The use of absolute neutrophil count and neutrophil-lymphocyte ratio as predictors of early onset neonatal sepsis

Background@#Neonatal sepsis contributes to significant morbidity and mortality. Blood culture, the gold standard in its diagnosis, has low sensitivity and is affected by multiple factors. Hence the need for markers derived from routine tests to improve diagnosis deserves further studies.@*Objectives@#This study aims to determine the association and optimal cut-off value and diagnostic performance of absolute neutrophil count (ANC) and neutrophil lymphocyte ratio (NLR) with early-onset neonatal sepsis in term neonates.@*Methodology@#This was a retrospective, analytical, single-center study of admitted patients from January 2016 to December 2021. Clinical factors were analyzed and NLR and ANC were derived from CBC and interpreted using the Manroe chart.@*Results@#Included were 200 neonates with a median birth AOG of 38 weeks. Microorganisms were isolated from nine of 154 neonates with blood culture, corresponding prevalence of 5.84% (95% CI 2.71–10.80). Initial CBC showed elevated mean WBC and 76.5% of neonates were considered to have elevated ANC. Optimal cut-off point of NLR for detecting culture-proven sepsis was 2.86, with a sensitivity of 88.89% (95% CI, 51.75–99.72%) and specificity of 36.55% (95% CI, 28.72–44.95%). The ANC gave the best balance of sensitivity and specificity with an accuracy of 75.50%.@*Conclusions@#The NLR demonstrated good discriminative ability for predicting clinical neonatal sepsis based on ANC. However, individually or simultaneously, these markers demonstrated poor discriminative ability for culture-proven neonatal sepsis in term neonates. ANC and NLR can be used to aid in the diagnosis of clinical neonatal sepsis.

Risk of neutropenia among clozapine users and non-users: results from 5,847 patients

Objective: Clozapine is underprescribed due to neutropenia risk. Blood tests every 3 months in those on continuous treatment for > 1 year who have never had an absolute neutrophil count (ANC) < 2,000/µL has been proposed as a monitoring strategy; however, there are no South American data to support this recommendation. This study sought to investigate whether clozapine use and other variables could explain the occurrence of ANC < 1,000/µL in patients with severe mental disorders. Methods: A total of 5,847 subjects were included, 1,038 on clozapine. We performed a Cox regression considering the outcome as ANC < 1,000/µL at any time point. Predictors were sex, age, ethnicity, clozapine use, ANC > 2,000/µL during the first year of blood monitoring, and presence of a severe medical condition. Results: In the Cox regression model, ethnicity (white) (hazard ratio [HR] 0.53; 95%CI 0.29-0.99, p < 0.05) and ANC > 2,000/µL (HR 0.04; 95%CI 0.01-0.10, p < 0.001) were protective factors, while presence of a severe medical condition (HR 69.35; 95%CI 37.45-128.44, p < 0.001) was a risk factor for ANC < 1,000/µL. Other variables were not significant, including clozapine use (HR 1.33; 95%CI 0.74-2.39, p > 0.05). Conclusions: These findings suggest that clozapine does not increase the risk of neutropenia in subjects with ANC > 2,000/µL during the first year of use and in the absence of a severe medical condition. These results could help guide clinical and public-health decisions regarding clozapine blood monitoring guidelines.

Coagulation index and ALC in children with lymphoma before and after chemotherapy changes and its clinical significance / 国际检验医学杂志

Objective To explore the changes of coagulation index and absolute neutrophil count(ANC) before and after chemotherapy in lymphoma and its clinical significance.Methods 80 cases of lymphoma chil-dren admitted in our hospital from February 2013 to February 2016 were selected as the observation group,In addition,50 healthy subjects were enrolled as control group.The levels of prothrombin time(PT),fibrinogen (FIB),activated partial thromboplastin time(APTT),ANC were compared between the two groups.Results The levels of coagulation,ANC in the observation group were significantly higher than those in the healthy control group,the difference was statistically significant(P<0.05).There were no significant differences in coagulation function,ANC levels between children with stage Ⅰ and Ⅱ(P>0.05).There was no significant difference between the two groups(P>0.05).The levels of coagulation,ANC in children with chemotherapy were significantly lower than those before chemotherapy(P<0.05).There was no significant difference in co-agulation function,ANC level between chemotherapy group and chemotherapy group before chemotherapy (P>0.05).Conclusion Coagulation function and ANC levels are correlated with chemotherapy efficacy in children with lymphoma.Detection of coagulation function and ANC level during chemotherapy is helpful for finding and preventing bleeding in children with lymphoma.

