Relative Lymphopenia Research Articles

Long-term dietary exposure to the non-steroidal anti-inflammatory drugs diclofenac and ibuprofen can affect the physiology of common carp (Cyprinus carpio) on multiple levels, even at “environmentally relevant” concentrations

The aim of the study was to evaluate the effects of emerging environmental contaminants, the non-steroidal anti-inflammatory drugs (NSAIDs) diclofenac (DCF) and ibuprofen (IBP), on physiological functions in juvenile common carp (Cyprinus carpio). Fish were exposed for 6 weeks, and for the first time, NSAIDs were administered through diet. Either substance was tested at two concentrations, 20 or 2000 μg/kg, resulting in four different treatments (DCF 20, DCF 2000, IBP 20, IBP 2000). The effects on haematological and biochemical profiles, the biomarkers of oxidative stress, and endocrine disruption were studied, and changes in RNA transcription were also monitored to obtain a comprehensive picture of toxicity. Fish exposure to high concentrations of NSAIDs (DCF 2000, IBP 2000) elicited numerous statistically significant changes (p < 0.05) in the endpoints investigated, with DCF being almost always more efficient than IBP. Compared to control fish, a decrease in total leukocyte count attributed to relative lymphopenia was observed. Plasma concentrations of total proteins, ammonia, and thyroxine, and enzyme activities of alanine aminotransferase (ALT), aspartate aminotransferase, and alkaline phosphatase (ALP) were significantly elevated in either group, as were the activities of certain hepatic antioxidant enzymes (superoxide dismutase, glutathione-S-transferase) in the DCF 2000 group. The transcriptomic profile of selected genes in the tissues of exposed fish was affected as well. Significant changes in plasma total proteins, ammonia, ALT, and ALP, as well as in the transcription of genes related to thyroid function and the antioxidant defense of the organism, were found even in fish exposed to the lower DCF concentration (DCF 20). As it was chosen to match DCF concentrations commonly detected in aquatic invertebrates (i.e., the potential feed source of fish), it can be considered “environmentally relevant”. Future research is necessary to shed more light on the dietary NSAID toxicity to fish.

Variations in complete blood counts and cellular morphological alterations in blood smear of COVID-19 patients from a tertiary care center

Corona viruses are a large family of viruses of which Corona virus disease 19 (COVID 19) infection evokes a hyperinflammatory response and severe acute respiratory distress syndrome in human beings. Complete blood count evaluation and peripheral smear examination is an essential tool for early diagnosis and management of COVID-19 positive patients. This study was aimed to evaluate the variations in complete blood counts (CBC) and changes in the cellular morphology in the blood smear in patients affected with COVID-19. This was an observational study, undertaken in a tertiary care center. The study included baseline blood samples from 96 proven COVID-19 positive cases. The samples were subjected for automated complete blood count analysis and peripheral smear examination.Thequantitative data were expressed by mean and Standard deviation. Qualitative categorical variables were expressed as numbers and percentages. Out of the total 96 cases, the most common quantitative finding was neutrophilic leukocytosis with relative lymphopenia. Five cases of absolute lymphopenia was observed. Majority of the cases had normal hemoglobin values and normal platelet counts. The characteristic morphological changes were seen in neutrophils and lymphocytes. The neutrophils showed presence of toxic granules, cytoplasmic vacuolations and hypolobation.The morphological alteration in lymphocytes included reactive lymphocytes with plasmacytoid and monocytoid morphology, large granular lymphocytes and Turk cells. Infrequent finding of leukoerythroblastic reaction was also observed in our study.To summarize, hematological investigation of COVID 19 cases may show several abnormal findings. Quantitative findings like Neutrophilia and lymphopenia were characteristic, whereas, the most common morphological alteration observed was atypical lymphocytes. Quantitative and qualitative alterations of hematological parameters are one of the investigations which would aid timely diagnosis of the disease. Toxic granules and cytoplasmic vacuolations in neutrophils may indicate ongoing sepsis in COVID 19 patients which in turn aids in efficient management of the patients to reduce the mortality rate.

