Complete Blood Count Components Research Articles

The complete blood count and cardiovascular disease: analyses across six cohorts of 23,370 adults.

The complete blood count (CBC) is one of the most commonly performed laboratory studies. Although studies have found associations between the CBC and cardiovascular disease (CVD), there is limited contemporary information regarding the relationship between the CBC and traditional risk factors and their joint association with CVD endpoints. We sought to define the relationships between the CBC and traditional CVD risk factors and their joint association with CVD endpoints in diverse adult populations. We first examined the relationships between the CBC variables (directly and their principal components), traditional CVD risk factors, and mortality in NHANES (n=7843). Next, we validated and extended these findings to more refined CVD endpoints in five additional cohorts (n=15,527). We first examined the variance accounted for by common laboratory studies (lipid panel, HbA1c, hs-CRP, and basic metabolic panel) by traditional risk factors in NHANES. With the exception of hemoglobin (Hb)-related components, we found that traditional risk factors accounted for less than 20% of the variance in CBC values, similar to that of lipid parameters. Additionally, in the clinically adjusted model, the CBC was more strongly associated with all-cause mortality than the lipid panel or CRP (p<0.0001). Next, we validated and extended these findings across five additional longitudinal cohorts with a mean follow-up of 16 years to evaluate the association of individual CBC parameters and their principal components with refined CVD endpoints. In the fully adjusted meta-analyses across the five cohorts, several CBC components including the white blood cell (WBC) count, neutrophil (PMN) count, hemoglobin (Hb) level, and an integrated immune cell score, were associated with individual CVD endpoints and a composite CV endpoint (MACE3: incident stroke, MI, and revascularization) with standardized hazard ratios of 1.13 (p=0.002), 1.15 (p=0.0006), 0.82 (p<0.0001), and 2.16 (p<0.0001) respectively. This study represents the first systematic examination of the relationship between CBC features and established risk factors, as well as numerous CVD endpoints, in a diverse cohort of 23,370 adults. The findings of this study underscore the potential utility of integrating CBC features into CVD risk assessment and suggest important mechanistic insights into the association between individual CBC components and the genesis of CVD.

The role of inflammation markers in occurrence of radial artery occlusion.

Aim: Radial artery occlusion (RAO) is a major complication of catheterization via transradial access (TRA). Our aim is to reveal the ability of high-sensitive C-reactive protein (hs-CRP) and complete blood count (CBC) components, which are inflammation markers, to predict RAO. Methods: Patients were divided into two groups: 103 with RAO and 300 without RAO. The relationship between CRP, CBC components and RAO was evaluated. Results: A significant increase in hs-CRP, monocyte, platelet (PLT), platelet distribution width (PDW) and plateletcrit values was observed after TRA, and only the increase in PDW, PLT and hs-CRP was found to be independent determinants in regression analysis. Conclusion: High PDW and PLT and increased hs-CRP levels are new independent determinants of the development of RAO.

Unraveling the clinical significance and prognostic value of the neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, systemic immune-inflammation index, systemic inflammation response index, and delta neutrophil index: An extensive literature review.

In the field of critical care medicine, substantial research efforts have focused on identifying high-risk patient groups. This research has led to the development of diverse diagnostic tools, ranging from basic biomarkers to complex indexes and predictive algorithms that integrate multiple methods. Given the ever-evolving landscape of medicine, driven by rapid advancements, changing treatment strategies, and emerging diseases, the development and validation of diagnostic tools remains an ongoing and dynamic process. Specific changes in complete blood count components, such as neutrophils, lymphocytes, monocytes, and platelets, are key immune system responses influenced by various factors and crucial in systemic inflammation, injury, and stress. It has been reported that indices such as neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), systemic immune-inflammation index (SII), systemic inflammation response index (SIRI), and delta neutrophil index calculated using various ratios of these elements, are important predictors of various outcomes in conditions where the inflammatory process is at the forefront. In this narrative review, we concluded that NLR, PLR, SII, and SIRI show promise in predicting outcomes for different health conditions related to inflammation. While these tests are accessible, reliable, and cost-effective, their standalone predictive performance for a specific condition is limited.

