Changes In White Blood Cell Counts Research Articles

White blood cell kinetics in patients with gynecologic cancer receiving mecapegfilgrastim prophylaxis: A multicenter real-world study.

e17502 Background: Some studies have indicated that using granulocyte-colony stimulating factor (G-CSF) following chemotherapy in patients with solid tumors may increase the risk of excessive white blood cell (WBC) elevation. In this real-world study, we aimed to assess the changes in WBC counts after prophylactic administration of 6 mg mecapegfilgrastim (a long-acting G-CSF) in multiple chemotherapy cycles among Chinese gynecological cancer patients, with a particular focus on those with low body weight (≤50 kg). Methods: A multicenter prospective cohort study was conducted involving gynecological cancer patients who received at least two consecutive chemotherapy cycles with mecapegfilgrastim 6 mg (administered 24 hours post-chemotherapy) between October 2019 and November 2021. Absolute WBC and absolute neutrophil counts (ANC) were recorded at baseline and on the 7th and 14th days of each cycle. Results: A total of 256 gynecological cancer patients completing 2-4 treatment cycles, including 86 with cervical cancer, 136 with ovarian cancer, and 34 with endometrial cancer, were analyzed. Of them, 58 had a pre-chemotherapy body weight of ≤50 kg, and 198 had a body weight of >50 kg. The majority of patients received taxane-based chemotherapy regimens with a cycle duration of ≥14 days. For day 7 post-chemotherapy WBC counts, data were collected from 535 cycles, including 125 cycles in the ≤50 kg group and 410 cycles in the >50 kg group. Elevated WBC counts (>10.0×10^9/L) were observed in 56 cycles (44.8%) in the ≤50 kg group and 177 cycles (43.2%) in the >50 kg group. On day 14 post-chemotherapy, data from 505 cycles, comprising 115 cycles in the ≤50 kg group and 390 cycles in the >50 kg group, indicated elevated WBC counts in 27 cycles (23.5%) in the ≤50 kg group and 63 cycles (16.2%) in the >50 kg group. In the ≤50 kg group, 3 cases (5.2%) experienced an ANC <0.5×10^9 /L, with no febrile neutropenia observed. In the >50 kg group, 11 cases (5.6%) experienced an ANC <0.5×10^9 /L, with 1 patient (0.51%) experiencing febrile neutropenia. Conclusions: In patients with low body weight (≤50 kg), the administration of 6 mg mecapegfilgrastim effectively stabilizes WBC elevation, exhibiting a favorable safety and efficacy profile. This regimen ensures the timely and appropriate progression of patients to subsequent cycles of chemotherapy. WBC counts in patients. [Table: see text]

Defining the Limits of Postpartum Leukocytosis: A Retrospective Cohort Study

There are established reference ranges for many laboratory values during pregnancy. Fewer studies exist regarding the expected white blood cell (WBC) count after delivery. The aim of this study was to determine appropriate postpartum leukocytosis in a diverse patient cohort. Patients who delivered a live fetus at 37 weeks or later were retrospectively identified. Complete blood counts collected on hospital admission and postpartum day one were used to quantify the change in WBC count associated with delivery. A total of 2245 patients were included; of these patients, 1476 delivered vaginally and 769 delivered via cesarean section. The average change in WBC count was 2.99 × 103/mm3. A WBC count of 20.19 × 103/mm3 defined the 95th percentile. The average rise in WBC count was 3.31 × 103/mm3 after vaginal delivery and 2.34 × 103/mm3 after cesarean section (p < 0.001). Patients with chorioamnionitis or endometritis had an average postpartum WBC rise of 7.38 × 103/mm3 compared to 2.99 × 103/mm3 in controls (p < 0.001). There was no difference in WBC count rise with comorbid asthma, diabetes, or chronic hypertension. A greater WBC count rise was found in patients with pregnancy-induced hypertension. This study provides reference values for the average rise in WBC count after delivery and the 95th percentile postpartum WBC count in a diverse, medically complex patient population with and without delivery complications. Our findings further highlight maternal medical comorbidities that may contribute to the degree of postpartum leukocytosis.

Effect of the Xanthine Oxidase Inhibitor, Febuxostat, on WBC Count in Asymptomatic Hyperuricemia: Subanalysis of the Randomized PRIZE Study.

