scholarly journals Effects of Intensive Phase Antituberculous Therapy on Hepatic and Haematological Parameters in Patients at the University Teaching Hospital in Lusaka, Zambia

2020 ◽  
Vol 4 (1) ◽  
pp. 35-42
Author(s):  
Glorious Mwaba ◽  
◽  
Derick Munkombwe ◽  
Patrick Kaonga ◽  
Mwangana Mubita ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Adverse Effects ◽  
Cell Count ◽  
White Cell Count ◽  
Haemoglobin Concentration ◽  
Alanine Transaminase ◽  
White Cell ◽  
University Teaching ◽  
Full Blood Count

Objectives and study design: Zambia is a high tuberculosis burden country. Antituberculous medicines are the mainstay of tuberculosis management. There have been several reports of antituberculous drug-related haematological and hepatic adverse effects noted in other settings. Adverse events have healthcare cost and morbidity implications. Prevalence and severity of these adverse effects are understudied in patients at University Teaching Hospitals hence the purpose of this study was to identify haematological and hepatic abnormalities and compare parameters before treatment and after completion of the intensive phase among the patients. Factors associated with abnormalities were also determined. A prospective longitudinal study was undertaken at Chest Clinic between April 2018 and July 2018. Study patients were followed up for 2 months. Full blood count and liver function tests were recorded at baseline and at follow-up. Abnormalities were defined according to the 2017 Department of AIDS Table for Grading the Severity of Adult and Paediatric Adverse Events. Data were analysed using SPSS version 22.0. Paired t-test and Wilcoxon matched-pairs signed-rank test were used to compare parameters. Logistic regression was performed to determine factors that were predictive of abnormalities. A p< 0.05 was considered statistically significant. Results: A total of 37 patients were involved in the study. 56.8% of patients were male. The mean age of patients was 36.2 years (19 – 57 years) while body mass index was 21.9 kg/m2. Only 37.8% of patients were sputum smear-positive at baseline. 56.8% of patients had HIV co-infection. 45.9% of patients were on antiretroviral therapy.45.2% of patients had grade 1-3 aspartate transaminase derangements at follow-up compared to 29.7% at baseline. 5.4% of the patients had grade 1-3 alanine transaminase derangements at baseline while 9.7% of patients had grade 1 at follow-up. Fewer patients (16.1%) had grade 1-2 anaemia at follow-up while 62.2% of patients at baseline had grade 1-4 anaemia. More patients (46.2%) had platelet derangements at follow-up compared to 25.8% at baseline. Fewer patients had differential white cell count derangements at follow-up compared to baseline. Statistically significant differences in haematological parameters: haemoglobin concentration, haematocrit, red, and white cell, eosinophil and neutrophil counts at baseline and follow-up were found. However, no statistically significant differences in red cell indices were observed. Changes in alanine transaminase levels at baseline and follow-up were statistically significant. Logistic regression was performed to determine the effects of age, gender, body mass index, HIV infection, antiretroviral therapy, sputum smear status, and appropriate baseline full blood count/liver function test parameters on the likelihood of study patients having deranged haemoglobin concentration, white cell count and alanine transaminase at follow-up. Logistic regression models to predict deranged haemoglobin concentration and white cell count were statistically insignificant. None of the predictor variables were associated with the likelihood of derangements in alanine transaminase. Conclusion: Findings of this study show that haematological and hepatic adverse effects were relatively fewer at follow-up and were mostly grades 1-3 in severity. Antituberculous therapy is relatively safe for patients during the initial phase.

Defining The morphological Appearance Of ETV6-Abl Diseases. Evaluation Of a Case

Blood ◽  
2013 ◽  
Vol 122 (21) ◽  
pp. 5271-5271
Author(s):  
Finella MC Brito-Babapulle ◽  
Barbara Czepulkowski
Keyword(s):  
Bone Marrow ◽  
Mast Cells ◽  
Cell Count ◽  
Gene Rearrangement ◽  
White Cell Count ◽  
Central Area ◽  
White Cell ◽  
Full Blood Count ◽  
Large Numbers ◽  
Cell Series

