 consecutive patients who underwent cardiac surgery at seven hospitals. Patient readmission data was abstracted from each hospital. The independent association with preoperative WBC count was determined using logistic regression. There were 259 patients readmitted within 30 days, with a median time of readmission of 9 days (IQR 4–16). Patients with elevated WBC count at baseline (10,000–12,000 and >12,000 mm3) had higher 30-day readmission than those with lower levels of WBC count prior to surgery (15% and 18% compared to 10%–12%,P=0.037). Adjusted odds ratios were 1.42 (0.86, 2.34) for WBC counts 10,000–12,000 and 1.81 (1.03, 3.17) for WBC count > 12,000. We conclude that WBC count measured prior to cardiac surgery as a measure of the patient’s inflammatory state could aid clinicians and continuity of care management teams in identifying patients at heightened risk of 30-day readmission after discharge from cardiac surgery.

Association Between White Blood Cell Counts and Brachial-Ankle Pulse Wave Velocity in Chinese Hypertensive Adults: A Cross-Sectional Study

Angiology ◽  
2021 ◽  
pp. 000331972110211
Author(s):  
Buyun Jia ◽  
Chongfei Jiang ◽  
Yun Song ◽  
Chenfangyuan Duan ◽  
Lishun Liu ◽  
...  
Keyword(s):  
Arterial Stiffness ◽  
Blood Cell ◽  
Pulse Wave Velocity ◽  
Wave Velocity ◽  
White Blood Cell ◽  
Pulse Wave ◽  
Final Analysis ◽  
Cross Sectional ◽  
Cell Counts ◽  
Wbc Count

Increased arterial stiffness is highly prevalent in patients with hypertension and is associated with cardiovascular (CV) risk. Increased white blood cell (WBC) counts may also be an independent risk factor for arterial stiffness and CV events. The aim of the study was to investigate the relationship between differential WBC counts and brachial-ankle pulse wave velocity (baPWV) in hypertensive adults. A total of 14 390 participants were included in the final analysis. A multivariate linear regression model was applied for the correlation analysis of WBC count and baPWV. Higher WBC counts were associated with a greater baPWV: adjusted β = 10 (95% CI, 8-13, P < .001). The same significant association was also found when WBC count was assessed as categories or quartiles. In addition, the effect of differential WBC subtypes, including neutrophil count and lymphocyte count on baPWV, showed the similar results. These findings showed that baPWV has positive associations with differential WBC counts in hypertensive adults.

scholarly journals Predictive values of Alvarado score, serum C-reactive protein, and white blood cell count in the diagnosis of acute appendicitis: a prospective study

2021 ◽  
Vol 17 (1) ◽  
Author(s):  
Ademola Olusegun Talabi ◽  
Tewogbade Adeoye Adedeji ◽  
Oludayo Adedapo Sowande ◽  
Olusanya Adejuyigbe
Keyword(s):  
Acute Appendicitis ◽  
Blood Cell ◽  
Cell Count ◽  
White Blood Cell Count ◽  
White Blood Cell ◽  
C Reactive Protein ◽  
Blood Cell Count ◽  
Alvarado Score ◽  
Reactive Protein ◽  
Wbc Count

Abstract Background The diagnosis of acute appendicitis in children is quite challenging as the rate of negative appendectomy varies between 15 and 57%. Increased utilization of imaging diagnostic facilities in advanced countries seems to have reduced the incidence of operating on normal appendix to a single digit. In low- and middle-income countries, the incidence remains unacceptably high (double digits). Inflammatory markers and scoring systems may be a suitable adjunct to increase diagnostic yield in most third world countries. Thus, the aim of this study was to evaluate the diagnostic value of Alvarado score, white blood cell count, and serum C-reactive protein in children with acute appendicitis. Results The ages of patients ranged between 4 and 15 years with a mean of 11.2 ± 2.8 years. The male to female ratio was 1.4 to 1.0. Nineteen percent of patients had negative appendiceal findings on histological examination. The sensitivity and specificity of Alvarado score, C-reactive protein estimation, total white blood cell count in diagnosing acute appendicitis were 86.4% and 63.2%, 98.8% and 36.8%, and 51.9% and 89.5% respectively. Alvarado score has the highest area under ROC curve analysis 0.824, 95% CI of 0.724 to 0.924 compared with CRP, 0.769. 95% CI of = 0.647 to 0.891 and WBC count, 0.765, 95% CI of 0.643 to 0.887. Both CRP and WBC count showed higher discriminatory values between complicated and uncomplicated appendicitis, p < 0.001. Conclusion Alvarado score outperformed other tests in setting the diagnosis of acute appendicitis. However, none of the tests can be relied on wholly for operative decision. Clinical judgement remains the bedrock for diagnosis and operative management.

