Temporal stability in American alligator (Alligator mississippiensis) white blood cells following capture and handling stress

Usefulness of Combined White Blood Cell Count and Plasma Glucose for Predicting In-Hospital Outcomes After Acute Myocardial Infarction

We investigated the combined effect of white blood cell (WBC) and platelet count on in-hospital mortality and pneumonia in acute ischemic stroke (AIS) patients. A total of 3,265 AIS patients enrolled from December 2013 to May 2014 across 22 hospitals in Suzhou city were included in the present study. We divided patients into four groups according to their level of WBC and platelet count: LWHP (low WBC and high platelet), LWLP (low WBC and low platelet), HWHP (high WBC and high platelet), and HWLP (high WBC and low platelet). A logistic regression model was used to estimate the combined effect of WBC and platelet counts on all-cause in-hospital mortality and pneumonia in AIS patients. HWLP was associated with a 2.07-fold increase in the risk of in-hospital mortality in comparison to LWHP (adjusted odds ratio (OR) 2.07; 95% confidence interval (CI), 1.02-4.18; P-trend =0.020). The risk of pneumonia was significantly higher in patients with HWLP than those with LWHP (adjusted OR 2.29; 95% CI, 1.57-3.35; P-trend <0.001). The C-statistic for the combined WBC and platelet count was higher than WBC count or platelet count alone for the prediction of in- -hospital mortality and pneumonia (all P < 0.01). High WBC count combined with a low platelet count level at admission was independently associated with in-hospital mortality and pneumonia in AIS patients. Moreover, the combination of WBC count and platelet count level appeared to be a better predictor than WBC count or platelet count alone.

The objective of this study was to determine if parity affected the effect of pegbovigrastim (PEG) treatment on white blood cell (WBC) counts in grazing dairy cows. Additionally, the association of prepartum body condition score (BCS) and non-esterified fatty acid (Pre-NEFA) concentration with WBC counts was investigated. The effect of early-lactation disease was included in the statistical analysis. A randomized controlled trial on four commercial grazing dairy farms was performed. Holstein primiparous (Control = 87, PEG = 89) and multiparous (Control = 181, PEG = 184) cows were randomly assigned to one of two treatments: first PEG dose 8 ± 5 (mean ± SD) days before the expected calving date and a second dose within 24 h after calving (PEG) compared to untreated controls (Control). Treatment effects were evaluated with mixed linear regression models. Treatment with PEG increased WBC, neutrophil, lymphocyte and monocyte counts at 6 ± 1 (mean ± SD) days in milk. Parity, BCS and their interactions with treatment were not associated with WBC counts. In control cows, Pre-NEFA concentration was associated with reduced WBC, neutrophil and lymphocyte counts and tended to be associated with reduced monocyte counts. Pegbovigrastim treatment reversed the negative association of Pre-NEFA concentration with neutrophil and monocyte counts and tended to reverse the negative association of Pre-NEFA concentration with WBC counts. In the PEG treated group, cows diagnosed with retained placenta or metritis showed lower neutrophil counts when compared to PEG treated cows without these clinical diseases. These data confirm that PEG treatment increases WBC, neutrophil, lymphocyte and monocyte counts in grazing dairy cows and that this effect is independent of parity. Pegbovigrastim treatment reversed the negative association of Pre-NEFA concentration with neutrophil and monocyte counts, and tended to reverse the negative association of Pre-NEFA concentration with WBC counts.

