AL Amyloidosis with Polycythemia, Leucocytosis and Thrombocytosis : A Case Report

A young lady presented to us with clinical and biochemical evidence of Nephrotic Syndrome. Her laboratory investigations also revealed Erythrocytosis, Leucocytosis and Thrombocytosis. A renal biopsy revealed a diagnosis of Amyloidosis which was further characterized as AL amyloidosis with further investigations (kappa chain monoclonal gammopathy). She was started with appropriate therapy and she showed significant decline in her monoclonal Proteins on follow up. Her Erythrocytosis, Leucocytosis and Thrombocytosis also normalized with the decline in the levels of monoclonal light chains. We postulate a link between the monoclonal protein associated growth factors and inflammatory markers which were responsible for this unique association between AL Amyloidosis and tri-lineage hematopoietic cell proliferation.

An Unusual Case of DRESS Syndrome Presenting with Marked Leucocytosis.

Drug reaction with eosinophilia and systemic symptom (DRESS) syndrome is a rare severe drug-induced idiosyncratic hypersensitivity characterized by maculopapular and/or erythrodermic eruption, fever, peripheral lymphadenopathy, eosinophilia or atypical lymphocytosis, and visceral organ involvement. The estimated incidence of this syndrome ranges from 1/1000 to 1/10,000 drug exposures. In this report, we describe a case of DRESS syndrome in a young female with a unique presentation. The DRESS syndrome can be difficult to diagnose as its clinical findings can mimic those of other systemic diseases. This case emphasizes the importance of incorporation of the patient’s clinical and medication history in the interpretation of hematological investigations.

Infectious mononucleosis with follicular tonsillitis and urinary tract infection

Despite the prevalence of Epstein-Barr virus (EBV) infection, new reports of weird and atypical manifestations of the infection continue to emerge, raising the question of how well we know this pathogen. The clinical appearance of patients who become infected throughout their youth or early adulthood is changing as the infection age rises in developed countries. Other physical symptoms are less noticeable and liver involvement is more noticeable throughout these stages. To inform health-care professionals of this change, an update on infectious mononucleosis variable manifestation is necessary. This case presented a 28-year-old female presented with a history of fever, nausea, and vomiting with odynophagia and cervical lymphadenopathy. Complete blood count and peripheral blood film examination revealed lymphocytic leukocytosis with many reactive lymphocytes. Her monospot test for EBV was positive along with a urine culture positive for Staphylococcus aureus.

Study of Clinical and Outcome Profile of Neonatal Sepsis with Thrombocytopenia Patients Admitted at Tertiary health care Centre Nanded

Background: Thrombocytopenia is a frequent problem in neonatal sepsis and is among the most predic?ve, independent risk factors for sepsis-associated mortality. The present study was undertaken to correlate neonatal sepsis and thrombocytopenia in terms of severity, clinical course, organism specificity and outcome. Method: Total 384 neonates age <28 days with sepsis and thrombocytopenia were studied and analyzed with their clinical profile, symptoms, lab findings and outcomes. Results: Male babies (55.86%), age <72 hrs (80.35%), preterm (68.70%) and LBW babies (85.58%) were more prone to sepsis. Maternal fever (67.44%), foul smelling liquor (53.79%) and PROM >18 hrs (66.74%) make babies more prone to neonatal sepsis. The Commonest clinical features were not accepting feed (69.95%), lethargy (67.85%) and breathing difficulty (79.04%). Early onset sepsis (82.54%) and probable sepsis (40.26%) were more common and associated with preterm and LBW babies. Leucocytosis was seen in 64.57%, thrombocytopenia moderate degree 45.67% and severe degree 34.65%, MPV >12 69.11%, ANC <1800 47.50%, micro ESR >15 mm 72.16% and CRP posi?vity 28.60%. Severe degree thrombocytopenia (<50000) was more common with PROM >18 hrs (83.02%), maternal fever (83.09%) and gram-nega?ve organism(61.29%). Leucopenia (<4000) was more common with maternal fever (75.79%), proven sepsis (43.16%) and gram-nega?ve organism (70.31%). Severe degree thrombocytopenia (61.29%), leucopenia (70.31%) and mortality (64.51%) were more commonly associated with gram-nega?ve organism. Outcome was bad with severe degree of thrombocytopenia (62.32%), leucopenia (73.91%), and gram-nega?ve organism (64.51%). Conclusion: Proper antenatal mother care, hygiene and early evalua?on for illness can prevent early onset of sepsis in neonates. Severity of degree of thrombocytopenia directly propor?onal to the worst outcome.