scholarly journals Decrease in white blood cell counts after thiopentone barbiturate therapy for refractory intracranial hypertension: A common complication

2013 ◽  
Vol 04 (S 01) ◽  
pp. S31-S34 ◽  
Author(s):  
Shin Yi Ng ◽  
Ki Jinn Chin ◽  
Tong Kiat Kwek
Keyword(s):  
Statistical Analysis ◽  
Blood Cell ◽  
Intracranial Hypertension ◽  
White Blood Cell ◽  
Retrospective Review ◽  
T Test ◽  
Barbiturate Coma ◽  
Barbiturate Therapy ◽  
The Mean ◽  
Wbc Count

ABSTRACT Background: Leucopenia has been reported after induction of thiopentone barbiturate therapy for refractory intracranial hypertension. However, the incidence and characterisitics are not well described. Aims: We performed a retrospective review to describe the incidence and characteristics of leucopenia after induction of thiopentone barbiturate therapy. Setting and Design: Our centre is a national referral centre for neurotrauma and surgery in a tertiary medical institution.Materials and Methods: We performed a retrospective review of all patients who received thiopentone barbiturate therapy for refractory intracranial hypertension during an 18 month period from January 2004 to June 2005 in our neurosurgical intensive care unit. Statistical Analysis Used: Statistical analysis was performed using SPSS version 15.0. All data are reported as mean ± standard deviation or median (interquartile range). The Chi square test was used to analyze categorical data and student t test done for comparison of means. For paired data, the paired t?test was used.-test was used. Results: Thirty eight (80.9%) out of 47 patients developed a decrease in white blood cell (WBC) count after induction of thiopentone barbiturate coma. The mean decrease in WBC from baseline to the nadir was 6.4 × 10 9 /L (P <lt; 0.001) and occurred 57 (3-147) h after induction. The mean nadir WBC was 8.6 < 3.6 × 10 9 /L. Three (6.4%) patients were leucopenic, with a WBC count of 2.8, 3.1, and 3.6 < 10 9 /L. None of them were neutropenic. We did not find an association between decrease in WBC count and clinical diagnosis of infection. We did not find any association between possible risk factors such as admission GCS, maximum ICP prior to induction of barbiturate coma, APACHE II score, total duration and dose of thiopentone given, and decrease in WBC count. Conclusions: Decrease in WBC count is common, while development of leucopenia is rare after thiopentone barbiturate coma. Regular monitoring of WBC counts is recommended.

The serological profile of early-onset and persisting post-cardiac surgery thrombocytopenia complicated by “true” heparin-induced thrombocytopenia

2012 ◽  
Vol 107 (05) ◽  
pp. 998-1000 ◽  
Author(s):  
Jane C. Moore ◽  
Susan Vogel ◽  
Jo-Ann I. Sheppard ◽  
Nathan I. Warkentin ◽  
John W. Eikelboom ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Early Onset ◽  
Heparin Induced Thrombocytopenia ◽  
Serological Profile ◽  
Post Cardiac Surgery

A Silk Purse from a Sow's Ear?

PEDIATRICS ◽  
1981 ◽  
Vol 68 (2) ◽  
pp. 305-306
Author(s):  
James K. Todd
Keyword(s):  
Blood Cell ◽  
Study Design ◽  
White Blood Cell ◽  
Viral Illness ◽  
Prior Literature ◽  
Object Lesson ◽  
Wbc Count

In the 1970s it became axiomatic that a manuscript discussing the value of the white blood cell (WBC) count and differential would be an object lesson in flawed study design and inaccurate interpretation of prior literature. Somehow I always seem to get dragged into the argument with the mistaken impression that I feel, as misquoted by Dr Karniski, that a "CBC could accurately distinguish between any child with bacteremia and a child with a viral illness."

scholarly journals Cutoff Value for Correcting White Blood Cell Count for Nucleated Red Blood Cells: What is it? Why is it Important?

