Ciprofloxacin and Metronidazole Allergy- 
A Case Report

Fluoroquinolones are well-tolerated antibiotics widely used for treating infections. According to the literature, ciprofloxacin is mostly involved in Drug-induced hypersensitivity reactions. The various reactions that are reported in various case reports due to ciprofloxacin include Steven Johnson syndrome, eczema, erythroderma, maculopapular rashes. Metronidazole is a 5-nitroimidazole compound introduced in 1959 to treat Trichomonas vaginalis infections. Ciprofloxacin and Metronidazole hypersensitivity is not very frequent it is usually well tolerated but allergic reactions to these drugs occur due to their increased use either alone or in combination. An 83-year-old female was admitted to the private ward of surgery at Shri Mahant Indiresh hospital with chief complaints of abdominal pain and chronic constipation as the patient was not passing stools for 10 days. The patient was diagnosed with Subacute intestinal obstruction (SAIO) based on various laboratory findings and the symptomatic treatment was given treatment. Hypersensitivity reactions can be of two types immediate that occurs within few hours of drug administration and delayed that occurs within 24-48 hours of drug administration. Here in this case the person developed vomiting immediately after few hours of Ciprofloxacin administration so it is an immediate IgE mediated anaphylactic reaction. Metronidazoleis causing Type 4 Delayed hypersensitivity reaction in this patient as rashes and itching developed the next day after administration of metronidazole drug. Healthcare professionals should maintain the record of a medication history of the patient to identify any drug allergy so that it can be avoided in the future and in case of any ADR it should be reported. The patient should be advised to go for a sensitivity test to check which drug he/ she is allergic to and should avoid taking that medication. The patient should tell his/ her history of drug allergy to the doctor so that doctor doesn’t prescribe that medication. Keywords: CBC-Complete Blood Count, RFT-Renal Function tests, LFT-Liver function tests, Hb-Hemoglobin, SGOT-Serum Glutamic oxaloacetic transaminases, ALP-Alkaline phosphatase, MCH-mean corpuscular Hemoglobin, MCHC-Mean corpuscular hemoglobin concentration, RBC-Red Blood Cells, SAIO-Subacute intestinal obstruction, USG- Ultrasound.

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Evaluation of Platelet Indices and Complete Blood Count in Canine Mammary Tumors

Acta Scientiae Veterinariae ◽

10.22456/1679-9216.114293 ◽

2021 ◽

Vol 49 ◽

Author(s):

Zeynep Günay Uçmak ◽

Lora Koenhemsi ◽

Melih Uçmak ◽

Mehmet Erman Or ◽

Özge Erdoğan Bamaç ◽

...

Keyword(s):