Neutrophil-to-lymphocyte ratio and lymphocyte count reflect alterations in central neurodegeneration-associated proteins and clinical severity in Parkinson Disease patients

IntroductionPeripheral inflammation has been recently associated to Parkinson disease (PD). However, how the peripheral inflammatory immune response could affect the clinical-pathological features of the disease is not fully understood. In this study, we assessed the peripheral immune profile of a well-characterized PD cohort, examining several correlations with CSF biomarkers of neurodegeneration and the main clinical parameters, aimed at better elucidating the complex dynamics of the brain-periphery interactions in PD. MethodsThe leukocyte populations counts (neutrophils, lymphocytes, monocytes, eosinophils, and basophils) and the neutrophil-to-lymphocyte ratio (NLR) were collected and compared in 61 PD patients and 60 sex/age matched controls (CTRLs). Immune parameters were correlated with CSF levels of total α-synuclein, amyloid-β-42, total and phosphorylated-tau and main motor and non-motor scores. ResultsPD patients had lower lymphocyte and higher NLR counts compared to CTRLs. In PD patients, the lymphocyte count directly correlated with CSF α-synuclein levels, whereas NLR displayed an inverse correlation with the CSF amyloid-β42 levels. The lymphocyte count also negatively correlated with HY stage, while NLR positively with the disease duration. ConclusionsThis study provided in vivo evidence that, in PD, changes in leukocytes in the periphery, assessed as relative lymphopenia and NLR increase, reflect in central neurodegeneration-associated proteins modifications, especially in α-synuclein and amyloid-β pathways, and greater clinical burden.

Epigenetic immune monitoring for COVID-19 disease course prognosis.

The course of COVID-19 is associated with severe dysbalance of the immune system, causing both leukocytosis and lymphopenia. Immune cell monitoring may be a powerful tool to prognosticate disease outcome. However, SARS-CoV-2 positive subjects are isolated upon initial diagnosis, thus barring standard immune monitoring using fresh blood. This dilemma may be solved by epigenetic immune cell counting. In this study, we used epigenetic immune cell counting by qPCR as an alternative way of quantitative immune monitoring for venous blood, capillary blood dried on filter paper (dried blood spots, DBS) and nasopharyngeal swabs, potentially allowing a home-based monitoring approach. Epigenetic immune cell counting in venous blood showed equivalence with dried blood spots and with flow cytometrically determined cell counts of venous blood in healthy subjects. In venous blood, we detected relative lymphopenia, neutrophilia, and a decreased lymphocyte-to-neutrophil ratio for COVID-19 patients (n =103) when compared with healthy donors (n = 113). Along with reported sex-related differences in survival we observed dramatically lower regulatory T cell counts in male patients. In nasopharyngeal swabs, T and B cell counts were significantly lower in patients compared to healthy subjects, mirroring the lymphopenia in blood. Naïve B cell frequency was lower in severely ill patients than in patients with milder stages. Overall, the analysis of immune cell counts is a strong predictor of clinical disease course and the use of epigenetic immune cell counting by qPCR may provide a tool that can be used even for home-isolated patients.

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.

Profile of Lymposites in New Tuberculosis (TB) Patients in Semarang City

The body's form of defense or natural immune response against intracellular bacteria is phagocytosis. Cells capable of phagocytosing macrophages in natural responses play a role in presenting antigens to lymphocytes in specific immune responses. The number of lymphocytes associated with the incidence of death in TB patients in hospitals. This study aims to determine the lymphocyte profile in pulmonary TB patients with new cases in the city of Semarang in 2020. This study uses a descriptive-analytic research design. The population in this study were new cases of pulmonary TB patients at the Semarang Health Center in 2020. The sample in this study was new cases of pulmonary TB patients at the Semarang Health Center from September to October 2020. The results showed that the newest cases of pulmonary TB were male (59%), and based on age the most were productive age (87.8%), and the lymphocyte profile of 78% of respondents had relative lymphopenia, 19.5% of respondents were normal and 2.4% of respondents experienced relative lymphocytosis. Overall, it can be said that the profile of patients with lymphopenia is 14.63%, and relative lymphopenia is 78%.

Relapsing pericarditis: Peripheral blood neutrophilia, lymphopenia and high neutrophil-to-lymphocyte ratio herald acute attacks, high-grade inflammation, multiserosal involvement, and predict multiple recurrences.