A-155 Unlocking the Complete Blood Count: Derivation of a Single-Panel Laboratory Test That Includes Monocyte Distribution Width to Create a Universal Sepsis Screening Tool

Abstract Background Sepsis is the leading cause of in-hospital death. Outcome improvement requires rapid detection and early antimicrobial therapy. The complete blood count (CBC) is ordered for more than two-thirds of all patients in the emergency department (ED). Individual CBC components have limited utility for sepsis screening due to low specificity and sensitivity. We sought to create a reliable sepsis screening tool by combining components of the CBC differential. Methods In this single-center retrospective cohort study, all adult patients who had a CBC with differential performed within 6 h of ED arrival during a 20-month period were eligible for inclusion. Repeat ED visits by the same patient were excluded. Our primary outcome was manifestation of sepsis within 72 h of ED arrival, detected from timestamped electronic health records using a previously validated electronic phenotype based on Sepsis-3 consensus criteria. Multivariable logistic regression was performed to identify individual components of the CBC differential that were independently associated with our outcome and to identify optimal cutoffs for discretization. Odds ratios were used to assign weights to each component and to derive a 10-point system for scoring likelihood of sepsis. Results 34 864 patients were included; 1306 (3.7%) met sepsis outcome criteria within 72 h of ED arrival and 181 (0.5%) had septic shock. White blood cell (WBC) count, monocyte distribution width (MDW), and the neutrophil to lymphocyte count ratio were found to predict sepsis. As shown in the figure, there was a linear relationship between our CBC infection severity index and likelihood of developing sepsis and septic shock. Patients with a high risk score (8 or above) had a greater than one in four chance of developing sepsis within 72 h. Conclusion A simple ten-point index derived from the most commonly used laboratory panel in medicine reliably estimated likelihood of developing sepsis.

The Predictive Ability of Hematologic Parameters for In-hospital Mortality In Patients Presenting With Pulmonary Embolism

Introduction Acute pulmonary embolism (PE) is one of the leading causes of mortality. Components of complete blood count indicate thrombotic and/or inflammatory status in various clinical conditions. In this study, we aimed to evaluate if hematological parameters could predict in-hospital mortality in patients presenting with PE. Methods Patients hospitalized with a diagnosis of acute PE in our tertiary center between 2016 and 2022 were involved in this retrospective study. Hematologic parameters obtained on admission were analayzed. PESI scores were calculated and comparative statistical and regression analyses were obtained. Results There were 254 patients (37.4% male). Thirty-eight patients (14.9%) were died in-hospital and formed ‘non-survivors’ group. NLr and RDW were found as independent risk factors associated with in-hospital mortality. Our results revealed a strong correlation between hematological parameters and PESI risk score and a cut off value of 5.9 for NLr was associated with 68.4% sensitivity and 68.1% specificity; besides that, cut off value of 14.1 for RDW was associated with 68.4% sensitivity and 62.6% specificity in prediction of in-hospital mortality. Conclusion Our current study showed that hematological parameters, assessed by routine blood count analysis, may serve as a promising and useful marker to foresee in-hospital mortality in patients presenting thru acute PE especially when used additive to validated risk scores.

Role of ratios of neutrophil and monocyte to lymphocyte and red cell distribution width to platelet in the detection of early onset neonatal sepsis in comparison with serum C-reactive protein

