Expected White Blood Cell Counts and Differentials in a Rat Model of Peritoneal Dialysis

Objective The purpose of this study was to establish baseline dialysate white blood cell (WBC) counts and differentials in noninfected rats on peritoneal dialysis (PO). Design Sixteen male Sprague-Oawley rats underwent PO in the first protocol, and eight from the 16 continued PO in the second through fourth protocols. At the beginning of the experiments, all animals had a PO catheter implanted and were initiated on PO with 1.5% dextrose dialysis solution twice daily. In the first protocol, WBC counts and differentials were assessed from day 4 to day 15 of dialysis in noninfected animals to establish “normal values” for such a rat model. In protocol 2, WBC counts and solute concentrations in small aliquots of dialysate obtained from the catheter were compared to values in well-mixed total drainage. Protocol 3 was designed to assess effects of dwell time on WBC counts. Protocol 4 examined the effect of glucose concentration of dialysis solution on WBC counts. Results In the first protocol, the mean dialysate WBC counts were significantly higher on the fourth day of dialysis, but stabilized below 2500 cells/mm3 by the eighth day. The percentage of neutrophils was stable around 20% -25%. In the second protocol, we found aliquots < 1 mL might underestimate the dialysate WBC count compared to the complete drainage. In the third protocol, WBC counts increased as cycle time became longer, but the percentage of neutrophils remained below 50%. In the fourth protocol, we did not find any effects of glucose concentration of instilled solutions on WBC counts and differentials. Conclusion This study of WBC counts and differentials in noninfected rats on peritoneal dialysis establishes the range above which infection should be suspected. WBC counts increase with cycle time. Small dialysate aliquots may underestimate WBC counts. Glucose concentration does not effect WBC counts.

Download Full-text

The Frequency of White Blood Cell and Temperature Events During Mechanical Ventilation and Their Association With Ventilator-Associated Events

Journal of Intensive Care Medicine ◽

10.1177/0885066615605036 ◽

2015 ◽

Vol 32 (4) ◽

pp. 273-277

Author(s):

Hawa Edriss ◽

Jeremy Whiting ◽

Kenneth Nugent

Keyword(s):

Blood Cell ◽

White Blood Cell ◽

Patient Characteristics ◽

Median Number ◽

Normal Range ◽

Cell Counts ◽

Medical Intensive Care ◽

White Blood Cell Counts ◽

Wbc Count ◽

Control Criteria

Background: Changes in white blood cell (WBC) counts and/or temperature could have important implications in patients on ventilators, but the frequency of these events is uncertain. Methods: We reviewed the medical records from 281 ventilation episodes in our medical intensive care unit to determine patient characteristics and the indications for ventilation. We determined the number of days during each ventilation episode in which the temperature (<96.8°F, >100.4°F) or WBC count (<4000/µL, >12 000/µL) was out of the normal range. Results: This study included 257 patients with a mean Acute Physiology and Chronic Health Evaluation 2 score of 13.5 ± 5.9 and a mean initial Pao2/Fio2 of 210 ± 110. The median number of ventilator days was 4 (interquartile range, 3-9). One hundred ninety-six of 275 eligible ventilator episodes (71.3%) had 1 or more temperature events, and 194 of 253 eligible ventilator episodes (76.7%) had 1 or more WBC events. Nineteen patients met the Center for Disease Control criteria for a ventilator-associated event (VAE). Twelve patients had an increased WBC count during the VAE period, and 11 had an increased temperature during this period. Conclusions: White blood cell counts and temperature events occur frequently in patients on ventilators and need evaluation but do not reliably identify patients with ventilator-associated complications.

Download Full-text

GMA161 Treatment of Refractory ITP: Efficacy of Fcγ-RIII Blockade.

Blood ◽

10.1182/blood.v108.11.1074.1074 ◽

2006 ◽

Vol 108 (11) ◽

pp. 1074-1074 ◽

Cited By ~ 3

Author(s):

James B. Bussel ◽

Vivek Patel ◽

Cynthia Dunbar ◽

Stephen Lemery ◽

Krista Tibbs ◽

...

