White Blood Cell Count Values Research Articles

Neutrophil-Lymphocyte Ratio Is Significantly Decreased in Preemptive Renal Transplant Patients

AimCardiovascular diseases and infections are the leading two causes of morbidity and mortality in end-stage renal disease (ESRD) patients. Kidney transplantation is the preferred method for renal replacement owing to better survival. There are reports of irreversibly damaged immune system in dialysis patients, which did not return to normal even after kidney transplantation. The neutrophil-lymphocyte ratio (NLR) is an easily applicable method for evaluation of inflammation. We hypothesized that preemptive kidney transplantation can improve inflammatory state compared with nonpreemptive recipients. To test our hypothesis, we retrospectively investigated pretransplant and posttransplant NLR and C-reactive protein (CRP) levels of ESRD patients and compared them with values in healthy controls. Materials and MethodsWe retrospectively analyzed NLR, CRP, and other hematologic parameters of ESRD patients who were transplanted between January 2005 and January 2014 on the day of transplantation and at the end of first year. We grouped the patients as preemptive and nonpreemptive ones. We excluded patients with coronary artery disease, obesity, hypotension, hyperthyroidism, uncontrolled diabetes mellitus, hematologic or solid organ cancers, and active documented infection at any evaluation period. ResultsWe included 137 ESRD patient and 34 healthy control individual in our study. Of the 137 ESRD patients, 52 (38%) were transplanted preemptively. Of the patients, 85 were already on either hemodialysis or peritoneal dialysis therapy at the time of transplantation. The white blood cell count value of the patient and control group (7246.72 ± 1460.26 and 76661.76 ± 1286.29, respectively; P = .43), NLR of the control group was significantly lower than patient group (1.98 ± 0.94 and 3.47 ± 2.33, respectively; P = .007). The NLR of the preemptive group was decreased substantially at the end of first year posttransplantation, the NLR of the preemptive group was significantly lower than the nonpreemptive group (3.08 ± 1.32 and 3.71 ± 2.33; P = .01). ConclusionsWe showed that all ESRD patients had an increased inflammation rate according to CRP and NLR when compared with healthy controls. We also found that improvement of inflammatory state in preemptive patients is significantly better than nonpreemptive patients at the end of first year evaluation.

Effects of synbiotic (Biomin IMBO) on haematological and immunological components of Russian sturgeon, Acipenser guldenstadti

The present study was carried out to evaluate the effects of synbiotic (Biomin IMBO) on haematological (white blood cell (WBC) and red blood cell (RBC) counts, haemoglobin (Hb) concentration, haematocrit (Hct), mean corpuscular haemoglobin (MCH), mean corpuscular volume (MCV) and mean corpuscular haemoglobin concentration (MCHC)) and immunological (immunoglobulin (IgM) and lysozyme activity) components of Russian sturgeon, Acipenser guldenstadti. Five experimental treatments and one control group with three replicates were considered. In treatment groups, fish were fed with diet containing 1 (T1), 1.5 (T2), 2 (T3), 2.5 (T4) and 3 (T5) g synbiotic/kg diet. In control group, fish were fed without supplement of synbiotic. Blood sampling for haematological and immunological studies was done at days 20, 40 and 60 after the beginning of the experiment. Based on our results, synbiotic supplement had no significant effects on values Hb, Htc, MCV and MCHC compared to control group (P > 0.05). Also, in all experimental treatments, these parameters did not considerable changes during the course of the experiment (P > 0.05). The effect of synbiotic supplement on MCH was not significant (P > 0.05); however, this value was higher in synbiotic supplement treatments compared to control group. MCH had no significant changes during the period of the experiment in all experimental groups (P > 0.05). In all synbiotic treatments, the values of WBC count, neutrophils, monocytes and eosinophils were higher than control group (P 0.05). The values of RBCs in T4 and T5 showed an increasing change over the course of the experiment (P 0.05).