Introduction and Aim: Early onset neonatal sepsis (EONS) is a preventable cause of neonatal mortality and morbidity. Blood culture, the current gold standard has a turn-around time of 48 to 72 hours and high false negatives. Thus, there is a need for reliable biomarkers for its early detection. The present study aims to find the utility of ratios derived from components of complete blood count in detecting EONS. Materials and Methods: The laboratory investigations of neonates with and without clinical sepsis were recorded using purposive convenience sampling technique. The total leucocyte count, absolute neutrophil count, C-reactive protein (CRP) and ratios of blood counts were compared by Mann Whitney test. Their performance was then analysed by receiver operating characteristic analysis. Results: A total of 196 neonates aged 0 to 3 days were considered for the study, out of which 98 cases were study group. Serum CRP and red cell distribution width to platelet (RPR) ratios were found to have statistical significance, albeit low sensitivity and specificity in detection of EONS. Positive correlation of RPR was found with CRP (p value=0.001). The area under the curve for CRP and RPR was 0.661 and 0.628 respectively. However, there was no statistical significant difference in neutrophil and monocyte to lymphocyte ratios between the study and comparative groups. Conclusion: In the background of low yield of culture positivity and its longer turnaround time, RPR can be used as a reliable biomarker in the diagnosis of EONS in conjunction with CRP.

Blood Count Parameters As Early Predictors of Clonal Cytopenia of Undetermined Significance (CCUS) Using a Diverse Ethnoracial Data Set

Background: Hematologic malignancies are a spectrum of disease that frequently have an insidious onset and may be difficult to diagnose. Improved screening using basic complete blood count parameters are needed to enhance early detection of these processes. Aging results in an expansion of hematopoietic clones that may predispose individuals to subsequent development of a hematologic malignancy. Recent studies with next generation sequencing (NGS) and whole-exome sequencing have identified certain somatic mutations known as DTA mutations that are associated with aging (e.g., DNMT3A, TET2, and ASXL1). These mutations, although more commonly seen in myeloid malignancies, are initially benign but may develop into overt hematologic malignancy and are collectively termed clonal hematopoiesis of indeterminate potential (CHIP). Similarly, individuals with cytopenia and clonal mutations are designated as clonal cytopenia of undetermined significance (CCUS). However, these mutations carry a risk of progression to hematologic malignancy. Animal models have shown that clonal hematopoiesis can accelerate cardiovascular mortality due to increased atherogenesis by causing inflammation and endothelial injury via upregulation of inflammasome pathways. Also, it has already been shown that clonal hematopoiesis with increasing number of clonal mutations, higher variant allele frequency and mutations in known driver genes have a higher risk of progression to hematopoietic malignancy (acute myeloid leukemia, AML). Certain acute phase reactants, like C-reactive protein (CRP) or erythrocyte sedimentation rate (ESR) have been used in prior studies as markers of inflammation and are strongly associated with variations in red cell size as determined by the red cell distribution width (RDW), reflecting chimeric clonal origins. We therefore propose that RDW and mean corpuscular volume (MCV) with or without other blood count parameters (red cell count, white blood cell count and platelet count) might be used as important predictors of progression of myeloid neoplasms, especially myelodysplastic syndromes (MDS), clonal cytopenias (CCUS) and acute myeloid leukemias (AML). Methods: Utilizing Epic's self-service reporting tool SlicerDicer, cohort discovery was performed on the Caboodle Patients data model. Cohort criteria included individuals with the cytopenia diagnostic grouper that had undergone blood or bone marrow myeloid panel next generation sequencing, that also had concurrent or historic complete blood count (CBC) results. Patients with known acute leukemias were excluded. Once the cohort was identified, a data pull was performed that captured CBC values, age, gender, race, and ethnicity, in addition to the NGS results. The NGS results were ranked into 3 classes from 0 to 2. Class 0 included results with no apparent disease, while class 2 results included high grade myeloid mutations (i.e. mutations in NRAS, KRAS, TP53, RUNX1 or ASKL1). Class 1 mutations were considered low grade and featured mutations not seen in class 2. The collated data was analyzed using SAS software. Results: Overall 72 patients met inclusion criteria. Patients ranged in age from 23 to 92 years, 48% identified as female and 52% identified as male with a mixture of race and ethnicity (Table 1). Abnormalities in several CBC components including MCH, MCHC, RBC count, and hemoglobin concentration were associated with increased odds of identifying those with malignant myeloid processes (Figure 1). It is notable that no mutations in FLT3 or KIT were observed in this cohort. Discussion: Based on our preliminary data, these cost-effective parameters can be added to an algorithm for risk assessment of hematologic neoplasms and better predict which patients will further benefit from targeted gene testing. Also, additional data will be helpful and applying this data to modern machine learning techniques will further the clinical application of these findings. Figure 1View largeDownload PPTFigure 1View largeDownload PPT Close modal

Usefulness of Complete Blood Count (CBC) to Assess Cardiovascular and Metabolic Diseases in Clinical Settings: A Comprehensive Literature Review.