Abstract A 30 year old female presented@30 weeks pregnancy with a few circulating myeloid blasts in her blood but a normal full blood count. She had previously used an epipen for acute allergic reactions and had bone pain at presentation. There was splenomegaly on examination. Bone marrow aspirate was extremely difficult to obtain but trephine roll showed eosinophils, basophils, occasional mast cells and occasional blasts A population of 23% hypergranulated basophilic cells were seen on aspirate whose aetiology is not clear and are assigned to the basophil/mast cell series. For want of a better term these cells are called Finella’s cells. Histological examination of trephine biopsy showed extreme hypercellularity, Grade III/IV reticulin fibrosis large numbers of eosinophils and basophils with mast cells confirmed by CD 117 staining. The large hypergranulated basophilic cells (Finella’s cells) were not visible on trephine staining. An isodicentric X on cytogenetic analysis and a bcr-abl probe showed a split abl with 2 signals. An ETV6-ABL1 gene rearrangement was present. The c-kit D816V mutation was not identified nor was FIP1L1-PDGFRA present. Subsequently the morphologic features described above allowed the suspicion in a further case. Various appearances of the bone marrow and blood allow the suspicion of a particular disease which then leads to the performance of the diagnostic test to confirm the suspected genetic abnormality. This is epitomised in the diagnosis of chronic myeloid leukaemia based on a high white cell count, myelocyte peak and excess of myeloid cells with an increase in cells such as eosinophils and basophils. The diagnosis is then made by demonstrating the presence of the Philadelphia chromosome or bcr-abl gene rearrangement. In contrast in cases with an ETV6-abl, the patient has a white cell count that is not markedly increased with a leucoerythroblastic blood film and a bone marrow examination that shows a superficial resemblance to a chronic myeloproliferative disease with marked myelofibrosis and large numbers of eosinophils and basophils some of which are morphologically abnormal. Megakaryocytes when seen show discrete nuclear fragments and hypolobation and eosinophils and basophils are increased leading to the case being mistakenly diagnosed as an eosinophilic disorder rather than a specific disease entity i.e ETV6-abl. It cannot be classified with the mastocytic leukaemia’s as the number of masts cells is not greater than 5% and they are not clustered but loosely distributed. The aetiology of Finella’s cells are unclear. Mast cells in blood smears are easily identifiable by their large granules which disfigure the nuclear outline and a central area of pallor or by their “slipper” shape and granule content. In this case the cells are larger than mast cells circular, have no central area of pallor,the excessive granularity masking the nuclear outline and leading one to question whether a PML-RARA fusion is present which it is not. The presence of eosinophils, basophils and these cells should make the viewer suspect an ETV6-abl disorder which is normally a cryptic fusion which will not be identified without use of the appropriate FISH/ RT-PCR test. The disease appears to undergo blast transformation as seen with CML and early transplantation is recommended as happened successfully with our case. Although several other cases have been reported in the literature by various authors and called bcr-abl negative CML, myeloproliferative neoplasms, myeloproliferative disorders with eosinophilia etc peripheral blood eosinophilia is not present and FIP1L1-PDGFRA is not present. The morphologic features that lead one to suspect the presence of theETV6-abl have not been previously delineated. THE ETV6-ABL fusion protein has tyrosine kinase activity and responds to imatinib or second generation TKI’s and therefore demonstrating its presence when faced by the classic morphologic appearance is of clinical importance. Disclosures: No relevant conflicts of interest to declare.

scholarly journals Patients with Clinical Acute Appendicitis Should have Pre-operative Full Blood Count and C-Reactive Protein Assays

2006 ◽  
Vol 88 (1) ◽  
pp. 27-32 ◽  
Author(s):  
D Birchley
Keyword(s):  
Acute Appendicitis ◽  
Cell Count ◽  
Neutrophil Count ◽  
White Cell Count ◽  
White Cell ◽  
Full Blood Count ◽  
Categorical Variables ◽  
C Reactive Protein ◽  
Reactive Protein

INTRODUCTION The role of inflammatory markers in the diagnosis of acute appendicitis has not been clearly defined. The aims of this prospective audit were to define the role of the serum markers of inflammation total white cell count, neutrophil count and C-reactive protein in the diagnosis of acute appendicitis with particular reference to the discrimination between uncomplicated and complicated appendicitis, and the prediction of abscess. PATIENTS AND METHODS The author compiled a prospective database over a 13-month period of all appendicectomies performed. After five exclusions (three having no notes for review and two having confounding second morbidity in the presence of a normal appendix), the data relating to 75 patients were analysed. RESULTS In patients judged on clinical grounds to require laparotomy for suspected acute appendicitis, white cell count and neutrophil count distinguish acute appendicitis from normal appendices when used as categorical variables, though they do not reflect the presence of abscess. C-reactive protein neither distinguishes appendicitis from normal, nor predicts abscess when used as a categorical variable, though higher levels suggest abscess. CONCLUSIONS Laboratory tests of the white cell count, neutrophil count and C-reactive protein are more effective in supporting a clinical diagnosis of acute appendicitis in patients with typical clinical features than in excluding the diagnosis.