Breast Cancer ◽

Mammary Tumor ◽

Blood Count ◽

Complete Blood Count ◽

Mammary Tumors ◽

Mean Corpuscular Hemoglobin ◽

Corpuscular Hemoglobin ◽

Platelet Indices ◽

Grade 3 ◽

Tumor Types

Background: Malignant mammary tumors in humans and bitches cause hematological disorders such as anemia, erythrocytosis, thrombocytosis, hyperproteinemia, and leucopenia. Novel studies have been conducted on the predictive and prognostic values of platelet (PLT) indices in human breast cancer (HBC). However, there is little information about the alterations in hematological parameters in canine mammary tumors (CMTs). The aims of this study were to evaluate the platelet indices and complete blood count (CBC) parameters in bitches with and without mammary tumor and to assess the above mentioned parameters with regard to histological tumor types and grades.Materials, Methods & Results: A total of 71 bitches were enrolled in this study. The bitches in the study group were divided into 2 groups which consisted of malignant epithelial mammary tumors (group EMT; n = 43) and malignant mixed mammary tumors (group MMT; n = 12). Control group (group C) consisted of clinically and gynaecologically healthy 16 bitches. Blood samples were obtained to perform the CBC and PLT indices analysis. Histopathological examinations were carried out under a light microscope. Histological tumor types and malignancy grades were classified. The bitches with mammary tumor showed significantly increased PLT values and decreased hematocrit (HCT), hemoglobin (HGB) and mean corpuscular hemoglobin (MCH) values versus the healthy ones, regardless of the tumor type. However, in comparisons with the group C, mean platelet volume (MPV) and mean corpuscular hemoglobin concentration (MCHC) values were different only in the group MMT, while plateletcrit (PCT) and mean corpuscular volume (MCV) values were different only in the group EMT. Also white blood cell (WBC), PLT and PCT values were higher than the referenced laboratory ranges in grade 3 tumors. In the presented study, MPV was considerably correlated with PLT, platelet distribution width (PDW) and PCT. Also, PCT and PLT had high sensitivity and specificity to distinct EMT and MMT from the healthy bitches.Discussion: Microcytic and hypochromic anemia occurs due to the decrease in the amount of HGB. Levels of MCV, MCH, and MCHC in the HBC group were reported to be significantly lower than in humans without breast cancer. Although anemia did not occur in EMT and MMT groups, obtained significances in the HCT, HGB, MCV, MCH, and MCHC levels between the bitches with and without mammary tumor were in line with the previous reports. In this study, WBC levels in grade 3 tumors were significantly higher than grade1 tumors (P < 0.05). Whereas levels of WBC in grade 1 and grade 2 tumors were in referenced laboratory ranges, it was higher in grade 3. Increased level of WBC in grade 3 was supposed to be due to the rise in malignancy as previously reported. Thrombocytosis was detected in 48.83% and 41.66% of the bitches in EMT and MMT groups, respectively. The higher percentage of CMTs with thrombocytosis in this study might be due to the difference in referenced upper limit of PLT in previous studies. The elapsed time between tumor formation and clinical presentation could be another influencing factor. Although PLT and PCT values were not significant according to the histological grading in this study, both parameters were found to be higher in grade 3 than the normal reference values. Further studies conducted with higher populations may lead the differences in these parameters to significance. With the support of further studies, alterations in the above mentioned parameters in bitches may contribute in the diagnosis process, management of treatment and may constitute an easy way to have an idea about the prognosis of mammary tumors.

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Narrowed reference intervals for complete blood count in a multiethnic population

Clinical Chemistry and Laboratory Medicine (CCLM) ◽

10.1515/cclm-2018-1263 ◽

2019 ◽

Vol 57 (9) ◽

pp. 1382-1387

Author(s):

Seungok Lee ◽

Chui Mei Ong ◽

Yu Zhang ◽

Alan H.B. Wu

Keyword(s):

San Francisco ◽

Blood Count ◽

Complete Blood Count ◽

Hemoglobin Concentration ◽

Reference Intervals ◽

Mean Corpuscular Hemoglobin ◽

Corpuscular Hemoglobin ◽

Multiethnic Population ◽

Race Ethnicity ◽

Eosinophil Counts

Abstract Background Biological variation studies have shown that the complete blood count (CBC) has narrow within-individual variation and wide group variation, indicating that the use of reference intervals (RIs) is challenging. The aim of this study was to examine differences in CBC RIs according to race/ethnicity in a multiethnic population at a hospital in San Francisco in hopes of improving the medical utility of CBC testing. Methods Subject data were obtained by screening CBC results from the medical records of outpatients meeting certain criteria who visited Zuckerberg San Francisco General Hospital from April 2017 to January 2018. From these records, sex- and race/ethnicity-specific CBC RIs were calculated as the 2.5th to 97.5th percentiles. Results From a total of 552 subjects, 47.9% were male (65 White, 50 Black, 71 Hispanic and 54 Asian) and 52.1% were female (51 White, 39 Black, 122 Hispanic and 72 Asian). The RIs of neutrophil, lymphocyte and eosinophil counts; and hemoglobin, mean corpuscular volume (MCV), mean corpuscular hemoglobin (MCH) and mean corpuscular hemoglobin concentration (MCHC) showed significant differences (p<0.05) among the four racial/ethnic groups: neutrophil, lymphocyte and eosinophil counts; and MCHC in males, and hemoglobin, MCV, MCH and MCHC in females. Conclusions Race/ethnicity-specific CBC RIs should be taken into consideration in a multiethnic population to better interpret patient status and make progress toward precision medicine.

