Standard values of the white blood count with regard to breed, sex, age and season

Background: In middle-income countries, malnutrition concentrates in marginalized populations with a lack of effective preventive strategies. Objective: Identify risk factors for undernutrition in a peri-urban Ecuadorian community of children aged 12 to 59 months. Methods: Data from a cross-sectional survey in 2011 of children 1 to 5 years were analyzed including demographic data, medical history and examination, food frequency questionnaire (FFQ), anthropometric measurements, and blood for complete blood count, C-reactive protein, vitamin A, iron, and zinc levels. Dietary Diversity Score (DDS) was calculated from FFQ. Bivariate and multivariate analysis assessed effects on primary outcome of undernutrition by DDS, vitamin deficiencies, and demographic and nutritional data. Results: N = 67, 52.2% undernourished: 49.3% stunted, 25.4% underweight, and 3% wasted; 74.6% (n = 50) were anemic and 95.1% (n = 39) had low serum zinc. Dietary Diversity Score was universally low (mean 4.91 ± 1.36, max 12). Undernutrition was associated with lower vitamin A levels (20 306, IQR: 16605.25-23973.75 vs 23665, IQR: 19292-26474 ng/mL, P = .04); underweight was associated with less parental report of illness (43.8%, n = 7 vs 80% n = 40, P = .005) and higher white blood count (13.7, IQR: 11.95-15.8 vs 10.9, IQR: 7.8-14.23 × 109/L, P = .02). In multiple regression, risk of undernutrition decreased by 4% for every $10 monthly income increase (95 CI%: 0.5%-7.4%, P = .02, n = 23); risk of underweight decreased by 0.06 for every increased DDS point (adjusted odds ratio: 0.06; 95 CI%: 0.004-0.91, P = .04, n = 23). Conclusions: In this peri-urban limited resource, mostly Indigenous Ecuadorian community, stunting exceeds national prevalence, lower monthly income is the strongest predictor of undernutrition, lower DDS can predict some forms of undernutrition, and vitamin deficiencies are associated with but not predictive of undernutrition.

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Massive Eosinophilic Reaction to Desipramine in Conjunction with Pneumonia*

The Canadian Journal of Psychiatry ◽

10.1177/070674378402900212 ◽

1984 ◽

Vol 29 (2) ◽

pp. 142-144 ◽

Cited By ~ 5

Author(s):

R.P. Kraus ◽

R.J. Clarke ◽

R.A. Remick

Keyword(s):

Affective Disorder ◽

Female Patient ◽

Blood Count ◽

Bipolar Affective Disorder ◽

Dry Mouth ◽

White Blood Count ◽

Medication Change ◽

Supportive Management

The authors report on a female patient with bipolar affective disorder who presented with marked eosinophilia in conjunction with pneumonia five days after a medication change from amitriptyline to desipramine (for intolerable dry mouth). She improved with discontinuance of medications and supportive management, and her eosinophilia normalized. Reinstitution of desipramine was followed by prompt appearance of asymptomatic eosinophilia, which resolved with discontinuation of desipramine. A subsequent depression managed with amitriptyline was followed by no abnormal white blood count findings. Eosinophilia is occasionally encountered in imipramine or desipramine therapy and, although usually asymptomatic, appears to be manageable by switching to amitriptyline or nortriptyline.

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P5610Inflammatory response after ExoVasc personalized external aortic root support (PEARS) procedure in patients with Marfan syndrome or non-Marfan genetic aortopathy

European Heart Journal ◽

10.1093/eurheartj/ehz746.0554 ◽

2019 ◽

Vol 40 (Supplement_1) ◽

Author(s):

R Kockova ◽

J Maly ◽

A Krebsova ◽

M Labos ◽

J Pirk

Keyword(s):

