The atypical lymphocyte count: a novel predictive factor for severe thrombocytopenia related to dengue

2020 ◽  
Vol 114 (6) ◽  
pp. 424-432
Author(s):  
Visula Abeysuriya ◽  
Clarice Shi Hui Choong ◽  
Basuru Uvindu Thilakawardana ◽  
Primesh de Mel ◽  
Malka Shalindi ◽  
...  
Keyword(s):  
Platelet Count ◽  
Predictive Factor ◽  
Lymphocyte Count ◽  
Characteristic Curve ◽  
Dengue Infection ◽  
Severe Dengue ◽  
Full Blood Count ◽  
Severe Thrombocytopenia ◽  
Atypical Lymphocyte ◽  
Predictive Values

Abstract Background Early identification of patients at risk of severe dengue disease (DD) is critical to guide its management. We evaluated whether the atypical lymphocyte count (ALC), generated from the Sysmex automated full blood count analyzer, is predictive of severe thrombocytopenia secondary to Dengue infection. Methods We prospectively collected data on patients admitted with DD between December 2017 and October 2018. ALC data were extracted from the Sysmex XS500i analyzer from day 1 to day 7 of admission. Clinical data were obtained from patients' medical records. Results We enrolled 256 patients with DD. A negative correlation between ALC on admission and platelet count on day 5 to day 7 (Spearmen's correlation; day 5:-0.485, day 6:-0.428 and day 7:-0.344) (p=0.001) was observed. Based on receiver operator characteristic curve analysis, we found that an ALC of >0.5x103/L had 90% sensitivity and 70% specificity for severe thrombocytopenia (platelet count <50x109/L) on day 5. The positive and negative predictive values were 74.4 and 91.2%, respectively (power 84.7). Conclusions We propose that ALC on admission may be a novel negative predictive factor for severe thrombocytopenia on day 5 to day 7 of DD. Further studies are required to validate our findings and evaluate whether ALC is predictive of other complications of DD.

scholarly journals PS1289 THE ATYPICAL LYMPHOCYTE COUNT: A NOVEL PREDICTIVE FACTOR FOR SEVERE DENGUE INFECTION

HemaSphere ◽  
2019 ◽  
Vol 3 (S1) ◽  
pp. 589-590
Author(s):  
V. Abeysuriya ◽  
C. Choong ◽  
S. de Mel ◽  
B.U. Thilakawardana ◽  
P. de Mel ◽  
...  
Keyword(s):  
Predictive Factor ◽  
Lymphocyte Count ◽  
Dengue Infection ◽  
Severe Dengue ◽  
Atypical Lymphocyte

Is there any association between body mass index and severity of dengue infection?

2021 ◽  
Author(s):  
Mohd Syis Zulkipli ◽  
Sanjay Rampal ◽  
Awang Bulgiba ◽  
Devi Peramalah ◽  
Nor'Ashikin Jamil ◽  
...  
Keyword(s):  
Body Mass Index ◽  
Platelet Count ◽  
Dengue Fever ◽  
Body Mass ◽  
Dengue Infection ◽  
Mixed Effects ◽  
Warning Signs ◽  
Severe Dengue ◽  
Full Blood Count ◽  
Response Analysis

Abstract Background Dengue, an acute infectious disease caused by a flavivirus, is a threat to global health. There is sparse evidence exploring obesity and the development of more severe dengue cases in adults. With increasing prevalence of obesity in areas with a high risk of dengue infection, obesity may increase the burden and mortality related to dengue infection. Our study aimed to determine the association between obesity and the development of more severe dengue infection in primary healthcare settings and whether these associations were modified by dengue fever phase. Methods A cohort study was conducted among laboratory-confirmed dengue patients aged >18 y in the central region of Peninsular Malaysia from May 2016 to November 2017. We collected demographic, clinical history, physical examination and laboratory examination information using a standardized form. Dengue severity (DS) was defined as either dengue with warning signs or severe dengue. Participants underwent daily follow-up, during which we recorded their vital signs, warning signs and full blood count results. Incidence of DS was modeled using mixed-effects logistic regression. Changes in platelet count and hematocrit were modeled using mixed-effects linear regression. The final multivariable models were adjusted for age, gender, ethnicity and previous dengue infection. Results A total of 173 patients were enrolled and followed up. The mean body mass index (BMI) was 37.4±13.75 kg/m2. The majority of patients were Malay (65.9%), followed by Chinese (17.3%), Indian (12.7%) and other ethnic groups (4.1%). A total of 90 patients (52.0%) were male while 36 patients (20.8%) had a previous history of dengue infection. BMI was significantly associated with DS (adjusted OR=1.17; 95% CI 1.04 to 1.34) and hematocrit (%) (aβ=0.09; 95% CI 0.01 to 0.16), but not with platelet count (x103/µL) (aβ=−0.01; 95% CI −0.84 to 0.81). In the dose response analysis, we found that as BMI increases, the odds of DS, hematocrit levels and platelet levels increase during the first phase of dengue fever. Conclusion Higher BMI and higher hematocrit levels were associated with higher odds of DS. Among those with high BMI, the development of DS was observed during phase one of dengue fever instead of during phase two. These novel results could be used by clinicians to help them risk-stratify dengue patients for closer monitoring and subsequent prevention of severe dengue complications.