The anti-inflammatory effects of the xanthine oxidase inhibitor, febuxostat, a urate-lowering agent, have been reported in animal studies. However, the anti-inflammatory effects of urate-lowering therapy and its associated cardiovascular protective effects have not been fully determined in actual clinical practice. This study aimed to investigate the effect of febuxostat on white blood cell (WBC) count in patients with asymptomatic hyperuricemia and to assess for potential correlations between changes in WBC count and inflammatory biomarkers and atherosclerosis in this patient population. This was a post hoc subanalysis of the PRIZE study, a multicenter, prospective, randomized, open-label clinical trial. In the PRIZE study, asymptomatic hyperuricemia patients were randomized to febuxostat group or control group with non-pharmacological therapy and evaluated the effect on vascular. The primary endpoints of this study were the assessment of the time course of WBC count over 24 months and its changes from baseline. Correlations of WBC count with high-sensitivity C-reactive protein (hs-CRP) and mean common carotid artery (CCA)-IMT were also exploratorily examined in the febuxostat group. A total of 444 patients (febuxostat group, n=223; control group, n=221) with WBC measurements available at baseline and at least one of the follow-up time points of 12 or 24 months, were enrolled. Febuxostat modestly, but significantly, reduced WBC counts at 12 and 24 months compared with the baseline levels (P=0.002 and P=0.026, respectively). Notably, the WBC count in the febuxostat group at 12 and 24 months was significantly lower than that in the control group (P=0.007 and P=0.023, respectively). The changes in WBC count were associated with those of hs-CRP (P=0.038), but not with CCA-IMT (P=0.727). Febuxostat therapy for 24 months modestly, but significantly, decreased WBC count in patients with asymptomatic hyperuricemia. This might potentially reflect a modest anti-inflammatory action of febuxostat in clinical settings.

Suggested Flowchart Through Integrated C-Reactive Protein and White Blood Cell Count Analysis for Screening for Early Complications After Gastric Bypass: a Single-Center Retrospective Study.

Early leakage detection following bariatric procedures is crucial, but a standardized evaluation method is lacking. The aim was to validate the potential benefits of postoperative day 1 (POD1) C-reactive protein (CRP) levels and white blood cell (WBC) counts in distinguishing at-risk patients following Roux-en-Y gastric bypass (RYGB) while considering the impact of obesity-related chronic inflammation. Retrospective analysis of 261 consecutive patients aged 18-65 years with a body mass index (BMI) of 32.5-50 kg/m2 who underwent primary RYGB between 2017 and 2022. Sequential changes in CRP levels and WBC counts measured 48 h preoperatively and on POD1 morning were collected and compared between patients with/without complications and in patients without complications stratified by preoperative CRP levels. Female patients and those with a higher BMI tended to have higher baseline CRP levels, which were positively related to postoperative CRP. Patients experiencing complications had higher WBC counts and a higher prevalence of WBC counts >14,000/μl (77.8% vs. 25.4%; p<0.001) than those without complications. Baseline CRP ≥ 0.3 mg/dl, a longer operative time, and blood loss >10 ml were significantly more common with WBC counts above 14,000/μl; a reasonable range of change in WBC count (∆WBC) derived from its positive correlation to postoperative WBC count (r=0.6695) may serve as a useful complementary indicator. An individualized CRP threshold setting and integrated interpretation of the WBC count can be more appropriate than using static criteria for differentiating at-risk patients after RYGB. Further studies are needed to validate these findings and determine their generalizability.

Assessment of three different radioiodine doses for ablation therapy of thyroid remnants: Efficiency, complications and patient comfort.

I-131 radioiodine (RAI) ablation removes postoperative residual tissue and facilitates follow-up in low- and intermediate-risk differentiated thyroid cancer (DTC). Although low doses have been reported to be as effective as higher doses for ablation, the doses administered still vary depending on the patient and the practitioner. We aimed to evaluate the ablation efficiency, complications, and length of stay (LOS) of patients with DTC treated with 3 different doses for ablation. Patients with DTC who received RAI therapy were retrospectively reviewed. One hundred thirty patients with low-intermediate-risk, according to American Thyroid Association classification, without known lymph nodes or distant metastases were included. Patients were divided into 3 groups as 30 to 50 mCi, 75 mCi, and 100 mCi. Residue thyroid and salivary glands were evaluated from 9 to 12 months post-RAI I-131 scans. No significant difference was found between groups regarding ablation success (P = .795). In multivariable analyses, pretreatment thyroglobulin (hazard ratio = 0.8, 95% confidence interval 0.601-0.952, P = .017) and anti- thyroglobulin antibody (hazard ratio = 1.0, 95% confidence interval 0.967-0.998, P = .024) were 2 independent predictors of ablation success. The mean LOS was 2.1 ± 0.3, 2.6 ± 0.6, and 2.9 ± 0.4 days, respectively, (P = .001). LOS rates of ≥ 3 days were 13.2%, 54.3%, and 84.8%, respectively. Mild decreases in hemoglobin, white blood cell (WBC), and platelet counts were observed in all groups after 6 weeks without any clinically significant findings. A lower rate of change in WBC counts was observed in the 30 to 50 mCi group compared to others. There was no dose-dependent difference regarding the early complaints questioned. Ablation with 30 to 50 mCi provides benefits such as shorter LOS, better patient comfort, less salivary gland dysfunction, and less WBC suppression, thus reducing costs without decreasing efficacy.

Evaluating Effects of AIV Infection Status on Ducks Using a Flow Cytometry-Based Differential Blood Count.