Effect of bovine colostrum on the absolute neutrophil counts of Acute Lymphocytic Leukemia patients undergoing chemotherapy: A double-blind randomized placebo-controlled study

Background@#Changes in the blood cell counts, such as leukopenia and neutropenia, in patients with Acute Lymphoblastic Leukemia (ALL) are common events following chemotherapy. These commonly delay further administration of chemotherapeutic agents. Furthermore, the risk of infection rises correspondingly with the degree of neutropenia. Bovine colostrum is a rich source of immunoglobulins and other antimicrobial factors. These immunoglobulins are believed to improve the immune function and may be effective in the prevention of neutropenia following chemotherapy. @*Objective@#To determine the efficacy of bovine colostrum in preventing neutropenia among ALL patients undergoing chemotherapy. @*Methods@#This study included pediatric patients, aged 6 months to 18 years old diagnosed with ALL undergoing chemotherapy. Twenty-one subjects were randomly assigned to receive bovine colostrum or placebo that were taken twice a day for a week beginning from the first day of chemotherapy. Baseline complete blood count (CBC) and the absolute neutrophil count (ANC) were determined before and after 7 days of giving the colostrum or placebo. A ttest was applied to determine significant differences before and after the supplementation on each group. @*Results@#Results showed that there was a significant increase in ANC of patients given bovine colostrum as compared to the placebo group with a pvalue of 0.007. There were also significant increases in the white blood cells and platelet counts in those who were given bovine colostrum, with p-values of @*Conclusion@#Exclusively breastfed infants who were admitted for very severe pneumonia at the critical care areas showed better outcomes in terms of shorter ICU stay and ventilator use, and lower incidence of HAI as compared to the NEBF infants. However, data showed no significant association between mortality and type of feeding.

The effects of GCSF on the recovery time and duration of hospitalization in patients with anti-thyroid drug-induced agranulocytosis in a tertiary hospital / Journal of the ASEAN Federation of Endocrine Societies

@#<p style="text-align: justify;"><strong>OBJECTIVES:</strong> This study aims to determine if there is a significant difference in the recovery time and duration of hospital stay of patients with anti-thyroid drug-(ATD) induced agranulocytosis with and without granulocyte colony-stimulating factor (GCSF) therapy. It also aims to describe the clinical characteristics of patients who had anti-thyroid drug-induced agranulocytosis.<br /><strong>METHODOLOGY:</strong> This is a retrospective study of hyperthyroid patients on anti-thyroid drugs (ATD) who had an absolute neutrophil count (ANC) of less than 500/?L. Their charts were reviewed for collection of data on age, gender, body mass index (BMI), type and duration of ATD and use of antibiotic and steroid. Recovery time and length of hospital stay were compared between those who received and did not receive GCSF.<br /><strong>RESULTS:</strong> With similar clinical features between the GCSF and non-GCSF groups, the recovery time from agranulocytosis and duration of hospitalization were significantly shorter in the GCSF group, despite lower ANC.<br /><strong>CONCLUSION:</strong> GCSF significantly decreased recovery time (4 versus 7 days, p=0.005) and duration of hospital stay (5 versus 7 days, p=0.009) of hyperthyroid patients with anti-thyroid drug-induced agranulocytosis compared to patients not given GCSF.</p>

Clinical profile and outcome of infections among adult leukemia patients with febrile neutropenia admitted at the University of Santo Tomas Hospital