Evaluation of inflammatory and liver injury biomarkers among drug-naive viral hepatitis B patients: A study in a referral laboratory, Ghana

Background and Aim: Globally, hepatitis B virus (HBV) infection is among the commonest chronic infections and the leading cause of liver cancer. This study evaluated inflammatory and liver injury biomarkers among newlydiagnosed HBV-infected patients to reveal inflammation and liver injury levels. Patients and Methods: This case-control study was conducted among 146 newly diagnosed drug-naive patients and 64 blood donors. Questionnaires were administered to obtain demographic data. Blood samples were collected to assess viral serological markers, inflammatory markers, liver function, and hematological indices. Also, noninvasive markers of liver fibrosis (APRI: aspartate transaminase - platelet ratio index, FIB-4: fibrosis 4 index, and AAR: aspartate - alanine transaminase ratio) were mathematically derived. The patients were categorized into acute and chronic infections based on their viral serological markers. Results: Overall, 81.5% of the patients had an acute HBV infection, whereas 18.5% had a chronic HBV infection. There was a significant increase in the biomarkers of inflammation, C-reactive protein (CRP) and interleukin 6, and liver injury (liver transaminases, FIB-4 index, and APRI) among the drug-naive chronic HBV-infected patients. The study also revealed significant anemia and leucocytosis in patients with chronic HBV infection. Further, the study showed a strong correlation between CRP and alanine transaminase among patients with chronic HBV infection. Conclusion: There was increased anemia, inflammation, and liver fibrosis among the drug-naive chronic HBVinfected patients; hence, public education is required so patients with viral hepatitis B in Ghana would visit the clinic earlier enough for proper clinical management.

Prospective study of etiology of liver abscess and comparison of different ways of its management

Background: Liver abscess is a collection of purulent material in the liver parenchyma which can be due to bacterial, parasitic, fungal or mixed infection. It has become one of the most common communicable disease with much more prevalence in underdeveloped and developing countries. Two most common type of liver abscess are amoebic and pyogenic. Pyogenic liver abscess is more common in western world while amoebic liver abscess is more commonly found in third world countries, which are under developed, and more people living under lower socio economic conditions.Methods: A prospective study of 50 patients with clinical diagnosis of liver abscess admitted in the department of surgery B. R. D. Medical College Gorakhpur during a period of one year.Results: There was male predominance (98%) and most of the patient belongs to younger age group and low socio economics status. In amoebic liver abscess there was strong correlation with alcohol intake (66%).Conclusions: In our study most of the patients were group 21-30 years and the most common presenting symptom was right upper quadrant pain and fever. In most of the patients, the common hematological finding was mild anaemia with leucocytosis with altered LFT.

Clinical, epidemiological and laboratory characteristics of children with febrile seizures

Background: Febrile seizure is the most common type of seizure disorder that occurs in children aged 6-60 months. Recurrences are common. This study was conducted to evaluate the epidemiology, clinical profile and laboratory parameters of children presenting with febrile seizure in a teaching hospital.Methods: This was a descriptive retrospective study among children presenting with febrile seizure admitted to KIMS, Bengaluru from March (2018-2019). Children between six months to five years were included in the study while patients with prior episodes of afebrile seizures, abnormal neurodevelopment and not meeting the age criteria were excluded. Patient’s demographic and clinical data were collected from the in-patient records and analysed.Results: Among 60 children with febrile seizures were enrolled in our study with highest prevalence in males (58%) and amongst 13-24 months age group (37%). Majority (20%) presented in the monsoon season (June) and in the morning hours (43%). Simple febrile seizures and complex febrile seizures were observed in 60% and 40% respectively. Majority (73%) who developed first episode of seizure were below 24 months ago with mean age of 18.71±11.50 months. 42% had recurrence and was significantly associated with first episode of febrile seizures at age ≤1 year and family history of seizures. Upper respiratory tract infections were the commonest cause of fever. Anaemia and leucocytosis were seen in 72% and 70% cases respectively.Conclusions: Febrile seizure was observed predominantly in children below two years, simple febrile seizure being the commonest. Recurrence was common and significantly associated with the first episode of febrile seizure at the age one year or below and family history. Majority had anaemia which showed that iron deficiency anaemia could be a risk factor. Leucocytosis was present in most which could be either due to underlying infection or due to the stress of seizure itself.