Ducks have recently received a lot of attention from the research community due to their importance as natural reservoirs of avian influenza virus (AIV). Still, there is a lack of tools to efficiently determine the immune status of ducks. The purpose of this work was to develop an automated differential blood count for the mallard duck (Anas platyrhynchos), to assess reference values of white blood cell (WBC) counts in this species, and to apply the protocol in an AIV field study. We established a flow cytometry-based duck WBC differential based on a no-lyse no-wash single-step one-tube technique, applying a combination of newly generated monoclonal antibodies with available duck-specific as well as cross-reacting chicken markers. The blood cell count enables quantification of mallard thrombocytes, granulocytes, monocytes, B cells, CD4+ T cells (T helper) and CD8+ cytotoxic T cells. The technique is reproducible, accurate, and much faster than traditional evaluations of blood smears. Stabilization of blood samples enables analysis up to 1 week after sampling, thus allowing for evaluation of blood samples collected in the field. We used the new technique to investigate a possible influence of sex, age, and AIV infection status on WBC counts in wild mallards. We show that age has an effect on the WBC counts in mallards, as does sex in juvenile mallards. Interestingly, males naturally infected with low pathogenic AIV showed a reduction of lymphocytes (lymphocytopenia) and thrombocytes (thrombocytopenia), which are both common in influenza A infection in humans. IMPORTANCE Outbreaks of avian influenza in poultry and humans are a global public health concern. Aquatic birds are the primary natural reservoir of avian influenza viruses (AIVs), and strikingly, AIVs mainly cause asymptomatic or mild infection in these species. Hence, immunological studies in aquatic birds are important for investigating variation in disease outcome of different hosts to AIV and may aid in early recognition and a better understanding of zoonotic events. Unfortunately, immunological studies in these species were so far hampered by the lack of diagnostic tools. Here, we present a technique that enables high-throughput white blood cell (WBC) analysis in the mallard and report changes in WBC counts in wild mallards naturally infected with AIV. Our protocol permits large-scale immune status monitoring in a widespread wild and domesticated duck species and provides a tool to further investigate the immune response in an important reservoir host of zoonotic viruses.

Challenging the Interpretation of White Blood Cell Counts in Patients with Sepsis Following Packed Cell Transfusion.

Critically ill patients with sepsis often require packed cell transfusions (PCT). However, PCT may affect white blood cell (WBC) counts. We conducted a population-based retrospective cohort study to trace changes in WBC count following PCT in critically ill patients with sepsis. We included 962 patients who received one unit of PCT while hospitalized in a general intensive care unit, and 994 matched patients who did not receive PCT. We calculated the mean values of WBC count for the 24 h before and 24 h after PCT. Multivariable analyses using a mixed linear regression model were performed. The mean WBC count decreased in both groups, but more in the non-PCT group (from 13.9 × 109/L to 12.2 × 109/L versus 13.9 × 109/L to 12.8 × 109/L). A linear regression model showed a mean decrease of 0.45 × 109/L in WBC count over the 24 h following the start of PCT. Every 1.0 × 109/L increase in the WBC count prior to PCT administration showed a corresponding decrease of 0.19 × 109/L in the final WBC count. In conclusion, among critically ill patients with sepsis, PCT causes only mild and clinically non-prominent changes in WBC count.

Outcome of COVID-19 mRNA Vaccination in Patients Treated With Clozapine WHO Previously Went Through SARS-COV-2 Infection.

The outbreak of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic had multiple consequences for the health care system, especially for patients with mental illnesses. Schizophrenia patients particularly appear to have a higher risk of complications due to coronavirus-19 (COVID-19). Clozapine remains the gold standard for treatment-resistant schizophrenia (TRS). However, the COVID-19 pandemic had an important negative impact on clozapine treatment, mainly because of its administration protocol, which was very difficult to follow during the restrictions imposed in the pandemic, and its side effects in patients with COVID-19 infection. Vaccination is an effective method of avoiding SARS-CoV-2 infection or its severe complications, especially in susceptible populations. Data on adverse events after vaccination against COVID-19 are limited, both in the general population and in schizophrenia patients. The study aimed to investigate the safety of COVID-19 vaccination in patients treated with clozapine for hematological parameters. We conducted an analytical cross-sectional study between July 1, 2021, and June 30, 2022. We compared 2 groups of COVID-19 vaccinated patients who had previously experienced SARS-CoV-2 infection: The first group was treated with clozapine, whereas the second group was treated with other antipsychotics. The primary objective was to identify granulocytopenia, leukocytopenia, and lymphocytopenia. The results were measured after the second dose of the Pfizer-BioNTech vaccine. This study included 100 patients. White blood cell count changes were limited to a few cases of mild granulocytopenia (8.16% in the clozapine group and 3.92% in the nonclozapine group, P = 0.37) with no cases of severe granulocytopenia or agranulocytosis. As far as leukocyte counts are concerned, mRNA COVID-19 vaccination seems to be safe in patients treated with clozapine who previously had SARS-CoV-2 infection. Leukocyte changes had no clinical implications.