2019 ◽  
Vol 50 (4) ◽  
pp. e82-e90 ◽  
Author(s):  
Benie T Constantino ◽  
Gilbert Keith Q Rivera
Keyword(s):  
Blood Cell ◽  
Red Blood Cells ◽  
White Blood Cell ◽  
Blood Cells ◽  
Leukocyte Count ◽  
Nucleated Red Blood Cells ◽  
Cutoff Values ◽  
Long Time ◽  
Wbc Count ◽  
Manual Correction

Abstract Nucleated red blood cells (RBCs) are normally observed in the peripheral blood of neonates and during pregnancy. Under other conditions, the presence of nucleated RBCs in circulating blood indicates disorder in the blood-producing mechanism. The increased presence of nucleated RBCs, however, falsely elevates the leukocyte count, as measured by most automated hematology analyzers, warranting a manual correction of the leukocyte count. For a long time, cutoff values for correcting white blood cell (WBC) count for the presence of nucleated RBCs have been used regularly, particularly in developing countries. However, because those values are largely subjective, they can vary widely between laboratories worldwide. These varied cutoff values include 1, 5, 10, 20, and 50; it appears that the numbers 5 and 10 are the most common values used in corrections; the reasons require further elucidation. In this article, we discuss the merits of correcting the WBC count for nucleated RBCs at certain cutoff points.

Impact of white blood cell count on clinical outcomes in patients treated with aspirin-free ticagrelor monotherapy after percutaneous coronary intervention: insights from the GLOBAL LEADERS trial

2020 ◽  
Author(s):  
Masafumi Ono ◽  
Mariusz Tomaniak ◽  
Wolfgang Koenig ◽  
Ramzi Khamis ◽  
Ranil de Silva ◽  
...  
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Blood Cell ◽  
White Blood Cell ◽  
Primary Endpoint ◽  
Coronary Intervention ◽  
Open Label ◽  
Experimental Strategy ◽  
Percutaneous Coronary ◽  
Wbc Count ◽  
Reference Strategy

Abstract Aims The aim of this study was to investigate the efficacy and safety of ticagrelor monotherapy in patients undergoing percutaneous coronary intervention (PCI) stratified according to the baseline white blood cell (WBC) count. Methods and results This is a post hoc analysis of the GLOBAL LEADERS trial, a multi-centre, open-label, randomized all-comer trial in patients undergoing PCI, comparing the experimental strategy (23-month ticagrelor monotherapy following 1-month dual anti-platelet therapy [DAPT]) with the reference strategy (12-month aspirin monotherapy following 12-month DAPT). Patients were stratified into two WBC groups, either &lt; or ≥median WBC count of 7.8 × 109 cells/L (lower or higher WBC group, respectively). The primary endpoint was a composite of all-cause mortality or new Q-wave myocardial infarction at 2 years. Of 14 576 patients included in the present study, 7212 patients (49.5%) were classified as the lower WBC group, who had a significantly lower risk of both ischaemic and bleeding outcomes at 2 years. At 2 years, the experimental strategy was associated with a significant lower incidence of the primary endpoint compared with the reference strategy in the lower WBC group [2.8% vs. 4.2%; hazard ratio (HR): 0.67; 95% confidence interval (CI): 0.52–0.86] but not in the higher WBC group (4.8% vs. 4.7%; HR: 1.01; 95% CI: 0.82–1.25; Pinteraction=0.013). There were no significant differences in the risks of Bleeding Academic Research Consortium type 3 or 5 bleeding between two anti-platelet strategies regardless of the WBC groups. Conclusion Increased WBC counts, which may reflect degree of inflammation, at the time of index procedure may attenuate the anti-ischaemic benefits of ticagrelor monotherapy observed in patients with lower WBC counts.

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