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Hematological parameters of the blood count in a healthy population of pregnant women in the Northwest of Morocco (Tetouan-M'diq-Fnideq provinces)

Pan African Medical Journal ◽

10.11604/pamj.2018.29.205.13043 ◽

2018 ◽

Vol 29 ◽

Cited By ~ 2

Author(s):

Saad Bakrim ◽

Youssef Motiaa ◽

Ali Ouarour ◽

Azlarab Masrar

Keyword(s):

Pregnant Women ◽

Reference Values ◽

Blood Count ◽

Complete Blood Count ◽

Hematological Parameters ◽

Control Group ◽

Mean Corpuscular Hemoglobin ◽

Healthy Population ◽

Corpuscular Hemoglobin ◽

Significant Difference

Introduction: numerous biological parameters are physiologically modified during normal pregnancy, in particular hematology. The knowledge of these modifications of the maternal body by biologists and clinicians allows the screening of possible anomalies. In Morocco, the reference values of the complete blood count test for pregnant woman are missing, as are those specific to different trimesters of pregnancy. The aim of this study is to look for the reference values for healthy pregnant women of the Northwest region of Morocco, to compare them to those of non-pregnant women (control) and to those of the literature. Methods: blood samples were taken voluntarily from 3898 healthy pregnant women from 18 to 46 years old who presented themselves at the center of health Kalaa and at the service of gynecology obstetrics of the Provincial Hospital Center of M'diq (Morocco), for prenatal care. To establish the reference intervals of the CBC for non-pregnant women, a control group was constituted by 7035 healthy women from 18 to 50 years old selected according to the Moroccan law of blood donation. The CBC was measured on a Sysmex KX21N® analyzer. For each sample a systematic blood smear was done to determine the leukocyte differential. Results: a statistically significant difference between the pregnant women and control group was noted (p < 0.05) for all the hematological parameters: red blood cells, hematocrit, hemoglobin, mean corpuscular volume, mean corpuscular hemoglobin, mean corpuscular hemoglobin concentration, leukocytes, neutrophils, basophils, eosinophils, lymphocytes, monocytes, platelets and mean platelet volume. So, the comparison of the averages established between the first, second and third trimester of pregnancy showed the existence of a significant variation with regard to all the parameters of the CBC test looked for (p < 0.001). Conclusion: the present study provides additional baseline data for basic hematological parameters in healthy pregnant Moroccan women and concluded that pregnancy in women has the tendency to alter some hematological indices. For these reasons, there is an interest to take these modifications into account for optimal maternal and fetal medical care.

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Multiple Abdominal Cocoons: An Unusual Presentation of Intestinal Obstruction and a Diagnostic Dilemma

Case Reports in Surgery ◽

10.1155/2015/282368 ◽

2015 ◽

Vol 2015 ◽

pp. 1-4 ◽

Cited By ~ 2

Author(s):

Mohammad Zain Sohail ◽

Shumaila Hasan ◽

Benan Dala-Ali ◽

Shahanoor Ali ◽

M. A. Hashmi

Keyword(s):

Intestinal Obstruction ◽

Abdominal Cavity ◽

Fibrous Membrane ◽

Unknown Aetiology ◽

Abdominal Cocoon ◽

Diagnostic Dilemma ◽

Previous Abdominal Surgery ◽

History Of ◽

Subacute Intestinal Obstruction ◽

Encapsulating Peritonitis

Sclerosing encapsulating peritonitis (SEP) or abdominal cocoon is a rare acquired condition with an unknown aetiology. It is characterized by encapsulation of the small bowel by a fibrous membrane and can lead to intestinal obstruction. We present the case of a 42-year-old gentleman with a history of hepatitis C, tuberculosis, and previous abdominal surgery, who presented with subacute intestinal obstruction. Surgical exploration of the abdomen revealed that the entire contents were enclosed into three distinct sacs by a dense fibrous membrane. Excision of the sacs was performed followed by adhesiolysis. This is believed to be the first reported case of multiple cocoons within the abdominal cavity. The case is discussed with reference to the literature.

