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Blood Jun 2020
Topics: Aged; Betacoronavirus; COVID-19; Coronary Artery Disease; Coronavirus Infections; Diabetes Mellitus, Type 2; Granulocytes; Humans; Hypoxia; Kidney Failure, Chronic; Leukocyte Count; Leukocytosis; Male; Pandemics; Pneumonia, Viral; SARS-CoV-2
PubMed: 32526026
DOI: 10.1182/blood.2020006483 -
Cancer Jun 2023Hyperleukocytosis in patients with acute myeloid leukemia (AML) has been associated with worse outcomes. For cytoreduction, leukapheresis has been used but its clinical...
BACKGROUND
Hyperleukocytosis in patients with acute myeloid leukemia (AML) has been associated with worse outcomes. For cytoreduction, leukapheresis has been used but its clinical utility is unknown, and low-dose cytarabine (LD-cytarabine) is used as an alternative method.
METHODS
Children with newly diagnosed AML treated between 1997 and 2017 in institutional protocols were studied. Hyperleukocytosis was defined as a leukocyte count of ≥100 × 10 /L at diagnosis. Clinical characteristics, early complications, survival data, and effects of cytoreductive methods were reviewed. Among 324 children with newly diagnosed AML, 49 (15.1%) presented with hyperleukocytosis. Initial management of hyperleukocytosis included leukapheresis or exchange transfusion (n = 16, considered as one group), LD-cytarabine (n = 18), hydroxyurea (n = 1), and no leukoreduction (n = 14).
RESULTS
Compared with patients who received leukapheresis, the percentage decrease in leukocyte counts following intervention was greater among those who received LD-cytarabine (48% vs. 75%; p = .02), with longer median time from diagnosis to initiation of protocol therapy (28.1 vs. 95.2 hours; p < .001). The incidence of infection was higher in patients (38%) who had leukapheresis than those who receive LD-cytarabine (0%) or leukoreduction with protocol therapy (14%) (p = .008). No differences were noted in the outcomes among the intervention groups. Although patients with hyperleukocytosis had higher incidences of pulmonary and metabolic complications than did those without, no early deaths occurred, and the complete remission, event-free survival, overall survival rates, and outcomes of both groups were similar.
CONCLUSION
LD-cytarabine treatment appears to be a safe and effective means of cytoreduction for children with AML and hyperleukocytosis.
Topics: Humans; Child; Cytoreduction Surgical Procedures; Leukocytosis; Leukemia, Myeloid, Acute; Leukocyte Count; Leukapheresis; Cytarabine
PubMed: 36943896
DOI: 10.1002/cncr.34751 -
Mayo Clinic Proceedings Jul 2010The association between malignancy and development of a paraneoplastic leukocytosis, the so-called leukemoid reaction, has long been appreciated. Although a leukemoid... (Review)
Review
The association between malignancy and development of a paraneoplastic leukocytosis, the so-called leukemoid reaction, has long been appreciated. Although a leukemoid reaction has conventionally been defined as a peripheral blood leukocytosis composed of both mature and immature granulocytes that exceeds 50,000/microL, a less profound leukocytosis may be appreciated in many patients harboring a malignant disease. More recent insights have shed new light on this long-recognized association, because research performed in both murine models and cancer patients has uncovered multiple mechanisms by which tumors both drive myelopoiesis, sometimes leading to a clinically apparent leukocytosis, and inhibit the differentiation of myeloid cells, resulting in a qualitative change in myelopoiesis. This qualitative change leads to the accumulation of immature myeloid cells, which due to their immune suppressive effects have been collectively called myeloid-derived suppressor cells. More recently, myeloid cells have been shown to promote tumor angiogenesis. Cancer-associated myeloproliferation is not merely a paraneoplastic phenomenon of questionable importance but leads to the suppression of host immunity and promotion of tumor angiogenesis, both of which play an integral part in tumorigenesis and metastasis. Therefore, cancer-associated myeloproliferation represents a novel therapeutic target in cancer that, decades after its recognition, is only now being translated into clinical practice.
