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Are white blood cell count, platelet count, erythrocyte sedimentation rate and C-reactive protein useful in the diagnosis of septicaemia and endocarditis?

In 851 predominantly adult patients with septicaemia or endocarditis data regarding white blood cell (WBC) count, platelet count, ESR and C-reactive protein (CRP) obtained within 3 days of admission were analyzed retrospectively. Among 232 patients with complete laboratory data none had the combination of normal ESR, negative CRP and lack of both leukocytosis and thrombocytopenia. CRP was positive (greater than 10 mg/l) in 93%, ESR was elevated (greater than 20 mm/h) in 90%, leukocytosis (WBC greater than 9 X 10(9)/l) was present in 60% and thrombocytopenia (platelets less than 150 X 10(9)/l) in 35% of the patients. Patients with pneumococcal infection had generally higher ESR and CRP values and WBC counts than patients with other infections.

Blood Sedimentation↗

Inter-relationships between platelet count, platelet IgG, serum IgG, immune complexes and severity of liver disease.

Thrombocytopenia is a common finding in subjects with chronic liver diseases. A variety of mechanisms may underlie this. Immunological disturbances are commonly a feature in chronic liver disease, including hyperglobulinaemia and the presence of autoantibodies and circulating immune complexes and immune mechanisms could therefore contribute to thrombocytopenia. We have investigated the relationships between blood platelet count, serum IgG and IgG immune complexes and IgG associated with platelets in 92 subjects with chronic liver disease (27 with chronic active hepatitis, 38 with primary biliary cirrhosis and 27 with alcoholic liver disease). Severity of liver impairment was a major determinant of degree of thrombocytopenia. Also, an inverse relationship was demonstrated between platelet count and platelet-associated IgG. In subjects with chronic active hepatitis the relationships between platelet count, serum IgG immune complexes and platelet-associated IgG were consistent with a role for immune mechanisms in general and immune complexes in particular as mediators of the thrombocytopenia.

Antigen-Antibody Complex↗

The effect of pre-eclampsia on complete blood count, platelet count and mean platelet volume.

Pre-eclampsia is a condition observed during pregnancy and threatens the life of both mother and foetus. There are studies, which suggest platelets play a major role in the pathogenesis of pre-eclampsia. The aim of this study is to compare the complete blood count (CBC) parameters, especially platelet count and mean platelet volume (MPV), in pre-eclamptic and normal pregnant women and to evaluate whether these parameters have a prognostic significance in determining the severity of eclampsia. The study and control groups consist of 56 pre-eclamptic and 43 normal pregnant women, respectively. There was no statistically significant difference according to CBC, platelet count and MPV when pre-eclamptic and severely pre-eclamptic patients were compared with controls. As a result, we observed no prognostic significance of CBC, platelet count and MPV on the presence and/or severity of pre-eclamptic condition. There are conflicting results especially on the significance of MPV in the literature, and possibly this confliction is due to the difference between methods and/or equipments used for automated blood count.

Adult↗

Quantitative trait loci for baseline white blood cell count, platelet count, and mean platelet volume.

A substantial genetic contribution to baseline peripheral blood counts has been established. We performed quantitative trait locus/loci (QTL) analyses to identify chromosome (Chr) regions harboring genes influencing the baseline white blood cell (WBC) count, platelet (Plt) count, and mean platelet volume (MPV) in F(2) intercrosses between NZW/LacJ, SM/J, and C57BLKS/J inbred mice. We identified six significant WBC QTL: Wbcq1 (peak LOD score at 38 cM, Chr 1), Wbcq2 (42 cM, Chr 3), Wbcq3 (0 cM, Chr 15), Wbcq4 (58 cM, Chr 1), Wbcq5 (82 cM, Chr 1), and Wbcq6 (8 cM, Chr 14). Three significant Plt QTL were identified: Pltq1 (24 cM, Chr 2), Pltq2 (36 cM, Chr 7), and Pltq3 (10 cM, Chr 12). Two significant MPV QTL were identified, Mpvq1 (62 cM, Chr 15) and Mpvq2 (44 cM, Chr 8). In total, the WBC QTL accounted for up to 31% of the total variance in baseline WBC count, while the Plt and MPV QTL accounted for up to 30% and 49% of the total variance, respectively. These analyses underscore the genetic complexity underlying these traits in normal populations and provide the basis for future studies to identify novel genes involved in the regulation of mammalian hematopoiesis.

Alleles↗

The relationship of white cell count, platelet count, and hematocrit to cigarette smoking in adolescents: the Oslo Youth Study.

