scholarly journals The Restrictive Type, Infectious Complications, a Long Duration of Illness Might Predict Nadir Hematological Values Among Individuals With Anorexia Nervosa During the Refeeding Period: A Retrospective Study

2021 ◽  
Author(s):  
Michitaka Funayama ◽  
Akihiro Koreki ◽  
Yu Mimura ◽  
Taketo Takata ◽  
Satoyuki Ogino ◽  
...  
Keyword(s):  
Anorexia Nervosa ◽  
Platelet Count ◽  
Cell Count ◽  
Infectious Complications ◽  
Blood Cell Count ◽  
Duration Of Illness ◽  
Long Duration ◽  
Hematological Abnormalities ◽  
Restrictive Type ◽  
Hematological Values

Abstract BackgroundAlthough hematological abnormalities in patients with anorexia nervosa have been documented, the mechanisms involved have not been fully clarified, especially during the refeeding period, when hematological values further decrease after admission prior to improving. Here we address potential mechanisms underlying the hematological abnormalities of anorexic inpatients during the refeeding period.MethodsWe recruited patients from 101 admissions corresponding to 55 individual patients with anorexia nervosa with severe malnutrition (body mass index, 13.4 ± 3.4) from the neuropsychiatry unit in Ashikaga Red Cross Hospital during the period from October 1999 to March 2018. We analyzed three hematological cell measures (hemoglobin, white blood cells, platelets) to determine their levels at admission and their lowest levels during the refeeding period and calculated the rate of decrease in those values from admission to the nadir levels. We analyzed each measure using a general mixed model with explanatory variables, including data upon admission and a treatment-related indicator. ResultsThe initial hemoglobin value of 12.1 ± 2.7 g/dl decreased by 22.3% to 9.4 ± 2.5 g/dl; the initial white cell count was 5387 ± 3474/μl, which decreased by 33.6% to 3576 ± 1440/μl; the initial platelet count of 22.6 ± 10.1 ×104/μl decreased by 24.3% to 17.1 ± 8.0 ×104/μl. All nadir levels were observed during the refeeding period from the fifth to tenth day of hospitalization. The anorexia nervosa restrictive type was associated with a lower nadir level of hemoglobin and white blood cell count. Infectious complications were related to a lower nadir level of hemoglobin and platelet count. A longer duration of illness was associated with a lower nadir white blood cell count. ConclusionsNadir hematological cell measures of inpatients with anorexia nervosa during the refeeding period might be predicted by the restrictive type, infectious complications, and a long duration of illness. These factors might be used as indicators to guide clinical approaches for controlling hematological deficiencies during the refeeding period.

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.

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.

scholarly journals Reference Ranges for Hematological Values in Umbilical Cord Blood in Pokhara, Nepal

2016 ◽  
Vol 36 (2) ◽  
pp. 160-164 ◽  
Author(s):  
Sahisnuta Basnet ◽  
Sandip Kumar Singh ◽  
Brijesh Sathian ◽  
Rajnish Mishra
Keyword(s):  
Blood Cell ◽  
Cord Blood ◽  
Cell Count ◽  
Umbilical Cord ◽  
Umbilical Cord Blood ◽  
Blood Count ◽  
Complete Blood Count ◽  
Reference Ranges ◽  
Blood Cell Count ◽  
Hematological Values

Correction: Due to an error in loading the metadata, the author Sahisnuta Basnet was omitted. Sahisnuta Basnet was therefore added to the metadata on 9th January 2017. The PDF was correct.Introduction: Reference hematological values in newborns are informative in evaluation of newborns to determine state of health or disease. For a given population, reference values may differ in accordance with various factors such as age, sex, race, diet, drug intake, altitude, socio-economic status and also the method employed for determination of the values. The aim of this study was to establish reference ranges of complete blood count using umbilical cord blood of normal, healthy, full term neonates born in Manipal Teaching Hospital (MTH), Pokhara, Nepal.Material and Method: The study was conducted in 210 full term, healthy newborns delivered in MTH between Jan 2014 to Feb 2015. Cord blood was collected and a complete blood count was obtained using an automated hematology analyzer.Result: Mean hemoglobin was 15.24 ± 1.96 gm/dl and mean red blood cell count was 4.30 ± 0.63 (range 3.05 – 6.36) X 1012/L. Mean white blood cell count was 14.93 ± 4.44 (range 6.10 ± 31.7) X 109/L and platelet count was 226.88 ± 61.28 (range 105 ± 392) X 109/L. There was no significant difference found in hemoglobin, red cell, white cell and platelet counts between males and females in this study.Conclusion: The values obtained from our study provide ranges for some hematological values in healthy newborns of Pokhara Nepal. However, the hematological reference values for Nepalese cord blood needs to be confirmed by larger numbers of samples from different centers of Nepal.J Nepal Paediatr Soc 2016;36(2):160-164.