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Hemoglobin profiles of siblings of thalassemia patients

Paediatrica Indonesiana ◽

10.14238/pi55.2.2015.70-3 ◽

2015 ◽

Vol 55 (2) ◽

pp. 70

Author(s):

Muhammad Riza ◽

Septin Widiretnani

Keyword(s):

Thalassemia Major ◽

Cross Sectional Study ◽

Mean Corpuscular Hemoglobin ◽

Carrier Status ◽

Corpuscular Hemoglobin ◽

Inherited Disorders ◽

Cross Sectional ◽

Hemoglobin E ◽

History Of ◽

Complete Blood Counts

Background Thalassemia and hemoglobinopathies are themost common inherited disorders in many areas of the world,including South East Asia. The siblings of thalassemia major is agroup of high risk to carry the gene of thalassemia. Determiningthe carrier is useful for early treatment planning and preventionto the next child.Objective To determine carrier status among siblings ofthalassemia patients using a capillary electrophoresis system.Methods A cross-sectional study on the siblings of thalassemiamajor patients was performed from January 2011 to February2012 at Dr. Moewardi Hospital. Complete blood counts wereperformed in the siblings. Subjects with mean corpuscular volume(MCV) <80 fl and mean corpuscular hemoglobin (MCH) <27pg were subjected to analize hemoglobin fraction by capillaryelectrophoresis.Results Of the 26 subjects, there were 12 males and 14 females.The mean age was 9.38 (SD 6.8) years (range 1 to 29 years). Fromthe siblings, 10 were identified as normal, 5 were identified as ßthalassemia carriers and 5 were hemoglobin E (HbE) carriers. Sixsiblings were diagnosed with ß thalassemia/ HbE.Conclusion There are high occurrence of the two common typesof thalassemia carriers (ß and HbE) in our small group of subjectswho had a family history of thalassemia. Most of the siblingsof thalassemia had low MCV and MCH.

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EVALUATING SOME OF THE HEMATOLOGICAL PARAMETERS FOR HELICOBACTER PYLORI INFECTED PATIENTS

Periódico Tchê Química ◽

10.52571/ptq.v17.n36.2020.1067_periodico36_pgs_1052_1060.pdf ◽

2020 ◽

Vol 17 (36) ◽

pp. 1052-1060

Author(s):

Nidhal Abdullah HASHIM ◽

Younus Jasim ABDULLAH ◽

Hasan Rahman SHAWI

Keyword(s):

Helicobacter Pylori ◽

Complete Blood Count ◽

Hematological Parameters ◽

Control Group ◽

Mean Corpuscular Hemoglobin ◽

Healthy Individuals ◽

Corpuscular Hemoglobin ◽

Distribution Width ◽

Significant Difference ◽

H Pylori

Helicobacter pylori are Gram-negative curved rods that habitats the gastric mucosa and considered as the leading causes of stomach ulcers and duodenal ulcers in humans. The main object of this study was to evaluate the influences of the bacteria on several hematological parameters. A total of 60 patients aged between 15 to 40 years were included in this study (30 male and 30 female) in addition to 30 healthy individuals from the same ages who were considered as a control group. Venous blood (4 ml) was obtained from the study population and investigated for complete blood count (CBC) using an automated hematology analyzer. The results revealed that there is a substantial decrease (p 0.01) in Hemoglobin (Hb), Red cell distribution width (RDW), and mean corpuscular hemoglobin (MCH) in patients compared to control. However, no significant difference in Red blood cells (RBCs), Hematocrit (HCT), mean corpuscular volume (MCV) and mean corpuscular hemoglobin concentration (MCHC) in patients compared to control. Also, no significant differences were found in the white blood cell (WBC) between H. pylori infected and non-infected persons. Otherwise, there are significant differences (p 0.01) in lymphocytes, monocytes, granulocytes in the patients and healthy individuals. The results also found that there are significant statistical differences in some of the hematologic parameters among study groups according to their gender. The study concluded that Hb, RDW, lymphocytes, monocytes, granulocytes are decreased in H. Pylori infected patients suggesting that infection may have direct effects on blood parameters.