BackgroundElevated white blood cell (WBC) count is associated with risk of venous thromboembolism (VTE) in cancer patients initiating chemotherapy. It is not known whether the risk of VTE by WBC count in cancer patients is causal or merely a consequence of the malignant disease. To address this question, we studied the association between WBC count, measured prior to cancer development, and risk of VTE in subjects who did and did not develop cancer during follow-up in a prospective population-based study.MethodsBaseline characteristics, including WBC and neutrophil counts, were measured in 24304 initially cancer-free subjects who participated in the Tromsø Study in 1994-1995. Incident cancer diagnosis and VTE events were registered up to September 1, 2007. In the cancer cohort, WBC and neutrophil counts were measured in average 7.1 years before cancer development. Cox-regression models were used to calculate hazard ratios (HRs) for VTE by WBC and neutrophil counts as categorized variables (<40th, 40-80th, and >80th percentile) with 95% confidence intervals (CIs).ResultsDuring follow-up, 1720 subjects developed cancer and there were 388 VTE events, of which 116 occurred in the cancer-group (6.9 per 1000 person-years) and 272 in the cancer-free group (1.1 per 1000 person-years). In those who developed cancer, WBC count above the 80th percentile (≥8.6x109 cells/L) was associated with a 2.4-fold higher risk (HR 2.36, 95% CI: 1.44-3.87) of VTE compared to WBC count below the 40th percentile (<6.4x109 cells/L). No association was found between WBC count and VTE in those who stayed cancer-free (HR 0.94, 95% CI 0.65-1.36). Similar findings were observed for neutrophils.CommentPre-cancer WBC count was associated with risk of VTE in cancer patients, but not in cancer-free subjects. Our findings suggest that leukocytes may play a causal role in cancer-related VTE rather than only reflecting the low-grade inflammation associated with cancer.

Background: Polycythemia vera (PV) is characterized by clonal hematopoiesis leading to elevated peripheral blood counts and an increased risk of thrombotic events (TEs). Advanced age and TE history form the conventional risk model used to determine TE risk/treatment strategy. Associations between TEs and elevated hematocrit (HCT) levels exist, but associations with white blood cell (WBC) or platelet (PLT) counts have not been assessed consistently. The large, real-world, prospective Observational Study of Pts with Polycythemia Vera in US Clinical Practices (REVEAL; NCT02252159) followed pts with PV treated in community or academic centers. Aims: This analysis evaluated associations between elevated blood counts and TEs in pts with PV using data from REVEAL. Methods: Eligible pts had ≥3 lab values (blood counts) post-enrollment; pts with a post-enrollment TE but no lab value <6 mo before that TE were excluded. The association between blood counts and TEs was assessed using a time-dependent covariate Cox proportional hazards model. Time to first post-enrollment TE was modeled with time censored at last known visit for pts with no TE. Each lab parameter was modeled with sex, age, disease duration, and TE history at enrollment as baseline covariates and treatment as a time-dependent covariate. Blood counts were included as binary time–dependent covariates using the following thresholds: HCT >45%, WBC >11×109/L, PLT >400×109/L. Linear interpolation was used to determine lab values between observed lab values. Alternative thresholds for WBC (<7, ≥7 to <8.5; ≥8.5 to <11, and ≥11×109/L, and >12×109/L with HCT controlled at ≤45%) and PLT counts (>600×109/L) were evaluated. Statistical significance was considered at P<0.05. Results: 2271/2510 pts were eligible (median age, 66 y [range, 22–95]; male, 54.1%). Median disease duration was 4.1 y (range, 0–56.3), 456 (20.1%) had TE history; 52.6% of pts received hydroxyurea. Of 106 pts who had TEs, 30 had arterial TEs (most commonly, transient ischemic attack [n=15]) and 76 had venous TEs (most commonly, deep vein thrombosis [n=37]). Elevated HCT levels (>45%, hazard ratio [HR]=1.84 [95% CI, 1.234–2.749], P=0.0028), WBC (>11×109/L, HR=2.35 [1.598–3.465], P<0.0001), and PLT counts (>400×109/L, HR=1.60 [1.088–2.359], P=0.0170) were each associated with increased TE risk (Table 1). WBC count ≥11×109/L is associated with the highest TE risk compared with WBC count <7×109/L (HR=2.61 [95% CI, 1.594–4.262], P<0.0001). Elevated WBC >12×109/L was significantly associated with increased risk of TE with HCT controlled at ≤45%. PLT count (>600×109/L) increased TE risk (HR=1.37 [95% CI, 0.763–2.468]) compared with PLT count ≤600×109/L, but this was not statistically significant (P>0.05). In all models, advanced age, female sex, and TE history were associated with increased TE risk. Image:Summary/Conclusion: This analysis of REVEAL, the largest real-world cohort of PV pts to date, demonstrated that elevated HCT levels (>45%), WBC (>11×109/L), and PLT counts (>400×109/L) were associated with increased TE risk. An association of elevated WBC >12×109/L with increased risk of TE was also observed when HCT was controlled, indicating that TE risk may be reduced by controlling WBC as well as HCT. These data support the need to incorporate blood count into risk stratification and treatment strategies for pts with PV in clinical practice and to move beyond the conventional risk model. Further studies to understand the causal relationship between elevated blood counts and TEs are warranted.