To identify peripheral blood cellular correlates of active pericarditis and to verify whether peripheral blood neutrophils, lymphocytes and the neutrophil to-lymphocyte ratio (NLR) are associated with disease phenotype or prognosis. Observational prospective study on a cohort of 63 patients with idiopathic pericarditis followed for 12 months after each pericarditis recurrence. Two distinct analyses were performed: the "index attack" analysis focused on the first pericarditis episode in each patient, while the "all attacks" analysis included all episodes occurring during the study. Absolute and relative neutrophilia and lymphopenia, together with high NLR, were observed during active pericarditis, as compared with disease remission, at both analyses. Neutrophils showed a positive correlation with plasma C-reactive protein levels, while lymphocyte count showed a negative correlation. Relative neutrophil count was higher, and lymphocyte count lower in patients with pleural effusion; a higher NLR and lower absolute lymphocyte count were observed in those with peritoneal involvement. No correlations were found between peripheral blood neutrophil or lymphocyte counts and size of pericardial effusion, or with the presence of myocardial involvement. Peripheral neutrophilia, lymphopenia and NLR during acute attacks predicted the number of recurrences in the following 12 months. Peripheral blood neutrophilia and lymphopenia are typical of acute idiopathic pericarditis. Acute attacks of pericarditis are associated with neutrophilia and lymphopenia, as compared with disease remission. During acute attacks, neutrophilia and lymphopenia reflect the extent of serosal inflammation and could help to customize therapeutic management after remission has been achieved.

COVID-19 Case Report: Circulating blood cells morphology in convalescent patient

Objective: Many studies have detailed the mechanisms of infection and quantitative peripheral blood findings reported in severe acute respiratory syndrome virus 2 (SARS-CoV-2) patients during the severity of infection since the start of the coronavirus disease 2019 (COVID-19) pandemic. Though, only a few studies have described blood morphologic abnormalities. We report peripheral blood cells morphologic changes in convalescent patient. Design: We performed complete blood counts (CBC), and blood smear of 52-year-old patient who were COVID-19 positive test by (RT-PCR), from May 20, 2021, through June 15, 2021. The peripheral blood smears of a convalescent patient were collected the morphological structures of Leukocytes, red blood cells (RBCs) and platelets were examined and documented, after 3 weeks from infection with COVID-19 RT-PCR was negative to look for viral changes on blood cells morphology. Results: On a complete blood count (CBC), the most common quantitative hematologic abnormalities were mild anemia with RBCs showed no abnormality followed by WBCs normal in count, and relative lymphopenia. Neutrophils showed the most substantial morphologic alterations with C-shaped bi-lobulated nuclei, coarse toxic granulations and cytoplasmic vacuolization. Activated neutrophil granulocytes with elongated cell membrane, pseudo Pelger–Huët anomaly-like nuclei, ring form nuclei and pyknotic nucleus. Lymphocytes were atypical reactive lymphocytes with cytoplasmic pseudopod formation. Plasmacytoid lymphocytes with an eccentric nucleus and deeply basophilic cytoplasm are frequently seen. Monocytes seen in active form with cytoplasmic vacuolization and cytoplasm contain granules, with pseudopod formation. Platelets were adequate in number with giant platelets are occasionally seen. Smudge cell is also seen. RBCs were normocytic; normochromic. Conclusion: Our work identifies and characterizes significant morphologic abnormalities in recovered COVID-19 patients' peripheral blood cells. Understanding these morphologic changes, in addition to established hematologic parameters, can help follow with COVID-19 patient during recovery through serial CBC and peripheral smear examination. Serial complete blood count and blood film review may become an essential tool to help physicians allocate patients to risk categories based on morphological findings if these proposals are supported by large-scale investigations of convalescent patients.

