Serum bilirubin is negatively associated with white blood cell count

OBJECTIVE: Bilirubin is considered an important antioxidant, anti-inflammatory factor and immunomodulator. The current investigation aimed to explore the association between bilirubin and white blood cell (WBC) count in a large Chinese cohort. METHODS: A total of 61091 participants (29259 males, 31832 females) were recruited from a Chinese tertiary hospital. Data were sorted by sex, and the association between bilirubin and WBC count was analyzed after dividing bilirubin levels into quartiles. RESULTS: Most parameters (including age, body mass index, systolic blood pressure, diastolic blood pressure, alanine aminotransferase, total bilirubin, blood urea nitrogen, creatinine, uric acid, triglycerides and WBC count) were significantly higher in men than in women. Bilirubin displayed significant negative relationships with most other measured variables. Linear logistic regression analysis further indicated their negative relationships. Females showed a significantly higher frequency of leucopenia than males. Significant associations of leucopenia with high bilirubin quartiles were shown in binary logistic regression models for both sexes, with a much closer association in men than in women. For instance, for men with bilirubin levels in quartile 4, the adjusted likelihood of leucopenia was 1.600-times higher than that of men with values in quartile 1. For women with bilirubin levels in quartile 4, the adjusted likelihood of leucopenia was 1.135-times higher than that of women with values in quartile 1. CONCLUSION: Bilirubin is negatively related to WBC count. Significant associations exist between leucopenia and high bilirubin quartiles, and these associations are more obvious in men than in women.

On lupus, vitamin D and leukopenia / Acerca de lúpus, vitamina D e leucopenia

Resumo Introdução A regulação imune está entre os efeitos não calcêmicos da vitamina D. Assim, essa vitamina pode influenciar em doenças autoimunes, como o lúpus eritematoso sistêmico (LES). Objetivos Estudar a prevalência da deficiência de vitamina D no LES e sua associação com o perfil clínico, sorológico e de tratamento, bem como com a atividade da doença. Métodos Mensuraram‐se os níveis séricos de OH‐vitamina D3 em 153 pacientes com LES e 85 controles. Os dados sobre o perfil clínico, sorológico e de tratamento de pacientes com lúpus foram obtidos por meio da revisão de prontuários. Simultaneamente à determinação da vitamina D, foi feito um hemograma e foi aplicado o Sledai (SLE disease activity índex [índice de atividade da doença no LES]). Resultados Os pacientes com LES tinham níveis mais baixos de vitamina D do que os controles (p = 0,03). Na análise univariada, a vitamina D sérica esteve associada à leucopenia (p = 0,02) e ao uso de ciclofosfamida (p = 0,007) e metotrexato (p = 0,03). Foi verificada uma correlação negativa com a dose de prednisona (p = 0,003). Não foi encontrada associação com a atividade da doença medida pelo Sledai (p = 0,88). Em um estudo de regressão múltipla, somente a leucopenia permaneceu como uma associação independente (B = 4,04; p = 0,02). Também foi encontrada correlação negativa do nível sérico de vitamina D com os granulócitos (p = 0,01), mas não com a contagem de linfócitos (p = 0,33). Conclusão Os pacientes com LES têm mais deficiência de vitamina D do que os controles. Essa deficiência não está associada com a atividade da doença, mas com a leucopenia (granulocitopenia).

Resumo Introdução A regulação imune está entre os efeitos não calcêmicos da vitamina D. Assim, essa vitamina pode influenciar em doenças autoimunes, como o lúpus eritematoso sistêmico (LES). Objetivos Estudar a prevalência da deficiência de vitamina D no LES e sua associação com o perfil clínico, sorológico e de tratamento, bem como com a atividade da doença. Métodos Mensuraram‐se os níveis séricos de OH‐vitamina D3 em 153 pacientes com LES e 85 controles. Os dados sobre o perfil clínico, sorológico e de tratamento de pacientes com lúpus foram obtidos por meio da revisão de prontuários. Simultaneamente à determinação da vitamina D, foi feito um hemograma e foi aplicado o Sledai (SLE disease activity índex [índice de atividade da doença no LES]). Resultados Os pacientes com LES tinham níveis mais baixos de vitamina D do que os controles (p = 0,03). Na análise univariada, a vitamina D sérica esteve associada à leucopenia (p = 0,02) e ao uso de ciclofosfamida (p = 0,007) e metotrexato (p = 0,03). Foi verificada uma correlação negativa com a dose de prednisona (p = 0,003). Não foi encontrada associação com a atividade da doença medida pelo Sledai (p = 0,88). Em um estudo de regressão múltipla, somente a leucopenia permaneceu como uma associação independente (B = 4,04; p = 0,02). Também foi encontrada correlação negativa do nível sérico de vitamina D com os granulócitos (p = 0,01), mas não com a contagem de linfócitos (p = 0,33). Conclusão Os pacientes com LES têm mais deficiência de vitamina D do que os controles. Essa deficiência não está associada com a atividade da doença, mas com a leucopenia (granulocitopenia).