The Prognostic Significance of Established Hematological Parameters and Inflammatory Biomarkers in Assessing Dengue Infection Severity and Progression among Patients Ages 5 to 14 in a Tertiary Government Hospital in Pampanga, Philippines

2021 ◽  
Vol 156 (Supplement_1) ◽  
pp. S103-S104
Author(s):  
J R Cai ◽  
I B Camacho ◽  
E M Caras ◽  
J A Carayugan ◽  
K H Carmona ◽  
...  
Keyword(s):  
Lymphocyte Count ◽  
Hematological Parameters ◽  
Dengue Infection ◽  
Prognostic Significance ◽  
Absolute Lymphocyte Count ◽  
Warning Signs ◽  
Inflammatory Biomarkers ◽  
Severe Dengue ◽  
Predictive Values ◽  
Lymphocyte Ratio

Abstract Introduction/Objective Dengue virus (DENV) is an arthropod-borne virus which imposes a significant burden on the health system in most tropical and subtropical countries. In 2009, WHO classified Dengue into Dengue Without Warning Signs (DNWS), Dengue With Warning Signs (DWWS), and Severe Dengue (SD). This study aims to establish the prognostic value of predetermined hematological parameters and inflammatory biomarkers in assessing severity and progression of dengue infection among ages 5-14. Methods/Case Report A retrospective study was conducted to evaluate the Complete Blood Count, Inflammation biomarkers, and severity of dengue patients (5-14 of age). The diagnosis must be serologically confirmed by a positive NS1/IgM. Results (if a Case Study enter NA) A total of 36 patients participated in the study, having 18 from each groups of DWWS and SD. The mean age of Dengue cohort was 13.9 years with 59% (19/36) being male. Laboratory findings reveal SD to have lower platelet count (<100.00x109/L) during day 1-3 (p<0.001). Low WBC count (<4.00x109/L), Relative Eosinophil (<2.00%), and Absolute Lymphocyte count (<1.52x109/L) were evident on days 1-3 among DWWS and SD cases (p=0.023; p=0.045; p=0.033). Low relative neutrophil (<0.45%) was a constant finding in both clinical types throughout disease progression. SD group had significantly higher Neutrophil to Lymphocyte ratio (NLR) values among SD cases on days 4-6 (p<0.001). In contrast, Platelet to Lymphocyte ratio (PLR) was significantly lower among DWWS cases on days 4-6 (p=0.020). Monocyte to Lymphocyte (MLR) ratio had poor discriminative power (p=0.560). Conclusion The findings highlight decreased platelet, WBC, relative eosinophil, and absolute lymphocyte count to be common among Dengue patients. NLR and PLR were found to be good predictors of dengue severity during the initial phase of infection. Evaluating these values may aid clinicians in early diagnosis of severe dengue. However, larger samples are needed to further validate the predictive values of these parameters.

scholarly journals Can serum ferritin levels predict the severity of dengue early?: an observational study

2019 ◽  
Vol 7 (3) ◽  
pp. 876
Author(s):  
Velammal Petchiappan ◽  
Thaha Mohammed Hussain ◽  
Saravanan Thangavelu
Keyword(s):  
Platelet Count ◽  
Clinical Practice ◽  
Observational Study ◽  
Hospital Stay ◽  
Serum Ferritin ◽  
Early Recognition ◽  
Dengue Infection ◽  
Elevated Serum ◽  
Severe Dengue ◽  
Elderly Subjects