Objective To study the relation between white blood cell (WBC) count and left ventricular (LV) remodeling after emergency percutaneous coronary intervention (PCI) in patients with acute myocardial infarction (AMI).Methods A total of 117 ST segment elevation AMI patients having underwent emergency PCI were enrolled.WBC count,cardiac troponin Ⅰ (cTnI),high-sensitivity C-reactive protein (hs-CRP) and N-terminal pro-B-type natriuretic peptide (NT-proBNP) were obtained at admission before PCI.According to the WBC count level,patients were divided into normal WBC group (WBC count ≤ 10 ×109/L,60 cases) and elevated WBC group (WBC count ＞ 10 × 109/L,57 cases).Two-dimensional echocardiography was applied after PCI.The relation between WBC count and LV remodeling prognosis including LV ejection fraction (LVEF),LV end diastolic diameter (LVEDD) and LV aneurysm were compared after AMI.Results Admission NT-proBNP,hs-CRP and cTnI peak in elevated WBC group were higher than those in normal WBC group [ (2408.83 ± 3173.39) pg/L vs.(713.11 ± 636.82) pg/L,(39.64 ± 59.51) mg/L vs.(11.23 ± 14.14) mg/L,(107.76 ± 107.71) pg/L vs.(62.23 ± 87.79) pg/L,P ＜0.05].Admission WBC count was positively correlated with LVEDD and negatively correlated with LVEF (P ＜0.01 ).Patients with LV aneurysm had higher WBC count than those without LV aneurysm[ ( 12.59 ± 5.22) × 109/L vs. (9.27 ± 2.60) × 109/L,P =0.001 ].Multivariate analyses showed that admission WBC count ≥ 10.5 × 109/L was an independent determinant of LV aneurysm(OR =22.5,95％ CI:2.69-187.83,P ＜ 0.01 ),and this cut-off value yielded sensitivity of 76.9％ and specificity of 69.7％ respectively.Conclusion Admission WBC count may be considered as a prognostic biological tag in the prediction of the development of LV remodeling after emergency PCI in patients with AMI. Key words: Myocardial infarction; Leukocytes; Ventricular remodeling

Diagnosis of Periprosthetic Joint Infection

<b>2412</b> <h3><b>Objectives</b></h3> The objective of this study was to determine whether or not the white blood cell (WBC) count of the patient affects the labeling efficiency of the white blood cells with indium-111 for imaging. Before the matter was researched, it was thought that increased number of white blood cells would lead to a higher WBC label efficiency. <h3><b>Methods</b></h3> Random patient data were collected from the past two years consisting of a total of 100 patients. The patient’s medical record, current WBC count at the time of the labeling, and the labeling efficiency of the study were all recorded and graphed. A scatter plot was used to correlate a relationship between the patient’s WBC count and the corresponding labeling efficiency of the study. <h3><b>Results</b></h3> Graphing the patient’s WBC count against the labeling efficiency highlighted the relationship between the WBC count and the labeling efficiency. There is a consistent plateau showing that WBC counts ranging between 2,700 cells per microliter to 57,500 cells per microliter all generate adequate WBC label efficiency percents ranging from 70% to 97%. Even though normal WBC counts are between 4,500 cells per microliter and 10,000 cells per microliter, efficient labeling can occur outside the norm. Point A (96.3, 57.5) shows that even with a relatively increased WBC count, the percent is the same as if the patient had a WBC count of only 2,700 cells per microliter (Point A1: 96, 2.7). Comparing Point B (70, 4.8) with Point B1(90,3) shows that even with a normal WBC count, the labeling percent can be lower than a WBC count lower than the norm. <h3><b>Conclusions</b></h3> Graphing the patient’s WBC count against the labeling efficiency highlighted that there is not a definite relationship between the WBC count and the labeling efficiency. From relatively high to rather low WBC counts, the adequacy of the labeling percentage did not seem to be affected. <h3><b>Research Support</b></h3> Dugdale, David. "WBC count." MedicinePlus. U.S. National Library of Medicine, 15 Dec. 2010. Web. 26 Jan. 2011. &lt;http://www.nlm.nih.gov/medlineplus/ency/article/003643.htm&gt;