Aortic Root ◽

Hospital Readmission ◽

Blood Count ◽

White Blood Count ◽

Recurrent Fever ◽

C Reactive Protein ◽

Recurrent Pericarditis ◽

Reactive Protein ◽

Aortic Root Surgery ◽

St Elevation

Abstract Background External aortic root support (PEARS) is a novel prophylactic aortic root surgery. Purpose The study aimed to determine the severity of inflammatory response after the personalized external aortic root support (PEARS) procedure in comparison to after the standard prophylactic aortic root surgery (SPARS). Materials and methods The study was a single-centre, retrospective, based on hospital record analysis of patients who underwent the PEARS procedure (PEARS group) or SPARS (SPARS group) during 1998–2017. C-reactive protein (CRP), white blood count (WBC), and echocardiography were routinely obtained. Fever was defined as body temperature ≥38°C. Diagnosis of pericarditis included a minimum of three signs from chest pain, pericardial effusion, ST elevation, elevated CRP, and body temperature. Results PEARS and SPARS groups consisted of 13 and 14 patients, respectively, scheduled for prophylactic aortic root surgery. A majority of patients in both groups had Marfan syndrome with causal mutation in the fibrillin 1 (FBN1) gene (62% vs 79%). Patient baseline characteristics were similar in the two groups, except aortic root was significantly larger in the SPARS group than in the PEARS group (60±12 mm vs 48±5 mm; P=0.003). All surgical procedures were successful and without major complications. The peak values of CRP and WBC were significantly higher in the PEARS group (264.5±84.4 mg/L vs 184.6±89.6 mg/L; P=0.034 and 15.2±3.8 109/L vs 11.9±3.3 109/L; P=0.029). Early and recurrent fever requiring hospital readmission was significantly more frequent in the PEARS group (77% vs 36%; P=0.032 and 46% vs 7%; P=0.020). Early and recurrent pericarditis requiring hospital readmission was also more frequent in the PEARS group (31% vs 0%; P=0.024 and 31% vs 0%; P=0.024). Inflammatory characteristics Postprocedural inflammatory characteristics PEARS group SPARS group P value (N=13) (N=14) Peak level of CRP (mg/L) 264.5±84.4 184.6±89.6 0.034 Peak WBC (109/L) 15.2±3.8 11.9±3.3 0.029 ST elevation (N) 11 (85) 6 (43) 0.024 Early fever (N) 10 (77) 5 (36) 0.032 Recurrent fever (N) 6 (46) 1 (7) 0.020 Early pericarditis (N) 4 (31) 0 (0) 0.024 Recurrent pericarditis (N) 4 (31) 0 (0) 0.024 CRP, C-reactive protein; WBC, white blood count. Echocardiography-signs of inflammation Conclusions The PEARS procedure is an extremely promising surgical technique, but the postoperative inflammatory response occurs frequently and more severely in comparison to SPARS. Clearly, these findings warrant further investigation.

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246: Absence of Fever and Elevated White Blood Count Does Not Exclude the Diagnosis of Diverticulitis as Determined by CT in the Emergency Department

Annals of Emergency Medicine ◽

10.1016/j.annemergmed.2007.06.229 ◽

2007 ◽

Vol 50 (3) ◽

pp. S77

Author(s):

A.D. Mounday ◽

C. Aubin ◽

L. Lewis

Keyword(s):

Emergency Department ◽

Blood Count ◽

White Blood Count

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Acute myeloid leukaemia: an unusual cause of biliary strictures

BMJ Case Reports ◽

10.1136/bcr-2018-227821 ◽

2019 ◽

Vol 12 (3) ◽

pp. e227821

Author(s):

Adele Beck ◽

Hannah Hunter ◽

Simon Jackson ◽

David Sheridan

Keyword(s):

Bone Marrow ◽

Obstructive Jaundice ◽

Acute Myeloid Leukaemia ◽

Myeloid Leukaemia ◽

Blood Count ◽

Extrahepatic Bile Duct ◽

White Blood Count ◽

Full Blood Count ◽

Significant Past Medical History ◽

Acute Myeloid

A 17-year-old man with no significant past medical history presented with a 2-week history of worsening jaundice, lethargy, anorexia and progressive right upper quadrant abdominal pain. There were no stigmata of chronic liver disease. Initial investigations were suggestive of cholangitis with large intrahepatic and extrahepatic bile duct strictures but otherwise normal hepatic and splenic appearances. A percutaneous transhepatic cholangiogram with the positioning of drains was performed to alleviate the obstructive jaundice. Within 2 weeks of the first presentation, full blood count revealed a significantly raised white blood count and a subsequent peripheral blood smear and bone marrow were consistent with a diagnosis of acute myeloid leukaemia. Chemotherapy was started after partial improvement of his obstructive jaundice. Complete morphological and cytogenetic remission was obtained 4 weeks after the first cycle of chemotherapy (half dose of daunorubicin and full dose of cytarabine, treated off trial) on control bone marrow. The patient remains in remission.

