Molecular detection of Trypanosoma species and haematological alterations in four trypanosome-infected Nigerian horses

Trypanosomes cause anaemia and are responsible for widespread morbidity and mortality particularly in imported breeds of animals found in sub-tropical and tropical parts of the world. Light microscopy and polymerase chain reaction (PCR) were used to detect trypanosomes in naturally infected Nigerian crossbred horses at Obollo-Afor abattoir, Udenu Local Government Area, Enugu State Nigeria. Blood was collected via the jugular outflow from a total of 200 horses of varying ages and either sex. Conventional procedures were followed during the PCR assay, parasite identification in wet mount, Leishman-stained thin blood and buffy coat smears on glass slides. Light microscopy revealed Trypanosoma species with an elongated, streamlined and tapered body, highly suggestive of T. brucei brucei or its subspecies T. evansi or T. equiperdum. PCR assay produced the expected fragment size of 700 bp specific for ITS-1 region of the 18SrRNA gene of Trypanosoma species in 4 (2%) of 200 blood samples against the routine blood and buffy coat smear examination, which revealed trypanosomes in 3 (1.5%) out of 200 blood samples. Sex and age were not significantly (p>0.05) associated with the trypanosome infection. One of the Trypanosoma infected anaemic horses had microcytic normochromic anaemia, high erythrocyte sedimentation rate and normal leukocyte count, while one of the Trypanosoma species infected non-anaemic horses had erythrocytic parameters and ESR values that are within the reference range, with leukocytosis. It was concluded that the prevalence of equine trypanosomosis was very low, and it’s characterized by mild to moderate anaemia in clinical cases.

STAT3 and STAT5B Mutations in T/NK-Cell Chronic Lymphoproliferative Disorders of Large Granular Lymphocytes (LGL): Association with Disease Features

STAT3 and STAT5B (STAT3/STAT5B) mutations are the most common mutations in T-cell large granular lymphocytic leukemia (T-LGLL) and chronic lymphoproliferative disorders of NK cells (CLPD-NK), but their clinical impact remains unknown. We investigated the frequency and type of STAT3/STAT5B mutations in FACS-sorted populations of expanded T/NK-LGL from 100 (82 clonal; 6 oligoclonal; 12 polyclonal) patients, and its relationship with disease features. Seventeen non-LGL T-CLPD patients and 628 age-matched healthy donors were analyzed as controls. STAT3 (n = 30) and STAT5B (n = 1) mutations were detected in 28/82 clonal T/NK-LGLL patients (34%), while absent (0/18, 0%) among oligoclonal/polyclonal LGL-lymphocytosis. Mutations were found across all diagnostic subgroups: TCD8+-LGLL, 36%; CLPD-NK, 38%; TCD4+-LGLL, 7%; Tαβ+DP-LGLL, 100%; Tαβ+DN-LGLL, 50%; Tγδ+-LGLL, 44%. STAT3-mutated T-LGLL/CLPD-NK showed overall reduced (p < 0.05) blood counts of most normal leukocyte subsets, with a higher rate (vs. nonmutated LGLL) of neutropenia (p = 0.04), severe neutropenia (p = 0.02), and cases requiring treatment (p = 0.0001), together with a shorter time-to-therapy (p = 0.0001), particularly in non-Y640F STAT3-mutated patients. These findings confirm and extend on previous observations about the high prevalence of STAT3 mutations across different subtypes of LGLL, and its association with a more marked decrease of all major blood-cell subsets and a shortened time-to-therapy.

A study of the association of leukopenia with disease severity and mortality in patients diagnosed with COVID-19

Background: It has been observed in patients suspected with COVID-19 or presenting as confirmed cases of COVID-19 that a decreased total white blood cell count (leukopenia) is quite a common haematological presentation. In this study we aimed to determine the effect of leukopenia on the progress and severity of COVID-19, as well as to establish the association of leukopenia with disease severity and overall mortality.Methods: This was a longitudinal study conducted at Guru Teg Bahadur hospital, New Delhi from 1st July 2020 to 3rd August 2020. A sample size of 34 cases each in two groups (group A and B) was taken as one random case each day for the duration of the study; group A consisting of the patients presenting with leukopenia, while group B comprising of the patients with a normal leukocyte count.Results: The mean duration of hospital stay in group A was found to be 5.5±2.23 days, while the mean duration of stay in group B was found to be 2.9±1.17 days, showing a significant difference in the two groups with a p<0.001. It was also seen that a total of 8 out of 34 cases in group A and 2 out of the 34 cases in group B had expired during their hospital stay; a significant difference seen among the two groups with a p=0.04.Conclusions: Thus, in conclusion, this study demonstrates a definite and significant association between a decreased leukocyte count (leukopenia) and disease severity and mortality in patients with COVID-19.

