Bronchoalveolar Lavage Profiles in Uncontrolled Wheezy Children Compared by Asthma Predictive Index

The Asthma Predictive Index (API) predicts later asthma in preschoolers with frequent wheeze. We hypothesized that airway cytology differs between API positive(+ve)/negative(-ve) children with uncontrolled/recurrent wheezing with dominance of eosinophils in API (+ve) and neutrophils in API (-ve) groups respectively. Objective: To compare bronchoalveolar lavage (BAL) cell profiles in API (+ve)/(-ve) children with recurrent wheezing unresponsive to inhaled corticosteroids (ICS). Design: A retrospective analysis of BAL in 43 children, 3-36 months (median: 14 months) receiving ICS (31 API +ve ; 12 API -ve). BAL cell differential counts, bacterial/viral cultures, and lipid-laden macrophage percentages (LLM) were analyzed. Cell counts presented as median (range). Results: Neutrophil percentages were increased in both groups [API -ve 16% (1-76%); API +ve 42% (1-95%); P=NS]. Cell percentages were similar for lymphocytes [API-ve 12% (1-30%); API +ve 7% (1-37%)], and macrophages [API -ve 67.5% (12-97%); API +ve 41 % (2-94%)]. Eosinophil percentages were low in both groups [API -ve 1 % (1-2%); API +ve 1 % (1-11%)]. Bacterial cultures were positive in 16 (80%) API +ve and 4 (33%) API -ve patients (P=0.10). Conclusion: Cell profiles do not differ between API groups in children ≤36 months with recurrent wheezing unresponsive to ICS. Positive correlation between neutrophil percentages and positive bacterial cultures was seen independent of API. Persistent bacterial bronchitis likely plays an important role in the persistence of symptoms unresponsive to inhaled corticosteroid therapy regardless of API status with a trend to more positive cultures in API positive children.

Admission leukocytosis and its implications on intra cerebral haemorrhage

Background: Intracerebral haemorrhage is one amongst the most common subtype of stroke. It is a catastrophic disease with significant rate of mortality and may lead to severe disabilities. Immediate and effective treatment is a prime requisite of ICH, as rapid mortality occurs within first 24 hours. Definitive diagnosis of ICH is difficult as its symptoms are similar to ischemic stroke. Aim of current investigation was to establish a relationship between intra-cerebral haemorrhage and leukocytosis and to use it as an early tool for detecting haematoma expansion for prognostication and developing newer drugs using a suitable therapeutic target. Methods: Current investigation was an observational study carried out on 100 patients with intra-cerebral haemorrhage. Differential counts were studied with respect to influence of particular subtypes on hematoma expansion. Follow up NCCT was done after 48 hours of the event. Results: Results of present investigation revealed that mean age of the patients was 56 years, 82% were males and all the patients were hypertensive. It was observed that majority of patients with neutrophilic leukocytosis, did not show hematoma expansion and neutrophilic leukocytosis was preferentially present in patients with higher initial bleed volumes. Significant association was observed between monocytosis and haematoma expansion and association between lymphocytosis and volume expansion was observed to be non-significant. Conclusions: Current study findings can aid in early risk stratification and prognostication of ICH patients and can also provide a tool for identification of new therapeutic targets for controlling haematoma expansion.

Reevaluation of reference values for bone marrow differential counts in 236 healthy bone marrow donors

Despite the increasing role of molecular markers, differential counts and morphology of hematopoietic cells in the bone marrow (BM) remain essential diagnostic criteria in hematological diseases. However, the respective reference values for BM myelogram commonly used came from small series with limited numbers of healthy individuals. We evaluated the myelograms of 236 healthy individuals who underwent unrelated bone marrow donation. Health check-ups were performed 4 weeks prior to harvest. Samples for this study, taken from the first aspiration, were stained according to the standard Pappenheim method. Three experienced investigators assessed cellularity, megakaryopoiesis, and differential counts independently. The median donor age was 31 (range 18–51) years. Predonation tests did not reveal any relevant morbidity. Thirty-seven out of 42 hypocellular marrow samples were from younger donors up to 39 years. Content of megakaryocytes was normal in 210 specimens (89%). Gender and body mass index had significant impact on hematopoiesis, whereas age had not. The number of erythroblasts was higher (about 32%) and the proportion granulopoiesis slightly lower (about 50%) compared with previous studies. Differential counts showed also some differences with respect to individual maturation stages in these lines. Interrater comparisons showed greater reliability for the assignment of cells to the different hematopoietic cell lines than for single-cell diagnoses. This study largely confirms the results for cell counts in normal human bone marrow available from previous reports and provides some insights into factors that affect individual cell populations. It also reveals substantial variability among even experienced investigators in cytological diagnoses.