Background: Dengue infection is a major public health threat; early recognition is crucial to improve the survival in severe dengue. Although there are various biomarkers to predict the severity of dengue, they are not routinely used in clinical practice for prognostication. We analyzed whether serum ferritin can be used to predict the severity at an earlier stage.Methods: A hospital based prospective observational study was done involving 119 dengue cases diagnosed by positive NS1 antigen or dengue specific serology (capture ELISA). Serum ferritin was measured in all at the time of diagnosis. Clinical and platelet count monitoring was done daily; classified as severe and non-severe according to 2009 WHO criteria.Results: Out of 119, 5 developed severe dengue; patients with severe dengue had significantly lower median platelet count (p<0.0001); higher ferritin levels (p=0.03) and hospital stay (p<0.0001) than non-severe group. Age had a significant negative co-relation with platelet count (r= -0.427; p<0.0001); positive correlation with ferritin levels (r=0.16; p=0.08) and hospital stay (r= 0.26; p=0.004) indicating that elderly subjects are at risk of severe disease. Serum ferritin levels negatively correlated with the platelet count (r= -0.51 p<0.001). High ferritin levels in severe cases are noted from day 4 of clinical illness.Conclusions: Elevated serum ferritin levels can be used as a potential early prognostic marker to predict the severity of dengue infection in clinical practice.

scholarly journals Dengue Fever: Clinical, Laboratory Profile and Outcome in Pediatric Patient

2022 ◽  
Vol 6 (1) ◽  
Author(s):  
Pooja Gandhi ◽  
Pinkal Taral ◽  
Krunal Patel ◽  
Sanketsinh Rathod ◽  
Bhavini Rathwa
Keyword(s):  
Platelet Count ◽  
Dengue Virus ◽  
Dengue Fever ◽  
Care Center ◽  
Dengue Infection ◽  
Tertiary Care ◽  
Clinical Profile ◽  
Severe Dengue ◽  
Diverse Range ◽  
Laboratory Profile

Introduction: Infection with any of the 4 dengue virus serotypes results in a diverse range of symptoms, from mild undifferentiated fever to life-threatening hemorrhagic fever and shock. Given that dengue virus infection elicits such a broad range of clinical symptoms, early and accurate laboratory diagnosis is essential for appropriate patient management. So a study was carried out to know its clinical profile, correlation between the laboratory profile and the severity of dengue fever and outcome in dengue patients. Aim: To study the clinical profile, correlation between the laboratory profile and the severity of dengue fever and outcome in dengue patients at tertiary care center. Method: Retrospective Observational study from 1st May 2019 to 31st April 2021. Result: Total 323 patients were studied during 1st May 2019 to 31st April 2021. Most common presentation was fever (100%), most common clinical finding is hepatomegaly (14.2%). All severe dengue infection has platelet count < 50000/cumm. In study of 323 patients 194(60%) of dengue fever,85(26.4%) of DHF GRADE 1,9(2.8%) of DHF GRADE 2 were discharged .13(4%) patients of DSS were expired.22 patients (6.8%) went DAMA. Conclusion: Reliable diagnosis of dengue fever in endemic areas can be done by clinical parameters like presence of nausea, vomiting, pain abdomen and hepatomegaly. Monitoring platelet count, hematocrit and WBC count is very useful for management of dengue cases. Keywords: dengue fever, platelet count, outcome

Myelodysplasia Following Therapy with Tumour Necrosis Factor-alpha (TNF α) Inhibitors - An Uncommon Occurence.

Blood ◽  
2006 ◽  
Vol 108 (11) ◽  
pp. 4844-4844
Author(s):  
Anil V. Kamat ◽  
Raphael Ezekwesili ◽  
Yasser El-Miedany
Keyword(s):  
Bone Marrow ◽  
Platelet Count ◽  
Tumour Necrosis Factor ◽  
Neutrophil Count ◽  
Lymphocyte Count ◽  
Tumour Necrosis ◽  
Blood Count ◽  
Full Blood Count ◽  
Tnf Α ◽  
Necrosis Factor