The Correlation between the Levels of Troponin I with the Amount of Leukocytes in Patients Suspected Acute Myocardial Infarction

Acute Myocardial Infarction (AMI) is a manifestation of acute myocardial ischemia and is generally caused by the rupture of atherosclerosis and thrombus in the coronary blood vessels. Rupture causes an inflammatory process that leukocytes which acts as a marker of inflammation increases. Heart muscle damage that occurs also resulted in levels of troponin I as one of the markers of increased cardiac examination. Based on that research aims to determine the correlation between the levels of troponin I and the number of leukocytes in patients with suspected AMI.This research method is analytical observation with a data sample of 100 patients with suspected AMI diagnosis by doctors as well as examine the levels of troponin I and the number of leukocytes in dr. Abdulmadjid Chasbullah Bekasi. The correlation between the levels of troponin I and leukocyte counts were analyzed using Spearman's test. Data studied consisted of 52 people (52%) men and 48 (48%) of women. By age group, age range 46-65 years become the largest age group into patients with suspected AMI is 55 people (55%). Obtained 34 (34%) of patients with suspected AMI who had higher levels of troponin I and normal leukocyte count, and 39 (39%) of patients with suspected AMI who had troponin I levels and elevated leukocyte count. On Spearman’s test seen the correlation between levels of troponin I with the total of leukocytes in patients with suspected AMI (p = 0.000 and r = 0.50). This shows an increase in troponin I, which runs parallel with the increase in the total of leukocytes. Suggested for further research to see the difference increased levels of troponin I and the total of leukocytes between 3-5 hours and 14-18 hours after myocardial injury

PERBEDAAN LUARAN PASIEN STROKE ISKEMIK AKUT DENGAN LEUKOSIT NORMAL DAN LEUKOSITOSIS

DIFFERENCE IN OUTCOME OF ACUTE ISCHEMIC STROKE PATIENT WITH NORMAL LEUKOCYTE AND LEUKOCYTOSISABSTRACTIntroduction: Inflammation is an independent risk factor for ischemic stroke, which needs to be inhibited to reduce worsening occlusion of arteries due to atherosclerotic plaques. Increased leukocyte count is considered an acute damage marker of brain tissue that experiences ischemia and is used to determine the severity and prognosis of acute ischemic stroke.Aims: To analyse association between the number of leukocytes in acute onset ischemic stroke patients during admission and discharge.Methods: A prospective analytical observational study with a cohort design on acute ischemic stroke patients in Wangaya Regional Hospital, Denpasar-Bali between January and September 2018. Clinical manifestations were assessed using National Institutes of Health Stroke Scale (NIHSS). Data was collected through medical records and analysed using Chi-square test and Mann-Whitney.Results: Seventy-six subjects devided into 2 groups; normal leucocytes and leucocytosis group, 38 patients respectively. The normal leucocytes group was dominated with male subject (78.9%) and mean leucocytes count was 7,612/mm3. While leucocytosis group was dominated with female subjects (63.2%) and mean leucocytes count was 12,294/ mm3. Mean NIHSS at admission in normal leucocytes group and leucocytosis group was 5 (moderate) and 8 (moderate) respectively. Mean NIHSS at discharge in normal leucocytes group and leucocytosis group was 3 (low) and 11 (moderate) respectively.Discussion: Patients with acute onset ischemic stroke with normal leukocyte count during admission, tend to have better clinical outcome two times fold compared to the patients with leucocytosis.Keywords: Leukocytes, leucocytosis, acute ischemic stroke, NIHSSABSTRAKPendahuluan: Inflamasi merupakan faktor risiko independen terjadinya stroke iskemik, yang perlu dihambat untuk mengurangi perburukan oklusi pada pembuluh darah akibat plak aterosklerotik. Peningkatan kadar leukosit dianggap menunjukkan kerusakan akut jaringan otak yang mengalami iskemia dan digunakan untuk mengetahui tingkat keparahan dan prognosis stroke iskemik akut.Tujuan Mengetahui hubungan antara kadar leukosit terhadap manifestasi klinis pasien stroke iskemik onset akut pada saat masuk dan keluar perawatan.Metode: Penelitian observasional analitik prospektif dengan rancangan kohort terhadap pasien stroke iskemik onset akut yang dirawat di RSUD Wangaya, Denpasar, pada bulan Januari hingga September 2018. Manifestasi klinis subjek dinilai berdasarkan derajat beratnya stroke menggunakan National Institutes of Health Stroke Scale (NIHSS). Data dikumpulkan melalui rekam medis dan di analisis dengan uji Chi-square dan Mann-Whitney.Hasil: Didapatkan 76 subjek yang dibagi menjadi 2 kelompok, yaitu masing-masing 38 subjek pada kelompok dengan leukosit normal dan kelompok dengan leukositosis. Kelompok subjek leukosit normal, didominasi oleh subjek laki- laki (78,9%) dan rerata kadar leukosit 7.612/mm3, sedangkan pada kelompok leukositosis mayoritas perempuan (63,2%) dan rerata kadar leukosit 12.294/mm3. Rerata skor NIHSS saat masuk pada kelompok leukosit normal adalah 5 (moderat) dan pada kelompok dengan leukositosis adalah 8 (moderat). Adapun rerata skor NIHSS pada kelompok leukosit normal saat pasien keluar adalah 3 (ringan) dan 11 (moderat) pada kelompok leukositosis.Diskusi: Subjek stroke iskemik akut dengan kadar leukosit awal yang normal cenderung memiliki perbaikan manifestasi klinis pada saat keluar RS dua kali lebih baik daripada subjek dengan leukositosis.Kata kunci: Leukosit, leukositosis, stroke iskemik akut, skor NIHSS

