scholarly journals Hematologic changes after splenectomy for ovarian cancer debulking surgery, and association with infection and venous thromboembolism

2020 ◽  
Vol 30 (8) ◽  
pp. 1183-1188
Author(s):  
Olga T Filippova ◽  
Sun Woo Kim ◽  
Renee A Cowan ◽  
Andrew J Chi ◽  
Alexia Iasonos ◽  
...  
Keyword(s):  
Ovarian Cancer ◽  
Venous Thromboembolism ◽  
Blood Cell ◽  
Cell Count ◽  
Median Time ◽  
White Blood Cell Count ◽  
White Blood Cell ◽  
Blood Cell Count ◽  
Infection Group ◽  
Second Peak

IntroductionThe spleen plays a role in the immune and coagulative responses, yet a splenectomy may be required during ovarian cancer surgery to achieve complete cytoreduction. The aim of the study was to correlate hematologic changes with the development of infection and venous thromboembolism in patients undergoing splenectomy.MethodsThis single-institution retrospective review includes all patients undergoing splenectomy during cytoreductive surgery for advanced ovarian cancer, March 2001 to December 2016. We compared postoperative hematologic changes (evaluated daily before discharge) in patients developing infection within 30 days' post-surgery (Infection group) with those who did not (No-Infection group). We also compared patients developing venous thromboembolism with those without.ResultsA total of 265 patients underwent splenectomy. Median age was 64 years (range 22–88): 146 (55%) patients had stage IIIC and 114 (43%) patients had stage IV. The majority, 201 (76%) patients underwent splenectomy during primary debulking. A total of 132 (50%) patients comprised the Infection group (most common: urinary tract infection, 54%). Median time from surgery to infection was 8 days (range, 0–29). After initial rise in white blood cell count in both groups, the Infection group had a second peak on postoperative day 10 (median 16.6K/mcL, IQR 12.5–21.2) not seen in the No-Infection group (median 12K/mcL, IQR 9.3–16.3). A total of 40 (15%) patients developed venous thromboembolism, median time of 6.5 days (range, 1–43). All patients demonstrated a continuous rise in platelets during postoperative days 0–15. Thrombocytosis was present in 38/40 (95%) patients with venous thromboembolism vs 183/225 (81%) patients without (P=0.036). Median days with thrombocytosis was higher in venous thromboembolism (8 days, range 1–15) vs non groups (6 days, range 1–16, P=0.049).ConclusionWe identified initial leukocytosis after splenectomy in all patients. The Infection group had a second peak in white blood cell count on postoperative day 10, not present in the No-Infection group. Among patients with venous thromboembolism, thrombocytosis was more frequent and of longer duration.

Diagnostic value of post-operative platelet-to-white blood cell ratio after splenectomy in patients with advanced ovarian cancer

2019 ◽  
Vol 29 (8) ◽  
pp. 1292-1297 ◽  
Author(s):  
Konstantinos Lathouras ◽  
Georgios Panagakis ◽  
Sarah Joanne Bowden ◽  
Konstantinos Saliaris ◽  
Srdjan Saso ◽  
...  
Keyword(s):  
Ovarian Cancer ◽  
Platelet Count ◽  
Blood Cell ◽  
Cell Count ◽  
White Blood Cell Count ◽  
White Blood Cell ◽  
Predictive Value ◽  
Blood Cell Count ◽  
Cell Ratio ◽  
Grade Iii