Low lymphocyte count is a risk factor for Parkinsons disease

Importance: Biomarkers for the early detection of Parkinsons disease (PD) are needed. Patients with PD display differences in peripheral blood biomarkers of immune function, including leukocyte differential counts and C-reactive protein (CRP), compared to controls. These differences may be useful biomarkers to predict PD, and may shed light on PD pathogenesis. Objectives: To identify whether peripheral immune dysregulation is a pre-diagnostic feature of PD, and whether it plays a causal role. Design: Cross-sectional association analysis of the relationship between differential leukocyte count and other markers of acute inflammation at enrolment, and incident cases of PD in UK Biobank. We used Mendelian randomization to establish whether differences in leukocyte differential counts have a causal influence on risk of PD. Setting: UK Biobank; a population-based cohort with over 500,000 participants aged 40-69 recruited in the UK between 2006 and 2010. Participants: PD cases were defined as individuals with an ICD-10 coded diagnosis of PD. Cases were defined as incident if their age at diagnosis was greater than their age at recruitment to UKB. Controls were defined as individuals without a diagnosis of PD. After applying exclusion criteria for pre-existing health conditions that can influence blood counts, 507 incident PD cases and 328,280 controls were included in the analysis. Exposure: Blood cell markers (absolute and relative counts) and other markers of inflammation were obtained from blood tests of participants taken at the initial visit. Results: Lower lymphocyte count was associated with increased odds of incident PD (odds ratio [OR] 0.77, 95% confidence interval [CI] 0.65-0.90). There was weaker evidence of association between lower eosinophil and monocyte counts, lower CRP, and higher neutrophil counts on risk of incident PD. The association between lymphopenia and incident PD remained robust to sensitivity analyses. Mendelian randomization analyses suggested that the effect of low lymphocyte count on PD risk was causal (OR 0.91, 95% CI 0.85 - 0.99). Conclusions and relevance: In this large, prospective setting, lower lymphocyte count was associated with higher risk of subsequent PD diagnosis. Furthermore genetic evidence supported a causal role for lymphocyte count on PD risk.

Feasibility of manual white blood cell counts as a predictor of neonatal sepsis in a low-resource setting

Background Manual white blood cell (WBC) differential counts as a predictor for neonatal sepsis development in a low-resource setting have not been thoroughly evaluated. We hypothesized that manual differentiation (specifically immature:total [I:T] neutrophil ratios) would be feasible and useful as an adjunct to predict early-onset neonatal sepsis (EONS). Secondarily, we hypothesized that vaccination with bacillus Calmette-Guérin (BCG) and oral polio vaccine (OPV) could alter WBC differential counts and thus might reduce its predictive performance. Methods We performed a prospective cohort study within a randomized trial, randomizing healthy, high-risk newborns admitted to the nursery at the national hospital in Guinea-Bissau 1:1 to BCG+OPV at admission or at discharge (usual practice). Thin capillary blood films were prepared at 2 d of age in a subset of 268 neonates. WBC counts were assessed by microscopy and neonates were followed up for sepsis development within 2 weeks. Results Ninety-eight percent (264/268) of smears provided interpretable reads. Of the 264 children, 136 had been randomized to receive BCG+OPV prior to sampling; the remaining 128 were vaccinated at discharge. The I:T ratio (average 0.017) was lower among children who did not develop clinical sepsis but did not predict sepsis (p=0.70). Only three children had an I:T ratio >0.2 (associated with a higher probability of clinical sepsis in previous studies) but did not develop sepsis. Immunization did not alter WBC composition. Conclusions Manual WBC differentials are feasible in low-resource settings. WBC differentials are not affected by standard newborn immunization. However, the I:T ratio had no value in predicting subsequent development of sepsis.