Management and Outcome in Anorexia Nervosa

1983 ◽  
Vol 143 (3) ◽  
pp. 282-287 ◽  
Author(s):  
H. G. Morgan ◽  
Joan Purgold ◽  
Jill Welbourne
Keyword(s):  
Anorexia Nervosa ◽  
Evaluation Procedure ◽  
Factors Associated ◽  
Poor Outcome ◽  
Duration Of Illness ◽  
Long Duration ◽  
Special Clinic ◽  
Chronic Morbidity

SummaryThe outcome of 78 patients with anorexia nervosa treated in a special clinic is described, using a standardized follow-up technique. The findings are compared with two previous studies which utilized an identical evaluation procedure. Certain predictors of poor outcome already identified by previous studies (long duration of illness before referral, previous personality problems, difficulties in relationship between family and patient) are confirmed. The findings suggest that early intervention may be an important component of effective treatment. The possible advantages of long term continuity of outpatient care are also discussed and the need for careful scrutiny of criteria for hospital admission emphasized.It is concluded that chronic morbidity due to anorexia nervosa represents an important topic for further research. There is need for further identification of factors associated with chronicity, some of which may be secondary repercussions of the illness itself, and prospective evaluation of treatment programmes which focus on predictors of poor outcome.

Hydroxyurea in essential thrombocythemia: rate and clinical relevance of responses by European LeukemiaNet criteria

Blood ◽  
2010 ◽  
Vol 116 (7) ◽  
pp. 1051-1055 ◽  
Author(s):  
Alessandra Carobbio ◽  
Guido Finazzi ◽  
Elisabetta Antonioli ◽  
Alessandro M. Vannucchi ◽  
Giovanni Barosi ◽  
...  
Keyword(s):  
Platelet Count ◽  
Blood Cell ◽  
Cell Count ◽  
White Blood Cell Count ◽  
White Blood Cell ◽  
Essential Thrombocythemia ◽  
Complete Response ◽  
Blood Cell Count ◽  
Predictors Of Response ◽  
Definition Of

Abstract A definition of response by cytoreductive therapy in essential thrombocythemia was recently provided by the European LeukemiaNet (ELN). Complete, partial, or no clinicohematologic responses were defined on the bases of platelet count, disease-related symptoms, spleen size, and white blood cell count. To provide estimates and clinical correlation of responses according to these criteria, we retrospectively examined 416 essential thrombocythemia patients treated with hydroxyurea for at least 12 months. Complete response, partial response, and no response were 25%, 58%, and 17%, respectively. Age more than 60 years and JAK2V617F mutation were significant predictors of response. After a median follow-up of 3.9 years, we registered 23 deaths, 16 hematologic transformations, and 27 thrombotic events (rate, 1.66% patients/year). Age, previous thrombosis, leukocytosis (white blood cell count > 10 × 109/L), but not ELN responses, were independently associated with higher risk of thrombosis. The actuarial probability of thrombosis was significantly influenced by leukocytosis (P = .017) and not by platelet count, indicating that platelet number does not seem of prime relevance in the definition of ELN response.

scholarly journals Altered Haematological Variables of Pre-Eclamptic Patients in University of Calabar Teaching Hospital, Nigeria

2021 ◽  
Vol 6 (3) ◽  
pp. 56-64
Author(s):  
Stella B. Egbe ◽  
Patience A. Akpan ◽  
Euphoria C. Akwiwu ◽  
Josephine O. Akpotuzor
Keyword(s):  
Blood Pressure ◽  
Platelet Count ◽  
Blood Cell ◽  
Pregnant Women ◽  
Cell Count ◽  
Teaching Hospital ◽  
Haemoglobin Concentration ◽  
Blood Cell Count ◽  
Corpuscular Haemoglobin ◽  
Mean Corpuscular Haemoglobin

Pre-eclampsia is a gestational complication with immense outcomes on foetal/ infant and maternal health. This study assessed haematological variables of pre-eclamptic pregnant women receiving antenatal care at University of Calabar Teaching Hospital (UCTH), Calabar. Following due ethical considerations, 90 subjects aged 18-45 years were enrolled. They comprised 30 pre-eclamptic patients admitted into the antenatal ward, UCTH; 30 pregnant women with no medical condition attending antenatal clinic, UCTH and 30 apparently healthy non-pregnant women of same age range as control subjects. Weight, height and blood pressure were measured while a pre-tested structured questionnaire was used to obtain demographic data. Packed cell volume (PCV), haemoglobin (HB), red blood cell count (RBC), mean corpuscular volume (MCV), mean corpuscular haemoglobin (MCH), mean corpuscular haemoglobin concentration (MCHC), white blood cell count (WBC) with differentials, platelet count and mean platelet volume (MPV) were determined using Sysmex Haematology autoanalyzer (Sysmex, Japan). Significantly lower (p<0.05) PCV, HB, MCV and platelet count were recorded among pre-eclamptic patients compared to the pregnant and non-pregnant controls. Conversely, body mass index, blood pressures, MCHC, WBC and MPV of pre-eclamptic patients were significantly higher (p<0.05) compared to pregnant and non-pregnant controls. There were also significant differences (p<0.05) in RBC and differential white cell count among the three groups. Also, we observed appearance of protein in urine associated with increased blood pressure. It is concluded that haematological changes occur in pre-eclampsia and these changes reflect the bodys response to systemic inflammation induced by pregnancy and amplified by the presence of hypertension.