Keyword(s):

Blood Cell ◽

White Blood Cell ◽

Platelet Counts ◽

Cell Counts ◽

Blood Cell Counts ◽

White Blood Cell Counts ◽

Repeated Dosing ◽

Wbc Count ◽

Moderate Nausea ◽

Refractory Itp

Abstract Background: GMA161 is a humanized version of a monoclonal anti-Fcγ-RIII antibody, 3G8, that was in clinical trial in the second half of the 1980s. Infusion of 25 mg of 3G8 (0.25–0.5mg/kg) resulted in transient but dramatic responses in approximately 50% of refractory ITP patients who did not respond to IVIG. It was unclear why certain patients did not respond. Since 3G8 is a mouse monoclonal antibody, it could not be reinfused because of the development of HAMA. Furthermore, there was marked neutropenia and depletion of NK cells (the CD16-expressing leukocytes) and there were significant fever-chill-vomiting reactions that were triggered by the antibody-Fcγ-RIII interaction. Preventing the reactions required a cocktail of methylprednisolone, diphenhydramine, acetaminophen and metaclopramide. GMA161, in addition to being humanized, has the Fc portion denuded of carbohydrates to reduce the binding of its Fc portion to Fc receptors. Methods: The first cohort of 4 patients with chronic ITP (table) and platelet counts < 30,000/ul each received a single infusion of 0.1 mg/kg of GMA161 over 30 minutes. Results: Two of the 4 patients responded with peak platelet counts of 108,000/ul (from 27,000/ul) and 45,000/ul (from 11,000/ul) [figure 1]. Both had had ITP for > 20 years, failed splenectomy and also failed multiple previous therapies including rituximab, cyclophosphamide, steroids, danazol, and IVIg among others. The responses to GMA161 were short-lived, lasting between 7 and 10 days and, as shown in figure 1, the platelet counts peaked at slightly different times. Figure 2 illustrates the dramatic decrease in the WBC count occurring immediately after infusion but then rapidly returning to baseline; this decrease was apparent in all types of white cells, not just neutrophils. The first patient had marked chills, fever, and vomiting 2 hours after infusion; this was reminscent of reactions to 3G8. She received IV methylprednisolone with resolution. The second patient had mild-moderate nausea. The third and fourth patients received acetaminophen, diphenhydramine and ondansetron premedication and had no adverse events. Conclusions: The findings are exciting because this cohort received the starting (lowest) dose of GMA161, 0.1mg/kg, and yet had reasonable activity. The toxicity was minimal with appropriate premedication. In the next cohort, better responses may be anticipated since they will be receiving 0.3 mg/kg. The hope would be that repeated dosing might have a more lasting effect, in at least a subset of patients. GMA161: Cohort #1 Patient ID Age (yrs) Sex Splenectomy Duration of Disease (ITP) Months Major Bleeding Major Diagnoses Previous Treatments #1 29 Female Yes 90 No Anemia 7 #2 32 Female Yes No #3 70 Male Yes 300 No Diabetes 4 #4 59 Female Yes 120 Yes (ICH) Stroke/Asthma 6 Figure 1: Platelet counts of Responders to GMA 161 treatment Figure 1:. Platelet counts of Responders to GMA 161 treatment Figure 2: Mean White Blood Cell Counts of patients treated with GMA 161 Figure 2:. Mean White Blood Cell Counts of patients treated with GMA 161

Download Full-text

White Blood Cell Counts, Alcoholism, and Cirrhosis in Pneumococcal Pneumonia

Open Forum Infectious Diseases ◽

10.1093/ofid/ofx034 ◽

2017 ◽

Vol 4 (2) ◽

Cited By ~ 2

Author(s):

Julianna G. Gardner ◽

Divya R. Bhamidipati ◽

Adriana M. Rueda ◽

Duc T. M. Nguyen ◽

Edward A. Graviss ◽

...