Macrophage Inflammatory Protein-1 Beta (MIP-1<i>β</i>) and Platelet Indices as Predictors of Spontaneous Bacterial Peritonitis<br> —MIP, MPV and PDW in SBP

Background and aim: spontaneous bacterial peritonitis (SBP) is an important cause of morbidity and mortality in patients with cirrhosis and ascites. The diagnosis of SBP is established when the ascetic fluid polymorphnulear leukocyte (PMN) count is ≥ 250 cells / mm3 with or without a positive ascetic fluid culture. The objective of this study to measure macrophage inflammatory protein one beta (MIP-1β), mean platelet volume (MPV) and platelet distribution width (PDW) to evaluate their usefulness in the diagnosis of SBP in cirrhotic patients Patients/methods: A present study included 41 patients with liver cirrhosis and ascites. They divided into group SBP (21 patients) and group without SBP (20 patients) MIP-1β, MPV, PDW c-reactive protein (CRP) and total white blood cell count values were measured. The MIP-1β was measured in both serum and ascetic fluid. Results: A significant increase MPV, PDW, CRP and white blood cell was observed in SBP group compared to non SBP (P= <0.001, P= 0<0.004, P= 0.001, P= 0.001 respectively). In addition MIP-1β was significantly increased in ascetic fluid in patients with SBP versus non SBP (P= <0.001). A cutoff value of MPV 8.3 fl had 85.7% sensitivity and 75% specificity (Area under curve = 0.876) for diagnosis of SBP. A cutoff value PDW 15.4 had 90.4% sensitivity and 55% specificity (area under curve 0.762). a cutoff value MIP-1β in ascetic fluid was 121.9pg/ml had 76.1% sensitivity and 100% specificity (area under curve 0.881) for detecting SBP. Conclusion: MIP-1β and platelet indices are useful marker in diagnosis of SBP in cirrhotic patients particularly MIP-1β. Combined measurement of MIP-1β in serum and ascetic fluid was 100% sensitivity and specificity in diagnosis in SBP.

The Efficacy of Low-Dose Cytosine Arabinoside Therapy for Patients of Down Syndrome with Transient Abnormal Myelopoiesis

<Introduction>Transient abnormal myelopoiesis (TAM) occurs in about 10% of neonates with Down syndrome. While TAM is generally considered as self-limiting disease, substantial number of patients suffer from serious complications including liver fibrosis or pericardial effusion and eventually leads to fatal clinical outcomes. Low-dose cytosine arabinoside (CA) therapy has been reported to be effective for clinical symptoms of TAM patients, but it is still controversial as to which patient should be treated. We have retrospectively reviewed the clinical outcomes of TAM patients in our institution to confirm the efficacy as well as the safety of low-dose CA therapy by comparing the clinical outcomes before and after introduction of CA.<Patients>Before introduction of CA, we have experienced 20 TAM patients of 13 male and 7 female between September 1992 and November 2008. The median gestational age of those was 37w4d (range, 31w5d - 39w2d) , median peak value of white blood cell (WBC) count was 48×109/L (range, 19.8 - 399×109/L), and median peak direct bilirubin(DB) level was 0.9 mg/dL (range, 0.1 - 18.4 mg/dL), respectively. Sixteen of twenty patients (80%) had various complications including dyspnea, hepatosplenomegaly, pericardial effusion, and ascites.Since 2009, we have introduced low dose CA (0.4 - 1.0mg/kg/day) for those with high WBC count (>100×109/L) until WBC count decrease to 10×109/L . Three patients received chemotherapy, but one patient with high WBC count did not, because consent was not obtained. The median gestational age of those was 36w4d (range, 33w6d - 39w2d) , median peak value of WBC count was 106×109/L (range, 101 - 267×109/L), and median peak DB level was 1.95mg/dL (range, 1.0 - 11.0 mg/dL), respectively. All of them had various complications including dyspnea, hepatosplenomegaly, pericardial effusion, liver fibrosis and ascites.<Results>Before introduction of low dose CA therapy, five of six patients (83%) with high WBC count (>100×109/L) died of liver failure(4 of 5 patients) or AML, and one of 14 patients (7%) with low WBC count (<100×109/L) died of pneumonia at the age of eight without any relation to TAM. After introduction of CA, all three patients who received chemotherapy are alive without serious complications related to TAM or chemotherapy. Their blast cells in the peripheral blood disappeared promptly and liver dysfunction as well as biomarker of liver fibrosis is getting normalized. One patient who did not receive chemotherapy died of liver failure in spite of supportive care.<Conclusion>It is suggested that low dose CA therapy is safely conducted and is effective to improve the clinical outcomes of TAM patients with high WBC count. Prospective analysis is mandatory to confirm our findings by multi-institutional basis. DisclosuresNo relevant conflicts of interest to declare.