scholarly journals An unusual presentation of chronic lymphocytic leukemia

2017 ◽  
Vol 07 (03) ◽  
pp. 133-136
Author(s):  
Dinesh Atwal ◽  
Mihir Raval ◽  
Belal Firwana ◽  
Jeanette Ramos ◽  
Appalanaidu Sasapu
Keyword(s):  
Chronic Lymphocytic Leukemia ◽  
Cell Count ◽  
White Cell Count ◽  
Early Observation ◽  
White Cell ◽  
Lymphocytic Leukemia ◽  
Rare Presentation ◽  
Cell Counts ◽  
Sinus Mucosa

Abstract Chronic lymphocytic leukemia/small lymphocytic lymphoma (CLL/SLL) is a B-cell lymphocytic neoplasm with indolent clinical course. If identified early, observation is opted. Many variables lead to the initiation of treatment. Authors describe a 62-year-old male presenting with shortness of breath and found to have white cell count of 1360 × 109/L and subsequently was diagnosed with CLL/SLL. The patient received leukapheresis along with tumor lysis treatment and systemic chemotherapy with fludarabine, cyclophosphamide, and rituximab regimen. His course was complicated with deep venous thrombosis, extensive cutaneous, and sinus mucosa involvement by CLL/SLL. The patient clinically improved and on follow-up clinic visits documented normalization of his white cell counts. The case report brings up a rare presentation of CLL/SLL with such an extreme high white cell count, leukostasis symptoms and extramedullary involvement of disease and encourages providers to be vigilant of rare presentation of CLL/SLL.

scholarly journals P-BN49 The predictive role of white cell and platelet count for infective complications following splenectomy

2021 ◽  
Vol 108 (Supplement_9) ◽  
Author(s):  
Ozhin Karadakhy ◽  
Emma Poynton-Smith ◽  
Ian Beckingham
Keyword(s):  
Logistic Regression ◽  
Platelet Count ◽  
White Cell Count ◽  
White Cell ◽  
Stepwise Logistic Regression ◽  
Hospital Records ◽  
Long Term Follow Up ◽  
Infective Complications

Abstract Background Temporary elevation of white cell count (WCC) and platelets are commonly observed after splenectomy and can therefore make it difficult for the surgeon to distinguish a normal physiological response from potential infection. Clinicians are often misled by elevated post-operative WCC after splenectomy, resulting in delayed discharges and prolonged unnecessary hospital stays for patients. The aim of this study was to establish what constitutes a normal rise in WCC and platelets after splenectomy. Methods All 127 patients who had undergone a splenectomy between July 2016 and January 2021 were identified from a search of our centre's hospital episode statistics data.  WCC and platelet count on post-operative days one to seven as well as at least one long-term follow-up result count were identified from electronic hospital records. Hospital records were searched for data on pre-operative steroid administration and peri-operative infections. These cohort data were retrospectively analysed in SPSS using stepwise logistic regression, correlation analysis, and T-tests, as well as descriptive statistics. Results 86 (68%) patients underwent an elective splenectomy and 41 (32%) an emergency splenectomy. 35 (27.6%) patients developed infections post-operatively, while 92 (72.4%) did not. Logistic regression suggested that a raised WCC (above 17.5x109/L) at day 3 post-op was a significant predictor of infection (p &lt; 0.001): average WCC at day 3 for patients with infection was 20.00x109/L (SD = 6.23x109/L) compared to 14.86x109/L (SD = 4.01x109/L) for those without. Infective outcomes were not influenced by whether the surgery was emergency or elective. Overall, average WCCs were 9.63x109/L pre-operatively and 15.07x109/L long-term post-operatively. Even in the absence of infection, splenectomy led to a long-term rise in WCC of 3.8x109/L from baseline, to an average of 13.0x109/L [SD = 5.41x109/L): a T-test on the 56 patients without infection and with both pre-op and long-term WCCs showed a mean rise of 3.76x109/L, p &lt; 0.0001). Platelet count was not correlated with infection, though platelet counts rose from a mean of 261 × 109/L (SD = 103.4x109/L) pre-operatively to 581 × 109/L (SD = 236.3x109/L) at 7-day and 619 × 109/L (SD = 293.5x109/L) at long-term follow up across all patients – an average increase of 357 × 109/L, which did not significantly differ between patients with and without infective complications. Conclusions A rise in WCC and platelet count is normal post-splenectomy.  A rise in WCC&gt;17.5x109/L on day 3 post-splenectomy is strongly correlated with infection (regardless of trauma or platelet count). Long-term follow up suggests that while much of the WCC increase is transient, WCC remains higher than pre-operatively, as does platelet count, in post-splenectomy patients. A raised WCC or platelet count without signs of infection should not preclude timely discharge in otherwise well patients.

