Mean Monocyte Volume Research Articles

Utility of VCS Parameters as a Cost-effective and Early Marker of Sepsis: A Hospital-based Study.

Sepsis is a life-threatening condition. Nowadays, hospitals rely on laboratory parameters like CRP and procalcitonin to detect sepsis. There is a need to evaluate and validate more accurate and early predictors of sepsis in critically ill patients. We analyzed volume, conductivity, and scatter (VCS) parameters of leukocytes in sepsis patients and compared them with the control group with no illness. It was a prospective case-control study. A total of 80 patients were studied with 40 sepsis cases and 40 controls. Peripheral smear examination was done in all the cases. Other parameters, such as WBC count, neutrophil%, absolute neutrophil count (ANC), High-sensitive C-reactive protein (hs-CRP), procalcitonin, and blood cultures were analyzed. We took the data of the patients from medical records and correlated it with other tests. Complete blood picture reports were generated by the Beckman Coulter LH series (LH 750 and 780). VCS parameters for neutrophils, lymphocytes and monocytes were compared between both groups. The results were analyzed using SPSS software (16.0 version). The age group was 20-85 years with male predominance. The mean neutrophil volume (MNV) and mean monocyte volume (MMV) were higher in the sepsis group when compared with the control group. The mean neutrophil conductivity and scatter was lower in the sepsis group and comparatively higher in the control group, but it was insignificant. The mean neutrophil volume values were higher in the sepsis group even with low total leukocyte count (TLC) when the patient had sepsis. There is no change in the mean lymphocyte VCS parameter and mean monocyte conductivity, scatter in both the groups. The mean neutrophil volume and MMV are found to be good sensitive markers in the prediction of sepsis. Even when TLC is on the lower side in patients with sepsis, these parameters predict sepsis accurately. This helps clinicians to assess sepsis in patients at an early stage and has an important practical implication. Goyal H, Singhal A, Joseph M. Utility of VCS Parameters as a Cost-effective and Early Marker of Sepsis: A Hospital-based Study. Indian J Crit Care Med 2023;27(9):647-650.

Independent Validation of Sepsis Index for Sepsis Screening in the Emergency Department.

(1) Background: The early detection of sepsis is still challenging, and there is an urgent need for biomarkers that could identify patients at a high risk of developing it. We recently developed an index, namely the Sepsis Index (SI), based on the combination of two CBC parameters: monocyte distribution width (MDW) and mean monocyte volume (MMV). In this study, we sought to independently validate the performance of SI as a tool for the early detection of patients at a high risk of sepsis in the Emergency Department (ED). (2) Methods: We enrolled all consecutive patients attending the ED with a request of the CBC. MDW and MMV were measured on samples collected in K3-EDTA tubes on the UniCel DxH 900 haematology analyser. SI was calculated based on the MDW and MMV. (3) Results: We enrolled a total of 703 patients stratified into four subgroups according to the Sepsis-2 criteria: control (498), infection (105), SIRS (52) and sepsis (48). The sepsis subgroup displayed the highest MDW (median 27.5, IQR 24.6–32.9) and SI (median 1.15, IQR 1.05–1.29) values. The ROC curve analysis for the prediction of sepsis showed a good and comparable diagnostic accuracy of the MDW and SI. However, the SI displayed an increased specificity, positive predictive value and positive likelihood ratio in comparison to MDW alone. (4) Conclusions: SI improves the diagnostic accuracy of MDW for sepsis screening.

A new tool for sepsis screening in the Emergency Department.