Complete blood count (CBC) is one of the most common blood tests requested by clinicians and evaluates the total numbers and characteristics of cell components in the blood. Recently, many investigations have suggested that the risk of cancer, cardiovascular disease (CVD), arteriosclerosis, type 2 diabetes (T2DM), and metabolic syndrome can be predicted using CBC components. This review introduces that white blood cell (WBC), neutrophil-to-lymphocyte ratio (NLR), hemoglobin (Hb), mean corpuscular volume (MCV), red cell distribution width (RDW), platelet count, mean platelet volume (MPV), and platelet-to-lymphocyte ratio (PLR) are useful markers to predict CVD and metabolic diseases. Furthermore, we would like to support various uses of CBC by organizing pathophysiology that can explain the relationship between CBC components and diseases.

Association between first trimester platelet to lymphocyte ratio and stillbirth.

Neutrophil to lymphocyte ratio (NLR) and platelet to lymphocyte ratio (PLR) have been investigated as inflammatory markers of malignancies, cardiovascular and autoimmune diseases. We explored the association between NLR, PRL, measured during pregnancy, and stillbirth (SB). We conducted a retrospective case control study at a tertiary hospital center in New York City from May 2015 to July 2018. Cases were defined as SB pregnancies and controls as uncomplicated pregnancies. We calculated NLR and PLR using the complete blood count components routinely collected during prenatal care in the first trimester. The groups were matched by age, parity, body mass index (BMI) and race. We used receiver operating characteristic (ROC) curve analysis to evaluate the association of NLR and PLR to SB. We identified 28 patients with SB pregnancies and matched them with 28 controls. Age, parity, BMI, and race were equally distributed between the groups. The median gestational age of SB was 30 weeks (22-34). In the first trimester PLR was significantly lower in SB cases compared to controls (124.8 vs. 153.4, P=0.044) with an area under the curve (AUC) of 0.65. A PLR value higher than 156.4 accurately excluded SB with a sensitivity of 0.50, specificity of 0.89, positive predictive value of 0.013 and a negative predictive value of 0.998. NLR did not show a significant difference in the first trimester. A PLR higher than 156.4 in the first trimester appears to reliably exclude the occurrence of SB later during pregnancy. Lower platelet and higher lymphocyte levels may be related to an early inflammatory process. We speculate that pregnancies in which the initial myometrial invasion by the placental cells is dysfunctional and reflected by a high level of inflammation in the peripheral maternal blood, may contribute to fetal demise. Larger studies are needed to confirm our results.

Predictive value of preoperative complete blood count components on the occurrence of surgical site infection after elective cesarean section.