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Case Report: Pediatric pharmacobezoar with subacute intestinal obstruction

F1000Research ◽

10.12688/f1000research.25441.1 ◽

2020 ◽

Vol 9 ◽

pp. 1037

Author(s):

Mahnaz Hakeem ◽

Heeramani Lohana ◽

Sarwat Urooj ◽

Sheraz Ahmed

Keyword(s):

Case Report ◽

Intestinal Obstruction ◽

Abdominal Distension ◽

Acute Intestinal Obstruction ◽

Rare Entity ◽

Persistent Vomiting ◽

Delay In Diagnosis ◽

History Of ◽

Subacute Intestinal Obstruction ◽

High Index Of Suspicion

Bezoars are an undigested mass causing an intraluminal obstruction in children. Pharmacobezoars are formed from medicines or their vehicle, considered as a less frequent type observed in children. Our objective is to report a relatively rare entity as a potential cause of intestinal obstruction in children. Here we report a case of 13-year-old girl with a history of herbal medicine intake who presented with persistent vomiting and abdominal distension. She was diagnosed with acute intestinal obstruction and managed conservatively without any complications. The patient became stable within two days so was discharged home. We found that ineffective history could lead to a delay in diagnosis and management. Clinicians should have a high index of suspicion for pica and psychiatric disorders, especially in adolescent children.

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Complete Blood Count Peculiarities in Pregnant SARS-CoV-2-Infected Patients at Term: A Cohort Study

Diagnostics ◽

10.3390/diagnostics12010080 ◽

2021 ◽

Vol 12 (1) ◽

pp. 80

Author(s):

Roxana Covali ◽

Demetra Socolov ◽

Razvan Socolov ◽

Ioana Pavaleanu ◽

Alexandru Carauleanu ◽

...

Keyword(s):

Blood Cell ◽

Red Blood Cell ◽

Blood Count ◽

Complete Blood Count ◽

Hemoglobin Concentration ◽

Mean Corpuscular Hemoglobin ◽

Mean Corpuscular Hemoglobin Concentration ◽

Blood Cell Count ◽

Corpuscular Hemoglobin ◽

Distribution Width

Background: During viral outbreaks, pregnancy poses an increased risk of infection for women. Methods: In a prospective study, all patients admitted for delivery at term to Elena Doamna Obstetrics and Gynecology University Hospital in Iasi, Romania, between 1 April 2020 and 31 December 2020 were included. There were 457 patients, divided into two groups: group 1, SARS-CoV-2-positive patients (n = 46) and group 2, SARS-CoV-2-negative patients (n = 411). Among other tests, complete blood count was determined upon admittance, and the following values were studied: white blood cell count, lymphocytes, neutrophils, red blood cell count, hemoglobin, mean corpuscular hemoglobin concentration, mean corpuscular hemoglobin, mean corpuscular volume, red blood cell distribution width, hematocrit, platelet count, mean platelet volume, platelet distribution width, plateletcrit, and platelet large cell ratio. Results: in pregnant SARS-CoV-2-infected patients at term, there was a significant decrease in white blood cell, neutrophil, and lymphocyte count, and an increase in mean corpuscular hemoglobin concentration, compared to healthy pregnant women at term, although all still within normal limits. None of the other components of the complete blood count or fetal outcomes studied was significantly influenced by SARS-CoV-2 infection in pregnant patients at term.

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Clinicopathological Description from the Largest Series of Patients with the Novel Pro106Leu MPL gene Mutation Associated with Hereditary Thrombocythemia

Blood ◽

10.1182/blood-2020-136077 ◽

2020 ◽

Vol 136 (Supplement 1) ◽

pp. 7-8

Author(s):

Musa Alzahrani ◽

Areej Al Mugairi ◽

Saeed Al Turki ◽

Waleed Al Rajban ◽

Fatimah Alshalati ◽

...