Abstract Introduction-Tumour necrosis factor- alpha (TNF α) inhibitors such as infliximab & etanercept have various applications such as severe rheumatoid arthritis, seronegative spondyloarthritis, vasculitis, crohn’s disease & psoriasis. There have been few reports of haematological complications arising in patients treated with anti-TNF a therapies. There has been only one reported case of development of acute myeloid leukaemia after initiation of etanercept therapy. Case report-A 57year old gentleman with HLA B27 negative ankylosing spondylitis presented with chest infection. His full blood count showed Hb 5.9 g/l WBC 3.8 × 10^9/L Neutrophil count 2.7 × 10^9/L Lymphocyte count 0.7 × 10^9/L Platelet count 89 × 10^9/L & Reticulocyte count 21 × 10^9/L. Occasional myeloblasts were seen on the blood film. He had been on biological therapy for ankylosing spondylitis with infliximab 5mg/kg infusion on 8 weekly basis for 18 months which was stopped due to lack of efficacy. Subsequently he had been treated with etanercept 50 mg subcutaneous once weekly for the past 16 weeks prior to this presentation. His full blood count prior to initiation of infliximab & etanercept was Hb 11.6 g/l WBC 16 × 10^9/L Neutrophil count 12.8 × 10^9/L Lymphocyte count 2.1 × 10^9/L Platelet count 655 × 10^9/L and Hb 11.0 g/l WBC 8.2 × 10^9/L Neutrophil count 4.9 × 10^9/L Lymphocyte count 2.4 × 10^9/L Platelet count 591 × 10^9/L, respectively. He underwent bone marrow investigations. Bone marrow aspirate was aparticulate with dyshaemopoeisis. Dyserythropoeisis in form of irregular nuclei, occasional binucleated cells & delayed nucleo-cytoplasmic maturation was seen along with dysmyelopoeisis in form of binucleated cells & pelger forms. Blasts amounted to 14% of nucleated cells. Overall, impression was in keeping with refractory anemia with excess of blasts (RAEB-2). Trephine biopsy showed mildly hypocellular bone marrow with markedly disordered haemopoeisis. There was trilineage dysplasia with abundant micromegakaryocytes with immunocytochemistry for CD117 showing increased number of progenitors (10–20%). The appearances were in keeping with myelodysplasia with excess of CD117 positive progenitors. Cytogenetic study failed. The sepsis responded to broad spectrum antibiotics but he continues on red cell & platelet support on a weekly basis. Conclusion The chronology points to a TNF α inhibitor mediated effect in this patient. Despite the close temporal association between exposure to TNF α inhibitor therapy and the presentation of myelodysplasia in this patient, a causal relationship cannot be established with confidence. Tumour necrosis factor inhibitors find wide applications in inflammatory conditions with high TNF. Such treatment may be associated with uncommon complications. It is of interest to note there are ongoing trials using TNF α inhibitors in myelodysplastic syndrome. Checking a full blood count periodically, and immediately if the patient is unwell is recommended.

scholarly journals Atypical lymphocyte count correlates with the severity of dengue infection

PLoS ONE ◽  
2019 ◽  
Vol 14 (5) ◽  
pp. e0215061 ◽  
Author(s):  
Choong Shi Hui Clarice ◽  
Visula Abeysuriya ◽  
Sanjay de Mel ◽  
Basuru Uvindu Thilakawardana ◽  
Primesh de Mel ◽  
...  
Keyword(s):  
Lymphocyte Count ◽  
Dengue Infection ◽  
Atypical Lymphocyte

scholarly journals Clinico-laboratory profile and outcome of dengue fever among children attending a tertiary care hospital of rural Telangana, India

2020 ◽  
Vol 7 (2) ◽  
pp. 382 ◽  
Author(s):  
V. Shekar ◽  
K. Praveen Kumar ◽  
C. Soren ◽  
K. Venkataramana Reddy ◽  
N. Dharani
Keyword(s):  
Dengue Fever ◽  
Tertiary Care Hospital ◽  
Early Recognition ◽  
Dengue Infection ◽  
Tertiary Care ◽  
Warning Signs ◽  
Severe Dengue ◽  
Severe Thrombocytopenia ◽  
Care Hospital ◽  
Presenting Symptoms

Background: Dengue is a self-limiting, vector-borne disease transmitted by Aedes mosquito, causing a major public health threat globally. The objective of this study is to assess the clinical profile and outcome of the dengue infection in children less than 14 years of age September 2018 to August 2019 at the Pediatric Department of S.V.S. Medical College, the tertiary care hospital in Mahabubnagar, Telanagana.Methods: Prospective study of 82 hospitalized children of <14 years with the diagnosis of dengue illness. Children with diagnosis of dengue were classified further in to two groups as per WHO guidelines, Non-severe dengue fever (probable dengue, dengue with warning signs) and ‘Severe Dengue’ (Dengue Haemorrhagic Fever and/or Dengue Shock Syndrome (DHF/DSS). A separate questionnaire form used for documenting clinical history, laboratory parameters. Haematological parameters were noted, chest x-ray, ultra-sonogram in required cases was done. Children were managed as per WHO protocol. The outcomes of the cases were mentioned as discharge, left against medical advice and death.Results: A total of 82 children with dengue were divided in to 55(67%) non severe dengue and 27(33%) severe dengue with males 56(68.2%) and females 26(31.7%). The most common age of presentation was between 6-10 years 34(41.5%). Fever 73(89%) was the most common presenting symptoms. Pleural effusion and hepatomegaly were the commonest clinical findings 28(34.1%) each, which were more among the severe dengue patients. Gall bladder edema 29(35.3%) was the most common ultra-sonogram finding. Significant elevation of transaminases (SGOP, SGPT) was seen in 39(47.5%). Severe thrombocytopenia was observed in 22(26.8%) children. Management was by administration of colloids and crystalloids.Conclusions: Dengue is a global problem. Presenting features include high grade fever, vomiting, abdominal pain, skin rash. Early recognition of symptoms and proper management can reduce the mortality.