This article reports on the relationship between cigarette smoking, white blood cell count (WBC), platelet count (PC), and hematocrit in a Norwegian adolescent population. Data were obtained on 439 youths, 14 to 16 years old, as part of the Oslo Youth Study, an investigation of risk factors and behaviors for cardiovascular disease and cancer among adolescents. Analyses of covariance, controlling for height, weight, age, sexual maturation, high-density lipoprotein (HDL) cholesterol, and hematocrit revealed that both male and female regular smokers (those reporting smoking at least once a week) had significantly higher mean WBCs. Male regular smokers also had significantly higher PCs than nonsmokers, and female regular smokers had higher PCs than young women who smoked less often than once a month. Hematocrit, after adjustment for height, weight, age, sexual maturation, and HDL cholesterol, was significantly lower in male regular smokers, while female regular smokers had higher hematocrit values than nonsmokers or occasional smokers. Results of this study show that WBC and PC were increased in adolescents who started smoking relatively recently. This indicates that the increase in white cell count observed in smokers is unlikely to be due to a longstanding smoking-induced chronic disease condition.

Adolescent↗

Platelet count, platelet aggregation and fibrinogen levels following acute induction to high altitude (3200 and 3771 metres).

Two groups of 20 subjects each were separately exposed to altitudes of 3200 m and 3771 m for 10 days by rapid induction requiring 14 and 16 hours respectively to reach high altitude camps. A statistically significant fall in platelet counts was observed from day 2 at 3200 m and day 3 at 3771 m and counts remained decreased. Platelet aggregation was also decreased initially at both altitudes. Blood fibrinogen decreased only on day 2 at 3771 m with a significant increase over control values by day 10 at both altitudes.

Adult↗

The effect of dialyser membrane material on intradialytic changes in platelet count, platelet aggregation, circulating platelet aggregates and antithrombin III.

Blood surface interaction during hemodialysis leads to impairment of platelet function and decrease in platelet number, which besides heparinization, may cause or exacerbate bleeding in risk patients. Furthermore, antithrombin III has been shown to increase during dialysis, probably due to vascular endothelial injury caused by infusion of activated platelets into the patient. 23 patients were examined during two successive dialyses, using membranes based on regenerated cellulose (RC) and cellulose acetate (CA). In 12 of the patients, platelet aggregation induced by ADP, circulating platelet aggregates and immunological AT III and AT III activity were determined. Irrespective of the membrane used, hemodialysis was associated with deterioration of platelet function, reflected by a decrease in platelet aggregation with return to predialysis values at the end of dialysis. However, the decline in platelet count and the increase in circulating platelet aggregates were membrane dependent, with RC causing greater changes than CA. No changes in threshold concentration of ADP inducing secondary platelet aggregation or in either immunological AT III or AT III activity were seen during dialysis.

Adolescent↗

Platelet count, platelet function, coagulation activity and fibrinolysis in the acute phase of inflammatory bowel disease.

Twenty two patients with exacerbation of inflammatory bowel disease (19 with Crohn's disease, 3 with ulcerative colitis) and thrombocytosis were tested for possible activation of the coagulation and platelet system. Fifteen patients had abnormal platelet function i.e. unphysiologically high sensitivity in vitro towards ADP 2 mumol/l aggregation induction. In 81.8% of the patients we found enhanced fibrinogen concentrations. In 22.7% of the patients thrombin-antithrombin III values exceeded the upper limit of the reference range, and in 68.2% of the patients the D-Dimer concentration exceeded the upper reference limit as a result of reactive fibrinolysis. The altered platelet count and function, and the increased levels of fibrinogen and thrombin-antithrombin III with reactive fibrinolysis activation indicate the presence of prethrombotic factors in patients with exacerbation of inflammatory bowel disease. The presence of enhanced fibrinolysis in these patients might have consequences for the therapeutic treatment.

Adult↗

The relationship between the absolute granulocyte count, platelet count and total leukocyte count in cancer chemotherapy patients.

A cohort of 383 patients with a variety of malignancies receiving various chemotherapy programs was analyzed to determine the relationship between the absolute granulocyte count (AGC) and the total leukocyte count (TLC). Specific groups, who were elderly, had proven bone marrow involvement, or were receiving significant doses of prednisone, were studied. The relationship between the TLC and thrombocytopenia was also examined. Results revealed that in all groups there was a correlation between the TLC and the AGC with correlation coefficients ranging from 0.82 to 0.88. Both life-threatening thrombocytopenia and granulocytopenia were rare, providing and TLC was greater than 3.0 x 10(9)/L.

Adolescent↗

Leucocyte count, platelet count and erythrocyte sedimentation rate in pulmonary tuberculosis.