Leucocytes and Thrombosis

1973 ◽  
Vol 30 (01) ◽  
pp. 036-046 ◽  
Author(s):  
D.C Banks ◽  
J.R.A Mitchell
Keyword(s):  
Cell Count ◽  
White Cell Count ◽  
Cell Loss ◽  
White Cell ◽  
Structural Resemblance ◽  
The Masses

SummaryWhen heparinised blood is rotated in a glass flask at 37°C. the white cell count falls and it has been shown that this is due to the adherence and aggregation of polymorphonuclear white cells on the wall of the flask. The masses formed bear a close structural resemblance to thrombi and the mechanisms involved in white cell loss during rotation may therefore increase our knowledge of the thrombotic process.

An Assessment of Red Cell Deformability Using a Simple Filtration Method

1979 ◽  
Author(s):  
M Drummond ◽  
G Lowe ◽  
J Belch ◽  
C Forbes ◽  
J Barbenel
Keyword(s):  
Cell Count ◽  
Shear Viscosity ◽  
White Cell Count ◽  
White Cell ◽  
Red Cell ◽  
Cell Deformability ◽  
Red Cell Deformability ◽  
Simple Method ◽  
Filtration Method ◽  
Significant Difference

We investigated the reproducibility and validity of a simple method of measuring red cell deformability (filtration of whole blood through 5 µ sieves) and its relationship to haematocrit, blood viscosity, fibrinogen, white cell count, sex and smoking. The mean coefficient of variation in normals was 3. 7%. Tanned red cells showed marked loss of deformability. Blood filtration rate correlated with haematocrit (r = 0. 99 on dilution of samples, r = 0. 7 in 120 normals and patients). After correction for haematocrit, deformability correlated with high shear viscosity, but not low shear viscosity, fibrinogen or white cell count. In 60 normals there was no significant difference between males and females, or smokers and non-smokers, but in 11 smokers there was an acute fall in deformability after smoking 3 cigarettes (p<0. 05). Reduced deformability was found in acute myocardial infarction (n = 15, p<0. 01) and chronic peripheral arterial disease (n = 15, p<0. 01). The technique is reproducible, detects rigid cells and appears useful in the study of vascular disease.

scholarly journals The use of routine blood tests to assist the diagnosis of COVID-19 in symptomatic hospitalized patients

2021 ◽  
pp. 000456322199907
Author(s):  
IT Parsons ◽  
AT Parsons ◽  
E Balme ◽  
G Hazell ◽  
R Gifford ◽  
...  
Keyword(s):  
Cell Count ◽  
Retrospective Review ◽  
Blood Test ◽  
Patient Flow ◽  
White Cell Count ◽  
Area Under The Curve ◽  
White Cell ◽  
Test Results ◽  
Rt Pcr ◽  
Blood Tests

Introduction Specific patterns of blood test results are associated with COVID-19 infection. The aim of this study was to identify which blood tests could be used to assist in diagnosing COVID-19. Method A retrospective review was performed on consecutive patients referred to hospital with a clinical suspicion of COVID-19 over a period of four weeks. The patient’s clinical presentation and severe acute respiratory syndrome coronavirus 2 reverse-transcription polymerase chain reaction (SARS-CoV-2 RT-PCR) were recorded. The patients were divided by diagnosis into COVID (COVID-19 infection) or CONTROL (an alternate diagnosis). A retrospective review of consecutive patients over a further two-week period was used for the purposes of validation. Results Overall, 399 patients (53% COVID, 47% CONTROL) were analysed. White cell count, neutrophils and lymphocytes were significantly lower, while lactate dehydrogenase and ferritin were significantly higher, in the COVID group in comparison to CONTROL. Combining the white cell count, lymphocytes and ferritin results into a COVID Combined Blood Test (CCBT) had an area under the curve of 0.79. Using a threshold CCBT of –0.8 resulted in a sensitivity of 0.85 and a specificity of 0.63. Analysing this against a further retrospective review of 181 suspected COVID-19 patients, using the same CCBT threshold, resulted in a sensitivity of 0.73 and a specificity of 0.75. The sensitivity was comparable to the SARS-CoV-2 RT PCR. Discussion Mathematically combining the blood tests has the potential to assist clinical acumen allowing for rapid streaming and more accurate patient flow pending definitive diagnosis. This may be of particular use in low-resource settings.

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