Very high levels of lactate dehydrogenase at diagnosis predict central nervous system relapse in acute promyelocytic leukaemia

Very high levels of lactate dehydrogenase at diagnosis predict central nervous system relapse in acute promyelocytic leukaemia

Effects of aqueous extract of Waltheria indica leaves on blood profile of male albino rats

This study was to investigate the effect of oral administration of aqueous extract of Waltheria indica leaf on the blood profile of male albino rats. The extract showed significantly (p < 0.01) different increase of red blood and white blood cell counts values at 400 and 800 mg/kg doses. However, the extract showed insignificant difference in packed cell volume, mean corpuscular volume, mean corpuscular haemoglobin and haemoglobin concentrations between the control and the treated groups. Result also showed significant increase (p < 0.01) in the values of alanine and aspartate aminotransferases (ALT and AST), blood urea nitrogen (BUN) and creatinine at 800 and 2000 mg/kg doses. W. indica leaf extract also induced periportal cellular infiltration and diffuse hydropic degeneration of the hepatocytes in the liver. The study emphasized the cautious use of W. indica leaf as it may be hepatotoxic at high doses. Key words: Waltheria indica leaf, blood profile, liver, rats.

Variation and covariation in strongyle infection in East African shorthorn zebu calves.

SummaryParasite burden varies widely between individuals within a population, and can covary with multiple aspects of individual phenotype. Here we investigate the sources of variation in faecal strongyle eggs counts, and its association with body weight and a suite of haematological measures, in a cohort of indigenous zebu calves in Western Kenya, using relatedness matrices reconstructed from single nucleotide polymorphism (SNP) genotypes. Strongyle egg count was heritable (h2 = 23·9%, s.e. = 11·8%) and we also found heritability of white blood cell counts (WBC) (h2 = 27·6%, s.e. = 10·6%). All the traits investigated showed negative phenotypic covariances with strongyle egg count throughout the first year: high worm counts were associated with low values of WBC, red blood cell count, total serum protein and absolute eosinophil count. Furthermore, calf body weight at 1 week old was a significant predictor of strongyle EPG at 16–51 weeks, with smaller calves having a higher strongyle egg count later in life. Our results indicate a genetic basis to strongyle EPG in this population, and also reveal consistently strong negative associations between strongyle infection and other important aspects of the multivariate phenotype.

Procalcitonin for the differential diagnosis of infectious and non-infectious systemic inflammatory response syndrome after cardiac operation