In this study, we developed and evaluated the diagnostic accuracy of the Sepsis Index for early sepsis screening in the Emergency Department (ED). Sepsis Index is based on the combination of monocyte distribution width (MDW) and mean monocyte volume (MMV). Sepsis Index≥1 was selected to define sepsis. We tested its diagnostic accuracy in an ED population stratified in four groups: controls, Systemic Inflammatory Response Syndrome (SIRS), infection, and sepsis, according to Sepsis-2 criteria. Patients with sepsis displayed higher median Sepsis Index value than patients without sepsis. At the receiver operating characterictis (ROC) curve analysis forthe prediction of sepsis, the area under the curve (AUC) of MDW and Sepsis Index were similar: 0.966 (95%CI 0.947-0.984), and 0.964 (95%CI 0.942-0.985), respectively. Sepsis Index showed increased specificity than MDW (94.7vs. 90.6%), without any decrease in sensitivity (92.0%). Additionally, LR+ increased from 9.8 (MDW) to 17.4(Sepsis Index), without any substantial change in LR- (respectively 0.09 vs. 0.08). Finally, PPV increased from 0.286 (MDW) to 0.420 (Sepsis Index). Sepsis Index improves the diagnostic accuracy of MDW alone for sepsis screening.

The Role of Volume, Conductivity, Scatter Changes of Neutrophils and Monocytes in Diagnosis of Megaloblastic Anemia

Background: Megaloblastic anemias are macrocytic normochromic anemia with mean corpuscular volume (MCV) of 100 fl-140 fl and caused by deficiency of either cobalamin (vitamin B12) or folate. However, increased MCV is not specific for megaloblastic anemia, nor is Vitamin B12 assay by chemiluminescence. We undertook this study to evaluate the possible role of Volume, Conductivity and Scatter (VCS) of WBCs derived from standard hematology analyzer to indicate megaloblastic anemia.
 Methods: We performed a case control study comparing data of 60 patients with low serum vitamin B12 or folate levels with 60 healthy volunteers. Comparison of the volume, conductivity and scatter parameters for neutrophils and monocytes of cases and control were done.
 Result: The mean neutrophil volume of cases (158.37±18.13fl) was significantly higher (p= 0.0001) compared to controls (141.26±4.22fl). Similarly, mean monocyte volume of cases (183.34±16.90fl) was significantly (p=0.0001) higher compared to controls (166.55±8.66fl).
 The difference in the mean conductivity of both neutrophils and monocytes between cases and controls were insignificant (p=0.43).
 Conclusion: Our study suggests analysis of VCS parameters for neutrophils and monocytes was a simple and objective method that substantiates the existence of subclinical deficiency of vitamin B 12 and folate with fair degree of certainty.

Effects of Smoking on Volume, Conductivity and Scatter Parameters of Leukocytes

Aim: In this study, we aimed to determine changes in leukocytes volume, conductivity and scatter parameters in smokers compared to non-smokers. Methods: A total of 117 individuals (45 smokers and 72 non-smokers) were included in the study. While those who smoked at least 10 pack-years were included in the case group, those who never smoked at all were included in the control group. Results: While there was a statistically significant difference in mean neutrophil volume, mean neutrophil conductivity, mean lymphocyte conductivity, mean lymphocyte scatter, mean monocyte volume, mean monocyte conductivity, mean monocyte scatter, mean eosinophil conductivity values between the two groups, there was no statistically significant difference in mean neutrophil scatter, mean lymphocyte volume, mean eosinophil volume, mean eosinophil scatter values between the two groups. Conclusion: This study showed that smoking affected volume, conductivity and scatter parameters. Clinicians should consider whether the patient smokes if they want to diagnose any diseases using volume, conductivity and scatter parameters. Keywords: smoking, leukocytes, conductivity, scattering, neutrophils

Unique characteristics of leukocyte volume, conductivity and scatter in chronic myeloid leukemia