Keyword(s):

Bone Marrow ◽

Family History ◽

Univariate Analysis ◽

Mean Corpuscular Hemoglobin ◽

Corpuscular Hemoglobin ◽

Distribution Width ◽

Homozygous Genotype ◽

Medical City ◽

History Of

Background: Hereditary thrombocythemia (HT) has been reported in Japanese and African populations in association with S505N, and N35K c-Mpl mutations, respectively. A novel Pro106Leu germ-line mutation in the c-Mpl gene has recently been shown to be associated with HT in Arabic population. Clinical and bone marrow (BM) features of Pro106Leu mutation are largely unknown. Methods: The molecular genetic databases at two tertiary hospitals in Riyadh, King Abdulaziz medical city (KAMC) and King Saud University medical city (KSUMC), were searched to identify all patients (pts) with MPL Pro106Leu mutation. Clinical and pathological data were retrospectively collected. BM aspiration and biopsy were independently reviewed retrospectively by two consultant hematopathologists and agreement was reached by a consensus review. Simple descriptive statistics were used to summarize the results. A univariate subgroup analysis, comparing the hematologic parameters between the homozygous and heterozygous genotypes was conducted using Pearson Chi-Square and t-tests. Results: A total of 115 pts with Pro106Leu MPL mutation were included, 86 (75%) from KAMC and 29 (25%) from KSUMC. All pts were ethnically Arabs. Median age was 33 years (yrs) (range: 0.4-68), 65 (56.5%) were female, and 31 (27%) were pediatric pts (age <18 yrs). MPL Pro106Leu mutation was homozygous in 87 (75.7%) pts, and heterozygous in 28 (24.3%). Spleen was enlarged in 3 (3%) pts, not documented in 15 (13%), and normal in 97 (84%). History of bleeding was documented among 11 (10%) pts. Thrombosis history was positive in 5 (4%) pts only, unavailable in 6 (5%), and negative in 104 (90%). Family history of thrombocytosis was reported in 46 (40%), but family history was not documented in 20 (17%). Common comorbidities include: autoimmune disease in 33 (29%), diabetes 21 (18%), and hypertension 20 (17%). Reasons for MPL testing was: abnormal routine blood work 79 (69%), family history of thrombocytosis 23 (20%), or others 13 (11%). Thrombocytosis [platelet (plt) counts > 450 x109/L] was documented in 107 (93%) pts, normal in 4 (3.5%), and low in 4 (3.5%) at the time of diagnosis of Pro106Leu mutation. See figure 1. The median plt count at the time of diagnosis of MPL Pro106Leu mutation was 667 x 109/L (range: 13-1473). The median mean plt volume was 8 fL (range 6.1-10.2), white blood cell count 8.4 x 109/L (2.46-68.35), absolute neutrophil count 5 x 109/L (1.01- 21.19), hemoglobin 132 gm/L (85-148), mean corpuscular volume 84.1 fL (57-117.3), mean corpuscular hemoglobin 27.7 pg (18-37.5), mean corpuscular hemoglobin concentration 327 g/dL (300-351), and red cell distribution width 13.6 (10.9-22.8). Ferritin less than 30 was seen in 40 (35%) pts, 27 of whom were women. No ferritin done in 14 pts. Iron stores (based on bone marrow, ferritin and iron saturation) were adequate in 56 (49%), inadequate in 49 (43%), and not documented in 10 (9%). BCR-ABL, JAK2 and CALR were only detected in 1 pt each. One pt was not tested for CALR mutation. All other pts were negative for the three mutations. Out of all 115 pts, 33 (29%) had an evaluable BM. BM cellularity ranged from 20-100 %, 12/33 (36%) were hypocellular, 17/33 (52%) normocellular, and 4/33 (12%) hypercellular. Megakaryocyte (meg) morphology revealed dysplastic changes in 20 (60%) (hypolobated megs or with separated lobes), only 7 (21%) of cases had cloudlike megs but none had staghorn or giant megs as described in essential thrombocythemia. BM megs were increased in 29 (87%). Small size megs were seen in 15/33 (45%). Clustering of megs was seen in the majority of the cases 30/33 (90%) of whom, 29(87%) had loose and 20 (60%) dense clusters. On univariate analysis (see tables 1-2), homozygous genotype was associated with higher plt count. Total of 65 (57%) pts were prescribed aspirin, and 16 (14%) hydroxyurea. At the time of last follow-up 114 (99%) of pts were alive. The median follow-up was 7.8 yrs from the time of thrombocytosis (ranged from 0-24.8). No case developed disease progression to myelofibrosis. One pt was diagnosed with T-lymphoblastic lymphoma and later died from treatment complications and another pt was diagnosed with CML. Conclusion: Pro106Leu mutation is associated with marked thrombocytosis at a younger age with a low risk of thrombosis. Homozygous genotype is associated with a significantly higher plt count. BM usually shows either normo- or hypocellular marrow with increased megs proliferation, and clustering. Disclosures No relevant conflicts of interest to declare.