IntroductionSplenectomy-induced thrombocytosis and leukocytosis may obscure the early diagnosis of post-operative infection or sepsis. In trauma patients after splenectomy, a platelet-to-white blood cell ratio of <20 has been shown to reliably differentiate post-operative sepsis from transient physiological responses.ObjectiveTo determine whether the platelet-to-white blood cell ratio can be applied to differentiate between reactive post-operative changes and latent infection.MethodsAll consecutive patients with ovarian cancer who underwent splenectomy between January 2013 and October 2018 in two large European gynecological cancer centers were retrospectively evaluated. Main outcome measures were white blood cell count, platelet count, and platelet-to-white blood cell ratio on post-operative days 1, 5, and 7. These were correlated with surgical outcome and morbidity according to the Clavien-Dindo classification. A binomial logistic regression was applied to assess the predictive value of day 5 platelet-to-white blood cell ratio, white blood cell count, and platelet count for predicting grade III post-operative sepsis.ResultsNinety-five patients with ovarian cancer (mean age 54 years, range 18–75) were identified. Seventeen patients (17.9%) developed a grade III post-operative sepsis. In all post-operative patients, mean white blood cell count on day 5 decreased (from 15.4×103/μL to 11.4×103/μL), while the mean platelet count rose (from 260.7×103/μL to 385.3×103/μL). A high platelet count (>313×103/μL) failed to show any predictive value (OR=0.94; 95% CI 0.30 to 3.0; p=0.921). A low platelet-to-white blood cell ratio (<26) (OR=3.49; 95% CI 1.18 to 10.32; p=0.0241) and high white blood cell count (>14.5×103/μL) on day 5 (OR=11.0; 95% CI 3.3 to 36.2; p<0.001) were significant for predicting sepsis. Despite a significant OR, the sensitivity and specificity were low; day 5 platelet-to-white blood cell ratio at a cut-off point of 26 achieved a sensitivity of 72% and specificity of 53% (area under the curve 0.637, 95% CI 0.480 to 0.796) in predicting grade III post-operative sepsis.ConclusionsPlatelet-to-white blood cell ratio after cytoreductive surgery for ovarian cancer with splenectomy does not appear to have a strong predictive value in differentiating between sepsis and reactive splenectomy-induced changes. Leukocytosis, in combination with clinical assessment, may remain the most useful tool for prediction of sepsis after cytoreductive surgery with splenectomy.

SDF1 Plasma Levels and CD34+ Cells Recirculation After Autologous Peripheral Blood Stem Cell Transplant.

Blood ◽  
2009 ◽  
Vol 114 (22) ◽  
pp. 4571-4571
Author(s):  
Nicola Piccirillo ◽  
Giuseppe Ausoni ◽  
Silvia De Matteis ◽  
Luca Laurenti ◽  
Patrizia Chiusolo ◽  
...  
Keyword(s):  
Stem Cell ◽  
Blood Cell ◽  
Cell Count ◽  
Median Time ◽  
White Blood Cell Count ◽  
White Blood Cell ◽  
Plasma Levels ◽  
Conditioning Regimen ◽  
Blood Cell Count ◽  
Cxcr4 Axis