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Are Fibrinogen and Complete Blood Count Parameters Predictive in Incarcerated Abdominal Hernia Repair?

International Surgery ◽

10.9738/intsurg-d-13-00107.1 ◽

2014 ◽

Vol 99 (6) ◽

pp. 723-728 ◽

Cited By ~ 4

Author(s):

Sahin Kahramanca ◽

Oskay Kaya ◽

Gulay Ozgehan ◽

Hakan Guzel ◽

Cem Azili ◽

...

Keyword(s):

Hernia Repair ◽

Blood Count ◽

Complete Blood Count ◽

Abdominal Hernia ◽

White Blood Count ◽

Morbidity Rate ◽

Distribution Width ◽

Diagnostic Role ◽

Elective Group ◽

Group B

Abstract Therapeutic delays in cases of external incarcerated hernias typically result in increasing morbidity, mortality, and health expenditures. We investigated the diagnostic role of blood fibrinogen level, white blood count (WBC), mean platelet volume (MPV), and platelet distribution width (PDW) in patients with incarcerated hernia. Two groups, each containing 100 patients, were studied. Group A underwent elective, and group B underwent incarcerated and urgent external hernia repair. We observed high fibrinogen and WBC levels but low MPV and PDW values for patients in group B. Contrary to our expectations, we found lower MPV and PDW values in the complicated group than in the elective group. The morbidity rate and cost burden were higher in group B, and the results were statistically significant. Early operation should be recommended for patients with incarcerated external hernias if their fibrinogen and WBC levels are high.

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Comparison of G-CSF Administration Starting Day +5 Versus Based on White Blood Count Following Autologous Peripheral Blood Stem Cell Transplantation.

Blood ◽

10.1182/blood.v104.11.5053.5053 ◽

2004 ◽

Vol 104 (11) ◽

pp. 5053-5053

Author(s):

Michael Craig ◽

Yuan Yao ◽

Solveig Ericson

Keyword(s):

Stem Cell ◽

Stem Cell Transplantation ◽

Hospital Stay ◽

Cell Transplantation ◽

Peripheral Blood ◽

Blood Count ◽

Peripheral Blood Stem Cell ◽

White Blood Count ◽

Autologous Pbsct ◽

Blood Stem Cell Transplantation

Abstract Granulocyte colony stimulating factor (G-CSF) is commonly used following autologous peripheral blood stem cell transplantation (PBSCT) to promote bone marrow recovery. However, the optimal timing of G-CSF in this setting is unknown. We randomized 23 patients undergoing autologous PBSCT for a variety of malignant disorders to G-CSF administration 5 μg/kg/day starting day +5 (Arm A) versus when white blood count (WBC) recovered to 0.2 x 109/L or 0.1 x 109/L for 2 consecutive days (Arm B). Results: All patients engrafted. The median time to absolute neutrophil count (ANC) > 1.0 x 109/L in Arms A and B was 12.1 vs. 12.8 days (p=0.77). There was no significant difference in number of days of temperature >38.3°C (4.3 vs. 4.4 days, p=0.71) or hospital stay (23.8 vs. 22.1 days, p=0.93) between Arms A and B respectively. The mean amount of G-CSF administered was 3210 μg/patient in Arm A vs. 2384 μg/patient in Arm B, a significant reduction (p=0.035). Conclusion: Waiting for early signs of engraftment after autologous PBSCT before starting G-CSF administration is associated with a decrease in amount of G-CSF administration by 25%, with no increase in days with fever, time to neutrophil recovery, or length of hospital stay.

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Automated Quantitative Assessment of Bone Marrow in Normal Samples: Correlation with the Reference Method.

Blood ◽

10.1182/blood.v106.11.4192.4192 ◽

2005 ◽

Vol 106 (11) ◽

pp. 4192-4192

Author(s):

Gina Zini ◽

Mariagrazia Garzia ◽

Antonella Di Mario ◽

Elena Rossi ◽

Giuliana Farina ◽

...