Topics: Animals; CD11b Antigen; Cell Differentiation; Cocarcinogenesis; Disease Models, Animal; HLA-DR Antigens; Humans; Immune Tolerance; Inflammation; Leukemoid Reaction; Leukocytosis; Mice; Myeloid Cells; Myelopoiesis; Neoplasm Metastasis; Neoplasms; Neovascularization, Pathologic; Prognosis; Vascular Endothelial Growth Factor A
PubMed: 20592171
DOI: 10.4065/mcp.2010.0077 -
Clinical and Experimental Medicine Dec 2023Lymphomatosis cerebri (LC) is a rare type of primary central nervous system lymphoma with diffuse, nonenhancing infiltrative lesions and is often misdiagnosed. Our study...
Lymphomatosis cerebri (LC) is a rare type of primary central nervous system lymphoma with diffuse, nonenhancing infiltrative lesions and is often misdiagnosed. Our study aimed to investigate the clinical characteristics and prognosis of LC through analyzing patients from the literature and our own center, so as to improve early diagnosis and treatment. PubMed, Web of Science and our hospital databases were reviewed, and information on demographic, clinical, pathological, cerebrospinal fluid (CSF), neuroimaging and treatment options was extracted. Univariate survival analysis was conducted by generating survival curves and comparing them using the log-rank test. Multivariate analysis was performed using the Cox proportional hazards regression model to identify the prognostic predictors. A total of 81 patients (median age: 58 years; interquartile range, IQR: 50-66.5 years), 45 males and 36 females, were included. The most common symptoms were cognitive impairment (65.4%) and gait impairment (50.6%). Imaging studies indicated that all 81 patients had supratentorial structure involvement, and 93.8% (76/81) had bilateral hemisphere involvement. There were 53.3% (32/60) patients with CSF pleocytosis and 65% (39/60) patients with increased CSF protein levels. The median time of diagnosis was 4.8 months (IQR: 2.3-6.9 months). Compared with 4 (95% CI: 1.78-6.22) months for all 81 patients, the median OS was 20 (95% CI: 8.24-31.76) months for those who had chemotherapy plus radiotherapy. Multivariate Cox analysis revealed that chemoradiotherapy (HR: 0.12; 95% CI: 0.02-0.68) and higher CSF glucose level (HR: 0.01; 95% CI: 0.00-0.26) were inversely associated with death. The diagnosis of LC should be alerted when neuroimaging with bilateral hemispheric involvement and CSF abnormality with pleocytosis and increased protein. Once the diagnosis is confirmed, the combination of chemotherapy and radiotherapy can be considered if the patient's physical condition permits.Journal standard instruction requires an unstructured abstract. Kindly check and confirm.We have checked and confirmed that there is no problem.
Topics: Male; Female; Humans; Middle Aged; Leukocytosis; Prognosis; Survival Analysis; Retrospective Studies
PubMed: 37979126
DOI: 10.1007/s10238-023-01224-9 -
Medicine Jun 2021Aseptic meningoencephalitis is a rare central nervous system complication of relapsing polychondritis (RP).
RATIONALE
Aseptic meningoencephalitis is a rare central nervous system complication of relapsing polychondritis (RP).
PATIENT
We report a 61-year-old Japanese male patient with spiking fever and impaired consciousness. Neurological examination revealed meningealirritation, and cerebrospinal fluid (CSF) examination showed lymphocytic pleocytosis with elevated protein (199 mg/dL) and interleukin-6 (3810 pg/mL). Serological analysis showed high levels of anti-type II collagen antibodies, and the result of auricular biopsy was consistent with the diagnosis of RP showing cartilage degeneration surrounded by inflammatory cell infiltrations.