To analyze the predictive value of the preoperative complete blood count components on the occurrence of surgical site infection (SSI) after elective cesarean section. We conducted a retrospective case control study in a tertiary care hospital located in New York City during the period of November 1, 2018, to October 30, 2020. We included patients who developed SSI after elective cesarean section as cases and patients who did not develop SSI as controls. We tested the ability of neutrophil, lymphocyte, platelet, hemoglobin, hematocrit, total white blood cells, neutrophil to lymphocyte ratio, hemoglobin to platelet ratio, platelet to lymphocyte ratio, platelet to neutrophil ratio, platelet to hemoglobin ratio and neutrophil to hemoglobin ratio to identify the occurrence of SSI after cesarean section. We compared ten cases and 20 controls. The median lymphocyte and lymphocyte to hemoglobin ratio were statistically significantly higher in cases compared to controls (P=0.049 and P=0.04, respectively). A lymphocyte value higher than 1.5 x103/µL was the best cut-off to exclude the occurrence of SSI, with a sensitivity of 95%, a specificity of 50%, a positive predictive value of 5.5% and a negative predictive value of >99%. A lymphocyte to hemoglobin ratio higher than 1.13 was the best cut off to exclude the occurrence of SSI, with a sensitivity of 95%, a specificity of 60%, a positive predictive value of 6.8% and a negative predictive value >99%. The preoperative lymphocyte and lymphocyte to hemoglobin ratio should be incorporated into patient counseling and preoperative algorithms to identify patients who will develop SSI. The biological mechanisms involved remain to be investigated and our data should be confirmed by further and larger studies.

Platelet Count, Mean Platelet Volume, and Red Cell Distribution Width as Markers for Psoriasis Severity.

Psoriasis is a chronic, inflammatory skin condition that is growing in prevalence globally. Routinely available options to assess psoriasis severity and progression are limited. More options are needed to monitor disease progression as therapeutic management is based on disease severity. This study evaluates the usage of complete blood count components (CBC) including platelet count, mean platelet volume (MPV), and red cell distribution width (RDW) as hematological markers for assessing psoriasis severity. In this cross-sectional study of 120 patients with psoriasis, disease severity was assessed using the PASI score followed by a blood draw to determine whether correlations existed between each marker and PASI score. A significant, positive correlation was found between total platelet count and PASI while no such correlation was found in MPV and RDW. When stratifying for age, duration of disease, sex, and body parts involved, we found intriguing relationships and offer potential explanations for their occurrence. Our findings suggest that hematological parameters MPV, platelet count, and RDW found in the CBC are useful in identifying psoriasis severity to some extent. We foresee the use of RDW, MPV, and platelet count biomarkers as a complement to the PASI score in assessing severity for psoriasis patients, while also as a gauge for likelihood of developing comorbidities such as cardiovascular disease. J Drugs Dermatol. 2022;21(2):156-161. doi:10.36849/JDD.6127.

Red cell distribution width: A new parameter for predicting the risk of exacerbation in COPD patients

Red cell distribution width (RDW) is a numerical measurement of the size variability of erythrocytes and is routinely reported as a component of complete blood count in the differential diagnosis of anemia. In recent years, researchers have reported high mortality and poor prognosis associated with higher RDW in populations with cardiovascular disease, cancer, pneumonia, and chronic obstructive pulmonary disease (COPD). The aim of the study is to evaluate the role of RDW in predicting the risk of COPD exacerbations and the impact of symptoms. We designed an observational retrospective study based on patients hospitalized for acute exacerbation of COPD, between January 2015 and December 2018. We included 169 patients, 120 at GOLD four stage. RDW was significantly higher in COPD patients vs controls (P=.014). We found a positive correlation with c-reactive protein (r =0.375, P<.01), COPD assessment test (CAT) Score (R2=0.658, sy.x=2.226; P<.01), number of exacerbations (R2=0.289; sy.x=0.86; P=.002), and GOLD score (r=0.30; P=.05). In ROC curve analysis, the area under the curve of RDW for the identification of frequent exacerbator was 1.0 (95% confidence interval, 1.0-1.0; P<.0001). Our data show that elevated RDW may be a useful tool in predicting the risk of exacerbation in COPD patients and may be a good indicator of the impact of symptoms.