Successful Treatment of Refractory Idiopathic Aplastic Anemia with Rituximab

Blood ◽  
2008 ◽  
Vol 112 (11) ◽  
pp. 4114-4114
Author(s):  
Sreedhar Katragadda ◽  
John C Nelson
Keyword(s):  
Bone Marrow ◽  
Platelet Count ◽  
Blood Cell ◽  
Aplastic Anemia ◽  
Cell Count ◽  
Absolute Neutrophil Count ◽  
Neutrophil Count ◽  
Red Blood Cell ◽  
Antithymocyte Globulin ◽  
Blood Cell Count

Abstract We report the first case of refractory idiopathic aplastic anemia who responded to Rituximab (anti-CD 20 monoclonal antibody). The patient is a 22 year old Hispanic male construction worker who presented with a two week history of weakness, dyspnea on exertion and gum bleeding was found to have a platelet count of 11 × 109/L, hemoglobin of 7.4 g/dL, and white blood cell count of 1.6 × 109/L with 30% neutrophils. A bone marrow biopsy showed hypocellular marrow with relative lymphocytosis of mixed B and T cells and a normal chromosome analysis. A paroxysmal nocturnal hemoglobinuria (PNH) panel was negative. Serological studies did not show any evidence of HBV, HCV, CMV or EBV infection, but did show previous infection with parvo B19. He was initially treated with horse antithymocyte globulin (ATG) at a dose of 40 mg/kg for four days and cyclosporine. After ten weeks of treatment he was still requiring weekly packed red blood cell and platelet transfusions and G-CSF support. At that time he was treated with rabbit antithymocyte globulin and cyclosporine was continued. He had a partial recovery with absolute neutrophil count remaining mostly above 1 × 109/L, but he was still requiring red blood cell and platelet transfusions with baseline hemoglobin of 6 gm/dL and platelet count of less than 20 × 109/L. A bone marrow biopsy done ten weeks after the rabbit ATG treatment showed hypocellular marrow (20% cellularity) with trilineage hematopoiesis, with no evidence of dysplasia. Due to his transfusion dependence after eight months from his rabbit ATG treatment, he received Rituximab at a dose of 375 mg/m2 weekly for four weeks. He had a dramatic improvement of hemoglobin to 11.5 gm/dL and white blood cell count to 3.5 × 109/L, with an absolute neutrophil count of 2 × 109/L, although his platelet count remained at 20 × 109/L. He remains transfusion independent for a follow-up period of 8 months after the Rituximab treatment. Review of literature showed partial to good responses with Rituximab in aplastic anemia patient who refused treatment with ATG and cyclosporine (Hansen PB et al), aplastic anemia associated with CLL (Bharwani L et al), severe aplastic anemia induced by fludarabine and cyclophosphamide in a patient with B-CLL (Castiglioni MG et al) and, refractory Diamond-Blackfan anemia (Morimoto A et al).

Severe Thrombocytopenia Associated with Alatrofloxacin

2000 ◽  
Vol 34 (3) ◽  
pp. 330-334 ◽  
Author(s):  
Barry J Gales ◽  
Laurie B Sulak
Keyword(s):  
Native American ◽  
Platelet Count ◽  
Blood Cell ◽  
Cell Count ◽  
Time Course ◽  
American Woman ◽  
Drug Discontinuation ◽  
Severe Thrombocytopenia ◽  
Blood Cell Count ◽  
Normal White Blood Cell

OBJECTIVE: To report the development of severe thrombocytopenia during alatrofloxacin therapy. CASE SUMMARY: A 54-year-old Native American woman was admitted for pneumonia after completing a 10-day course of loracarbef 200 mg po bid. On admission, the woman was hypoxic (PO2 56 mm Hg) and had a platelet count of 408 times 103/mm3. Alatrofloxacin 300 mg iv piggyback qd was initiated in the emergency department. The patient's condition gradually improved during the next three days. While preparing for discharge on hospital day 4, the patient developed epistaxis that lasted approximately three hours. Laboratory testing revealed a platelet count of 7 times 103/mm3; stable red blood cell count, hemoglobin, and hematocrit values; and a normal white blood cell count. Alatrofloxacin therapy was discontinued and azithromycin was initiated on hospital day 4. Methylprednisolone 125 mg iv piggyback every 12 hours was initiated on hospital day 5. The platelet count fell to 2 times103/mm3 on hospital day 5 and then began to rise, reaching 60 times 103/mm3 when the patient was discharged on hospital day 8. DISCUSSION: Numerous infectious, disease-related, environmental, and pharmacologic factors may cause thrombocytopenia. Drug-induced thrombocytopenia usually develops during the first two weeks of therapy and resolves within one week of drug discontinuation. Thrombocytopenia occurred in <1% of more than 7000 patients receiving alatrofloxacin or trovafloxacin during clinical trials. CONCLUSIONS: The time course of this patient's development of and recovery from thrombocytopenia suggests that it was induced by alatrofloxacin. Clinicians should monitor patients receiving alatrofloxacin or trovafloxacin for signs and symptoms of bleeding and thrombocytopenia.

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