BackgroundModern automated hematology analyzers provide quantitative data on leukocyte size and structure that may be useful to distinguish reactive from neoplastic cellular proliferations. We compared leukocyte volume, conductivity and scatter (VCS) characteristics of chronic myeloid leukemia (CML), bcr-abl1-positive patients with those of non-neoplastic neutrophilia. Materials and methodsComplete blood counts and VCS data (LH750 hematology analyzers, Beckman Coulter) from 38 newly-diagnosed CML patients, 65 CML on imatinib mesylate therapy, 58 patients with elevated age-specific neutrophil counts due to varied causes, 100 pregnant women and 99 healthy controls were collated and compared. Receiver-operating-characteristic curves, logistic regression models and classification trees were studied for their abilities to distinguish various groups. ResultsUntreated CML had higher mean neutrophil volume and mean monocyte volume (MNV and MMV), mean lymphocyte scatter (MLS) and higher standard deviations of the mean neutrophil volume and conductivity (MNV-SD and MNC-SD) over all other groups (p < 0.0001 for all). MNV, MNC-SD and MLS distinguished CML from reactive neutrophilia + pregnancy groups (sensitivities 89.5%, 94.7%, 94.7% and specificities 90.6%, 95.6% and 94.0% respectively). Combination of MNV>163.0 AND MNC-SD>12.69 was 89.5% sensitive and 100% specific for CML. Two algorithmic classification-tree approaches using VCS parameters alone (i.e. without the aid of blood count parameters) correctly separated 100% cases of untreated CML from all others. ConclusionSuccessful distinction of untreated but not post-imatinib CML patients from subjects who were either normal, pregnant or had reactive neutrophilia by automated analyzer-derived cell-population data opens possibilities for their applications in diagnosing and understanding the pathogenesis of CML.

Volume, conductivity, and scatter parameters of leukocytes as early markers of sepsis and treatment response.

INTRODUCTION:Morphologic changes in the size and granularity of leukocytes seen in sepsis could be measured using the volume, conductivity, and scatter (VCS parameters) from the automated hematology analyzers. The objective of this study is to find the clinical usefulness of VCS parameters as possible indicators of sepsis and to determine the effect of treatment on these parameters.METHODS:This observational study was conducted in a tertiary level hospital in India. Hemogram and VCS parameters obtained from LH 750 (Beckman coulter, Fullerton, CA) from 134 proven blood culture-positive cases of sepsis were reviewed on the day of culture positivity (day 0), day 3, and day 7 were analyzed and compared with those of samples from otherwise healthy 100 participants. Statistical analysis of data was done, and cutoff value was established using receiver-operator characteristic curve.RESULTS:Out of 134 culture-positive cases, 55.2% (n = 74) Gram-negative and 44.8% (n = 60) Gram-positive bacteria were isolated. The mean neutrophil volume (MNV) and mean monocyte volume (MMV) were higher in the sepsis group compared to that of the control group (165.43 ± 18.21 vs. 140.59 ± 7.6, P = 0.001 for MNV and 179.8 ± 14.16 vs. 164.54 ± 9.6, P = 0.001 for MMV). A significant decrease in MNV and MMV was observed with the initiation of the treatment. Significant changes in scatter and conductivity parameters were also noticed. A cutoff value of 150.2 for MNV gave a sensitivity and specificity of 79.1% and 95%, respectively, with an area under the curve (AUC) of 92.3%. With a cutoff of 168.3, MMV had a sensitivity of 80.6% and specificity of 77.5%, AUC of 83%.CONCLUSION:VCS parameters such as MNV and MMV can be easily obtained by an automated hematology analyzer and could be used for early detection and therapeutic response in sepsis.

Evaluation of the Diagnostic Efficacy of Monocyte Parameters and MCP-1 to Distinguishing Active Tuberculosis from Latent Tuberculosis.

It is important to distinguish those with active Mycobacterium tuberculosis infection (ATB) from latent tuberculosis infection (LTBI) for monitoring and treating the disease. Monocytes play an important role and may undergo morphological changes against active TB infection. The aim of this study is to investigate the clinical usefulness of the monocyte morphometric parameters and monocyte chemoattractant protein-1 (MCP-1) to distinguish active tuberculosis (ATB) from latent tuberculosis infection (LTBI) and healthy controls (HC). Peripheral blood was collected from 97 ATB patients, 113 LTBI patients, and 101 healthy controls. The monocyte morphometric parameters were obtained using a UniCel Coulter DxH800 system. MCP-1 level was determined by enzyme-linked immunosorbent assay method. Cutoff values were established based on receiver operator characteristic (ROC) curve analysis. Mean monocyte volume with its standard deviation, mean monocyte conductivity, and MCP-1 were significantly increased in ATB compared with LTBI and HC. ROC curve analyses showed that simultaneous measurements of mean monocyte volume with its standard deviation, mean monocyte conductivity and MCP-1 achieved good sensitivity and specificity (93.8% and 93.1%), which may be clinically useful. The findings using monocyte morphometric parameters and MCP-1 to distinguish ATB from LTBI with high sensitivity and specificity may be a potential parameter for clinical.