DIAGNOSIS
A clinical diagnosis of RP was made according to the diagnostic criteria established by MacAdams et al.
INTERVENTION
Steroid pulse therapy (methylprednisolone 1000 mg, consecutive 3 days) followed by oral prednisolone (60 mg/day) resolved the patient's high fever and disturbance of consciousness.
OUTCOMES
The patient rapidly improved after steroid treatments and has a normal quality of life under the maintenance dose of steroid plus methotrexate (4 mg/week).
LESSONS
RP-associated meningoencephalitis is a rare complication with significant morbidity and mortality. It should be considered and differentiated in patients with RP with unexplained spiking fever and impaired consciousness. In addition, the assessment of cerebrospinal fluid interleukin-6 levels may be useful to investigate the disease activity of RP-related meningoencephalitis. Further prospective studies are required to confirm this result.
Topics: Glucocorticoids; Humans; Interleukin-6; Leukocytosis; Male; Meningoencephalitis; Methylprednisolone; Middle Aged; Polychondritis, Relapsing
PubMed: 34128872
DOI: 10.1097/MD.0000000000026315 -
Respiratory Care Jan 2016Spurious hypoxemia has been described in case reports during extreme hyperleukocytosis and has led to recommendations for immediate cooling and analysis of arterial...
BACKGROUND
Spurious hypoxemia has been described in case reports during extreme hyperleukocytosis and has led to recommendations for immediate cooling and analysis of arterial blood gases (ABGs). We sought to determine, in samples processed as recommended, the magnitude of spurious hypoxemia in acute leukemia subjects with hyperleukocytosis.
METHODS
A retrospective chart review was conducted of all subjects admitted between 2003 and July 2014 for acute leukemia, who presented with white blood cell (WBC) count > 50 × 10(9) cells/L and had ABGs performed. For each ABG, we collected PaO2 , SaO2 , simultaneous WBC count, and SpO2 when available. Bland and Altman analysis was used to assess the agreement between SpO2 and SaO2 .
RESULTS
One-hundred forty-six samples (from 45 subjects) were included, of which 57 samples (from 18 subjects) had data available for Bland and Altman analysis. Mean (SpO2 - SaO2 ) was 2.5%, and 95% CI for limits of agreement between SpO2 and SaO2 was (-10.1,15.1)%. The mean (SpO2 - SaO2 ) was significantly higher for WBC count > 100 × 10(9)/L as compared with WBC count < 100 × 10(9)/L (3.8% vs 0.4%, P = .04), and the 95% CIs for limits of agreement were (-10.3,18)% versus (-7.9,8.6)%. SpO2 and SaO2 were poorly correlated (r(2) = 0.19), whereas the difference (SpO2 - SaO2 ) was fairly correlated with WBC count (r(2) = 0.44). Overall, 11 of 19 samples with WBC count > 150 × 10(9)/L had PaO2 < 55 mm Hg whereas SpO2 was > 94%, the proportion being 5 of 62 samples for WBC count < 150 × 10(9)/L (P < .001). Three subjects with WBC count > 150 × 10(9)/L exhibited large SpO2 to SaO2 differences (10-20%) before leukapheresis, which decreased to below 5% afterward.
CONCLUSIONS
In subjects with acute leukemia and hyperleukocytosis, despite cooling and quickly analyzing the samples, we observed poor correlation and agreement between SpO2 and SaO2 , unacceptably low for WBC count > 100 × 10(9)/L. Our results suggest that current guidelines may not totally prevent the diagnosis of spurious hypoxemia.