Hematological parameters and remission induction of childhood acute lymphoblastic leukemia

Background High-risk acute lymphoblastic leukemia (ALL) is one of the most common childhood malignancies in Indonesia. Many factors can inhibit the induction of remission. Hematological parameters are usually not normal. Identification of corresponding factors is important to increase the likelihood of successful inductions.Objective To assess for associations between hematological parameters and induction of remission in children with acute lymphoblastic leukemia.Methods Data were collected from medical records of ALL patients hospitalized in the Pediatric Ward at Dr. Kariadi Hospital from May 2014 – May 2016. Dependent variables were hemoglobin, leukocytes, platelets, and absolute neutrophil count (ANC) levels; the independent variable was induction of remission.Results Out of 55 patients, 33 (60%) had anemia, 6 (10.9%) had leukocytosis, and 1 (1.8%) had hyperleukocytosis, whereas 9 (34.5%) had leukopenia and 29 (52,7%) had normal leukocyte levels. Thirty-one subjects (56.4%) had thrombocytopenia, 15 (27.3%) had thrombocytosis, and only 9 (16.4%) patients had normal platelet counts. There were 29 (52.7%) with absolute ANC > 500, whereas 26 (47.3%) had ANC level ≤ 500. Most patients (80%) experienced remission induction, while 20% did not. There were significant associations between ANC level and induction of remission (P=0.010) as well as between platelet level and induction of remission (P= 0.033). Regression logistic test revealed that ANC level ≤ 500 was associated with a 7-fold lower remission event compared to ANC level > 500 (RR 7.147; 95%CI 1.38 to 37.14).Conclusion Lower ANC level (≤ 500) was significantly associated with lower remission compared to higher ANC level (> 500).

Leukocyte count, systemic inflammation, and health status in older adults: a narrative review

Epidemiological and clinical studies suggest that elevated leukocyte count within the normal range can predict cardiovascular and total mortality in older adults. These findings are remarkable because this simple and common laboratory test is included in routine medical check-ups. It is well known that chronic systemic inflammation (inflammaging) is one of the hallmarks of aging and an important component of obesity-associated insulin resistance that can lead to type 2 diabetes and other health problems in both overweight individuals and elderly people. To understand the molecular mechanisms linking increased systemic inflammation with aging-associated diseases and elevated leukocyte counts in the elderly is to unravel the multiplicity of molecular factors and mechanisms involved in chronic low-grade systemic inflammation, the gradual accumulation of random molecular damage, age-related diseases, and the process of leukopoiesis. There are several possible mechanisms through which chronic low-grade systemic inflammation is associated with both higher leukocyte count and a greater risk of aging-associated conditions in older adults. For example, the IL-6 centric model predicts that this biomediator is involved in chronic systemic inflammation and leukopoiesis, thereby suggesting that elevated leukocyte count is a signal of poor health in older adults. Alternatively, an increase in neutrophil and monocyte counts can be a direct cause of cardiovascular events in the elderly. Interestingly, some authors assert that the predictive ability of elevated leukocyte counts with regard to cardiovascular and allcause mortality among older adults surpass the predictive value of total cholesterol. This review reports the recent findings on the links between elevated but normal leukocyte counts and the increased risks of all-cause, cardiovascular, and cancer mortality. The possible molecular mechanisms linking higher but normal leukocyte counts with increased risk of aging-associated diseases in the elderly are discussed here.