Keyword(s):

Bone Marrow ◽

Cell Count ◽

Blood Count ◽

Hematopoietic Cells ◽

Reference Method ◽

Mean Value ◽

White Blood Count ◽

Quantitative Detection ◽

Microscope Examination ◽

Age Related

Abstract Bone marrow (BM) analysis is conventionally performed by microscope examination on films of about 0.3ml of aspirated bone marrow fluid, stained with Romanowsky dyes. Until 1996 the simple automated screening of marrow composition was made very difficult by a number of factors, mainly the lack of the erythroblasts quantitation and the fat interference. From 1996 last generation automated hematology analyzers provide accurate and precise erythroblasts counts; moreover same systems have improved their software reducing the problem of fat interference. We have analyzed data from 100 normal BM samples from patients submitted for diagnostic and/or follow up purposes in our Hematology Day Hospital. BM fluid was harvested from the superior posterior iliac crest. The first 0,3–0.5 ml were used for smears, while the next 1–2 ml of BM, collected into K3-EDTA, were analysed with Coulter LH 750, a fully automated hematology analyzer which provides Complete Blood Count, White Blood Count Differential included Nucleated Red Blood Cells (NRBC) and Reticulocytes count. We used the microscope examination conventionally performed on films stained with Romanowsky dyes as reference method. Quantitative detection BM cellularity was obtained by semi quantitative evaluation based on the evaluation of hematopoietic cells in several marrow particles: physiological differences age related were also taken in account. If hematopoietic cells occupy less than 25% or more than 85% the sample is defined respectively hypocellular or hypercellular (none of our sample was as). Differential cell count was usually performed on two different slides counting 500 cells (1000 when hypercellular, but none of our sample was as). We found a strict correlation between microscope semi-quantitative cellularity evaluation and the instrumental cell count as sum of WBC plus NRBC, the Total Nucleted Cell Count (TNCC). The mean value of the TNCC in normal PM samples was 29,48 x109/L with a range 25,9–54,9 x109/L. These results are in good agreement with normal BM cell count reported in the literature using a cytofluorimetric method, which is 34,5 x109/L (SD28.0). The instrumental mean percentage of BM granulocytes corrected for TNNC was 62% (range: 23,5–93,7) versus a mean microscope percentage of 58,42% (range: 40–72). The automated NRBC BM count corrected for TNCC was 11,38% (range: 2,7 – 39,17) versus a microscopic mean value of 28% (range: 9–45). These results, including the slight NRBC underestimation probably due to partial mature cell lysis, are in line with the data of the literature. This study confirms the feasibility of routine automated cell count using a hematology in normal BM fluid samples. Automated methods will support morphologists quickly providing accurate and precise quantitative information such as TNCC and myeloid/erythroid ratio.

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The Expression and Clinical Significance of PRAME Gene in Acute Leukemia.

Blood ◽

10.1182/blood.v110.11.4225.4225 ◽

2007 ◽

Vol 110 (11) ◽

pp. 4225-4225

Author(s):

Rong Fu ◽

Kai Ding ◽

Zonghong Shao

Keyword(s):

Bone Marrow ◽

Acute Leukemia ◽

Clinical Significance ◽

Blood Count ◽

Mononuclear Cells ◽

Residual Disease ◽

White Blood Count ◽

Gene Expressions ◽

Healthy Donors ◽

Blast Cells

Abstract Objective To investigate the expression of PRAME (preferentially expressed antigen of melanoma) gene in acute leukemia and its clinical significance in monitoring prognosis, detecting minimal residual disease (MRD) and gene immunotherapy. Methods The expression of PRAME gene mRNA in bone marrow mononuclear cells is measured by reverse transcriptase polymerase chain reaction in 34 patients with acute leukemia and 12 bone marrow samples of health donors. The relationships between PRAME gene expressions and some clinical data, such as gender, age, white blood count, leukemic immunophenotype, the percentage of blast cells, and the karyotype of chromosome, were also estimated. Results PRAME gene was expressed in 38.2% of all the patients, 40.7% of all the AML patients, which was higher than the 28.6% of ALL patients (p >0.05). There was no expression of PRAME gene in healthy donors. In all the sub phenotypes of AML, the expressive rate of PRAME gene in M3 patients is 80%, which is higher than that in M2 (33.3%) and in M5 (28.6%). The expressive rate of PRAME gene was also positively correlated with the expression of CD15, CD33, and the abnormality in the karyotype of chromosome, but not correlated with age, gender, white blood count and percentage of blast cell in bone marrow. Conclusion PRAME gene is highly expressed in acute leukemia, and could be regarded as a useful tool for monitoring MRD. Differential expression in acute leukemia patients vs. healthy donors suggests that the immunogenic antigens PRAME are potential candidates for immunotherapy in acute leukemia.