Features of laboratory parameters in children with multisystem inflammatory syndrome associated with SARS-CoV-2

Multisystem inflammatory syndrome (MIS-C) is a new childhood disease associated with coronavirus SARS-CoV-2 that manifests itself 3–4 weeks after infection. The development of MIS-C is possible, despite the asymptomatic course of coronavirus infection. The pathogenetic features of MIS-C remain unclear. The aim of the study was to investigate the state of peripheral blood parameters in children with multisystem inflammatory syndrome associated with SARS-CoV-2 upon admission to a hospital. Material and methods. We examined 52 children with MIS-C from 1 to 14 years old, hospitalized in Children`s Clinical Hospital No. 3 in Novosibirsk in October–December 2020. Testing for the isolation of SARS-CoV-2 RNA in scrapings from the nasopharynx and oropharynx was carried out using real time PCR (test systems of DNA-Technology, Russia). The presence of specific IgM and IgG antibodies to SARS-CoV-2 in blood serum was determined by ELISA using Vector-Best kits (Russia). Results and discussion. It was noted that SARS-CoV-2 virus RNA was found only in 12.8 % of cases, while specific IgG antibodies in blood serum were detected in 100 % of children. IgM to SARS-CoV-2 antigens were detected in the blood serum only in 53.85 % of children with MIS-C. It has been established that unexpressed leukocytosis was found both in children under the age of 7 and in children of 8–14 years old. However, the leukocytes content in children of the older age group was significantly lower than in children aged 1–7 years. At the same time, in both age groups, some children had extremely low values of the indicator. The causes of severe leukopenia against the background of excessive inflammation remain unclear. Age groups (1–7 and 8–14 years) do not differ statistically significantly in the relative content of lymphocytes and neutrophils. In the study of individual values of the relative content of lymphocytes within the age groups, it was noted that only some children had lymphopenia of varying severity. Conclusions. Against the background of minor leukocytosis in children with MIS-C, upon admission to the hospital, there is a tendency to develop both relative and absolute lymphopenia, regardless of age. The study noted an extremely pronounced variability of individual values of the evaluated peripheral blood parameters, regardless of age, which, with similar clinical symptoms, characterized as MIS-C, requires further study in dynamics, taking into account the initial values of the indicators.There is no pronounced relationship between the leukocytes content and specific IgM antibodies to SARS-CoV-2 antigens in the blood.

Activation of mitochondrial telomerase reverses relative lymphopenia post myocardial infarction: results from the randomised, double-blinded TACTIC phase IIa pilot trial

Abstract Background Immune ageing is a phenomenon which includes lymphopenia, expansion of pro-inflammatory T-lymphocyte subsets and telomere shortening. While lymphopenia predicts mortality after myocardial infarction (MI), MI itself leads to both an increase in terminally differentiated memory CD8+ T-lymphocytes (CD8+ TEMRAs) and a decrease in telomere length. Activation of telomerase has been shown to ameliorate lymphopenia, and improve heart function after MI in mouse models. TA-65 is an oral telomerase activator, which may ameliorate immune ageing and improve outcome after MI. Methods This double-blinded, randomized placebo-controlled pilot study evaluated the use of TA-65 in 90 MI patients over 65 years, the average onset age for immune ageing. Patients were randomised to either TA-65 (16 mg daily, n=45) or placebo (n=45) for 12 months. The majority of patients underwent percutaneous coronary intervention (87%) or coronary artery bypass surgery (2%) as treatment for their index MI. The pre-defined primary endpoint was the proportion of CD8+ TEMRA T-lymphocytes at 12 months, a marker of immune ageing. A linear mixed effects model was used for the analysis. Results The proportion of CD8+ TEMRAs after 12 months did not differ between the 2 treatment groups, although only increased significantly in the placebo group (+2.2%, 95% CI: 0.14–4.24). TA-65 was well tolerated, with total adverse events lower in the treatment group (TA-65 vs. placebo group: n=130 vs. n=185). We observed at 12 months a 62% reduction in mean high-sensitivity CRP (hsCRP: TA-65 vs. placebo group: 1.1±0.9 vs. 2.9±6.4 mg/L) and a 15%-increase in mean peripheral blood lymphocytes in TA-65 after 12 months. In the whole sample, among those who were treated with TA-65 compared to Placebo, after 12 months peripheral blood lymphocytes increased (+285 cells /μl, 95% CI: 117–452). The latter was due to significant increases in the TA-65 group from baseline to 12 months across all major lymphocyte populations: CD3+ (+15%), CD4+ (+14%),CD8+ T-lymphocytes (+19%), B-lymphocytes (+17%) and natural killer cells (+12%), while no changes occurred in major lymphocyte populations in the placebo group over the course of the study. Conclusion In this randomised clinical trial, we found that while CD8+ TEMRAs were not significantly altered after 12 months, the telomerase activator TA-65 significantly increased all major lymphocyte subsets and substantially reduced hsCRP at 12 months in patients with MI. These findings suggest TA-65 holds great promise in potentially reducing inflammation while improving an age-related decline in major lymphocyte populations, thereby enhancing immunity. A larger, multicentre, powered phase IIb efficacy trial to examine the potential effect of TA-65 in prognosis and heart function after MI is therefore warranted. Funding Acknowledgement Type of funding sources: Private company. Main funding source(s): TA-Science, New York, USA