Analysis of nutritional status and influencing factors in patients with thoracoabdominal aortic dissection receiving 3D printing-assisted stent graft fenestration

BackgroundTo investigate the nutritional status of patients with aortic dissection (AD) treated with using 3D printing-assisted stent graft fenestration and explore the important factors affecting the nutrition status of patients with different numbers of fenestrations (holes).MethodsNinety-nine hospitalized patients with AD in a grade A tertiary hospital in Nanjing from January 2020 to December 2020 were selected as the study subjects. According to the different number of fenestrations, the patients were divided into four groups: one fenestration (group A), two fenestrations (group B), three fenestrations (group C) and four fenestrations (group D); and the nutrition status of patients in the four groups was analyzed. Then, according to whether the calories provided via infusion reached the 80% goal calories (25 kcal/kg/day) on postoperative day 5, the patients were assigned to the Reached group and Not reached group, and their inflammatory parameters, including white blood cell (WBC) and C-reactive protein (CRP), on postoperative days 1 and 5 were analyzed.ResultsCompared with patients in group B (18.8%), C (19.4%) and D (6.7%), patients in group A (48.6%) had the highest rate of reaching the nutrition requirement (80% goal calories). Further, in the Reached group, WBC count and CRP concentration were significantly reduced on postoperative day 5 compared with postoperative day 1, and the proportion of patients with abnormal WBC count was significantly decreased. In contrast, although the CRP concentration on postoperative day 5 in the Not reached group was significantly lower than that on postoperative day 1, no significant changes in WBC count were observed.ConclusionIn 3D printing-assisted stent graft fenestration for AD, multiple fenestrations (holes) were associated with a low rate of reaching nutrition requirements, which might be related to imflammation. Therefore, effective nutritional support should be given to patients with multiple fenestrations after operation to improve their nutritional status and prognosis.

Haematological changes in sailors who had COVID-19.

Follow-up of patients who had coronavirus disease 2019 (COVID-19) proves that clinical symptoms persist for months after recovery. A complex of such persistent manifestations is defined as the post-COVID-19 syndrome. One of the criteria for post-COVID-19 syndrome may be typical changes in white blood cell count and white blood cell (WBC) differential. The aim of the work is to study the frequency of haematological changes in sailors who had the acute coronavirus infection. The retrospective study covered 30 candidate sailors aged 21 to 60 years with a history of COVID-19 and persistent changes in the WBC count and WBC differential and who did not have haematological abnormalities during the previous medical examinations. Analysis of WBC and WBC count at the long-term period after COVID-19 confirmed persistent changes in the form of neutrophilia, lymphopenia, changes in the neutrophils and lymphocytes ratio. The revealed changes in the WBC count were typical and fit into several patterns: A. Absolute leukocytosis, absolute and relative neutrophilia, relative lymphopenia; B. Relative and absolute lymphopenia, relative neutrophilia; C. Relative and absolute lymphocytosis, relative neutropenia; D. Relative lymphopenia, without other changes in WBC differential. The most typical laboratory change in WBC count in patients with the past COVID-19 is relative or absolute leukopenia. Persistent changes in WBC count are not always outside of the reference range for absolute values and should be assessed by a complex of typical changes. The presence of typical changes in WBC count in a patient with the past COVID-19 requires a profound examination for the post-COVID-19 syndrome.

Qingwenzhike Prescription Alleviates Acute Lung Injury Induced by LPS via Inhibiting TLR4/NF-kB Pathway and NLRP3 Inflammasome Activation.

Background: Acute lung injury (ALI) is characterized by dysfunction of the alveolar epithelial membrane caused by acute inflammation and tissue injury. Qingwenzhike (QWZK) prescription has been demonstrated to be effective against respiratory viral infections in clinical practices, including coronavirus disease 2019 (COVID-19) infection. So far, the chemical compositions, protective effects on ALI, and possible anti-inflammatory mechanisms remain unknown. Methods: In this study, the compositions of QWZK were determined via the linear ion trap/electrostatic field orbital trap tandem high-resolution mass spectrometry (UHPLC-LTQ-Orbitrap MS). To test the protective effects of QWZK on ALI, an ALI model induced by lipopolysaccharide (LPS) in rats was used. The effects of QWZK on the LPS-induced ALI were evaluated by pathological changes and the number and classification of white blood cell (WBC) in bronchoalveolar lavage fluid (BALF). To investigate the possible underlying mechanisms, the contents of interleukin-6 (IL-6), tumor necrosis factor-α (TNF-α), monocyte chemoattractant protein (MCP-1), interleukin-1β (IL-1β), interleukin-18 (IL-18), and immunoregulatory-related factors interferon-γ (IFN-γ) were detected by ELISA. Furthermore, the expression of Toll-like receptor 4 (TLR4), p-IKKα/β, IKKα, IKKβ, p-IκBα, IκBα, p-NF-κB, nuclear factor-κB (NF-κB), NOD-like receptor family pyrin domain containing 3 (NLRP3), cleaved caspase-1, pro-caspase-1, apoptosis-associated speck-like protein containing CARD (ASC), and β-actin were tested by Western blot. Results: A total of 99 compounds were identified in QWZK, including 33 flavonoids, 23 phenolic acids, 3 alkaloids, 3 coumarins, 20 triterpenoids, 5 anthraquinones, and 12 others. ALI rats induced by LPS exhibited significant increase in neutrophile, significant decrease in lymphocyte, and evidently thicker alveolar wall than control animals. QWZK reversed the changes in WBC count and alveolar wall to normal level on the model of ALI induced by LPS. ELISA results revealed that QWZK significantly reduced the overexpression of proinflammatory factors IL-6, TNF-α, MCP-1, IL-1β, IL-18, and IFN-γ induced by LPS. Western blot results demonstrated that QWZK significantly downregulated the overexpression of TLR4, p-IKKα/β, p-IκBα, p-NF-κB, NLRP3, cleaved caspase-1, and ASC induced by LPS, which suggested that QWZK inhibited TLR4/NF-κB signaling pathway and NLRP3 inflammasomes. Conclusions: The chemical compositions of QWZK were first identified. It was demonstrated that QWZK showed protective effects on ALI induced by LPS. The possible underlying mechanisms of QWZK on ALI induced by LPS was via inhibiting TLR4/NF-kB signaling pathway and NLRP3 inflammasome activation. This work suggested that QWZK is a potential therapeutic candidate for the treatments of ALI and pulmonary inflammation.