Evaluation of mean monocyte volume in septicemia caused by Salmonella species.

OBJECTIVE:The objective was to study the significance of volume, conductivity, and scatter (VCS) parameters of monocytes in Salmonella infection.MATERIALS AND METHODS:We selected peripheral blood samples of 52 patients whose blood culture was positive for Salmonella species (Salmonella typhi and Salmonella paratyphi A) and analyzed VCS parameters by subjecting them to differential count in hematology analyzer LH750 (Beckman Coulter). Out of these, we studied VCS parameters of monocytes in Salmonella infection and compared with two control groups (control 1: other infections and control 2: normal subjects).RESULTS:Mean monocyte volume (MMV), standard deviation (SD) of MMV, and SD of mean channel monocyte conductivity were found to be significantly increased in Salmonella infection (P < 0.05) when compared with both controls. We propose a cutoff value of 185 for MMV with sensitivity and specificity of 80% and 73%, respectively, to predict Salmonella infection.CONCLUSIONS:MMV can be a useful tool for predicting Salmonella infection under appropriate clinical settings.

The morphological changes of monocytes in peripheral blood as a potential indicator for predicting active pulmonary tuberculosis

BackgroundMonocytes play a crucial role in immune response against Mycobacterium tuberculosis infection. The purpose of this current study was to investigate the morphology present on monocytes in peripheral blood from patients with active pulmonary tuberculosis (APTB) and the laboratory performance of the changes for discriminating cases from normal healthy subjects (NHS). MethodA total of 71 peripheral blood samples from patients with APTB, and 65 samples from NHS were analyzed. The mean monocyte volume with its distribution width and mean monocyte conductivity as well as monocyte light scatter were detected by VCS technology used on the LH750 hematology analyzer. Correlations of these changes with the serum cytokine level in the immune alterations were further evaluated. The Receiver operating characteristic curve (ROC) analysis was used to highlight the clinical implication. ResultsIn APTB patients, the mean monocyte volume showed significant difference associated with an evident elevation in the mean monocyte volume distribution width compared to those in NHS. Furthermore, the mean monocyte volume had positive relationship with the serum level of interleukine-1β response to M. tuberculosis infection. Simultaneous measurement of the mean monocyte volume and its distribution width was able to distinguish active infection with an excellent sensitivity of 84.5% and specificity of 90.5% comparable to those obtained from pro-inflammatory cytokine interleukine-6 identifying APTB with great accuracy. ConclusionThe morphological changes of monocytes particular increased mean volume may be a potential indicator to predict active tuberculosis infection.

Cytomorphometric Neutrophil and Monocyte Markers May Strengthen the Diagnosis of Sepsis.

The diagnosis of sepsis is challenging in the absence of a gold standard test. Recent studies have explored the role of neutrophil and monocyte volume, conductivity, and scatter (VCS), derived from automated hematology analyzers, in diagnosing sepsis. We assessed the diagnostic accuracy of VCS parameters in critically ill patients with sepsis. In this prospective study, VCS parameters, procalcitonin, and C-reactive protein (CRP) were assessed in patients with proven sepsis (cases) and 2 control groups (intensive care unit [ICU] patients without sepsis and healthy blood donors). The diagnostic property of each test was explored by calculating sensitivity, specificity, negative and positive predictive values, and area under the curve (AUC). The study included 65 patients with sepsis, 58 nonseptic ICU controls, and 98 blood donors. Procalcitonin and CRP were not significantly different ( P > .06) between patients with sepsis and nonseptic patients. Mean (95% confidence interval [CI]) neutrophil volume (MNV) was significantly higher ( P < .001) in patients with sepsis (165.5; 95%CI 161.6-169.4) than in nonseptic (157.3; 95%CI 154.6-160.1) patients and donors (148.9; 95%CI 147.9-150). A similar pattern was seen with mean monocyte volume (MMoV). Neutrophil and monocyte conductivity and scatter parameters were variably associated. The AUC was highest for MMoV (0.74) and lowest for CRP (0.62). Among all parameters, MNV and MMoV had the highest specificity of 85% and 80%, respectively. In critically ill patients with suspected sepsis, VCS parameters may help strengthen the diagnostic probability of sepsis. Future studies may explore the role of serial monitoring of VCS to track response to antimicrobial therapy.