scholarly journals Correlation of thrombocytopenia with degree of atypical lymphocytosis as a prognostic indicator in dengue

2017 ◽  
Vol 5 (9) ◽  
pp. 4041 ◽  
Author(s):  
Anagha A. Joshi ◽  
Gayathri B. R. ◽  
Swathi Kulkarni
Keyword(s):  
Early Diagnosis ◽  
Viral Infections ◽  
Prognostic Indicator ◽  
Health Concern ◽  
Severe Dengue ◽  
Differential Count ◽  
Severe Thrombocytopenia ◽  
Atypical Lymphocyte ◽  
Male Predominance ◽  
Platelet Counts

Background: Dengue viral infections may occur as epidemics and are of public health concern in India especially due to high mortality in advanced stages. Early diagnosis and treatment reduces the mortality significantly. To assess the utility of atypical lymphocyte counts with relation to platelet counts as a marker for severe dengue.Methods: A total of 132 serologically proven (by rapid card method) cases of dengue with atypical lymphocytosis (≥10%) and thrombocytopenia (<150×109/l) were analyzed during November 2016. The complete blood counts (obtained from automated hematology analyzer and Leishman stained peripheral smears) were analyzed.Results: Dengue infections were mostly seen in younger age (12-25 years) with slight male predominance. The relevant haematology findings noted were leukopenia in 36% and severe thrombocytopenia (<50×109/l) in 57% of cases. The differential count showed lymphocytosis in 64% with significant (≥20%) atypical lymphocytes in 52% which inversely correlated with platelet counts. Atypical lymphocytosis (≥20%) was noted in 9% of cases with mild as against 32% of severe thrombocytopenia.Conclusions: Atypical lymphocyte count can be used as predictor of severe thrombocytopenia and severe dengue. This helps in early diagnosis and proper management and drastic reduction in mortality.

scholarly journals Immature platelet fraction in children infected with dengue fever

2018 ◽  
Vol 6 (1) ◽  
pp. 5
Author(s):  
Amrutha B. S. ◽  
Adarsh E. ◽  
SreeKrishna Y. ◽  
Apoorva Naidu ◽  
Shivtej N.
Keyword(s):  
Platelet Count ◽  
Platelet Transfusion ◽  
Dengue Infection ◽  
Fatal Outcome ◽  
Rapid Identification ◽  
Reference Intervals ◽  
Severe Dengue ◽  
P Value ◽  
Reticulated Platelets ◽  
Immature Platelet Fraction

Background: Millions are infected with dengue every year.  Early diagnosis of dengue infection is important for proper treatment of DHF and DSS to avoid fatal outcome. Thrombocytopenia is a common hematological abnormality in dengue, which demands platelet transfusion in most of the severe dengue cases. Platelet transfusion though life-saving has its own hazards. Hence, we can use some new parameter like immature platelet fraction (IPF) which is a measure of reticulated platelets that reflects the rate of thrombopoiesis. The risk of platelet transfusion may be decreased by rapid identification of immature platelet fraction. This study was performed to establish reference of IPF values for the assessment of thrombopoiesis.Methods: Blood samples from 150 children were obtained on day of illness 3, 5 and 7. The IPF is identified by sysmex XE2100 hematology analyser in the reticulocyte channel using a fluorescent dye and a carefully designed gating system and counted by a special software termed IPF master7. IPF values against platelet count were assessed separately on day 3, 5 and 7.Results: The reference intervals of IPF > 8 % and IPF < 8 % were assessed against platelet count. Increase in IPF favored increase in platelet count on day 5 which was statistically significant with the p value <0.001.Conclusions: A rapid and inexpensive automated measurement of IPF can be integrated as a standard parameter to evaluate the thrombopoietic state of the bone marrow. From the study it can be concluded that IPF is an important predictor of increase in platelet count.  Increase in IPF>8 % suggests that platelet count will be increased in next 24 to 48hrs indicating that further blood transfusion will not be required.

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