Dynamic Curve Analysis of Indicators Related to Lumbar Cistern Drainage for Postoperative Meningitis

To analyze the dynamic curve of cerebrospinal fluid (CSF)-related indices in cases of postoperative meningitis after selective craniotomy and to provide reference data for the clinical treatment with lumbar cistern drainage (LCD). We conducted a retrospective study of LCD placement in 51 patients. Primary outcomes measured included dynamic changes of body temperature before and after intervention and cerebrospinal fluid biochemical parameters over the course of 13 days of catheter placement. We also assessed the bivariate correlation between white blood cell (WBC) count changes, polykaryocyte percentage, body temperature, and daily cerebrospinal fluid drainage volume. Finally, we analyzed the effect of average daily drainage volume, antibiotic choice, and surgical site on WBC count change curves. After LCD, there was a statistically significant difference (P < 0.01) between the WBC count before drainage and on the fourth day of drainage. There was a negative correlation between the change curve of the WBC count and the change curve of daily drainage volume (r=-0.56). When the daily drainage volume was 250-300 mL/day, the change curve pattern of the WBC count was consistent with the overall trend, and there was no significant difference in the curve of the WBC count between different surgical sites (P > 0.05). The WBC count can decrease significantly by day 4 after drainage, and placement of the LCD for 6-7 days is ideal. An average drainage volume of 250-300 mL/day is safe and effective.

Transient Leukopenia After Radioactive Iodine Treatment in Patients With Graves' Disease: A Retrospective Cohort Study.

ContextRadioactive 131I (RAI) for the treatment of differentiated thyroid cancer is known to induce bone marrow suppression, which occurs approximately 1 month after treatment. However, it is unknown whether RAI therapy for Graves’ disease causes bone marrow suppression.ObjectiveThis study aimed to evaluate the short- and long-term effects of RAI therapy on bone marrow function in patients with Graves’ disease.MethodsIn this retrospective cohort study, we included patients with Graves’ disease who received RAI therapy only once between 2003 and 2019 at Tokyo Women’s Medical University. Blood cell counts at baseline were compared with counts at 1, 2, 4, 12, 24, 48, 144, and 240 weeks after RAI therapy. Moreover, changes in white blood cell (WBC) count and leukopenia at 1 week after RAI treatment were compared by baseline patient characteristics.ResultsWe enrolled 48 patients. Leukopenia was observed in 6 patients at 1 week after RAI treatment, and the overall WBC count significantly decreased (P < 0.001) 1 week after the therapy; however, the values were not significantly lower after 2 weeks. Neither red blood cell nor platelet count were significantly altered. Moreover, independent of other factors, the neutrophil count at the baseline was significantly negatively associated with changes in WBC count or the occurrence of leukopenia 1 week after the RAI treatment.ConclusionThese data showed that RAI treatment induced transient reduction in the WBC count 1 week after treatment, although WBC levels were subsequently restored.

ABO blood groups as a new potential predictive factor in radiotherapy hematological changes.

Cancer treatments specially with new high Tec radiotherapy equipment's calling daily progression in method and predictive factors affecting treatment goals. Due to important effect of oxygen on cells radio sensitivity, tumor blood circulation and it's antigens like ABO blood groups maybe an important predictive factor for radiotherapy response and it is adverse events. The aim of this study was the assessment of the hematological manifestations of local radiotherapy and association with ABO blood groups. In this observational study, 2 ml of peripheral blood were taken from 152 patients with routine 3D conformal radiotherapy treatment course and the blood parameters achieve and documented at four stage during treatment courses. The data were analyzed by repeated measurement andone-way ANOVA. Statistically significant reductions of the platelets, white blood cells (WBC), and lymphocytes counts were demonstrated. Also an increased percentage of polymorphonuclear cells during local radiotherapy exposure was found. The changes in WBC counts were observed to be in association with ABO blood groups. The other evaluated factors were not significantly associated with ABO blood groups. Our results showed an association between radiotherapy patients ABO blood groups and some hematological changes in their blood circulation (Fig. 7, Ref. 23).