We have evaluated the haematological values of 50 adult patients with untreated pulmonary tuberculosis (PTB) and compared them with those of 50 normal age and sex-matched controls. Anaemia (usually mild) and an invariably (but moderately) elevated ESR were observed as expected. Thrombocytopaenia and thrombocytosis were observed in equal number of patients (18% respectively). We observed significant lymphopaenia (rather than lymphocytosis) in these untreated PTB patients, occurring in 46% (p < 0.0001). Lymphocytosis was observed in only 6% of the PTB patients. Another interesting observation was neutrophilic leucocytosis, which occurred in 40% of the patients. We would suggest that in evaluating results of haematological values in suspected cases of PTB, lymphopaenia rather than lymphocytosis, should be considered.

Adolescent↗

Platelet large cell ratio in the differential diagnosis of abnormal platelet counts.

Platelet volume indices, estimated by automated blood cell analyzers, are useful in the diagnosis of various conditions with abnormal platelet counts. Platelet count (PLT), Platelet large cell ratio (P-LCR), Platelet distribution width (PDW) and mean platelet volume (MPV) were studied in 779 patients with normal platelet counts, 74 patients with high platelet counts and 41 cases with low platelet counts. P-LCR was significantly decreased in patients with thrombocytosis than in normal while it was increased in thrombocytopenia. In patients with high counts, P-LCR was significantly decreased in reactive thrombocytosis than neoplastic thrombocytosis. P-LCR was increased in destructive thrombocytopenia than those with hypoproliferative thrombocytopenia though it was not statistically significant. P-LCR was inversely related to platelet count and directly related to PDW and MPV. Platelet large cell ratio if properly utilised can be a good aid in the differential diagnosis of conditions associated with abnormal platelet counts.

Blood Platelets↗

The effects of heparin and extracorporeal circulation on platelet counts and platelet microaggregation during cardiopulmonary bypass.

BACKGROUND: Cardiopulmonary bypass is associated with platelet activation and reduced platelet counts. Platelet activation may artifactually lower platelet counts by causing aggregation. In vivo platelet activation may increase existent platelet microaggregation ex vivo. We studied platelet counts and existent platelet microaggregation at different stages of cardiopulmonary bypass. METHODS: Twenty-one patients were studied before and after heparinization (300 U. kg(-1)) and at the end of cardiopulmonary bypass. Unaggregated (or single) platelets were counted in hirudin-anticoagulated blood, and total platelets were counted in ethylenediaminetetraacetic acid-anticoagulated blood. RESULTS: The total platelet count, 198 +/- 61 x 10(9). L(-1), was unaffected by heparin and stayed at 197 +/- 60 x 10(9). L(-1) (P =.7) but fell during extracorporeal circulation; the hemodilution-corrected count was 163 +/- 52 x 10(9). L(-1) (P =.0004). Heparinization reduced the unaggregated platelet count from (mean +/- 1 SD) 178 +/- 62 x 10(9). L(-1) to 155 +/- 60 x 10(9). L(-1) (P =.0001). Extracorporeal circulation had little additional effect. The hemodilution-corrected count was 142 +/- 48 x 10(9). L(-1) (P =.6). CONCLUSIONS: Heparinization caused platelet activation and increased existent platelet microaggregation ex vivo. During extracorporeal circulation, there was a reduction in total platelets that was greater than could be explained by hemodilution alone, but the unaggregated platelet count did not change significantly when corrected for hemodilution. Furthermore, the increased platelet microaggregation observed after heparinization was no longer evident after this loss. These findings suggest that during extracorporeal circulation, the platelets that formed into microaggregates after heparinization were lost from the circulation in preference to single platelets.

Adult↗

The size and number of bone marrow megakaryocytes in malignant lymphoma and their relationship to abnormalities in platelet count.

Platelet counts were measured routinely in 718 volunteer blood donors and 124 patients with malignant lymphoma. When considered by gender, the mean platelet counts of the patients with malignant lymphoma were significantly increased when compared to controls (P less than 0.01). In addition, 9% of males and 4% of females with lymphoma exhibited a thrombocytosis, in which their platelet counts exceeded the upper limit of the normal platelet count for control subjects (defined as 2 SDs in excess of the mean value). Megakaryocyte whole size, cytoplasmic and nuclear sizes, and megakaryocyte numbers were also quantified in bone marrow obtained from the iliac crest of 5 hematologically normal subjects and 26 patients with malignant lymphoma. Mean megakaryocyte sizes were significantly greater in subjects with lymphoma, when compared to control values (P less than 0.05). No significant differences in megakaryocyte numbers in bone marrow were observed between the two groups. For subjects with malignant lymphoma, platelet count was found to be significantly positively correlated with megakaryocyte size. The results of this study suggest that the elevated platelet count associated with malignant lymphoma is mediated by an increase in the size of the megakaryocytes in the bone marrow.

Adolescent↗