Comparison of the role of ultrasound guided transhepatic aspiration of gallbladder versus conservative management of acute calculous cholecystitis

Background: Gall stone disease remains one of the most common medical problem leading to surgical intervention. Cholecystitis accounts for 3-10% of abdominal pain worldwide. Acute cholecystitis is the most common complication of cholelithiasis accounting for 14 to 30% of cholecystectomies performed in many countries. Symptoms in cholecystitis are due to impaction of stone and subsequent distention of gallbladder with inflammation. Study is aimed to clarify the role of ultrasound guided transhepatic gallbladder aspiration in the early management of acute calculous cholecystitis.Methods: The study was conducted in total of 40 patients presenting with acute cholecystitis. 20 patients underwent ultrasound guided transhepatic aspiration of gallbladder with antibiotics (group A) and 20 patients were given antibiotics only (group B). Data were collected before intervention and post intervention duration of stay, pain according to visual analog scale, leucocytosis and fever were recorded for analysis. No complications were related to aspiration procedure.Results: Both groups were comparable. Group A patients had better pain relief (p=0.0001 day on 2 and p=0.004 on day 3 post aspiration), percentage reduction of leucocyte count (p=0.041 on day 3) and duration of hospital stay (p=0.004) which were statistically significant.Conclusions: Ultrasound guided transhepatic aspiration of gall bladder with antibiotics in acute cholecystitis results in better pain profile, faster reduction in leucocyte count and shorter duration of hospital stay when compared to antibiotics alone.

Leucocyte Profile of Adult Nigerians as Indicator of Severity Level of Acute Musculoskeletal Trauma

Leucocytosis, marked increase in the number of white blood cells (WBC) is a known physiological response to trauma. In recent times, several studies have asserted the absence of this response in Africans. In view of this, current study investigated the existence of, and prognostic implications of post-traumatic leucocytosis amongst adult Nigerians with acute musculoskeletal (MSK) trauma. Two hundred and twenty three (223) adult male and females (MSK traumatized) and fifty apparently healthy volunteers (adults) were ethically recruited from the National Orthopaedic Hospital, Enugu, regional centre for trauma, orthopaedic, burns and plastic surgery in south-east Nigeria. Using the Leishman’s stained blood smear technique, leucocyte profiles [Neutrophil, Lymphocytes, Basophils, Eosinophils and Monocyte counts] were obtained for each participant. In all case, Age, Gender and duration of hospitalization were also obtained. Following careful analysis, study found, using one way analysis of variance (ANOVA), a statistically significant increase (p < .05) in acutely traumatized subjects; with adults of ages 20 to 49 years constituting the majority (70%). A statistically significant lymphopenia was also observed in test population, with Pearson Product Moment Correlation proving positive for higher levels of WBC counts. A negative correlation was also seen for Neutrophils and lymphocyte counts, implicating the Neutrophil-Lymphocyte Stress Factor (NLSF). We recommend the exploration of the NLSF for prognosis of Leucocytosis in Africans.

Effect of Ronstar® on the Hematological Parameters of the Freshwater Catfish Clarias albopunctatus Fingerlings

Clarias albopunctatus juvenile (mean weight 85.40±2.67 g) was exposed to sublethal concentrations of Ronstar (0, 0.2, 0.6 and 1.2 mg/l) in a static renewal bioassay system for 15 days. The hematological parameters of the fish were determined every 5 days. When compared with the control, the erythrocyte count (RBC), hemoglobin (Hb) and the hematocrit (Hct) were significantly reduced (P<.05) between the treatment groups. These values also differed (P<.05) within the treatment groups. The leucocyte counts increased with increasing Ronstar concentration and during the exposure. Compared with the control, significant (P<05) lymphocytosis, monocytopenia, neutropenia and reduced eosinophil were all evident in the treatment groups. The reduction in the erythrocyte count and hemoglobin are indications of anemia in the fish exposed to Ronstar. The assay of these parameters could be of immense value in establishing safe limits for pesticides in Nigerian waters as well as in the monitoring of fish health.