To assess the value of procalcitonin (PCT) for the differential diagnosis between infectious and non-infectious systemic inflammatory response syndrome (SIRS) after cardiac operation. Patients diagnosed with SIRS after cardiac surgery and admitted to Department of Cardiovascular Surgery of Tokyo Medical and Dental University Graduate School between April 1st, 2011 and March 31st, 2013 were retrospectively studied. A total of 142 patients with SIRS were included, and they were divided into infectious group (n =47) or non-infectious group ( n =95) according to the diagnostic criteria of the Surviving Sepsis Campaign Guidelines for Management of Severe Sepsis and Septic Shock: 2012 (SSCG2012). The patients with infectious SIRS were included, and there were 11 with sepsis, 12 with severe sepsis without shock, and 24 with septic shock respectively.The clinical data of patients were compared, and the receiver operating characteristic curve (ROC curve) was plotted to assess the diagnostic value of infection and non-infectious diseases for PCT, C-reactive protein ( CRP) and white blood cell count ( WBC ) , as well as the diagnosis of the severity of sepsis. PCT, CRP, and WBC were significantly higher in the infectious SIRS group than those in the non-infectious SIRS group [ PCT ( J.Lg/L): 2.80 ( 1.24, 10.20) vs.0.10 (0.06, 0.21), Z=-9.020, P=O.OOl; CRP (mg/L): 158.0 (120.0, 199.0) vs. 58.0 (25.0, 89.0), Z=-7.264,P=O.OOl; WBC ( x 1Q9/L): 15.5 (11.0, 22.6) vs. 9.3 (7.2, 12.6), Z=-5.792, P=O.OOl ]. PCT had the highest sensitivity ( 91.5%) and specificity ( 93.7%) for differential diagnosis, with a cut-off value for infectious SIRS of0.4 7 fLg/L, and the cut-off value of CRP and WBC were 119.5 mg/L and l 0.85 X 1 09/L, respectively. There was no significant difference in WBC among sepsis group, severe sepsis group, and septic shock group (X 109/L: 12.40 (9.10, 24.20),13.30 ( 9.93, 16.93), 20.40 ( 13.45, 28.6), x2=5.638, P=0.060], while PCT, CRP had significant difference (PCT(fLg/L): 1.37 (0.72, 1.85), 3.16 (0.48, 13.24), 3.68 (1.67, 20.96), x2 =7.422, P=0.024; CRP (mg!L): 120.0(74.0, 180.0), 135.7 (81.7, 181.3), 171.1 (151.5, 306.0), x2 =9.524, P=0.009].PCT was more reliable than CRP in diagnosing severe sepsis without shock, but it was ineffective for diagnosing septic shock. The cut-off value of PCT for diagnosing severe sepsis without shock was 2.28 fLg/L, and the sensitivity was 66.7%, specificity was 90.9%.Cut-off value of CRP for the diagnosis of septic shock was 149.5 mg/L, with the sensitivity of 83.3%, and the specificity of 66.7%. PCT was a useful marker for the diagnosis of infectious SIRS after cardiac operation as compared with WBC and CRP. The optimal PCT cut-off value for diagnosing infectious SIRS was 0.47 fLg/L.

WBC COUNT AT DISCHARGE IS A STRONG PREDICTOR OF ALL-CAUSE MORTALITY IN PATIENTS WITH ACUTE CORONARY SYNDROME THAT UNDERWENT PERCUTANEOUS CORONARY INTERVENTION

Admission white blood cell (WBC) count is a predictor of outcome following acute myocardial infarction. However, the value of WBC count at discharge following ACS is unclear. We hypothesize that an elevated WBC count at discharge is associated with worse outcomes following ACS. We included patients

Are procalcitonin or other infection markers useful in the detection of group A streptococcal acute tonsillitis?

The Centor criteria and the streptococcal rapid antigen detection test (RADT) are commonly used to differentiate sore throat patients with group A streptococci (GAS) from patients with other pathogens. We aimed to investigate if procalcitonin (PCT), C-reactive protein (CRP), white blood cell count (WBC), and absolute neutrophil count (ANC) could increase the diagnostic accuracy when added to the Centor score and RADT, or be used instead of the RADT, in the differential diagnosis. A 6-month prospective study was carried out in a Danish general practice with 8 physicians. One hundred acute tonsillitis patients aged 15 to 40 y were included. The prevalence of GAS was 26%. The sensitivity (90%) and specificity (97%) of the RADT were high. Mean values of CRP, WBC, and ANC were significantly higher in patients with GAS compared to non-GAS patients (p < 0.001). However, the sensitivities (66-90%) and specificities (45-75%) were low. No difference in PCT levels was found (p = 0.334). CRP was the most reliable infection marker (sensitivity 90% and specificity 45%) for GAS aetiology. The sensitivity, specificity, and area under the curve of the RADT were higher than those of the 4 measured infection markers in the differentiation between GAS and non-GAS acute tonsillitis patients. The infection markers did not increase the diagnostic accuracy when added to the Centor score and RADT. When RADT is not available, measurement of CRP or ANC may increase the diagnostic accuracy in the detection of GAS-positive patients.