INTRODUCTION: Ferbile neutropenia is considered a medical emergency and remains a major cause of morbidity and mortality among cancer patients. In this population, infections are often characterized by the lack of significant clinical findings during physical examination and a clear focus of infection, perhaps because of the inability to mount an adequate inflammatory response. It has long been recognized that any delay in treatment may result in a higher risk of mortality especially when caused by highly virulent pathogens such as Pseudomonas aeruginosa.OBJECTIVE: To determine the clinical profile and disease outcome of the various infections an adult patient with leukemia who developed febrile neutropenia admitted at the University of Santo Tomas Hospital from January 1,2010 to July 31,2013.METHODOLOGY: This is a three and a half year retrospective descriptive study. Medical records of all patients >18 old with leukemia, who were admitted and assessed to have infection which developed at the time of the neutropenia were included.RESULTS: A total of 44 cases of leukemia with febrile neutropenia were reviewed. There was equal distribution between genders. Mean age was 39.64 years. Majority of patients had acute myelogenous leukemia (AML) [72.7%, (32/44)]. All patients had sepsis, where two, (4.5%) manifested with shock. Co-morbidities included hyperthyroidism (9.15%), diabetes milletus (DM) (6.8%), and hypertension (6.8%). Cefepime [40.9% (18/44)] and meropenem [31.8%, (14/44)] were the most coon antimicrobial agents used to treat neutropenic patients.All of the patients had blood cultures, however, only 12, (27.3%) yielded positive results. Among those with negative culture results, 18.8% received antibiotics prior to collection of blood. Other specimens tested sputum and urine. Among those with positive results, the most common organisms isolated were E. coli [33.3%, (4/12)] followed by Enterobacter cloacae [16.7%, (2/12)]. Other organisms isolated include Aeromonas hydrophilia , Pseudomonas aeruginosa , Stenotrophomonas maltophilia , coagulase-negative straphylococci (CoNS), and viridans streptococci.Nineteen (43.2%) patients had pneumonia, while five (11.4%) patients had urinary tract infection. Seventeen (38.6%) patients had no known focus of infection despite aggressive search. Culture positivity was observed more frequently among those with profound neutropenia [91.7% (11/12)] and those with Multinational Association for Supportive Care in Cancer (MASCC) score of less than 21 [100%, (6/6)].Thirty seven (84%) of patients were discharged improved, (six 14%) died due to infection and one patients was discharged against medical advice. Mortality was high among those with profound neutropenia, (6/6, 100%) and those with MASCC score of less than 21 [100%, (6/6)].CONCLUSION: Acute myelogenous leukemia cases comprised majority of febrile neutropenic patients. All patients had sepsis commonly involving the lungs. Co-morbidities included hyperthyroidism, DM and hypertension and few patients had prior use of antibiotics. Blood culture was positive in more than one fourth of the population. The most common organisms isolated were E. coli followed by Enterobacter cloacae. Mortality was high among patients with profound neutropenia and MASCC score of less than 21.  

An Analysis of Neutropenia after the Administration of High-dose Intravenous Immunoglobulin or Anti-D Immunoglobulin on Acute Immune Thrombocytopenic Purpura Children: Age based Analysis / 임상소아혈액종양

BACKGROUND: The purpose of this study is to evaluate the decreased neutrophil count after the administration of high-dose intravenous immunoglobulin (IVIG) or anti-D immunoglobulin (anti-D Ig) to children with acute immune thrombocytopenic purpura (ITP). In addition, post-treatment changes in absolute neutrophil count (ANC) were also analyzed according to patient age. METHODS: We retrospectively performed a chart review of 83 patients who had received IVIG or anti-D Ig to manage the decreased platelet count due to acute ITP. Pre- and post-treatment ANC were analyzed in the IVIG treatment group and anti-D Ig treatment group, and ANC were compared between each group. In addition, all the subjects were divided into two groups according to age: infantile group and other group, and ANC of these two groups were compared. RESULTS: A decrease in ANC in just a day and recovering to its pre-treatment value on the 7th post-treatment day was observed for the IVIG treatment group. Especially, the decrease in ANC observed in the infantile group was found to recover in 14 days, where-as ANC recovery in the other group was seen within 2 days after the treatment. There was no statistically significant decrease in ANC in the anti-D Ig treatment group. CONCLUSION: IVIG used for childhood acute ITP caused a decrease in ANC more severely than with the administration of anti-D Ig. Subjects aged less than 12 months who were treated with IVIG for acute ITP showed more ANC decrease and needed longer time to recover normal ANC compared to those over 12 months of age.

Diagnostic Usefulness of White Blood Cell and Absolute Neutrophil Count for Postoperative Infection after Anterior Cervical Discectomy and Fusion Using Allograft and Demineralized Bone Matrix

STUDY DESIGN: Prospective study. PURPOSE: We investigated normative temporal levels of white blood cell (WBC) and absolute neutrophil count (ANC) in uncomplicated anterior cervical discectomy and fusion (ACDF) using allograft and demineralized bone matrix (DBM). OVERVIEW OF LITERATURE: No study has investigated the diagnostic usefulness of WBC and ANC for postoperative infection following ACDF using allograft and DBM. METHODS: Blood samples of 85 patients, who underwent one or two-level ACDF, were obtained and evaluated before surgery and on the first, third, fifth, seventh, fourteenth, thirtieth, and ninetieth postoperative days. No infection was found in all patients for at least one year follow-up period. RESULTS: Mean WBC and ANC values increased significantly and reached peak levels on the first postoperative day. The peaked levels rapidly decreased but still remained elevated above the preoperative levels on the third postoperative day. The levels returned close to the preoperative levels on the fifth postoperative day. The mean WBC and ANC values did not get out of their normal reference ranges throughout the follow-up periods. One-level and two-level ACDF exhibited a similar course of postoperative changes in WBC and ANC values and no significant difference in mean levels of WBC and ANC throughout the follow-up periods. CONCLUSIONS: Uncomplicated ACDF using allograft and DBM showed normal values of WBC and ANC during the early postoperative period. Therefore, significant abnormal values of WBC and ANC at an early postoperative period suggest the possibility of the development of acute postoperative infection after ACDF using allograft and DBM.