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Effect of Circadian Variation on Neutrophil Mobilization to Peripheral Blood in Benign Constitutional Neutropenia

Blood ◽

10.1182/blood.v128.22.2502.2502 ◽

2016 ◽

Vol 128 (22) ◽

pp. 2502-2502

Author(s):

Joao Tadeu Damian Souto Filho ◽

Rodrigo Doyle Portugal ◽

Marcio Nucci

Keyword(s):

Neutrophil Count ◽

Blood Count ◽

Conflicts Of Interest ◽

Circadian Variation ◽

Practical Interest ◽

Diagnostic Methods ◽

Alternative Form ◽

White Blood Count ◽

Early Afternoon ◽

History Of

Abstract Background and Objective: Benign constitutional neutropenia (BCN) or benign ethnic neutropenia (BEN) is an asymptomatic condition characterized by mild chronic neutropenia in patients with no history of recurrent infections. In most of these patients neutropenia is discovered incidentally in a complete blood count ordered for routine screening. This is particularly concerning for general practitioners because neutropenia is associated with infections and hematologic malignancies. Thus, many patients are commonly referred to a specialist for evaluation, which leads to further testing and increased costs of care without evidence of improved personal or public health. To ensure that individuals with BCN are healthy, some diagnostic methods can be used to assess neutrophil mobilization from reserve compartments, including epinephrine, corticosteroids, endotoxins and vigorous exercise. We herein present an alternative form of assessment for individuals with BCN based on neutrophil circadian variation. Neutrophils in healthy individuals have a physiological increase of between 10 and 20% by early afternoon. In this study, we hypothesized that because patients with BCN have higher G-CSF basal levels and a greater physiological response to this cytokine, a larger increase in neutrophils can be detected in a blood test performed in the afternoon compared to routine tests performed in the morning. A physiological increase in neutrophil levels in individuals with BCN would be of great practical interest. This could reduce costs of laboratory tests and reduce medical and patient concerns. Methods: We studied patients who had neutropenia that was detected in routine blood count and with suspected BCN. Patients with clinical symptoms, laboratory test result changes and history of chronic, inflammatory, autoimmune or neoplastic diseases were excluded. Patients >60 years were excluded because they have a higher prevalence of myelodysplasia and other concomitant diseases. Neutrophil counts were evaluated in patients with BCN using paired blood counts performed in the early morning (between 7:00 and 9:00 am) and in the early afternoon (between 1:00 and 3:00 pm). The neutrophil counts were stratified into the following four groups: < 500, 500-1000, 1000-1500 and 1500-2000/µL. Results: We evaluated 157 patients with neutropenia and 118 individuals met the entry criteria. Their median age was 36 years (range, 3-60 years), and 41 (35%) were male. Median blood count results were as follows: white blood count, 2880/µL; hemoglobin, 12.9 g/dL; and platelets, 223,000/µL. The difference between the median neutrophil counts performed in the morning (1164/µL) and afternoon (2070/µL) was 904/µL (95% CI=770-1040; p<0.001). This difference reflects an increase of 94.3% in neutrophil counts between the two tests. The percent increase in neutrophils between the two assessments was higher in patients with a lower neutrophil count in the morning examination (OR=20.9; p<0.001). The lower the morning neutropenia, the greater the increase observed (513.8%, 110.6%, 70.5% and 46.8%, respectively, in the 500, 500-1000, 1000-1500 and 1500-2000/µL groups). We evaluated categories of neutrophil levels in the blood count in the morning and afternoon. Among the 118 subjects with baseline neutrophil count <2000/µL, 52 (44%) had values >2000/µL in the afternoon. Of the 65 who had remain with neutrophils <2000/µL, 48 (40%) showed an increase to neutrophil categories higher than the initial examination, 18 (15%) remained in the same category and no individual showed a decrease in neutrophil counts between the morning and afternoon. Conclusions: Our findings identify a simple, easy and feasible way to assess neutrophil reserve in patients with BCN, with a potential reduction in costs of the assessment. Disclosures No relevant conflicts of interest to declare.

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