Clinical differences between H3N2 and H1N1 influenza 2012 and lower respiratory tract infection found using a statistical classification approach

BackgroundInfluenza A H1N1 and H3N2 are two influenza waves that have been identified in past years.MethodsData from 77 inpatients from three tertiary hospitals were included and statistical analysis was performed in three different clusters.ResultsThirty-four patients (44.2%) had respiratory distress upon admission, 31.2% had a smoking history or were active smokers, 37.7% manifested disease symptoms, and 7.8% were obese (body mass index >41). The mean age of patients was 51.1 years. Cough was the most common symptom observed in 77.9% of the patients, accompanied by sputum production (51.9%) and fatigue (42.9%). Hemoptysis and vomiting were rarely recorded in the patients (9.1% and 16.9%, respectively). Oseltamivir administration varied between 0 and 10 days, giving a mean value of 2.2 days. In particular, 19 patients received no drug, 31 patients received drug for only for 1 day, 19 patients for 5 days, and 8 patients from 2 to 10 days.ConclusionClusters of symptoms can be used to identify different types of influenza and disease severity. Patients with vaccination had pneumonia, whereas patients without vaccination had influenza A. Patients more than 54.5 years old had H3N2 and patients less than 54.5 years had H1N1. White blood cell count values increased from normal to elevated in H3N2 patients but still remained abnormal in lower tract infection and H1N1 patients.

An investigation of pulmonary findings of Crimean–Congo haemorrhagic fever patients

Crimean-Congo haemorrhagic fever (CCHF) generally affects many organs. In this study a retrospective evaluation of the pulmonary findings of CCHF patients was made. The records of patients were retrospectively analysed. For each patient an evaluation was made of age, sex, occupation, place of residence, contact with ticks, smoking history, and pulmonary radiological and laboratory findings. A confirmed diagnosis of CCHF was made on determination by enzyme-linked immunosorbent assay or polymerase chain reaction. Of the 128 patients, 48.4% were female. Symptoms of coughing were determined in 18% of patients, sputum in 4.7%, chest pain in 3.9%, dyspnoea in 3.1%, and haemoptysis in 0.8%. The mortality rate was 7%. In terms of sex, place of residence, contact with ticks, smoking, findings of the respiratory system, and physical examination findings, no statistically significant difference was seen between the survivor and nonsurvivor groups (P > 0.05). The white blood cell count values of the survivors were determined to be significantly lower compared to those of the nonsurvivors and the alanine aminotransferase, alkaline phosphatase, lactate dehydrogenase, creatine phosphokinase, and C-reactive protein values of the nonsurvivors were significantly higher compared to those of the survivors (P < 0.05). CCHF can be fatal for the respiratory system. An early diagnosis of CCHF and referral to a specialised centre is therefore important.

Relationship of admission mean platelet volume, platelet distribution width and white blood cells with ST resolution in patients with acute ST segment elevation myocardial infarction treated with streptokinase without history of previous cardiovascular surgery

