Routine White Blood Cell Count Research Articles

Research and analysis on computed tomography signs and clinical characteristics of chronic duodenal papilla mucositis and duodenal papillary carcinoma.

Objective: To investigate the computed tomography (CT) findings of chronic duodenal papilla mucositis and duodenal papillary carcinoma, and provide more imaging information for early diagnosis of duodenal malignant diseases.Methods: CT findings and clinical data of 40 patients with chronic duodenal papilla mucositis and 46 patients with duodenal papillary carcinoma were retrospectively analyzed. Observation and measuring of direct duodenal papilla signs (including size, shape, density, enhancement uniformity, etc.), indirect duodenal papilla signs (including pancreaticobiliary dilatation) and clinical indicators (including tumor markers CA19-9, CA125, CEA, blood routine white blood cell count, bilirubin, age, gender, etc.) were carried out according to CT as well as statistical analysis.Results: There were significant differences in duodenal papilla regular morphology, age and CA19-9 (p < .05), and significant differences in duodenal papilla maximum transverse diameter, diameter of common bile duct, diameter of pancreatic duct, total bilirubin, direct bilirubin, and jaundice in duodenal papillary carcinoma group (p < 0.01). There were no significant differences in duodenal papilla enhancement uniformity, plain CT value, arterial CT value, portal CT value, enhancement uniformity, presence or not of calculus at the lower end, gender, CEA, CA125, white blood cell count, and abdominal pain with fever (all p > .05).Conclusion: CT is helpful for the diagnosis of duodenal papilla disease, but the CT findings of patients with duodenal papillary carcinoma tend to be similar to findings of chronic duodenal papilla mucositis, which is easy to lead to misdiagnosis, so comprehensive diagnosis should be made according to the direct and indirect CT signs as well as laboratory and clinical manifestations of duodenal papilla, so as to improve the diagnosis of duodenal papillary carcinoma, and reduce missed diagnosis and misdiagnosis.

Reliability of absolute lymphocyte count as a marker to assess the need to initiate antiretroviral therapy in HIV-infected children

CD4 counts are a standard laboratory measure of disease progression in HIV-infected children. However, CD4 counting is done by flow cytometry and may not always be possible in every centre treating HIV-infected children in resource-limited countries. Absolute Lymphocyte Count (ALC) can be derived easily by performing a routine white blood cell count. The World Health Organization (WHO) in 2006 had recommended ALC to identify HIV-infected children in need of ART in resource-limited settings, when CD4 cell count is not available. This study aims to assess the reliability of using ALC as a marker for starting antiretroviral therapy (ART) in HIV-infected children in a tertiary hospital setting. Retrospective analysis of 46 HIV-infected children who presented at a pediatric HIV clinic at a tertiary referral centre from 2002-2005. Using WHO 2006 guidelines for cutoff values of ALC and 2008 guidelines for CD4% as a comparative standard, a retrospective analysis was done on ART-naοve HIV-infected children who underwent baseline CD4% and ALC, and sensitivity and specificity of ALC was calculated. Fischer exact two-tailed analysis was used to correlate ALC and CD4 and need for starting ART. Sensitivity of ALC was 27.6% (72.4% were false negatives), specificity was 70.6%, with positive predictive value of 61.5%. On comparison across all clinical stages of disease, only 13/46 children (28.2%) would have been started on ART according to ALC cutoffs versus 29/46 children (63.04%) using CD4 criteria (P value=0.0015). In children with WHO clinical Stage 1 or 2 of disease, only 1/11 (9.1%) children were identified by ALC as requiring ART as opposed to 6/11 (54.5%) children by CD4% (P=0.0635). ALC is an unreliable marker to determine the need for starting ART in HIV-infected children.

Studies on onset patterns in antithyroid drug-induced agranulocytosis

We studied the patterns of the onset of antithyroid drug-induced agranulocytosis. From 1975 to 1990, 19,050 patients with Graves' disease receiving treatment with antithyroid drugs were seen at our clinic. For all patients with Graves' disease treated with an antithyroid drug, a routine white blood cell count was done every 2 weeks until euthyroid state was gained, and a count was done once every moth thereafter. Of these, 70 were found to have agranulocytosis. Agranulocytosis was defined as a granulocyte count of 500/mm3 or less. In only 19 of the 70 was agranulocytosis detected after the occurrence of infection (symptomatic: classical agranulocytosis). The remaining 51 patients were asymptomatic when agranulocytosis was detected during routine white blood cell and granulocyte count monitoring. However, 17 of the 51 patients became symptomatic several days after the withdrawal of antithyroid drug treatment (shifted from asymptomatic to symptomatic agranulocytosis). Thirty-four patients had no symptoms of infection throughout the course of the disease (asymptomatic agranulocytosis). In conclusion, 1) We found three patterns in the onset of antithyroid drug-induced agranulocytosis: classical (symptomatic), a shift from asymptomatic to symptomatic, and asymptomatic agranulocytosis, 2) Unexpectedly, classical (symptomatic) agranulocytosis was seen in only 19 of the 70 patients, 3) We were again remained of the importance of routine white blood cell and granulocyte count monitoring.