Efficacy of new leukocyte parameters versus serum C-reactive protein, procalcitonin, and interleukin-6 in the diagnosis of neonatal sepsis.

The aim of this study was to investigate and compare the efficacy of the new leukocyte parameters mean neutrophil and monocyte volume (MNV, MMV), conductivity (MNC, MMC), scattering (MNS, MMS) and volume distribution width (NDW, MDW) with serum C-reactive protein (CRP), procalcitonin (PC) and interleukin (IL)-6 in the diagnosis of neonatal sepsis. A total of 227 newborns (132 boys, 95 girls) were analyzed. There were 116 infants in the sepsis group (proven sepsis, n = 40; clinical sepsis, n = 76) and 111 in the control group. Venous blood samples were collected from infants at the time of diagnosis and complete blood count, peripheral blood smear, blood cultures, CRP, PC, IL-6 and MNV, MMV, MNC, MMC, MNS, MMS, NDW, and MDW were analyzed. MNV, NDW, MMV and, MDW were higher in infants with sepsis than in controls (P < 0.05 for all). MNS was lower in the patients with sepsis (P = 0.002). There was no significant difference between the sepsis and control groups in terms of MNC, MMC and MMS. Although the predictive value of leukocyte parameters including neutrophil and monocyte volume, conductivity, scattering and volume distribution width in the diagnosis of neonatal sepsis was lower than that of CRP, PC and IL-6, some of these new parameters may be useful in the differential diagnosis of newborn sepsis, along with the other screening tools. In particular, MNV seems to be the most useful parameter with the highest specificity; also, the importance of PC in the diagnosis of early onset sepsis was confirmed.

Volume Conductivity and Scatter Parameters as an Indicator of Acute Bacterial Infections by the Automated Haematology Analyser

Complete blood picture is the first and foremost investigation ordered for evaluation of acute infectious processes which require early and prompt intervention. With the advent of automated Coulter (®) Haematology analysers, the Volume, Conductivity & Scatter parameters of the leucocytes could be analysed for the early detection of the infections. To evaluate the clinical usefulness of Volume, Conductivity & Scatter parameters of neutrophils & monocytes in predicting the onset of acute bacterial infections. Peripheral blood samples from 94 patients with infections (systemic infections n=36 & localised infections n=58) and 46 control subjects were studied using the Volume, Conductivity & Scatter parameters by the Coulter Haematology analyser. We observed a significant increase in the mean channel of neutrophil volume & mean channel of monocyte volume from patients with infections (both systemic & localised) as compared with control subjects (Mean Neutrophil Volume: 158.3 ± 13.7 vs 137.2 ± 4.3; p<0.001) & (Mean Monocyte Volume: 177.8± 16 vs 161.7 ± 6.04; p <0.001). However, there was no significant difference in the Mean Neutrophil Volume of patients with systemic infection & localised infections (160.5±17.5 vs 156.8±10.5, p>0.05). The Volume, Conductivity & Scatter parameters like Mean Neutrophil Volume & Mean Monocyte Volume are more sensitive parameters and could prove to be a quick diagnostic indicator of acute bacterial infections.