Background:Mean platelet volume (MPV) and platelet distribution width (PDW), markers of platelet reactivity, and white blood cell count (WBC-C), a marker of inflammation, have been shown to be predictive of unfavorable outcomes among survivors of ST elevation myocardial infarction (STEMI). we aimed to evaluate the value of admission of MPV, PDW and WBC-C for the prediction of ST segment resolution, in patient with acute STEMI treated with Streptokinase.Materials and Methods:This cross sectional study conducted on 280 patients with STEMI treated with streptokinase, from August 2009 until August 2011, in Afshar cardiovascular center, Yazd, Iran. Blood samples were obtained on admission in 280 patients with STEMI. According to sum of ST segment resolution and Schroder's method, patients divided two groups ((patients with ST resolution≥ 70% versus group with ST resolution < 70%)). The best cut off value of MPV, PDW and WBC-C for prediction of ST resolution (STR) were identified by using the receiver operating characteristic curve. The optimum cut off level was determined by selecting points of test value that provided the greatest sum of sensitivity and specificity.Results:Of 280 patients enrolled this study, 39.3% of the patients with STR≥70% and in 60.7% with STR<70% were found. Patients in the STR < 70% group had higher admission MPV (10.6 ± 0.8 vs. .9.5 ± 0.8, P = 0.00) and higher PDW (13.8 ± 1.8 vs. 11.8 ± 1.7, P = 0.00)and higher WBC-C (12.1 ± 3.1 vs. 10.5 ± 2.5, P = 0.00) compare with patients with ST resolution ≥ 70%. The best cut off value of MPV for predicting STR < 70%was 10/05 fl (sensitivity 71/8 and specificity 80.9%) and for PDW was 12.85 fl (sensitivity 71.2% and specificity 83.6%) and for WBC-C was 12.65 × 1000 (sensitivity 42.9% and specificity 82.7%). The greatest area under the receiver operating characteristic (ROC) curve and greatest predicting value for ST resolution lower 70% was due to PDW (area = 0.812, P = 0/00).Conclusion:MPV, PDW and WBC-C at admission might be valuable in the prediction of impaired STR and in planning the need for adjunctive therapy to improve outcomes with STEMI treated with Streptokinase. We can speculate that acute STEMI patients having MPV-PDW and WBC-C values above their's cut off patients should be considered for stronger antiplatelet and helps anti inflammation treatment to be able to attain a favorable ST resolution and better clinical outcome.

Haematological and Serum Biochemical Characteristics of Hacco Cocks Fed Cocoabean Shell Supplemented with Vitamin E and Beta-Glucan

3 Abstract: A fifty-six (56) days feeding trial was conducted in a completely randomized design to determine the haematological and serum biochemical characteristics of Hacco cocks fed Cocoabean Shell (CBS) supplemented with vitamin E and beta-glucan. Forty (40) cockerels (aged twenty-five weeks) were used. Treatment diets comprised T1 (control) (i.e. 0% CBS); T2 (20% CBS); T3 (20% CBS + Vitamin E) and T4 (20% CBS + Beta-glucan). The haematological parameters determined were Packed Cell Volume (PCV), haemoglobin concentration (Hb), Red Blood Cell Count (RBC) and White Blood Cell Count (WBC). Others included the WBC differential counts-polymorphs, lymphocytes, monocytes and eosinophils. The serum biochemical parameters determined were serum enzyme activities namely Spartate Amino Transferase (AST), Alanine Amino Trasferase (ALT) and alkaline phosphatase. Other parameters were total protein albumin, globulin and cholesterol. Treatment had significant (p 0.05) affected by the treatment. Cocks that were fed CBS and CBS + Beta-glucan had similar PCV, RBC and WBC and polymorphs with the control group, while those that were fed CBS + vitamin E had lower values for PCV, RBC and polymorphs than the control group. The groups fed CBS + vitamin E had higher (p<0.05) WBC values than other groups. All the serum parameters determined were not significantly affected by dietary treatment. It was concluded that 20% CBS in diets of cocks did not show adverse effect on the blood parameters of the cocks. When supplemented with β-glucan, there was no adverse effect either. However, when supplemented with vitamin E, some haematological parameters were adversely affected.