Antithyroid drug-induced agranulocytosis: special reference to normal white blood cell count agranulocytosis

This retrospective study was aimed at establishing the importance of the leukocyte differentiated count and not only routine white blood cell count in patients treated with antithyroid drug. From 1975 to September 1992, 77 patients with antithyroid drug-induced agranulocytosis were examined. In 12 patients (15.6%), the total white blood cell (WBC) count was greater than 3000/mm3. Eight of them showed a downward trend in their leukocyte counts (3000-4000/mm3). Consequently, granulocyte counts were measured. Two of the 12 patients had "symptomatic" agranulocytosis detected after the occurrence of infection. Because antithyroid drug-induced agranulocytosis was strongly suspected, granulocyte counts were checked. In the remaining two patients, the total WBC count was 5700/mm3 and 5900/mm3, respectively. One was hospitalized to receive thyroid surgery. Although she was asymptomatic, agranulocytosis was unexpectedly detected on a routine preoperative examination. The other was diagnosed as agranulocytosis by routine WBC and granulocyte count monitoring since June 1989. Correct diagnosis was based on the leukocyte differentiated counts. We concluded that the leukocyte differentiated count and not only routine white blood count was critically important for the correct diagnosis of antithyroid drug-induced agranulocytosis in patients with Graves' disease.

Antithyroid Drug-Induced Agranulocytosis: Is Routine White Blood Cell Count Effective for the Detection?-Reply

In Reply.— We appreciate and agree with comment by Asawa et al that the leukocyte differentiated count, not only routine white blood cell count is critically important for correct diagnosis of antithyroid drug-induced agranulocytosis in some cases. From January 1975 to May 1989, total white blood cell (WBC) count was measured using automatic blood-cell analyzer (Sysmex CC700, Toa Medical Electronics Co Ltd, Kobe, Japan). Whenever total WBC count was 4.0 × 10 9 /L or less, a blood smear analysis was carried out. This fact was not mentioned in our article, 1 therefore, we would like to clarify it here. From 1975 to 1990, 72 patients presented with antithyroid drug-induced agranulocytosis. In 12 patients, total WBC count was greater than 3.0 × 10 9 /L (3.1 to 5.9 × 10 9 /L. Nine of 12 patients showed a downward trend in their leukocyte counts.

Antithyroid drug-induced agranulocytosis: is routine white blood cell count effective for the detection?

Antithyroid drug-induced agranulocytosis: is routine white blood cell count effective for the detection?

Antithyroid Drug-Induced Agranulocytosis: Is Routine White Blood Cell Count Effective for the Detection?

Antithyroid Drug-Induced Agranulocytosis: Is Routine White Blood Cell Count Effective for the Detection?

Antithyroid drug-induced agranulocytosis. The usefulness of routine white blood cell count monitoring

This study was aimed at establishing the importance of routine monitoring of white blood cell counts in patients with Graves' disease receiving antithyroid drug treatment. In the 12-year period from 1975 to 1987, 15,398 patients with Graves' disease receiving treatment with antithyroid drugs were seen at our clinic. Of these, 55 (0.4%) were found to have agranulocytosis. Agranulocytosis was defined as a granulocyte count of 0.5 x 10(9)/L or less. In only 12 of the 55 patients was agranulocytosis detected after the occurrence of infection (symptomatic; classic agranulocytosis). The remaining 43 patients were asymptomatic when agranulocytosis was detected during routine white blood cell count monitoring. However, 14 of these 43 patients became symptomatic several days after withdrawal of antithyroid drug treatment despite antimicrobial treatment (asymptomatic to symptomatic). Twenty-nine patients who were treated appropriately had no symptom of infection throughout the course of the disease, despite the absence of or an extremely small number of granulocytes in circulation (asymptomatic). These results suggest that a "routine monitoring" of the white blood cell count could be the most effective way of predicting and detecting agranulocytosis due to antithyroid drug treatment.

Agranulocytosis, leukopenia, and psychotropic drugs.

The usefulness of a routine white blood cell count (WBC) in detecting a developing agranulocytosis is questionable. Routine WBCs may foster a false sense of security and lead a physician to discount other symptoms; on the other hand, not every WBC below 3,700/cu mm is cause for abandoning a helpful drug. We feel that the medical staff should be on the alert for evidence of infection in patients taking psychotropic drugs so that laboratory tests can be ordered if indicated by current symptoms or a history suggesting a high risk.