Corticosteroid-induced leukocytosis in pregnancy: A prospective observational study

Background: In the course of managing preterm labour, increasing trends of total white cell count raises concern for the obstetrician, suggesting a possible underlying infectious aetiology. Although mild leukocytosis is expected in pregnancy, the patterns of increment after corticosteroid administration are not well described beyond animal models and in a small number of human studies. Methods: Seventy-three consecutive patients who required antenatal corticosteroids for either preterm labour or prelabour caesarean section were recruited and given a standard course of 12mg dexamethasone phosphate, twelve hours apart. Venous blood samples were taken before administration, at six hours and 36 hours after the first dose of dexamethasone. Results: The total white count trend was 10.31±2.62 at baseline, 11.44±3.05 at six hours and 12.20±3.49 at 36 hours. Neutrophil-lymphocyte ratio was 3.60±1.31, 8.73±3.63 and 3.24±1.49 respectively, reflecting relative neutrophilia and lymphopenia which normalised by 36 hours. Conclusion: In contrast to previous studies, we found only a slight increment in total white cell count of about 10%. The marginal changes described in our study would not normally raise any clinical concern, although vigilance should be exercised if higher levels were observed.

Leucocytosis in a case of Lung Cancer: Infection or Paraneoplastic Syndrome? - Dilemma in Diagnosis and Treatment

A 65 year old male smoker was diagnosed with squamous cell carcinoma of upper lobe of the right lung complicated with Horner’s syndrome and gradually increasing leucocytosis. Alhough the inflammatory biomarker level in serum was low, there was no definite way to determine the cause of the leucocytosis (whether infection or hematologic paraneoplastic syndrome). After empirical antibiotic therapy, his fever subsided but the leucocytosis persisted. It was difficult for us to take a decision regarding the priority of the treatment of infection or the lung cancer. Only after the first cycle chemotherapy, did the leucocytosis rapidly drop down. Normal serum procalcitonin level and quick response to chemotherapy indicated that leucocytosis was a manifestation of paraneoplastic syndrome. Treating the underlying cancer is the first step.

Leucocytosis in Febrile Seizure.

Introduction: Febrile seizure (FS) is a common condition affecting 2-5% of children. Peripheral blood leucocyte count with its differential is an initial test looking for the cause of fever and high count is usually accounted for the seizure activity. Objectives: To find the incidence of febrile seizure and to evaluate the relationship between fever duration before seizure, seizure duration and the total leucocyte as well as neutrophil response. Methodology: It is a cross sectional study done at Kathmandu Medical College and Teaching Hospital, Kathmandu, Nepal, for one year. After an informed consent, children from 6 months to 6 years with FS were admitted. Those with afebrile seizures and who refused to give consent were excluded. A detail history and examination was done on admission. All were investigated for the source of fever including total and differential count. Results: Out of a total 1742 children admitted, 115 (6.6%) children had febrile seizure. Simple febrile seizure was observed in 93(81%) and 22(19%) was complex febrile seizure. 42% of them had leucocytosis. The duration of fever before the onset of seizure is found to be negatively correlated with total leucocyte count (r = -0.418, p<0.001) and neutrophils count alone (r = -0.375, p<0.001). The duration of seizure is not correlated to both the total leucocyte count (r = -0.162, p = 0.85) and the neutrophil (r = -0.109, p= 0.247). Conclusion: The incidence of febrile seizure is 6.6%. Leucocytosis and neutrophilia in children is negatively correlated with the duration fever before the onset of seizure, associated with underlying infection if any and is not related to seizure event and its duration. Thus any child with febrile seizure with high leucocyte count should be evaluated for infection.

Haematological changes in African lungfish, Protopterus annectens after aerial exposure.

Specimens of the west African lungfish, Protopterus annectens (mean weight 294.3 g mean length 38.1 cm), procured from Agulu lake at Agulu in Anambra state, Nigeria were removed from the ambient water and exposed to complete aerial life for a period of seven consecutive days after which some of their haematological changes were determined. There were significant polycythaemia, leucocytosis, thrombocythaemia and elevation of haemoglobin contents (p<0.05). The importance of these haematological adjustments which the fish makes whilst subjected to complete aerial habitat prior to aestivation are discussed.