White Blood Cell Count and Mortality in the Baltimore Longitudinal Study of Aging

Background: White blood cell (WBC) count is associated with incident coronary heart disease (CHD). Coronary artery calcification (CAC) is a measure of subclinical atherosclerosis that predicts CHD events. Since data are sparse regarding the association of WBC count with future CAC, we examined the association of WBC count in early adulthood (age 18-30 yrs.) with the presence of CAC 15 or 20 years later (age 33-50 yrs.). Methods: We included CARDIA participants who had baseline data on risk factors and WBC counts, and participated in the Year (Y) 15 or Y20 examinations with CAC score information. We performed age-, sex-, and race-adjusted linear regression analyses to examine the cross-sectional association between baseline (Y0) WBC count (total and subtypes) and known CHD risk factors, including systolic blood pressure (SBP), BMI, smoking (packs/year), total and HDL-cholesterol. We used multiple logistic regressions to assess prospective associations between Y0 WBC count and the presence of CAC at Y15 and Y20. Results: Among 3094 participants, mean (SD) age at baseline was 25± 4 years, 57% were women and 45% were black. In total, 263 and 566 subjects had CAC score&gt;0 at Y15 and Y20 examination, respectively. Y0 SBP, BMI, and smoking (p&lt;0.001), and HDL-cholesterol (p=0.01) were significantly associated with Y0 total WBC counts. Compared to participants without CAC at Y20, those with CAC score&gt;0 had higher Y0 counts (10 9 /L, SD) of total WBC (6.0 ± 1.8 vs. 6.2 ± 1.9, p=0.04), lymphocyte (2.16 ± 0.75 vs. 2.23 ± 0.76 p=0.05), and eosinophil (0.16 ± 0.13 vs. 0.18 ± 0.16, p&lt;0.001). These counts were positively associated with the presence of Y20 CAC after adjusting for potential confounders ( Table 1 ). Similar patterns were observed for Y15 CAC (data not shown). Conclusion: Total WBC and certain subtype counts in young adulthood are significantly associated with presence of CAC 15 or 20 years later in early middle age. These findings suggest the possible involvement of WBC in the initiation and/or early development of atherosclerosis. Table 1. Y0 WBC counts and CAC presence at Y20 (OR (95% CI) per 1 x 10 9 /L WBC counts Model 1 * Model 2 ** Total WBC 1.24 (1.12, 1.37) 1.11 (1.00, 1.24) Monocyte 1.02 (0.93, 1.13) 0.96 (0.87, 1.07) Neutrophils 1.13 (0.99, 1.28) 1.06 (0.93, 1.21) Lymphocyte 1.16 (1.05, 1.28) 1.03 (0.93, 1.14) Eosinophil 1.17 (1.05, 1.29) 1.14 (1.02, 1.27) * Age, sex, race adjusted; ** Model 1 plus Y0 education, SBP, BMI, TC, HDL, smoking and blood pressure lowering medication use.

Spermidine/spermine N1-acetyltransferase activity associates with white blood cell count in myeloid leukemias

White blood cell (WBC) count has been related to risk for coronary heart disease. The relationship may be due to the association between WBC count and cardiovascular risk factors. So far, it has been shown that WBC count is associated with body mass index, total cholesterol, triglyceride, glucose, blood pressure and some lifestyle factors. It is not known, however, whether WBC count is associated with other risk factors such as total homocysteine or γ‐glutamyl transferase. The association between WBC count, total homocysteine and γ‐glutamyl transferase was analyzed cross‐sectionally in middle‐aged Japanese men. In a univariate regression analysis WBC count was associated positively with total homocysteine (β (standard regression coefficient) = 0.112; p<0.001) but not with γ‐glutamyl transferase (β = 0.033; p = 0.309). In a multivariate analysis which included cigarette smoking, physical activity, ethanol consumption, vegetable intake and body mass index, the association between WBC count and total homocysteine remained significant (β = 0.062; p = 0.026). The association may partially explain the reported association between elevated WBC count and cardiovascular disease.