Daily rhythms of acute phase proteins in cattle under different natural environmental conditions

This study was conducted to assess the pattern of daily rhythms of acute phase proteins (APPs), including haptoglobin (Hp) and serum amyloid A (SAA), and the pattern of daily rhythms of fibrinogen (Fb), white blood cell counts (WBC) and packed cell volume (PCV) in Holstein Friesian and Modicana dairy cattle. Blood samples were collected every 3h over a 48h period from six Holstein Friesian and six Modicana dairy cattle during two different periods: January and July.Hp was higher in Modicana cattle than Holstein Friesian cattle in both periods, and it was lower in July than January in both breeds. All parameters, except PCV, showed daily rhythmicity in both breeds, during the two periods. In Holstein Friesian cattle, Hp and WBC acrophases were postponed by about 2h during July with respect to January and with respect to Modicana cattle in the same period. A high correlation between individual values of WBC and of APPs was observed. The exact mechanism that causes this variation is not clear. More studies are necessary to understand the amount of these variations and to provide diagnostic and prognostic information useful for the animal welfare control.

A New Simple Model for Prediction of Hospital Mortality in Patients with Intracerebral Hemorrhage

The current prognostic models for mortality and functional outcome after intracerebral hemorrhage (ICH) are not simple enough. To predict the outcome of ICH, a new simple model, ICH index (ICHI), was established and evaluated in this study. Medical records of all cases with ICH in our hospital from January 2008 to August 2009 were reviewed. Multiple linear regression analyses were used to assess the contributions of independent variables to hospital mortality after ICH. Age, serum glucose, white blood cell counts (WBC), and Glasgow Coma Scale (GCS) score were found to be greatly associated with mortality. A formula of ICH index [ICHI = age (years)/10 + glucose (mmol/L) + WBC (10(9) /L) - GCS score] was established. Furthermore, the receiver operating characteristic (ROC) analyses were performed to estimate the predictive value of the ICHI. The model showed an area under the ROC curve (AURC) of 0.923 (95% CI: 0.883-0.963, P < 0.001). The best cut-off value of ICHI for mortality was 18, which gave sensitivity, specificity, and Youden's index of 0.65, 0.95, and 0.60, respectively. The hospital mortality was extremely increased when 18 < ICHI < 28 (mortality 72.0%) and when ICHI ≥ 28 (mortality 100%), in contrast with overall mortality (21.6%). The ICHI can be a simple predictive model and complementary to other prognostic models.

Elevated serum C-reactive protein as a predictive factor for anastomotic leakage in colorectal surgery

BackgroundC-reactive protein (CRP) has been used as an indicator of postoperative complications in abdominal surgery. Its short half-life makes it a reliable marker of the systemic inflammatory response secondary to a surgical procedure or to the appearance of complications, rapidly returning to normal values with the recovery of the patient. AimTo demonstrate the value of sequential serum determinations of postoperative C-reactive protein (CRP) and white blood cell counts (WBC) in the identification of increased risk of anastomotic leakage after colorectal surgery. MethodsWe reviewed the daily postoperative serum CRP and white blood cell counts in 173 patients who underwent surgery for colorectal disease with anastomosis, between January 2008 and October 2009. Patients with anastomotic leakage (Group A, n = 24) were compared to patients without leakage (Group B, n = 149). Patients with ongoing infections before surgery or with acquired postoperative infections other than leakage were excluded. Mean pre- and postoperative values of CRP and WBC were compared. ResultsThe diagnosis of anastomotic leakage was made between the 4th and 11th postoperative day (POD; mean 7th POD). The daily average values of serum CRP were significantly higher in group A starting at the 2nd POD and remained significantly elevated until the diagnosis of leakage (p = 0.003). The cut-off value of 140 mg/L on the 3rd POD maximized the sensitivity (78%) and specificity (86%) of serum CRP in assessing the risk of leakage. Comparison of postoperative serum WBC values did not show any significant differences between the two groups until the 6th POD. ConclusionAccording to these results, an early and persistent elevation of CRP after colorectal surgery with anastomosis, is a marker of anastomotic leakage. A cut-off value > 140 mg/L on POD3 maximizes sensitivity and specificity.