Inflammatory response markers in rats undergoing abdominal surgical procedures.

BackgroundThe aim of this study was to determine the effectiveness of cortisol, interleukin (IL)-6, C-reactive protein (CRP), and white blood cell (WBC) count as inflammatory markers to evaluate the postoperative inflammatory response associated with various abdominal surgical procedures in rats.MethodsWistar albino rats (N=152) were randomly assigned to 7 groups: control, hepatectomy, splenectomy, nephrectomy, colectomy, gastrectomy, and sham. Apart from the control group, each group was then divided into 3 subgroups: 6th, 24th and 48th h. Thus, a total of 19 groups were defined, each including 8 rats. At the 6th, 24th and 48th h following the surgical procedures blood samples from each rat were collected. The plasma concentrations of IL- 6, cortisol, CRP, and WBC were measured.ResultsBoth the surgery category and the elapsed time after the surgery had a significant effect on IL-6 levels (P<0.0001). Blood CRP levels were primarily determined by the surgery category (P<0.0001). Neither surgery nor the elapsed time had a significant effect on the cortisol levels. The elapsed time after surgery was the major factor that influenced the differences in WBC count among the surgery groups (P<0.0001).ConclusionsOur results cumulatively indicate that the levels of IL-6, CRP, and cortisol and WBC count change at different time points after several abdominal surgical procedures. Cortisol level is not related to the type of surgical procedure or the elapsed time, while WBC count decreases with the elapsed time. None of the changes in the markers investigated in this study is specifically related to the category of abdominal surgical procedure.

WBC COUNT AS A PROGNOSTIC INDICATOR IN THE TREATMENT OF IDIOPATHIC PULMONARY FIBROSIS

SESSION TITLE: Tuesday Abstract Posters SESSION TYPE: Original Investigation Posters PRESENTED ON: 10/22/2019 01:00 PM - 02:00 PM PURPOSE: Idiopathic pulmonary fibrosis (IPF) is a progressive form of interstitial lung disease resulting in varying degrees of scarring that is further exacerbated by acute inflammatory processes. White blood cell (WBC) count has been established as an inflammatory marker and is a known prognostic indicator in several cardiopulmonary processes. For IPF patients on disease-modifying therapy such as nintedanib or pirfenidone, the correlation between WBC and disease-related events has not been well studied. METHODS: Patient demographics, complete blood cell (CBC) counts, and pulmonary function tests from patients with IPF evaluated at Inova Fairfax Hospital between October 2014 and January 2019 were collected. CBCs were compared before and after initiation of anti-fibrotic therapy. Outcome events collated were respiratory hospitalizations, lung transplant, or death following the initiation of anti-fibrotic therapy. Event-free survival was calculated and compared between patients on nintedanib versus pirfenidone. RESULTS: Sixty-one patients with IPF had CBCs available prior to initiation of anti-fibrotic therapy. WBC range was 3.5 to 16.0 (median 8.0). Subsequently, 28 patients had been started on pirfenidone and 33 patients had been prescribed nintedanib. Of the 61 patients, those with baseline WBC count less than 8 (N=32) had a median event-free survival of 710 days (P=NS) compared with 703 days (P=NS) for those with baseline WBC count greater than 8 (N=29). The median change in WBC count amongst the 61 patients was -0.3. Median event-free survival for those with an increase in WBC count (N=23) after initiating anti-fibrotic therapy was 683 days (P=NS) compared with 761 days (P=NS) for those with no change or a decrease in WBC count (N=38). CONCLUSIONS: Trending the change in WBC count in patients with IPF on anti-fibrotic therapy did not serve as a prognostic indicator with statistical significance. This result may have been influenced by the small sample size of the study. Additionally, although WBC count has been suggested as a biomarker of prognosis in IPF, the mechanism of action of anti-fibrotic therapy may be independent of factors that influence the WBC count. CLINICAL IMPLICATIONS: Based on the findings of this study, further research is indicated to investigate the potential significance of WBC count and its role in inflammation in the evolution of IPF and its management. DISCLOSURES: No relevant relationships by Scott Barnett, source=Web Response Speaker/Speaker's Bureau relationship with Genentech Please note: $5001 - $20000 Added 03/15/2019 by Anne Brown, source=Web Response, value=Honoraria Consultant relationship with Promedior Please note: $5001 - $20000 Added 03/15/2019 by Anne Brown, source=Web Response, value=Consulting fee No relevant relationships by Talha Demirci, source=Web Response Speaker/Speaker's Bureau relationship with Genentech Please note: $1001 - $5000 Added 03/08/2019 by Christopher King, source=Web Response, value=Honoraria Consultant relationship with Roche-Genentech Please note: $20001 - $100000 Added 03/15/2019 by Steven Nathan, source=Web Response, value=Consulting fee Speaker/Speaker's Bureau relationship with Boerhinger-Ingelheim Please note: $20001 - $100000 Added 03/15/2019 by Steven Nathan, source=Web Response, value=Honoraria Consultant relationship with Promedior Please note: $5001 - $20000 Added 03/15/2019 by Steven Nathan, source=Web Response, value=Consulting fee Consultant relationship with Bellerophon Please note: $5001 - $20000 Added 03/15/2019 by Steven Nathan, source=Web Response, value=Consulting fee Advisory Committee Member relationship with United Therapeutics Please note: $1001 - $5000 Added 03/15/2019 by Steven Nathan, source=Web Response, value=Consulting fee