Mean Platelet Volume and Red Cell Distribution Width Values in Patients with COVID-19 Admitted to Intensive Care Units or Wards from Emergency Department

Background: Mean platelet volume (MPV) and red cell distribution width (RDW) values are components of complete blood count (CBC) which is a routine, cheap and fast test used in the evaluation of patients admitted to the emergency department (ED). The present study aimed to investigate RDW and MPV values in patients with Novel Coronavirus Disease 2019 (COVID-19) admitted to intensive care units (ICU) or wards from the ED. Methods: A retrospective data analysis of patients who were admitted to Ankara City Hospital ICUs and wards with the diagnosis of COVID-19 was performed. Group 1 included patients admitted to ICUs and Group 2 included those admitted to wards. Results: A total of 127 patients were admitted with a COVID-19 diagnosis. Mean age in Group 1 and Group 2 were 46±17 and 41±14, respectively. The number of patients admitted to ICU (Group 1) was 46 (36.2%), and the number of patients admitted to wards (Group 2) was 81 (63.7%). Of all patients, 122 patients (96.06%) were discharged and 5 patients (3.9%) died. RDW values in Group 1 was higher than those in Group 2 (p<0,001). Similarly, MPV was higher in Group 1 than Group 2 (p<0,001). Conclusion: In patients with COVID-19, RDW and MPV values are higher in those admitted to ICU than patients admitted to wards from the ED.

CE: Back to Basics: The Complete Blood Count.

In this latest article in the AJN series Back to Basics-developed to improve nurses' understanding and application of common laboratory diagnostic tests-the author delineates the meaning and function of complete blood count components, highlighting the important pathophysiological evidence they provide and using composite patient scenarios to assist nurses in recognizing findings that can inform their plan of care and produce the best patient outcomes.

Use of Middleware Data to Dissect and Optimize Hematology Autoverification

Background: Hematology analysis comprises some of the highest volume tests run in clinical laboratories. Autoverification of hematology results using computer-based rules reduces turnaround time for many specimens, while strategically targeting specimen review by technologist or pathologist. Methods: Autoverification rules had been developed over a decade at an 800-bed tertiary/quarternary care academic medical central laboratory serving both adult and pediatric populations. In the process of migrating to newer hematology instruments, we analyzed the rates of the autoverification rules/flags most commonly associated with triggering manual review. We were particularly interested in rules that on their own often led to manual review in the absence of other flags. Prior to the study, autoverification rates were 87.8% (out of 16,073 orders) for complete blood count (CBC) if ordered as a panel and 85.8% (out of 1,940 orders) for CBC components ordered individually (not as the panel). Results: Detailed analysis of rules/flags that frequently triggered indicated that the immature granulocyte (IG) flag (an instrument parameter) and rules that reflexed platelet by impedance method (PLT-I) to platelet by fluorescent method (PLT-F) represented the two biggest opportunities to increase autoverification. The IG flag threshold had previously been validated at 2%, a setting that resulted in this flag alone preventing autoverification in 6.0% of all samples. The IG flag threshold was raised to 5% after detailed chart review; this was also the instrument vendor's default recommendation for the newer hematology analyzers. Analysis also supported switching to PLT-F for all platelet analysis. Autoverification rates increased to 93.5% (out of 91,692 orders) for CBC as a panel and 89.8% (out of 11,982 orders) for individual components after changes in rules and laboratory practice. Conclusions: Detailed analysis of autoverification of hematology testing at an academic medical center clinical laboratory that had been using a set of autoverification rules for over a decade revealed opportunities to optimize the parameters. The data analysis was challenging and time-consuming, highlighting opportunities for improvement in software tools that allow for more rapid and routine evaluation of autoverification parameters.

Association Between Complete Blood Count Components and Intrahepatic Cholestasis of Pregnancy.