INVESTIGATING HETEROGENEITY OF TREATMENT EFFECT FOR CONVALESCENT PLASMA IN SEVERE COVID-19: SECONDARY ANALYSIS OF A RANDOMIZED CONTROLLED TRIAL

INVESTIGATING HETEROGENEITY OF TREATMENT EFFECT FOR CONVALESCENT PLASMA IN SEVERE COVID-19: SECONDARY ANALYSIS OF A RANDOMIZED CONTROLLED TRIAL

THE EFFECT OF DEXAMETHASONE ON HEMATOLOGIC PROFILES, HEMOSPORIDIAN INFECTION, AND SPLENIC HISTOLOGY IN HOUSE FINCHES (HAEMORHOUS MEXICANUS).

Research on host response to infectious disease often involves pharmacological induction of immunosuppression, frequently through administration of dexamethasone. Reports on the effect of dexamethasone in birds are largely restricted to poultry and pigeons. This study describes changes in white blood cell (WBC) differentials, hemoparasite counts, splenic histology, and splenic CD3 immunoreactivity in House Finches (Haemorhous mexicanus). Experimental group birds (n=9) were treated with a daily intramuscular injection of 25 µg of dexamethasone for 8 d; a control group (n=9) received daily saline solution. Smears were made with blood collected immediately before the first dose (day 0) and on d 4, 8, and 9, and stained with modified Wright. The WBC differential counts were performed by three blinded observers, parasite counts by two blinded observers, and histology by one blinded observer. Dexamethasone-treated birds experienced relative heterophilia and lymphopenia on d 4 (P=0.008); heterophilia was also present at d 8 (P=0.018). Hemosporidian counts were significantly increased in dexamethasone-treated birds on d 4 and 8 (P=0.048 and P=0.031, respectively). In contrast with control birds, all dexamethasone-treated birds lacked histologically apparent splenic lymphoid follicles (P<0.001). No significant difference was observed in splenic CD3 immunoreactivity between groups. Our results indicate that dexamethasone has an effect on the hematologic profile of House Finches and suggest that it may be a useful method to induce immunosuppression in this species.

Lymphopenia and mortality among patients undergoing coronary angiography: Long-term follow-up study.

BackgroundLymphopenia is associated with adverse prognosis in chronic disease states that are related to immune dysregulation. We aimed to determine the association between lymphopenia and mortality in patients presenting to coronary angiography and investigate whether elevated red blood cell distribution width (RDW), an established cardiovascular prognostic marker, further refines risk stratification.MethodsRetrospective analysis of patients undergoing coronary angiography for evaluation or treatment of coronary artery disease between 2003 and 2018. Mortality risk associated with relative (1000–1500/μL) or severe (< 1000/μL) lymphopenia was analyzed using adjusted Cox proportional hazards regression models.ResultsOverall, 15,179 patients aged 65 ± 12 years underwent coronary angiography. During a median follow-up of 8 years, 4253 patients died. Compared to normal lymphocyte count, the adjusted hazard ratio (HR) for mortality was 1.31 (95% confidence interval [CI] 1.21–1.41) and 1.97 (95% CI 1.75–2.22) for relative and severe lymphopenia, respectively. The increase in mortality associated with severe lymphopenia was significant in patients presenting in the non-acute setting (HR 2.18, 95% CI 1.74–2.73), ST-segment elevation myocardial infarction (STEMI) (HR 1.59, 95% CI 1.15–2.21), or unstable angina/non-STEMI (HR 2.00, 95% CI 1.70–2.34); p-value for interaction 0.626. The association of lymphopenia with mortality remained significant after additional adjustment to RDW. High RDW (> 14.5%) was associated with reduced survival, and it improved the predictive accuracy of lymphocytes count with an increase in Harrell’s Concordance statistic from 0.634 (SE = 0.005) to 0.672 (SE = 0.005), p < 0.001.ConclusionsLymphopenia is associated with increased risk of mortality during long-term follow-up in patients undergoing coronary angiography, regardless of the coronary presentation. High RDW may enhance the predictive ability of lymphopenia.