Significance of leukocytosis prior to cardiac device implantation.

Infection remains a dreaded complication after cardiac implanted electronic device (CIED) placement. The prognostic value of the preoperative white blood cell (WBC) count, in the absence of other signs of infection, at time of CIED placement as a predictor of postoperative infection, has not been previously examined. The study population included 1,247 consecutive device implantations over a 4-year period that met inclusion criteria. The association between preoperative WBC count and resultant infection postoperatively was examined. Early infection was defined as definite infection of the pocket or lead system or development of systemic infection identified <60days after implantation. Preoperative WBC counts were obtained within 48hours of the procedure. Baseline characteristics of the population studied were mean age of 65years, 66% men, and 72% Caucasian. Pacemakers, implantable cardioverter defibrillators (ICDs), and biventricular ICDs were implanted in 41%, 44%, and 15%, respectively. Average procedure time was 174minutes ± 80. Of 1,247 device implantations, there were 10 infections (0.8%). Mean preprocedure WBC count in those diagnosed with infection was 8.1×103 /uL (range 5-11.7) and in those without infection was 7.8×10(3)/uL (range 2.3-29) (P=0.73). Cases resulting in infection demonstrated minimal change in WBC count (mean +5.5 ± 26.5%). There was no statistically significant difference in preprocedure WBC count between the two groups (P=0.7). Regardless of preprocedural WBC, no patients had other signs and symptoms of infection at time of device implantation. As an isolated finding, an elevated preprocedure WBC should not delay the implantation of an indicated device.

The values of applying classification and counts of white blood cells to the prognostic evaluation of resectable gastric cancers

BackgroundThe classifications and counts of white blood cells (WBCs) have been proved to be able to be used as prognostic markers in cancer cases. The present study investigated the potential values of the classifications and counts of WBC, including lymphocyte (LY), monocyte (MO), neutrophil (NE), eosinophil (EO), and basophil (BA) in the prognosis of resectable gastric cancers (GCs).MethodsThis retrospective study recruited 104 resectable GC cases which were pathologically confirmed. The patients were divided into two groups according to the median pre-treatment values. To evaluate the changes in WBC counts and classification after treatment, we introduced the concept of post/pre-treatment ratios (≤ 1 indicated count was not increased after therapy, while > 1 suggested increased count).ResultsPre-treatment NE and total WBC counts were negatively correlated with overall survival (OS). Surgery significantly decreased the level of NE count, but increased the level of EO, whereas had no effect on the levels of LY, MO, BAor total WBC. Adjuvant chemotherapy significantly decreased the level of BA. Whole course of treatment (surgery combined with adjuvant chemotherapy) had no significant effect on the counts of LY, MO, NE, EO, BA or total WBC. Post/pre-treatment ratios of LY, MO NE, EO, BA and total WBC levels had no effects on OS. Univariate analysis indicated that AJCC stage (III) and higher level of pre-treatment total WBC count were prognostic factors affecting OS. Multivariate Cox regression analysis revealed that AJCC stage (III) and higher level of pre-treatment total WBC count were independent prognostic factors.ConclusionsPre-treatment NE count and pre-treatment total WBC count may be potential prognostic factors for the prognostic evaluation of GCs.

Increase in white blood cell count is associated with the development of atrial fibrillation after an acute coronary syndrome

BackgroundEvidence linking an elevated white blood cell count (WBCC), a marker of inflammation, to the development of atrial fibrillation (AF) after an acute coronary syndrome (ACS) is limited. We examined the association between WBCC at hospital admission, and changes in WBCC during hospitalization, with the development of new-onset AF during hospitalization for an ACS. MethodsDevelopment of AF was based on typical ECG changes in a systematic review of hospital medical records. Increase in WBCC was calculated as the difference between maximal WBCC during hospitalization and WBCC at hospital admission. Multiple logistic regression analysis was used to adjust for several potentially confounding demographic and clinical variables in examining the association between WBCC, and changes over time therein, with the occurrence of AF. ResultsThe median age of study patients (n = 1325) was 60 years, 31.8% were women, and 80.1% were non-Hispanic whites. AF developed in 7.3% of patients with an ACS. Patients who developed AF, as compared with those who did not, had a similar WBCC at admission, but a greater increase in WBCC during hospitalization (6.0 × 109 cell/L vs. 2.7 × 109 cell/L, p < 0.001). After adjusting for several potentially confounding factors, an increase in WBCC was associated with the development of AF. This association was observed in patients with different ACS subtypes, types of treatment received, and according to time of acute symptom onset. ConclusionIncrease in the WBCC during hospitalization for an ACS should be further studied as a potentially simple predictor for new-onset AF in these patients.