Neutrophil-Lymphocyte Ratio as a Predictor of Adverse outcomes of Acute Pancreatitis

Background: Most acute pancreatitis risk scoring systems use total white blood cell counts (WBC) as one of the riskfactors. Thevalue of the neutrophil-lymphocyte ratio (NLR) to predict the severity of acute pancreatitis has not been previously evaluated. Methods. This observational study included 283 patients admitted to a tertiarycenter between 2004 and 2007. The patients were arranged into tertiles according to NLR and WBC values. The primary outcomes were intensive care unit (ICU) admission and length of stay (LOS) in the hospital. Results:According to NLR tertiles, patients in the 3rd tertile (NLR ≥7.6) had significantly more ICU admissions (17 vs. 2.2%, p < 0.0001) and longer average LOS (6.2 vs. 4.2 days, p < 0.002) compared with those in the 1st tertile (NLR <3.6). According to WBC tertiles, patients in the 3rd tertile had more ICU admissions (12.6vs.6.2%, p=0.12) and a longer average LOS (5.8vs. 4.4 days, p = 0.059) compared to patients in the 1st WBC tertile, but thisdid not reach statistical significance. In the multivariate model including NLR, WBC and other predictors, only NLR tertiles (p < 0.0262) and modified early warning scores (p<0.0025) were significant predictors of ICU admission. Likewise, in the multivariate model of LOS, only NLR and glucose level were significant predictors of longer LOS (p<0.0161 and p < 0.0053, respectively). Conclusion: NLR is superior to total WBC in predicting adverse outcomes of acute pancreatitis. According to our data, we suggest using the NLR cutoff value of >4.7 as a simple indicator of severity in patients presenting with acute pancreatitis.

Studies on Serum Haemolytic Complement and Haematological Parameters in Apparently Healthy Dromedary Camels (&lt;i&gt;Camelus Dromedarius&lt;/i&gt;) in Northern Nigeria

Studies on serum haemolytic compliment and haematological parameters in 330 apparently healthy dromedary camels (Camelus dromedarius) were conducted in northern, Nigeria. The survey was conducted in the abattoirs of three major northern cities of Maiduguri, Kano and Sokoto. The parameters measured using standard procedures were complement level via the classicalpathway (CH ), packed cell volume (PCV), red blood cell 50 (RBC) and white blood cell counts (WBC). Mean CH units in 50 the camels investigated was 360 ± 15.8. In addition, PCV 12 (32.9 ± 1.5), total RBC (10.2 x 10 /L ± 1.2) and WBC (7.2 x 109 ± 1.3) values were obtained. There was no significant(p>0.05) differences between sexes and ages in all the parameters studied. The result obtained can be used as preliminary data in the investigation of the role of complement and blood cells in some immune mediated parasitic, bacterial and viral diseases of the dromedary camel in the study area.

Umbilical cord blood as a replacement source for admission complete blood count in premature infants

We hypothesize that a complete blood count (CBC) with manual differential from umbilical cord blood is equivalent to a CBC with manual differential obtained from the neonate on admission. A CBC and manual differential was performed on 174 paired umbilical cord blood and admission blood samples from infants <35 weeks gestation. Paired t-test and Pearson's correlation coefficient were the primary statistical tools used for data analysis. Cord and admission blood white blood cell (WBC) count, hemoglobin and platelet count all significantly (P<0.0001) correlated with paired neonatal samples (R=0.82, 0.72, 0.76). Admission blood WBC count fell within the variation of WBC count values from currently accepted neonatal admission blood sources. Cord blood hemoglobin was not clinically different than admission hemoglobin (1.0 g dl(-1)). Cord blood platelet counts were not different from admission blood platelet counts (5800 cells per μl, P=0.23). The immature to total granulocyte ratio was not different between samples (P=0.34). Umbilical cord blood can be used for admission CBC and differential in premature infants.