Clinical features and outcomes of COVID-19 patients admitted at a tertiary hospital in Cebu City, Philippines.

The World Health Organization has categorized coronavirus disease 2019 (COVID-19) into mild, moderate, severe, and critical illness severities to guide clinical decision-making. This study aimed to describe the clinical characteristics, complications, and outcomes of COVID-19 patients by illness severity, at a tertiary healthcare center in Cebu City, Philippines. This was a retrospective, observational cohort study that examined clinical information of patients with confirmed COVID-19 infection admitted between March and September 2020. Data from 901 admitted patients were analyzed, with 185 (20.5%) classified as mild, 429 (47.6%) as moderate, 223 (24.7%) as severe, and 64 (7.1%) as critical. The frequency of male gender, advancing age, co-morbidities (hypertension and diabetes mellitus), inflammatory marker elevation (LDH, CRP, Ferritin, Procalcitonin), and elevated mean white blood cell counts with relative neutrophilia and lymphopenia increased with COVID severity. Severe and critical cases of COVID presented with more diffuse lung involvement in chest radiographs and abnormal electrocardiographic patterns such as ischemic changes, PVCs, PACs, and sinus tachycardia. The most common complications on admission were ARDS (10.9%), AKI (10.1%), shock (6.6%), and cardiac arrest (6.3%). Mortality rates were highest in critical cases (82.8%). Severe and critical COVID-19 cases were predominant on final disposition, rising to 62.5% of the study population from 32.1% on admission. This study highlights key differences in clinical characteristics, complications, and outcomes between illness severities. Risk prediction models are needed for disease progression and poor outcomes.

Evaluation of Hematological Parameters in Predicting Intensive Care Unit Admission in COVID-19 Patients.

Hematological parameters like total leukocyte count (TLC), neutrophil, lymphocyte, and absolute eosinophil counts (AEC), and neutrophil-to-lymphocyte ratio (NLR) are known to predict the severity of novel coronavirus disease 2019 (COVID-19) patients. In the present study, we aimed to study the role of complete blood count parameters in triaging these patients requiring intensive care unit (ICU) admission. A retrospective study was done over a period of 2 months. Patients, who were ≥ 18 years of age with COVID-19 confirmed on SARS-CoV-2 reverse transcription-polymerase chain reaction (RT-PCR) and whose routine hematology counts were sent within 24 h of admission, were included in the study. Cut-off values of 47.5 years for age, 11.3 × 109/L for TLC, and 9.1 for NLR were predictive of disease severity among COVID-19 patients. Relative neutrophilia ≥ 70% (p < 0.007), relative lymphopenia ≤ 20% (p < 0.002), AEC ≤ 40/cumm (p < 0.001), and NLR ≥ 9.1 (p < 0.001) were significantly associated with ICU admission. Routine hematological parameters are cost-effective and fast predictive markers for severe COVID-19 patients, especially in resource-constrained health care settings to utilize limited ICU resources more effectively.

Protective Effect of Lactobacillus sporogenes against Arsenic-Induced Hematological Alterations in Male Albino Wistar Rats.