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

Background: Age, prior thrombotic events, and an elevated hematocrit are established risk factors for increased risk of thrombosis in patients with polycythemia vera (PV). Evidence also suggests that elevated white blood cell (WBC) counts ≥ 11×109/L are a significant independent risk factor for thrombosis in patients with PV (P =0.02; Barbui T, et al. Blood. 2015; 126:560-561). Therefore, this analysis was conducted to evaluate the impact of ruxolitinib (Rux) and best available therapy (BAT) treatment on WBC counts among patients with Baseline WBC counts ≥ 11×109/L in the RESPONSE trial. RESPONSE is a global, multicenter, open-label phase 3 trial investigating Rux and BAT in patients with PV who are resistant to or intolerant of hydroxyurea (HU). In the RESPONSE trial, Rux was associated with durable improvements in hematocrit control without phlebotomy compared with BAT as well as reductions in WBC counts.Methods: Changes from Baseline in WBC counts in the Rux arm (n=110), BAT arm (n=112), and HU subgroup of the BAT arm (n=66) were evaluated as part of an exploratory analysis using the RESPONSE 80-Week analysis dataset. Patient subgroups with Baseline WBC counts ≥ 11×109/L and < 11×109/L were analyzed for changes in WBC counts at Weeks 12, 32, and 80. For patients with Baseline WBC counts ≥ 11×109/L, the proportion of patients who achieved a decrease in WBC counts to ≤ 10×109/L or a ≥50% reduction at Week 12 and Week 32, respectively, was summarized; time to achieve the decrease was analyzed by Kaplan-Meier method.Results: Baseline mean WBC counts were generally similar among patients in the Rux arm, BAT arm, and HU subgroup (17.6×109/L, 19.0×109/L, and 17.4×109/L, respectively). The proportion of patients with Baseline WBC counts ≥ 11×109/L was also similar among the Rux arm, BAT arm, and HU subgroup (75%, 71%, and 70%, respectively). In patients with Baseline WBC counts ≥ 11×109/L, patients treated with Rux had greater mean reductions in WBC counts compared with the BAT arm and HU subgroups, and these reductions were maintained over time; mean changes from Baseline in WBC values at Week 12/Week 32 (×109/L) were -7.7/-7.2 for Rux, -3.2/-4.2 for BAT, and -1.2/-2.2 for HU. In patients with lower Baseline WBC counts, mean values remained stable over time. The change from Baseline to Week 12 for individual patients with Baseline WBC counts ≥ 11×109/L is shown in Figure 1. In patients with Baseline WBC counts ≥ 11×109/L, worsening WBC counts were observed in 10.8% of patients in the Rux arm vs 35.4% in the BAT arm (P =0.0002) and 47.8% in the HU subgroup (P <0.0001). In this same subgroup with elevated WBC counts, a greater proportion of patients in the Rux arm achieved WBC counts ≤ 10×109/L or a ≥50% reduction compared with the BAT arm or HU subgroup (Week 12: Rux, 41% vs BAT, 19% vs HU, 13%; Week 32: Rux, 45% vs BAT, 22% vs HU, 9%); median time to this reduction was 8 weeks in the Rux arm and was not reached in the BAT arm or HU subgroup.Conclusion: Rux treatment resulted in better control of WBC counts compared to BAT in patients with PV. These changes in the Rux arm occurred early after study initiation (within a median of 8 weeks) and were durable over time. Although RESPONSE was not powered to assess the impact of Rux on thromboembolic events, the lower rate of thromboembolic events observed in the Rux arm vs the BAT arm (1.8 vs 8.2 per 100 patient-years of exposure) is consistent with the observed effects of Rux on hematocrit, WBC counts, and C-reactive protein levels, which are all associated with thromboembolic risk. [Display omitted] DisclosuresMiller:Incyte Corporation: Honoraria, Research Funding. Kiladjian:Novartis: Other: Travel grant; Research Funding paid to institution (Hôpital Saint-Louis et Université Paris Diderot); Incyte Corporation: Consultancy; Novartis: Consultancy. Naim:Incyte Corporation: Employment, Equity Ownership. Sun:Incyte Corporation: Employment, Equity Ownership. Gadbaw:Novartis Pharmaceuticals Corporation: Employment, Equity Ownership. Vannucchi:Baxalta: Membership on an entity's Board of Directors or advisory committees; Novartis Pharmaceuticals Corporation: Membership on an entity's Board of Directors or advisory committees, Research Funding, Speakers Bureau; Shire: Speakers Bureau.