Abstract Abstract 4571 The chemokine stromal-cell derived factor-1alpha (SDF1) is the major chemotactic stimulus for human hematopoietic stem cell (HSC) and through its receptor CXCR4 is critically involved in directional migration and homing of hematopoietic progenitors and stem cells. Usually HSC mobilization is achieved after a proteolytic disruption of SDF1-CXCR4 axis after G-CSF administration. Several report showed HSC circulating during early post transplant phase but the mechanism of recirculation is not clear. Based on these premises we studied the role of SDF1 during autologous peripheral blood stem cell transplant (aPBSCT) and its relations with recirculating HSC and G-CSF administration. From January 2009 to July 2009 we enrolled 12 patients undergoing aPBSCT for hematologic malignancies or solid tumors: 7 males, 5 females, with a median age of 60 years, affected by multiple myeloma (6 patients), Non Hodgkin's lymphoma (5 patients) and Ewing's sarcoma (1 patient). After conditioning regimen (6 Busulfan and Melphalan, 6 High Dose Melphalan) they received a median of 7.56 ×106/kg cell CD34+ on day 0 and, subsequently early (day +1) or delayed (day +6) G-CSF administration. SDF1 was assayed in plasma samples collected at baseline, on day 0,2,6,8,10,12 after aPBSCT using an immunoenzymatic technique. Characteristics of patients of two groups are shown in table 1. There was no statistical difference in CD34+ cell dose infused. All patients achieved engraftment: neutrophil recovery (PMN count >500 cells/microL) was achieved after a median time of 11 days; platelet recovery (Plt>50×103/microL) after a median time of 14 days; patients were discharged after a median time of 20.5 days. CD34+ cells after transplant were detectable on day +10 (9.06 cells/microL) achieving peak level on day +12 (21.69 cells/microL) confirming timing and magnitude of this phenomenon. SDF1 assay showed a decrease in concentration from the baseline to hematopoietic engraftment: 2278.3 pg/ml (range 1799.1-3619.6) at baseline and 1850.1 pg/ml on day +12 (range 564.4-2551.7). This decrease in concentration was statistically significant (p=0.0094) and was chronologically related to engraftment ad CD34+ recirculation. We found a statistically significant negative correlation between SDF1 plasma levels and CD34+ cell count after aPBSCT: r=-0.957, p0.043. Interestingly we found a negative correlation between SDF1 plasma levels and white blood cell count starting from day +6 to day +12 (r=-0.91, p=0.03). This finding was confirmed by a positive correlation between SDF1 plasma levels on day +6 and time to achieve a PMN count >500 cells/microL: r=0.67, p=0.01 (Figure 1). The correlations found between SDF1 plasma levels and kinetics of engraftment suggested us to compare engraftment of patients on the base of SDF1 plasma levels. Interestingly patients showing SDF1 plasma levels <2300 pg/ml on day +6 (8 patients) compared to patients with higher levels (4 patients) had a faster PMN recovery in terms of days to achieve a PMN count >500 cells/microL (10.5 days vs 16.5 days, p=0.043), days to achieve a PMN count >1000 cells/microL (11 days vs 18 days, p=0.044) and days with a PMN count <100 cell/microL (5 days vs 12 days, p=0.02). Interestingly taking in to account G-CSF administration schedule, the significant decrease of SDF1 plasma levels observed in whole group of patients was noticed only in patients receiving delayed G-CSF. Patients receiving early G-CSF administration showed small variation of chemochine concentration confirming the key role of G-CSF in perturbing SDF1-CXCR4 axis. In conclusion our data confirm the involvement of SDF1-CXCR4 axis in post transplant CD34+ recirculation. SDF1 decrease with subsequent CD34+ release may represent a key mechanism to explain repopulation of hematopoietic stem cell niche after myeloablation induced by conditioning regimen. Furthermore there was a clear relation between SDF1 plasma levels and kinetic of engraftment. Table 1: Characteristics of patients Number of patients 12 sex 7 male; 5 female age 60 years (range 26-65) diagnosis A Group
 5 NHL
 1 ES B Group
 6 MM conditioning regimen BuMel HdMel G-CSF starting day +1 +6 CD34+x106/kg cells infused 7.56 (range 3.1-16.6) Legend: NHL Non Hodgkin's Lymphoma; ES: Ewing's Sarcoma; MM: Multiple Myeloma; BuMel: Busulfan and Melphalan; HdMel:High Dose Melphalan Figure 1: White blood cell count, neutrophil count and SDF1 assay after transplant. Figure 1:. White blood cell count, neutrophil count and SDF1 assay after transplant. Disclosures: No relevant conflicts of interest to declare.

scholarly journals White Blood Cells and Severe COVID-19: A Mendelian Randomization Study

2021 ◽  
Vol 11 (3) ◽  
pp. 195
Author(s):  
Yitang Sun ◽  
Jingqi Zhou ◽  
Kaixiong Ye
Keyword(s):  
Blood Cell ◽  
Cell Count ◽  
White Blood Cell Count ◽  
White Blood Cell ◽  
Blood Cells ◽  
Mendelian Randomization ◽  
Association Studies ◽  
White Blood Cells ◽  
Genome Wide Association Studies ◽  
Blood Cell Count

Increasing evidence shows that white blood cells are associated with the risk of coronavirus disease 2019 (COVID-19), but the direction and causality of this association are not clear. To evaluate the causal associations between various white blood cell traits and the COVID-19 susceptibility and severity, we conducted two-sample bidirectional Mendelian Randomization (MR) analyses with summary statistics from the largest and most recent genome-wide association studies. Our MR results indicated causal protective effects of higher basophil count, basophil percentage of white blood cells, and myeloid white blood cell count on severe COVID-19, with odds ratios (OR) per standard deviation increment of 0.75 (95% CI: 0.60–0.95), 0.70 (95% CI: 0.54–0.92), and 0.85 (95% CI: 0.73–0.98), respectively. Neither COVID-19 severity nor susceptibility was associated with white blood cell traits in our reverse MR results. Genetically predicted high basophil count, basophil percentage of white blood cells, and myeloid white blood cell count are associated with a lower risk of developing severe COVID-19. Individuals with a lower genetic capacity for basophils are likely at risk, while enhancing the production of basophils may be an effective therapeutic strategy.