Association between Glycemic Control and Hematologic Indices in Type 2 Diabetic Patients

This article is available from http://www.labmedonline.org 2016, Laboratory Medicine Online This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. Background: Diabetes mellitus (DM) is characterized by impaired glucose regulation and various complications. It is known that chronic inflammation and platelet activation play a role in development of insulin resistance or diabetic complications. This study investigated whether hematologic parameters are useful for monitoring blood glucose regulation or complications in DM patients. Methods: Total 90 diabetic patients were divided into two groups according to their hemoglobin A1c (HbA1c) levels: 59 regulated DM patients with HbA1c levels<7% and 31 unregulated DM patients with HbA1c levels≥7%. Results: White blood cell counts (P =0.021), neutrophil counts (P =0.005), monocyte counts (P =0.040), neutrophil % (P =0.042) and the neutrophil lymphocyte ratio (NLR) (P =0.032) were significantly higher in the unregulated DM group compared to that in the regulated DM group. There were no differences in lymphocyte counts, lymphocyte %, monocyte %, mean neutrophil volume, mean monocyte volume, platelet count, and mean platelet volume between groups. Neutrophil counts and NLR were higher in unregulated DM patients with complications than in the regulated DM group. A positive correlation was observed between HbA1c and white blood cell count (r=0.389, P <0.001) and neutrophil count (r=0.361, P <0.001). Conclusions: In DM patients, neutrophil counts and NLR were related to glycemic control and the presence of complications. Additionally, neutrophil counts showed a positive correlation with HbA1c. Therefore, neutrophil counts and NLR can be used as related markers for diabetic regulation and complications during the follow-up of diabetic patients.

Clinical evaluation of cell population data parameters in predicting engraftment after hematopoietic stem cell transplantation

To explore the cell population data (CPD) parameters of DxH800 hematology analyzer in predicting engraftment after hematopoietic stem cell transplantation. Data from 109 patients who underwent hematopoietic stem cell transplantation at Peking University First Hospital between July 2013 and September 2014 were selected, all CBC data including CPD parameters from the beginning to engraftment (absolute neutrophil count > 500/µl) were gathered and analyzed to find the early markers of myeloid engraftment and establish the cut-off value. The makers which could predict myeloid engraftment were mean neutrophil volume (MNV) and mean monocyte volume (MMV), the cut-off value was ≥ 180 fl and ≥ 190 fl, respectively, and engraftment was predicted earlier (2.2 ± 1.3) days and (2.3 ± 1.7) days than absolute neutrophil count. By analyzing the CPD data of DxH800 hematology analyzer, engraftment can be predicted approximately 2 days earlier than absolute neutrophil count.

Cell population data in neonates: differences by age group and associations with perinatal factors.

Cell population data (CPD) describe physical parameters of white blood cell subpopulations and are reported to be of some value in the diagnosis of sepsis in neonates. Before using the CPD for diagnosing sepsis, the baseline features of the CPD distribution in healthy neonates should be clarified. The aim of this study was to compare the CPD distributions of healthy neonates and other age groups and to identify perinatal factors that are associated with changes in the CPD distribution of healthy neonates. The CPD distribution of 69 samples from term neonates was compared with adolescents and adults. The CPD distribution of 163 samples from healthy neonates was analyzed in association with perinatal factors, including gestational age, chronologic age, birthweight, delivery mode, premature rupture of membranes, diabetes, and pregnancy-induced hypertension. The CPD distribution for term neonates was significantly different from those in adolescents and adults. The mean lymphocyte volume showed a negative correlation with gestational age at birth (r = -0.305; P < 0.01). The mean neutrophil volume was smaller in the cesarean section group than in the normal delivery group. The small for gestational age (SGA) group had smaller mean neutrophil volume and mean monocyte volume than the appropriate for gestational age group. The CPD distribution of healthy neonates differed from those of adolescents or adults, and the differences were associated with gestational age, delivery mode, and being SGA.

Correlation between the Quantity of White Blood Cells and Their Volume Distribution Parameters in Humans

Using correlation and factor analyses, the following parameters were studied in males and females: correlations between the white blood cell (WBC) count; mean neutrophil, lymphocyte, and monocyte volume; volume variation; asymmetry coefficients; and volume distribution excess in populations of WBCs. A clear interrelationship between the quantity and the volume, i.e., the quality, was shown. The cosubordination relationship involves all studied classes of WBCs appearing as a parameter correlation within the distinct classes as well as between different classes. This phenomenon is strongly sex-specific. The relative quantity or cell volume is changed together with the concerted behavior of other WBC classes, i.e., content, volume, and distribution of the cells. It is suggested that such functional alterations are compensatory in nature and facilitate optimization of the capillary blood flow.