PERBEDAAN HASIL PEMERIKSAAN JUMLAH LEUKOSIT ANTARA METODE MANUAL IMPROVED NEUBAUER DENGAN METODE AUTOMATIC HEMATOLOGY ANALYZER

Leucocytes are nucleated cells in the blood that can be divided into 5 types. Every cell can be calculated its percentage in the blood by doing types calculation and can be distinguished by the size of the core form, color of granules and cytoplasm inside. This study aimed to determine the results of the difference calculation of leukocytes count examination between Manual Method (Improved Neubauer) and Automatic Hematology Analyzer Method in outpatients at the General Hospital of Kendari. Samples of this study were 30 people taken by accidental sampling. The results of the study with 30 samples using manual method (Improved Neubauer), 25 patients (83.4%) had normal leukocyte and 5 patients (16.6%) had abnormal, and examination using Automatic Hematology Analyzer Method showed 22 patients (73.4%) had normal leukocyte and 8 patients (26.6%) had abnormal. Based on paired test of samples obtained p value = 0, 000, so it can be concluded that there is significant difference between count examination of leukocytes using Manual Method with Improved Neubauer and Automatic Hematology Analyzer Method.

EFFECT OF LENGTH OF PREMATURE RUPTURE OF MEMBRANES PERIOD TOWARD APGAR SCORE OF THE INFANT AND MATERNAL LEUKOCYTE SERUM IN ULIN GENERAL HOSPITAL BANJARMASIN

Premature rupture of membranes (PROM) is a condition of rupture of membranes before the birth takes place. The incidence of PROM varies from 3% to 10% of all births and complicates more than 3% of pregnancies with PROM. The purpose of this study was to determine the relationship between the length of the PROM period toward the APGAR score of the infant and maternal leukocyte serum. The research design was analytic observational with retrospective cohort approach. From the result we found a correlation between PROM period with outcome of infant’s APGAR score, there were a total of 89 samples fulfilling the inclusion criteria, with 57 samples of PROM<12 hours (51 with good APGAR score and 6 with bad APGAR score) and 32 samples PROM> 12 hours (16 with good APGAR score, and 16 with bad APGAR score). From the result of the correlation of leukocyte level with the length of PROM period was found total of 84 samples fulfilling the inclusion criteria, with 54 samples of PROM<12 hours (53 with normal leukocyte score and 1 with leukocytosis score) and 30 samples PROM> 12 hours (28 with normal leukocyte score, and 2 with leukocytosis score). From the analysis results we obtained a strong relationship between the length of PROM period with the infant’s APGAR (P = 0.0001, OR 8.5), whereas in the relationship between the length of PROM period with maternal blood leukocyte level there is no significant relationship (p= 0,599). Keywords: Premature Rupture of Membranes, APGAR, Leukocyte Serum

The discrepancy between manual and computerized leukocyte and thrombocyte counts

Background Discrepancy between results of leukocyte and throm-bocyte count by computerized and manual examination may existObjective To determine the discrepancy between computerizedand manual leukocyte and thrombocyte count.Methods The design was a randomized sampling cross sectionalstudy. The blood sample was examined with computerized CellDyn 1400 instrument for the leukocyte and thrombocyte count. Formanual examination, blood smear was performed to measurethrombocyte while leukocyte was measured in Improved Neubauerhemocytometer. The results of computerized examination wereused as gold standard. Sensitivity, specificity, predictive values ofmanual count were calculated. The agreement of Kappa and McNemar test were determinedResults Blood specimens drawn from 100 patients with differentkinds of diagnoses were examined using computerized and manualmethods. In computerized group, 66% had normal leukocyte and55% had normal thrombocyte count. In the manual group, 78% ofsubjects had normal leukocyte and 82% had normal thrombocytecount. From leukocyte examination, the sensitivity of manual countwas 87.9%, specificity was 41.2%, and positive predictive valuewas 74.36 with the agreement of Kappa of 0.32 and Mc Nemarvalue of 0.036. From thrombocyte examination, the sensitivity was96.4%, specificity was 35.6%, and positive predictive value was64.6 with the agreement of Kappa of 0.41 and Mc Nemar value of0.41.Conclusion The result of manual thrombocyte count was in ac-cordance with computerized with the agreement of Kappa of 0.41.On the other hand, there was a discrepancy between manual infavor of computerized leukocyte count with the agreement of Kappaof 0.32