Differences in the Adverse Effects of Azathioprine between Inflammatory Bowel Disease and Autoimmune Hepatitis in Korean Patients / 대한소화기학회지

BACKGROUND/AIMS: Azathioprine (AZA) has been widely used in the therapy of inflammatory bowel disease (IBD) and autoimmune hepatitis (AIH). However, studies evaluating the adverse effects of AZA in these two diseases are lacking. The aim of this study was to compare the adverse effects of AZA in Korean IBD and AIH patients. METHODS: Patients with IBD or AIH who were treated with AZA at Keimyung University Dongsan Medical Center (Daegu, Korea) between January 2002 and March 2011 were enrolled. Their medical records were reviewed retrospectively in terms of clinical characteristics and adverse effects of AZA. RESULTS: A total of 139 IBD patients and 55 AIH patients were finally enrolled. Thirty IBD patients (21.6%) and eight AIH patients (14.5%) experienced adverse effects of AZA. In particular, the prevalence of leukopenia was significantly higher in the IBD group than in the AIH group (p=0.026). T474C mutation was observed in three of 10 patients who were assessed for thiopurine methyltransferase (TPMT) genotype. CONCLUSIONS: IBD patients are at increased risk for the adverse effects of AZA compared with AIH patients, of which leukopenia was the most commonly observed. Therefore, IBD patients receiving AZA therapy should be carefully monitored.

Pediatric patients with bicytopenia/pancytopenia: Review of etiologies and clinico-hematological profile at a tertiary center.

Background: The etiology of bicytopenia/pancytopenia varies widely in children, ranging from transient marrow viral suppression to marrow infiltration by fatal malignancy. Depending on the etiology, the clinical presentation can be with fever, pallor or infection. Knowing the exact etiology is important for specific treatment and prognostication. Aims: To evaluate the etiological and clinico-hematological profile in children with bicytopenia and pancytopenia. Materials and Methods: A review of bicytopenic and pancytopenic children referred for bone marrow examination from January 2007 to December 2008 was done. Detailed history, clinical examination and hematological parameters at presentation were recorded. Results and Conclusion: During the study period, a total of 990 children were referred for bone marrow examination for different indications. Of these, 571 (57.7%) had either pancytopenia (17.7%) or bicytopenia (40%). Commonest form of bicytopenia was anemia and thrombocytopenia seen in 77.5% cases, followed by anemia and leukopenia in 17.3% and leukopenia and thrombocytopenia in 5.5% cases. Most common etiology was acute leukemia (66.9%) in bicytopenic children and aplastic anemia (33.8%) in pancytopenic children. Children with bicytopenia had a higher incidence of underlying malignancy (69.5% vs. 26.6%), splenomegaly (60.5% vs. 37.4%), lymphadenopathy (41.8% vs. 15.1%) and circulating blasts (64.6% vs. 20.1%) and a lower incidence of bleeding manifestations (12.1% vs. 26.6%) as compared to children with pancytopenia.

Medical admissions of oncology patients to the University Hospital of the West Indies

A prospective study of 80 oncology patients (42 men, 38 women; mean age 50.3 years) admitted to the University Hospital of the West Indies, Jamaica, was conducted over a six month period (August 1, 1995 to January 31, 1996). There were 103 admissions representing 8.7of total admissions to the medical wards. Solid tumours and haematological malignancies accounted for equal proportions of admissions. 62were emergency admissions. Investigation of constitutional symptoms, abnormal physical findings, infection and chemotherapy were the commonest reasons for admission. Complications developed in 42.7of admissions, the commonest being renal and/or hepatic impairment; anaemia, leukopaenia and thrombocytopenia; and nosocomial infections. 35of the patients died during the study period. The mean length of stay was 12.9 days (SD 12.8). Mean hospital stay was significantly longer in admissions involving an initial diagnosis of cancer and in those resulting in complications (p < 0.001).

Alteraciones hematologicas en ninos de madres toxemicas / Hematological disorders in children from toxemic mothers

La toxemia del embarazo se ha asociado con alteraciones hematologicas, neutropesia y trombocitopenia, sobre todo en el recien nacido, aunque hay controversias al respecto. Para dilucidar este hecho se estudiaron prospectivamente con seguimiento clinico y hematologico completo 81 recien nacidos, hijos de madres toxemicas, la mayoria con toxemia severa. Como controles se analizaron 21 recien nacidos sanos escogidos en forma secuencial. El etudio se hizo en el Hospital Universitario del Valle, Cali, Colombia, entre septiembre y noviembre de 1987. En los hijos de madres toxemicas hubo mayor anoxia perinatal; no se encontro leucopenia ni robocitopenia como lo informa la literatura; hubo mayor hematocrito y menor numero de nuetrofilos sin llegar a neutropesia; a mayor severidad de la toxemia se encontraron alteraciones en las plaquetas, es decir, trombocitopenia y trombocitosis, por igual, siendo este ultimo hallazgo un hecho no informado. Finalmente, las drogas que se usaron para el manejo de la toxemia, no influyeron en el recuento plaquetario