An Analysis of Neutropenia after the Administration of High-dose Intravenous Immunoglobulin or Anti-D Immunoglobulin on Acute Immune Thrombocytopenic Purpura Children: Age based Analysis / 임상소아혈액종양

BACKGROUND: The purpose of this study is to evaluate the decreased neutrophil count after the administration of high-dose intravenous immunoglobulin (IVIG) or anti-D immunoglobulin (anti-D Ig) to children with acute immune thrombocytopenic purpura (ITP). In addition, post-treatment changes in absolute neutrophil count (ANC) were also analyzed according to patient age.METHODS: We retrospectively performed a chart review of 83 patients who had received IVIG or anti-D Ig to manage the decreased platelet count due to acute ITP. Pre- and post-treatment ANC were analyzed in the IVIG treatment group and anti-D Ig treatment group, and ANC were compared between each group. In addition, all the subjects were divided into two groups according to age: infantile group and other group, and ANC of these two groups were compared.RESULTS: A decrease in ANC in just a day and recovering to its pre-treatment value on the 7th post-treatment day was observed for the IVIG treatment group. Especially, the decrease in ANC observed in the infantile group was found to recover in 14 days, where-as ANC recovery in the other group was seen within 2 days after the treatment. There was no statistically significant decrease in ANC in the anti-D Ig treatment group.CONCLUSION: IVIG used for childhood acute ITP caused a decrease in ANC more severely than with the administration of anti-D Ig. Subjects aged less than 12 months who were treated with IVIG for acute ITP showed more ANC decrease and needed longer time to recover normal ANC compared to those over 12 months of age.

Should we still use Camitta's criteria for severe aplastic anemia? / 대한혈액학회지

BACKGROUND: The criteria by Camitta for diagnosis in severe aplastic anemia (SAA) has been used since 1976. However, there has been no attempt to verify the Camitta's criteria, that the survival in patients with SAA may differ by absolute neutrophil count (ANC), platelet count (PLT), and corrected reticulocyte count (CRC), which are components of the Camitta's criteria. METHODS: 117 SAA patients diagnosed by the Camitta's criteria were analyzed, retrospectively. Univariate and multivariate analyses were used to evaluate the factors affecting overall survival (OS). RESULTS: Response by immunosuppressive therapy (IST) or stem cell transplantation (SCT) significantly affected OS (P=0.001). Therefore, we excluded treatment responders for analysis. Finally, 92 SAA patients including treatment non-responders by IST or SCT and conservative care group were analyzed by using univariate and multivariate analyses. The median age of analyzed patients was 54.5 years. Male to female ratio was 1:1. The median follow-up duration was 74.23 months (range, 54.71-93.74 months). The median ANC, PLT, and CRC were 394/microL, 12,000/microL, and 0.39%, respectively. In multivariate analyses, ANC or =500/microL (P=0.015, HR 2.694, 95% CI: 1.20-6.01) and age (P=0.015, HR 1.022, 95% CI: 1.00-1.04) were the significant factors for OS. CONCLUSION: ANC could be an essential, not an optional criterion for diagnosing SAA. This study suggests the possibility that the Camitta's criteria be modified. Studies in large cohorts are needed to transform the Camitta's criteria.

Change of absolute neutrophil count after intravenous immunoglobulin administration for the children with idiopathic thrombocytopenic purpura / 소아과

PURPOSE: Intravenous immunoglobulin (IVIG) is effective for the treatment of idiopathic thrombocytopenic purpura (ITP) in children. Recently, several reports have been published that show its impact on the absolute neutrophil count. The present study was performed to confirm these findings. METHODS: Data on 26 ITP patients were analyzed. Patients with febrile illness or increased C-reactive protein levels at presentation, which would influence the neutrophil counts, were excluded to determine the sole impact of IVIG. In addition, patients who received steroid treatment were also excluded. RESULTS: Sixteen boys and ten girls were analyzed. For patients who received an IVIG dose of 0.4 g/kg/day (n=17), the absolute neutrophil count (ANC) measured next day was significantly decreased. For patients who received an IVIG dose of 1 g/kg/day (n=9), the ANC measured the next day was also significantly decreased. However, the decrease was more profound in the high-dose group compared to the low-dose group. Among six cases with profoundly decreased ANC greater than 1,000/ mm3, four patients (67%) received IVIG at a dose of 1 g/kg/day. All four cases with increased ANC were treated with IVIG dose of 0.4 g/kg/day, and three cases (75%) among them had a febrile reaction during IVIG administration. None of the cases with decreased ANC had a febrile reaction. No cases had infectious complications reported. CONCLUSION: IVIG treatment for ITP patients appears to suppress the ANC. This decrease of ANC was more pronounced when a higher dose of IVIG was used. Some cases with increased ANC counts after IVIG use were found only in low-dose IVIG group, and was associated with febrile reactions during IVIG use.