Keyword(s):

Blood Cell ◽

White Blood Cell ◽

Pneumococcal Pneumonia ◽

Medical Center ◽

Alcohol Ingestion ◽

Characteristic Finding ◽

Cell Counts ◽

Blood Cell Counts ◽

White Blood Cell Counts ◽

Wbc Count

Abstract Background An elevated white blood cell (WBC) count is a characteristic finding in pneumococcal pneumonia. Very low WBC counts, occurring in some cases, are often associated with overwhelming pneumonia and have been attributed to alcohol-induced suppression of bone marrow. However, a systematic study of neutropenia, leukocytosis, alcohol ingestion, and cirrhosis in pneumococcal pneumonia has not been previously reported. Methods Using a database of patients with pneumococcal pneumonia at our medical center, we extracted data on WBC counts at admission, differential counts, alcohol ingestion, and cirrhosis, and we related these to 7-day and 30-day mortality. Results White blood cell counts were <6000/mm3 in 49 of 481 patients (10.2%) with pneumococcal pneumonia and >25000/mm3 in 40 (8.3%). Mortality at 7 days was 18.4% and 12.5%, respectively, 5-fold and 3-fold greater in patients with WBC <6000 or >25000 than in those with WBC counts between 6000 and 25000 (P < .001). Increased band forms were not associated with a worse outcome (P = .12). Alcohol use and cirrhosis were not associated with WBC counts <6000 (P = .63 and P = .41, respectively). Conclusions In a large series of cases of pneumococcal pneumonia, WBC counts <6000 or >25000 correlated significantly with increased 7-day mortality. More than 10% band forms was not associated with a poor outcome. Alcohol abuse was not associated with low WBC or increased mortality. Our findings suggest that greater consideration be given to more intense care for patients with bacterial pneumonia who have very high or very low WBC counts at the time of hospital admission.

Download Full-text

An Alternative Elastase-mediated Degradation of Fibrinogen and Fibrin Observed in a Patient with Herpes Simplex Encephalitis and Pneumonia

Thrombosis and Haemostasis ◽

10.1055/s-0038-1650550 ◽

1996 ◽

Vol 76 (02) ◽

pp. 184-186 ◽

Cited By ~ 2

Author(s):

Kenji lijima ◽

Fumiyo Murakami ◽

Yasushi Horie ◽

Katsumi Nakamura ◽

Shiro Ikawa ◽

...

Keyword(s):

Herpes Simplex ◽

Blood Cell ◽

White Blood Cell ◽

Herpes Simplex Encephalitis ◽

Pmn Elastase ◽

Cell Counts ◽

Blood Cell Counts ◽

Sds Page ◽

White Blood Cell Counts ◽

Pmn Élastase

SummaryA 74-year-old female developed pneumonia following herpes simplex encephalitis. Her white blood cell counts reached 28,400/μl, about 90% of which consisted of granulocytes. The polymorphonuclear (PMN) elastase/α1-arantitrypsin complex levels increased and reached the maximum of 5,019 ng/ml, indicating the release of a large amount of elastase derived from the granulocytes. The mechanism of PMN elastase release was most likely to be granulocyte destruction associated with phagocytosis. The cleavage of fibrinogen and fibrin by PMN elastase, independent of plasmin, was indicated by the presence of the fragments in immunoprecipitated plasma from the patient corresponding to elastase-induced FDP D and DD fragments and the absence of fragments corresponding to plasmin-induced FDP D and DD fragments on SDS-PAGE. These findings suggested that the large amount of PMN elastase released from the excessive numbers of granulocytes in this patient with herpes simplex encephalitis and pneumonia, induced the cleavage of fibrinogen and fibrin without the participation of plasmin.

Download Full-text

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

Angiology ◽

10.1177/00033197211021199 ◽

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.

Download Full-text