Topics: Aged; Blood Gas Analysis; Female; Humans; Hypoxia; Leukapheresis; Leukemia, Myeloid, Acute; Leukemia, Promyelocytic, Acute; Leukocyte Count; Leukocytosis; Male; Middle Aged; Oxygen; Partial Pressure; Retrospective Studies; Severity of Illness Index
PubMed: 26420901
DOI: 10.4187/respcare.04196 -
British Medical Journal Feb 1972
Topics: Hodgkin Disease; Humans; Leukemia; Leukocyte Count; Leukocytosis; Tuberculosis
PubMed: 5008655
DOI: No ID Found -
Stroke Jun 2016Acute leukocytosis is a well-established response to intracerebral hemorrhage (ICH). Leukocytes, because of their interaction with platelets and coagulation factors, may...
BACKGROUND AND PURPOSE
Acute leukocytosis is a well-established response to intracerebral hemorrhage (ICH). Leukocytes, because of their interaction with platelets and coagulation factors, may in turn play a role in hemostasis. We investigated whether admission leukocytosis was associated with reduced bleeding after acute ICH.
METHODS
Consecutive patients with primary ICH were prospectively collected from 1994 to 2015 and retrospectively analyzed. We included subjects with a follow-up computed tomographic scan available and automated complete white blood cell count performed within 48 hours from onset. Baseline and follow-up hematoma volumes were calculated with semiautomated software, and hematoma expansion was defined as volume increase >30% or 6 mL. The association between white blood cell count and ICH expansion was investigated with multivariate logistic regression.
RESULTS
A total of 1302 subjects met eligibility criteria (median age, 75 years; 55.8% men), of whom 207 (15.9%) experienced hematoma expansion. Higher leukocyte count on admission was associated with reduced risk of hematoma expansion (odds ratio for 1000 cells increase, 0.91; 95% confidence interval, 0.86-0.96; P=0.001). The risk of hematoma expansion was inversely associated with neutrophil count (odds ratio, 0.90; 95% confidence interval, 0.85-0.96; P=0.001) and directly associated with monocyte count (odds ratio, 2.71; 95% confidence interval, 1.08-6.83; P=0.034). There was no association between lymphocyte count and ICH expansion (odds ratio, 0.96; 95% confidence interval, 0.79-1.17; P=0.718).
CONCLUSIONS
Higher admission white blood cell count is associated with lower risk of hematoma expansion. This highlights a potential role of the inflammatory response in modulating the coagulation cascade after acute ICH.
Topics: Age Factors; Aged; Aged, 80 and over; Disease Progression; Female; Hematoma; Humans; Intracranial Hemorrhages; Leukocyte Count; Leukocytosis; Male; Middle Aged; Monocytes; Neutrophils; Predictive Value of Tests; Retrospective Studies; Sex Factors; Tomography, X-Ray Computed
PubMed: 27103016
DOI: 10.1161/STROKEAHA.116.013176 -
Tropical Medicine & International... Sep 2017Diagnosis of bacterial meningitis often requires cytometry, chemistry and/or microbiologic culture capabilities. Unfortunately, laboratory resources in low-resource... (Meta-Analysis)
Meta-Analysis Review
OBJECTIVE
Diagnosis of bacterial meningitis often requires cytometry, chemistry and/or microbiologic culture capabilities. Unfortunately, laboratory resources in low-resource settings (LRS) often lack the capacity to perform these studies. We sought to determine whether the presence of white blood cells in CSF detected by commercially available urine reagent strips could aid in the diagnosis of bacterial meningitis.
METHODS
We searched PubMed for studies published between 1980 and 2016 that investigated the use of urine reagent strips to identify cerebrospinal fluid (CSF) pleocytosis. We assessed studies in any language that enrolled subjects who underwent lumbar puncture and had cerebrospinal fluid testing by both standard laboratory assays and urine reagent strips. We abstracted true-positive, false-negative, false-positive and true-negative counts for each study using a diagnostic threshold of ≥10 white blood cells per microlitre for suspected bacterial meningitis and performed mixed regression modelling with random effects to estimate pooled diagnostic accuracy across studies.