Identifying Top Predictors of Change in Noncalcified Coronary Burden in Psoriasis by Machine Learning Over 1-Year

2021 ◽  
pp. 247553032110007
Author(s):  
Eric Munger ◽  
Amit K. Dey ◽  
Justin Rodante ◽  
Martin P. Playford ◽  
Alexander V. Sorokin ◽  
...  
Keyword(s):  
Machine Learning ◽  
Blood Pressure ◽  
Blood Cell ◽  
Cell Count ◽  
White Blood Cell Count ◽  
White Blood Cell ◽  
Severity Index ◽  
Blood Cell Count ◽  
Psoriasis Area Severity Index ◽  
Severity Index Score

Background: Psoriasis is associated with accelerated non-calcified coronary plaque burden (NCB) by coronary computed tomography angiography (CCTA). Machine learning (ML) algorithms have been shown to effectively identify cardiometabolic variables with NCB in cross-sectional analysis. Objective: To use ML methods to characterize important predictors of change in NCB by CCTA in psoriasis over 1-year of observation. Methods: The analysis included 182 consecutive patients with 80 available variables from the Psoriasis Atherosclerosis Cardiometabolic Initiative, a prospective, observational cohort study at baseline and 1-year using the random forest regression algorithm. NCB was assessed at baseline and 1-year from CCTA. Results: Using ML, we identified variables of high importance in the context of predicting changes in NCB. For the cohort that worsened NCB (n = 102), top baseline variables were cholesterol (total and HDL), white blood cell count, psoriasis area severity index score, and diastolic blood pressure. Top predictors of 1-year change were change in visceral adiposity, white blood cell count, total cholesterol, c-reactive protein, and absolute lymphocyte count. For the cohort that improved NCB (n = 80), the top baseline variables were HDL cholesterol related including apolipoprotein A1, basophil count, and psoriasis area severity index score, and top predictors of 1-year change were change in apoA, apoB, and systolic blood pressure. Conclusion: ML methods ranked predictors of progression and regression of NCB in psoriasis over 1 year providing strong evidence to focus on treating LDL, blood pressure, and obesity; as well as the importance of controlling cutaneous disease in psoriasis.

scholarly journals Enoxaparin-induced reactive thrombocytosis: a case report

2021 ◽  
Vol 19 (1) ◽  
Author(s):  
Tao Xiang ◽  
Ming Cheng
Keyword(s):  
Molecular Weight ◽  
Platelet Count ◽  
Blood Cell ◽  
Cell Count ◽  
White Blood Cell Count ◽  
White Blood Cell ◽  
Hip Replacement ◽  
Low Molecular Weight ◽  
Blood Cell Count ◽  
Reactive Thrombocytosis

Abstract Background Enoxaparin is an anticoagulant that falls in the class of medications called low molecular weight heparins (LMWHs), and is used to prevent or treat patients with deep vein thrombosis (DVT) and pulmonary embolism. Enoxaparin is the most widely used LMWH for DVT prophylaxis following knee or hip replacement surgery. Common side effects of enoxaparin include bleeding, petechiae at the injection site, and thrombocytopenia. However, reactive thrombocytosis is a rarely reported adverse reaction. We managed a patient who developed enoxaparin-associated thrombocytosis, which was completely resolved after treatment cessation. Case presentation A 78-year-old female was hospitalized for post-hip replacement rehabilitation. Low molecular weight heparin 40 mg/day was administered subcutaneously to prevent deep venous thrombosis (DVT). At admission, her platelet count was normal (228 × 109/L) and her white blood cell count was slightly elevated (12.91 × 109/L). Seven days after admission, the patient developed thrombocytosis, which peaked on the 14th day (836 × 109/L), while her white blood cell count had returned to normal (8.86 × 109/L). Her therapeutic regimen was reviewed, and enoxaparin was identified as a potentially reversible cause of reactive thrombocytosis. Switching from enoxaparin to rivaroxaban lead to a gradual decrease in the patient’s platelet count, which eventually returned to normal levels 16 days after enoxaparin was discontinued. No complications secondary to thrombocytosis was observed, and no conclusion was reached on the use of small doses of aspirin for antithrombotic therapy under these circumstances. Conclusion Enoxaparin-induced reactive thrombocytosis should be suspected in patients with thrombocytosis following enoxaparin administration as an anticoagulant to prevent certain complications.

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