ObjectiveSome components of the routine complete blood count (CBC) and their ratios, such as neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) have been found to be sensitive biomarkers of preeclampsia and other inflammatory obstetric conditions. We wanted to evaluate whether they can be associated with intrahepatic cholestasis of pregnancy (ICP).Materials and MethodsWe conducted a retrospective case-control study between May 1, 2015 and July 1, 2018. Cases were considered pregnancies with ICP and control healthy pregnancies. Cases and controls were matched for age, parity, and race.We compared the levels of white blood cells (WBC), hemoglobin, neutrophils, lymphocytes, NLR, PLR, platelets, red cell distribution width (RDW), and mean platelet volume (MPV) in the first and third trimesters between cases and controls. In addition, we compared the same components in the third trimester between patients with mild (serum total bile acid (TBA) of 10 - 40 µmols/L) and severe (TBA > 40 µmols/L) ICP. ResultsThere were 33 patients with ICP and 33 controls. There were no significant differences between the two groups in the first trimester. WBC, neutrophil count, and NLR were decreased in women with ICP in the third trimester compared to controls. MPV was significantly higher in the third trimester of patients with ICP compared to controls. RDW was lower in mild ICP compared to severe ICP in the third trimester.ConclusionDecreased WBC, neutrophil, NLR, and MPV values are associated with ICP and may be useful additions to the diagnostic algorithm for ICP. Larger studies are needed to assess the responsible underlying molecular pathogenic mechanisms.

The Prognostic Model of Pre-Treatment Complete Blood Count (CBC) for Recurrence in Early Cervical Cancer

The aim of the present study was to investigate the prognostic role of the pre-treatment complete blood count (CBC) profile as a predictive marker of survival, recurrence, and death in early stage squamous cell carcinoma and adenocarcinoma of the cervix. The pre-treatment CBC profiles of the patients from nine tertiary medical centers in South Korea who were treated surgically for early stage cervical cancer were reviewed. Statistical models by the Akaike’s information criterion (AIC) were developed using CBC profiles to calculate individuals’ risk scores for clinical outcomes. A total of 1443 patients were included in the study and the median follow-up was 63.7 months with a range of 3–183 months. Univariate analyses identified the components of CBC that were significantly related to clinical outcomes including white blood cell (WBC), hemoglobin, neutrophil, and platelet levels. The models developed using CBC profiles and the conventional clinical predictive factors provided individuals’ risk scores that were significantly better in predicting clinical outcomes than the models using the conventional clinical predictive factors alone. Pre-treatment CBC profiles including WBC, hemoglobin, neutrophil, lymphocyte, and platelet levels were found to be a potential biomarker for survival prognosis in early cervical cancer.

Prognostic value of baseline complete blood count components in advanced gastric cancer patients: A multicenter retrospective study.

e16528 Background: Gastric cancer (GC) is one of the most prevalent malignant types in the world and an aggressive disease with a poor 5-year survival. Pretreatment CBC-based biomarkers, including blood neutrophil, lymphocyte, monocyte, and platelet counts; hemoglobin (Hb) levels; and their combinations, such as the neutrophil-lymphocyte ratio(NLR), lymphocyte-monocyte ratio (LMR) and platelet-lymphocyte ratio (PLR), have been reported to reflect systemic and local inflammation associated with cancer progression and prognosis. There has been growing interest in using CBC-based measures as biomarkers for GC. Methods: This chart-review study aimed to evaluate the effect of baseline levels of different components of routine CBC examination as well as other patients and disease characteristics on progression free survival (PFS) and overall survival (OS) in metastatic gastric cancer patients. Total 135 metastatic gastric cancer patients who had diagnosed and treated in three oncology centers in Saudi Arabia from 2011 to 2016 were incorporated. Various potential prognostic factors had measured in univariate and multivariate analysis. Results: After a median follow up of 21.4 months, the median OS / PFS were 11.0 and 6.1 months, respectively. Higher albumin level ( &gt; 3g/dl), low neutrophil percentage ≤ 75%, high lymphocyte percentage &gt; 15%, neutrophil /lymphocyte ≤ 2.5, high eosinophil count &gt; 0.4 k/ml, and EOX/EOF chemotherapy vs. doublet chemotherapy were associated with better PFS in univariate analysis. Conversely, in multivariate analysis, only serum albumin and eosinophil levels were related to PFS. In univariate analysis, higher serum albumin (3 g/dl), low neutrophil percentage ≤ 75%, high lymphocyte percentage &gt; 15%, neutrophil/lymphocyte ≤2.5, high eosinophil count &gt; 0.4 k/ml, receiving 1st line chemotherapy vs. no chemotherapy, receiving &gt; 6 cycles of chemotherapy, receiving EOX/EOF chemotherapy vs. doublet chemotherapy, platelet count ≤450 k/ml, male gender were associated with better OS. In multivariate analysis, lower neutrophil percentage, higher serum albumin, male sex and higher number of chemotherapy cycles were independently associated with OS. Conclusions: Higher eosinophil level was associated with improved PFS while lower neutrophil percentage and higher number of chemotherapy cycles were independent predictors of OS. Higher albumin levels independently predicted better OS and PFS.