The aim of the present study was to evaluate the arsenic-induced hemotoxicity and to evaluate the protective effects of Lactobacillus sporogenes in male albino Wistar rats. A total of 36 adult male albino Wistar rats were procured and divided into 3 groups of 12 animals each. Group 1 rats served as control, group 2 rats were administered sodium arsenite (@5mg/kg BW/day), groups 3 rats were supplemented with L. sporogenes (@15 million spores/kg BW/day) along with sodium arsenite administered along with sodium arsenite orally daily for 28 consecutive days. Weekly body weights, hematological profile, and erythrocyte morphology were assessed. Significant (P < 0.05) reduction in mean weekly body weights (g) was observed in group 2 than group 1; however, a significant (P < 0.05) increase in weekly body weights was observed in group 3 as compared to group 2. A significant (P < 0.05) decrease in erythrocyte-related parameters and platelet counts, and a significant (P < 0.05) leukocytosis, relative lymphopenia, absolute neutrophilia, and monocytosis were noticed among arsenic-treated rats when compared to the control group. Blood smear of arsenic-treated rats contains echinocytes, microcytes, and spherocytes when compared to control. Scanning electron microscopic examination of blood revealed altered erythrocyte morphology in arsenic-treated rats with poikilocytosis and blebbing of the erythrocyte membrane. Supplementation of L. sporogenes along with arsenic resulted in improvement of all the hematological parameters and reduction in morphological abnormalities in comparison to the toxic control group. It is concluded that supplementation of L. sporogenes can effectively alleviate the arsenic-induced hematological alterations.

Comprehensive Laboratory Data Analysis to Predict the Clinical Severity of Coronavirus Disease 2019 in 1,952 Patients in Daegu, Korea.

BackgroundLaboratory parameter abnormalities are commonly observed in COVID-19 patients; however, their clinical significance remains controversial. We assessed the prevalence, characteristics, and clinical impact of laboratory parameters in COVID-19 patients hospitalized in Daegu, Korea.MethodsWe investigated the clinical and laboratory parameters of 1,952 COVID-19 patients on admission in nine hospitals in Daegu, Korea. The average patient age was 58.1 years, and 700 (35.9%) patients were men. The patients were classified into mild (N=1,612), moderate (N=294), and severe (N=46) disease groups based on clinical severity scores. We used chi-square test, multiple comparison analysis, and multinomial logistic regression to evaluate the correlation between laboratory parameters and disease severity.ResultsLaboratory parameters on admission in the three disease groups were significantly different in terms of hematologic (Hb, Hct, white blood cell count, lymphocyte%, and platelet count), coagulation (prothrombin time and activated partial thromboplastin time), biochemical (albumin, aspartate aminotransferase, alanine aminotransferase, lactate, blood urea nitrogen, creatinine, and electrolytes), inflammatory (C-reactive protein and procalcitonin), cardiac (creatinine kinase MB isoenzyme and troponin I), and molecular virologic (Ct value of SARS-CoV-2 RdRP gene) parameters. Relative lymphopenia, prothrombin time prolongation, and hypoalbuminemia were significant indicators of COVID-19 severity. Patients with both hypoalbuminemia and lymphopenia had a higher risk of severe COVID-19.ConclusionsLaboratory parameter abnormalities on admission are common, are significantly associated with clinical severity, and can serve as independent predictors of COVID-19 severity. Monitoring the laboratory parameters, including albumin and lymphocyte count, is crucial for timely treatment of COVID-19.

Association between treatment-related lymphopenia and survival in glioblastoma patients following postoperative chemoradiotherapy

PurposeOur study investigated the association between treatment-related lymphopenia and overall survival (OS) in a series of glioblastoma (GBM) patients. We also explored clinical and dosimetric predictors of lymphocytes depletion.MethodsBetween 2015 and 2019, 64 patients were treated at the same institution with postoperative chemoradiotherapy. Peripheral lymphocyte count (PLC) data and dose–volume histogram parameters were collected. Radiotherapy (RT) schedule consisted in standard total dose of 60 Gy in 30 daily fractions, with concomitant and adjuvant temozolomide (TMZ). Posttreatment acute absolute lymphopenia (nadir AAL) was calculated as a PLC lower than 1.0 × 103/mm3. Acute relative lymphopenia (ARL) was expressed by the nadir-PLC/baseline-PLC ratio < 0.5. Nadir-PLC was the lowest PLC registered between the end of RT and the first month of follow-up. Survival rates were estimated with Kaplan–Meier curves. Clinical and dosimetric variables related to AAL/ARL and OS were identified by univariate and multivariate analyses.ResultsA total of 57 patients were eligible and included in the analyses. The median PLC was significantly decreased following chemoradiotherapy (2180/mm3 vs 900/mm3). Median OS was 16 months (range 5–55 months), with no significant difference between patients who developed nadir AAL and those who did not (16 months vs 16.5 months; p = 0.304). When considering ARL vs non-ARL, median OS was 14 months vs 26 months (p = 0.013), respectively. In multivariate Cox regression only age, sex, extent of surgery, access to adjuvant chemotherapy and brain D98% were independently associated with OS.ConclusionAlthough iatrogenic immunosuppression could be associated with inferior clinical outcomes, our data show that treatment-related lymphopenia does not adversely affect GBM survival. Prospective studies are required to confirm these findings.