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725. Complete Blood Count Values Vary in Degree of Change with Day of Fever in Children with Dengue Fever

Open Forum Infectious Diseases ◽

10.1093/ofid/ofab466.922 ◽

2021 ◽

Vol 8 (Supplement_1) ◽

pp. S461-S462

Author(s):

Melissa E Day ◽

Miguel E Mejia Sang ◽

Yonairy Collado Puello ◽

Elvira J Diaz Brockmans ◽

Stephanie Rivera Defillo ◽

...

Keyword(s):

Dominican Republic ◽

Blood Cell ◽

Mean Corpuscular Volume ◽

Blood Count ◽

Complete Blood Count ◽

Hemoglobin Concentration ◽

Mean Corpuscular Hemoglobin ◽

Corpuscular Volume ◽

Mean Corpuscular Hemoglobin Concentration ◽

Corpuscular Hemoglobin

Abstract Background Dengue fever (DF) is an acute viral disease which can lead to severe illness, including dengue hemorrhagic fever, marked by thrombocytopenia and hemolytic anemia, as well as end-organ damage. Despite the well-known presentation and prevalence, changes in hematologic markers across the DF course have not been well-described in children. We sought to investigate the association of clinical laboratory values over time with dengue disease progression and outcome in a pediatric population in the Dominican Republic. Methods Pediatric participants were enrolled at Hospital Infantil Dr. Robert Reid Cabral in Santo Domingo, Dominican Republic, in a prospective, observational case-based study. Laboratory values, including complete blood count (CBC) indices and dengue titer results, were collected over the course of hospital stay. Using linear mixed models, we assessed whether 13 different CBC values and time trajectories differed by dengue status, including age and sex as covariates. To account for multiple testing, p≤0.0033 was considered significant. Results A total of 575 children ages 0 to 211 months met inclusion criteria; 51.8% (n=298) were male, and the median (IQR) age was 59 (14-93) months. Eighty-two percent (n=472) of participants had DF. CBC values across days 1 to 10 of fever in those with and without DF are depicted in Figure 1. Those with DF showed levels dropping more quickly across days of fever for hematocrit and hemoglobin (p≤ 0.002), with a more rapid decline in those with severe DF (p < 0.0001). Those with DF had levels increasing more quickly for mean corpuscular hemoglobin concentration (MCHC), monocyte number, and white blood cell counts (p ≤ 0.003), with those with severe DF having a more rapid increase (p < 0.001). The direction of the change across time differed by DF status for mean corpuscular volume and red blood cell distribution width (RDW) (p ≤ 0.0003), with those with severe DF showing an increase in RDW across day of fever (p= 0.0004). Figure 1. CBC values across day of fever in dengue (blue) and non-dengue (purple) patients. The graph above depicts the following CBC values across day of fever in dengue (blue) and non-dengue (purple) patients: a) white blood cell (WBC) count, b) platelet count, c) monocyte number, d) hemoglobin, e) mean corpuscular hemoglobin concentration (MCHC), and f) mean corpuscular volume (MCV). Values with an asterisk (*) represent significant values (p < 0.0033). Conclusion The trajectory of CBC measures differs between those with and without DF, despite similar clinical presentations. These laboratory differences may facilitate a better understanding of the clinical course of DF and may aid in earlier identification of DF in resource-limited settings. Disclosures Elizabeth P. Schlaudecker, MD, MPH, Pfizer (Grant/Research Support)Sanofi Pasteur (Advisor or Review Panel member)

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