Prediction of Clozapine-Induced Occurrences of Hematological Abnormalities Using Initial Hemodynamic Changes / 신경정신의학

STUDY OBJECT: Clozapine has been known to induce variety of side effects. Amongst of all, the hematological abnormalities, especially agranulocytosis, has prohibited the wide-spread use of this drug. There have been a lot of efforts to predict the hematological abnormalities based upon the demographical and clinical characteristics. In addition, although only a few, prediction by the initial hemodynamic change was also attempted. This study was carried out as an attempt to find a reliable predictor of clozapine-induced hematological abnormalities based upon the baseline hematological status and the initial hemodynamic change by clozapine. METHOD: Regardless of the diagnosis, the complete blood count data of every patient who had received clozapine in Seoul National University Hospital from 1996 to the present were analyzed. The risk group was defined as the patient whose absolute neutrophil count(ANC) had dropped below 1500mm3 equal or more than 3 times during the one year after clozapine trial. The occurrences of future clozapine-induced hematological abnormalities were predicted by the baseline ANC and the initial ANC change. RESULT: The baseline ANC immediately before clozapine trial, the degree of ANC declining during the first week, and that of ANC rising during the 2nd and 3rd week all showed significant difference between the risk group and the safe group. The likelihood ratio of risk was 7.75(95% confidence interval: 2.77-21.3) implying significant risk of hematological abnormalities when the baseline ANC was below 2000mm3, and the likelihood ratio of risk was 0.372(0.159-0.798) when the baseline ANC was above 4000mm3. In likewise manner, the interval likelihood ratios of risk associated with the ANC rising during the first 3 weeks were calculated. These two predictor variables contributed mutually independent information in predicting future hematological abnormalities. CONCLUSION: The baseline ANC and the initial hemodynamic change after clozapine trial could help predicting future clozapine-induced hematological abnormalities. If the more reliable predictors can be found, prescreening high risk patients using these predictors and the close hematological monitoring of these patients may not only decrease the risk associated with clozapine usage, but also widen the indication of clozapine by relieving much of the burden currently imposed upon the doctors.

The Risk Factor of Bacteremia in Children with Febrile Neutropenia due to Chemotherapy

PURPOSE: We evaluated the easily-assessable risk factors to predict bacteremia in children with febrile neutropenia, who received anticancer chemotherapy. METHODS: We retrospectively reviewed 46 children who had febrile neutropenia caused by anticancer chemotherapy between March, 1993 and February, 1997. The patients with localized infection on presentation were not eligible for this study. We evaluated the correlation between bacteremia and some variables, including absolute neutrophil count (ANC), absolute monocyte count (AMoC) and absolute phagocyte count (APC). RESULTS: There was total of 147 consecutive episodes of fever in 46 children, with 90 episodes of fever were noted in neutropenic patients without localized infection. There were 20 episodes of bacteremia (22.2%) in 90 episodes of febrile neutropenia. The mean ANC of 365.5 +/- 448.3/microliter, mean AMoC 132.3 +/- 310.4/microliter and mean APC 502.0 +/- 603.3/microliter did not show significant correlation with bacteremia. There was no statistically significant correlation between bacteremia and ANC or AMoC. There was higher risk of bacteremia in patients with AMoC less than 100/microliter as compared with patients with AMoC above than 100/microliter (odds ratio : 1.39, 95%CI : 0.41-4.69). There were 17 episodes of bacteremia (28.8% of 59 febrile episodes) in patients with APC less than 500/microliter and 3 episodes of bacteremia (9.7% of 31 febrile episodes) in patients with APC above than 500/microliter (P=0.03, odds ratio : 3.78, 95%CI : 1.01-14.10). CONCLUSION: There was a statistically-significant correlation between bacteremia and APC with higher risk of bacteremia in patients with APC less than 500/microliter. Trials should be conducted to test whether APC may be used to assign some children to less intensive or outpatient antibiotic therapy at the time of presentation of febrile neutropenia.