RESULTS
Our search returned 13 studies including 2235 participants. Urine reagent strips detected CSF pleocytosis with a pooled sensitivity of 92% (95% CI: 84-96), a pooled specificity of 98% (95% CI: 94-99) and a negative predictive value of 99% when the bacterial meningitis prevalence is 10%.
CONCLUSIONS
Urine reagent strips could provide a rapid and accurate tool to detect CSF pleocytosis, which, if negative, can be used to exclude diagnosis of bacterial meningitis in settings without laboratory infrastructure. Further investigation of the diagnostic value of using protein, glucose and bacteria components of these strips is warranted.
Topics: Adolescent; Adult; Aged; Bacteria; Carboxylic Ester Hydrolases; Child; Child, Preschool; Health Resources; Humans; Infant; Infant, Newborn; Leukocyte Count; Leukocytes; Leukocytosis; Meningitis, Bacterial; Middle Aged; Reagent Strips; Sensitivity and Specificity; Spinal Puncture; Young Adult
PubMed: 28627004
DOI: 10.1111/tmi.12913 -
Medicina (Kaunas, Lithuania) Feb 2022: Secondary cerebral vasospasm (CV) with subsequent delayed cerebral ischemia (DCI) after aneurysmal subarachnoid hemorrhage (aSAH) remains an unpredictable pathology....
: Secondary cerebral vasospasm (CV) with subsequent delayed cerebral ischemia (DCI) after aneurysmal subarachnoid hemorrhage (aSAH) remains an unpredictable pathology. The aim of this retrospective study was to investigate the association between inflammatory parameters, white blood cell (WBC) count, and C-reactive protein plasma levels (CRP) and the occurrence of secondary CV in patients with aSAH. : The medical records of 201 Intensive Care Unit patients in Riga East University Hospital with aSAH were retrospectively reviewed in a 24-month period. WBC count and CRP values were observed at admission to the hospital and on the third day. According to the inclusion criteria, 117 (48 males) participants were enrolled for further analysis, with average age of 56 ± 15 years (mean ± SD). In total, secondary CV was diagnosed in 21.4% of cases, and DCI in 22.4% of cases. The patients were classified into three groups: SAH-CV group ( = 25), SAH-DCI group ( = 12), and SAH or control group ( = 80), for comparative analysis. : We found that SAH-CV patients demonstrated notably higher inflammatory parameters compared to controls: WBC 13.2 ± 3.3 × 10/L vs. 11.2 ± 3.7 × 10/L; = 0.01 and CRP median 9.3 mg/L vs. 1.9 mg/L; < 0.001, respectively. We found that the odds of developing CV increased by 5% for each CRP increase of 1 mg/L at admission (OR, 1.05; CI, 1.014-1.087; = 0.006). Concomitantly, the odds increased by 16% for every rise in WBC count of 1 × 10/L (OR, 1.16; CI, 1.02-1.32; = 0.02). WBC count was associated with the occurrence of CV with 96% sensitivity and 40% specificity, with a cut off level of 10.015 × 10/L and AUC 0.683; = 0.006. CRP displayed 54% sensitivity and 90% specificity with a cut off value of 8.9 mg/L and AUC 0.751; < 0.001. Moreover, higher values of inflammatory parameters at admission correlated with a longer stay in ICU (r = 0.3, = 0.002 for WBC count and r = 0.305, = 0.002 for CRP values), and poor outcome (death) was significantly associated with higher CRP values at admission and on the third day (16.1. vs. 2.2. and 57.4. vs. 11.1, < 0.001, respectively). Higher mortality was detected in SAH-CV patients (32%) compared to controls (6.3%; < 0.001). : Inflammatory parameters such as WBC count and CRP values at admission might be helpful to predict the development of secondary CV.
Topics: Adult; Aged; C-Reactive Protein; Female; Humans; Leukocytosis; Male; Middle Aged; Retrospective Studies; Subarachnoid Hemorrhage; Vasospasm, Intracranial
PubMed: 35208646
DOI: 10.3390/medicina58020323