Association Between Eosinophilic Leukocyte Count and Hematoma Expansion in Acute Spontaneous Intracerebral Hemorrhage.

Background/Objective: Hematoma expansion (HE) predicts poor outcome and is an appealing treatment target in spontaneous intracerebral hemorrhage (ICH). Clinical evidence has shown an association of HE with peripheral white blood cells (WBC) count, but the individual contributions of leukocyte subtypes between literatures are described inconsistently. Our aim was to determine the relationship between admission absolute and differential leukocyte counts and HE by using different growth definitions.Methods: We analyzed spontaneous ICH patients who underwent baseline cranial computed tomography and blood sampling within 6 h of stroke onset in our institution between September 2013 and August 2018. Hematoma volume was calculated using a semiautomated 3-dimensional reconstruction algorithm. According to commonly used absolute or relative growth definitions (>6 mL, >12.5 mL, or >33%), we defined 5 types of HE. A propensity score-matching analysis was performed to evaluate the influence of complete blood count components on HE across the various growth definitions. The receiver operating characteristic analysis assessed the predictive ability of leukocyte counts for HE.Results: A total of 1,066 patients were included, of whom 11–21% met the 5 HE definitions. After propensity score-matching, except using the definition of >12.5 mL growth or its combination with >33% growth, both WBC and neutrophil count were independently associated with reduced risk of HE (odds ratio [OR] for 103 cells increase; OR, 0.86–0.99; all p < 0.05) after adjusting confounders in multivariate analyses. However, monocyte count was correlated with increased risk of HE under the usage of >12.5 mL expansion definition only (OR, 1.43; p = 0.024). There was no association between lymphocyte count and HE (all p > 0.05). Regardless of the growth definition, admission eosinophil count was directly associated with the risk of HE (OR, 6.92–31.60; all p < 0.05), and was the best predictive subtype with area under the curve 0.64, sensitivity 69.5%, and specificity 58.9% at the optimal cut-off value of 45 cells/μL.Conclusions: Growth definition affects the relationship of HE with leukocyte subtypes counting. Eosinophil count robustly predicts HE, and may be a surrogate when using an inflammatory marker to help select acute ICH patients with high expansion risk for hemostasis treatment in clinical trial and practice.

Demir Eksikliği Anemisinde Terapötik Yanıtı Tahmin Etmek İçin Yeni Bir Parametre: Kırmızı Kan Hücresi Dağılım Genişliği

Aim: Anemia is a public health problem worldwide. Cost effectiveness and efficient use of resources are vitally important. Red blood cell distribution width, which can be obtained from a standard complete blood count, is a measure of the variability in size of circulating erythrocytes. The present study was performed to investigate whether red blood cell distribution width can be used to predict response to iron therapy. Methods: This study was conducted in 50 patients admitted to hematology and family medicine clinics. Complete blood count and reticulocyte count were determined on day 5; complete blood count was examined 1 month after commencement of therapy. Results: Statistically significant differences were detected between hemoglobin levels and red blood cell distribution width values at the time of diagnosis and on day 5 and after 1 month of therapy. A significant positive correlation was found between the increase in red blood cell distribution width and the increase in hemoglobin. Conclusion: Red blood cell distribution width may be used in place of reticulocyte count to predict response to iron therapy. Red blood cell distribution width is the best biomarker for this purpose as a component of complete blood count, and therefore it may be accepted as superior to reticulocyte count.