Hematology of Wild Lake Erie Watersnakes (Nerodia sipedon insularum) with Natural Ophidiomycosis

Habitat loss, human persecution, and infectious diseases all threaten declining reptile populations. Lake Erie watersnakes (Nerodia sipedon insularum, LEWS), once classified as an endangered species in part due to human persecution, have recovered to stable population levels but have been observed with a high prevalence of ophidiomycosis. Strategies are needed to mitigate the current disease threat, including assessing overall wellness. Hematologic analysis provides information about the presence of inflammation and infection and thus informs health-based conservation efforts, but has not been previously performed in LEWS. The objective of this study was to evaluate hematologic parameters in LEWS and identify differences based on ophidiomycosis status. Blood was drawn from wild-caught snakes at nine sites in 2018 and 2019 and complete blood counts were performed in 180 individuals. For apparently healthy snakes, packed cell volume was significantly higher in males (median = 32.5%) compared to females (median = 26.5%; P = 0.03). Animals classified as having possible or apparent ophidiomycosis, or those with skin lesions, had a relative azurophilia and lymphopenia compared to individuals classified as negative or Ophidiomyces present, or those without skin lesions (P < 0.01). This is the first study to investigate hematology in a free-ranging population of LEWS and will serve as a baseline for future investigations that aim to improve conservation efforts through population health monitoring.

ABCL-365: Non-Hodgkin Lymphoma Developed in the Clinical Course of a Child with Wiskott-Aldrich Syndrome

Context Wiskott-Aldrich syndrome (WAS) is a rare X-linked disorder characterized by thrombocytopenia, dermatitis, recurrent infections, and malignancies. Hematological malignancies are common in WAS patients; unfortunately, they usually have a poor prognosis. Objective Evaluation of a clinical case of hematologic malignancy in a child diagnosed with primary immunodeficiency WAS. Methods We analyzed clinical records, lymph node biopsy, thrombocyte count, serum immunoglobulins, and genetics. Results A three-year-old male child, born to non-consanguineous parents, with a neonatal history of respiratory infections, eczema, and thrombocytopenia, was admitted to our department. Clinical examination revealed bilateral pneumonia, cervical lymphadenopathy (2×2 cm) with 4-month duration, eczematous lesions over the face, and multiple ecchymotic patches over the upper and lower limbs. With a clinical suspicion of Wiskott-Aldrich syndrome (WAS), he was investigated further. His platelet counts were variable, with a minimum of 18–20x109/L, with a mean platelet volume of 11 fL. Clinical symptoms correlated with leukocytosis, with values over 24x109/L, a left shift (non-segmented neutrophils 10%–36%), and relative lymphopenia 12%–22%. Because immunodeficiency was suspected, immunological investigations were performed, and evaluation of serum immunoglobulins showed increased concentrations of total immunoglobulin E, ranging from 85 µE/mL to 2000 µE/mL (age norm is G in intron 2 of the WAS gene. Computed tomography revealed multiple, large, coalescent nodes in the cervical, axillary, mediastinal, and perihilar regions. The patient subsequently underwent a right axillary lymph node biopsy, which was reported as diffuse large B-cell lymphoma patients (DLBCL). According to his immunological and hematological diagnosis, he was admitted to the hematological department for the preparation and initiation of a bone marrow transplant. Conclusions Variable clinical forms can be present in WAS. Due to poor immunological response, patients frequently develop malignancy, with NHL being the most common. Prognosis of NHL in WAS remains poor, and transplant remains the only curative therapy presently for WAS.