Background: Increased inflammatory reaction can aggravate brain injury after acute ischemic stroke, but the clinical effect of such response is not fully understood. The aim of this study was to determine associations of peripheral white blood cell (WBC) count on clinical outcome among participants of the ENCHANTED study. Methods: Data are from the Enhanced Control of Hypertension for &lt; and &amp;gt; for &gt; Thrombolysis Stroke Study (ENCHANTED), aninternational, multicenter, randomized controlled trial where patients with acute ischemic stroke were randomized to low-dose (0.6 mg/ kg) or standard-dose (0.9 mg/kg) IV alteplase.Blood samples were collected on admission &amp;lt; for &lt; and &amp;gt; for &gt; WBC count was measured at local laboratories. The primary outcome was death or disability, defined by scores 3–6 on the modified Rankin Scale at 90 days.Secondary outcomes included ordinal mRS shift,fatal intracerebral hemorrhage(ICH) by various standard criteria.Associations of baseline WBC count &amp;lt; for &lt; and &amp;gt; for &gt; outcomes were evaluated in logistic regression models. Results: There were 3179 participants with relevant data who were classified into quartiles of WBC counts (≤ 6.30, 6.31–7.82, 7.83–9.80, &amp;lt; for &lt; and &amp;gt; for &gt; ≥ 9.81х109/L, respectively).Increased WBC count was associated with younger age,elevated NIHSS scores, less antithrombotic used,elevated heart rate,elevated fever treated,stroke severity. Risks of death or major disability at 90 days increased progressively with higher WBC count: frequencies of 30.4%, 34.7%,39.1% &amp;lt; for &lt; and &amp;gt; for &gt; 44.8% for quartile groups, respectively (P &lt;.0001 for trend). After adjustment for baseline clinical &amp;lt; for &lt; and &amp;gt; for &gt; imaging variables including age, sex, body temperature, systolic BP, heart rate, high NIHSS scores, &amp;lt; for &lt; and &amp;gt; for &gt; randomized treatment, the association between WBC count &amp;lt; for &lt; and &amp;gt; for &gt; primary outcome was still significant (P &lt;.0001 for trend). Conclusions: Elevated WBC count on admission may be an independent prognostic predicator in patients with Acute Ischemic Stroke, but this requires further evaluation in a prospective cohort study.

The Effect of Ruxolitinib on White Blood Cell Counts in Patients with Polycythemia Vera: Results from the RESPONSE Trial

The significance of serial white blood cell (WBC) counts in trauma patients with a suspected hollow viscus injury (HVI) is unknown. The purpose of this study was to examine the role of serial WBC counts in the diagnosis of a HVI. After institutional review board approval, all injured patients admitted to a Level I trauma center from January 2003 to December 2007 with at least one WBC measurement were included in a retrospective analysis. The WBC profiles for patients with a HVI were compared against those without HVI. All WBC counts are reported as [x10(3)/microL]. The mean WBC count of the overall study population (n = 5,950) on admission was 11.6 +/- 5.3. Overall, 59.2% had an elevated WBC count on admission. A significant relationship between increasing Injury Severity Score and increasing WBC count on admission was found by linear regression. When comparing patients with HVI (n = 267) with patients without HVI (n = 5,683), no significant difference was found for admission WBC count. The highest WBC count within the first 24 hours for patients with HVI was 16.7 +/- 4.7. This was significantly higher than that for the 4,520 patients without any intraabdominal injury (13.0 +/- 5.2, adjusted p < 0.001). Penetrating injury, a concomitant severe thoracic trauma (chest Abbreviated Injury Scale value >or=3), and highest WBC count >or=20.0 in the first 24 hours were independent risk factors for HVI. A maximal WBC count <or=12.5 in the first 24 hours was independently associated with a lower incidence of HVI. The area under the receiver operating characteristic curve for the highest WBC count in the first 24 hours for predicting HVI was 0.723 (95% CI: 0.656-0.790). Multiple variables likely impact the WBC count in trauma patients. WBC count elevation on admission is nonspecific and does not predict the presence of a HVI. With serial measurements, WBC counts >or=20.0 are independently associated with a HVI, whereas counts <or=12.5 rule against the presence of HVI. However, the sensitivity of these cutoff values to predict a HVI is poor. The diagnostic value of serial WBC counts for predicting a HVI within the first 24 hours after trauma is very limited.