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The patient with acute cardiovascular problems
Published in Peate Ian, Dutton Helen, Acute Nursing Care, 2020
The normal WBC count in adults is 4–11 × 109/L, and when an infection is present, the WBC count may be significantly raised. A white cell count above 11 × 109/L is known as leucocytosis. An abnormally low WBC count, below 4 × 109/L, is known as leukopenia and can be caused by factors such as corticosteroids and chemotherapy drugs. Leukopenia renders the individual vulnerable to infections of all types. Problems related to infection and sepsis are discussed in Chapter 12.
Diagnostic Reasoning and Clinical Problem Solving
Published in Cheston B. Cunha, Burke A. Cunha, Infectious Diseases and Antimicrobial Stewardship in Critical Care Medicine, 2020
The diagnosis significance of leukocytosis (with or without an L shift) is often given undue Dx significance. At best, in a critically ill patient, leukocytosis is a measure of stress (ill in the CCU) and not infection per se. Of much greater diagnostic significance is leukopenia. If present, otherwise-unexplained leukopenia points to a viral etiology in a CAP patient. Leukopenia can also serve as DxE in some CAP cases, e.g., Legionnaire’s disease. Legionnaire’s disease is consistently accompanied by a marked leukocytosis. Therefore, the presence of in patient where Legionnaire’s disease is in the DDx should eliminate it from further diagnostic consideration. Of more diagnostic usefulness is relative lymphopenia. Once again, this, like all other diagnostic findings, is useful only if otherwise unexplained. In a severe CAP patient, relative lymphopenia points to Legionnaire’s disease, CMV, or influenza as the likely cause of CAP.
The Lymphatic/Immune System and Its Disorders
Published in Walter F. Stanaszek, Mary J. Stanaszek, Robert J. Holt, Steven Strauss, Understanding Medical Terms, 2020
Walter F. Stanaszek, Mary J. Stanaszek, Robert J. Holt, Steven Strauss
Since the lymphatic system is involved in immunity, infections are a common result of lymphatic disorders. When any part of the immune system is suppressed, as by drugs that cause leukopenia, any lymphadenopathy (disease of the lymph nodes), or lymphangitis (inflammation of the lymph vessels), the individual may become immunocompromised. Such immunosuppression may also be an intended or unavoidable result of drug therapy, as in the transplant patient who is on immunosuppressive therapy to reduce the risk of rejection or the cancer patient being treated with antineoplastic agents. These agents suppress the immune system because the immune cells are produced more rapidly than most others, making them more susceptible to the cytotoxic effects of these drugs.
Time to incorporate preemptive NUDT15 testing before starting thiopurines in inflammatory bowel disease in Asia and beyond: a review
Published in Expert Review of Clinical Pharmacology, 2023
Devendra Desai, Anuraag Jena, Vishal Sharma, Toshifumi Hibi
Some of the above-mentioned guidelines recommend preemptive testing for NUDT15 polymorphism. However, many gastroenterologists do not recommend it prior to initiating thiopurine therapy. Some clinicians start in doses as low as 25 or 50 mg daily. This approach should work in most patients, except in patients who have homozygous variant. Three of 153 (1.96%) patients in our database had homozygous NUDT15 variant (unpublished observation). In Tables 1 and 2, the proportion of patients with TT genotype is up to 7%. In these patients, this approach (no preemptive NUDT15 testing) will result in early leukopenia, risk of infections and death. Another aspect which needs to be considered in these patients is the delay in achieving the therapeutic thiopurine metabolite level. The medicolegal consequences of leukopenia are not clearly defined.
When breast cancer comes to the ICU: outcomes and prognostic factors
Published in Acta Oncologica, 2023
Clara Vigneron, Julien Charpentier, Florence Coussy, Jérôme Alexandre, Frédéric Pène, Matthieu Jamme
Seventy-five patients (42.4%) were admitted because of non-specific complications, mainly infection (n = 56, 31.6%) and thrombo-embolic events (n = 6, 3.4%) (Table 2). Eight patients (8.4%) exhibited leukopenia at admission. Forty-seven patients (26.6%) were admitted because of specific complications, mainly pleural effusion (n = 10, 5.6%), hypercalcemia (n = 10, 5.6%), neurological complications (n = 5, 2.8%) and thrombotic microangiopathy (n = 4, 2.3%). Drug-related and procedural adverse events accounted for 11 (6.2%) and 8 (4.5%) admissions. The median SOFA score at admission was 5 points [4–8]. Seventy-two (40.7%) patients required invasive mechanical ventilation, 57 (32.2%) vasopressors or inotropes, and 26 (14.7%) renal replacement therapy during the ICU stay.
Managing adult patients with infectious diseases in emergency departments: international ID-IRI study
Published in Journal of Chemotherapy, 2021
Hakan Erdem, Sally Hargreaves, Handan Ankarali, Hulya Caskurlu, Sevil Alkan Ceviker, Asiye Bahar-Kacmaz, Meliha Meric-Koc, Mustafa Altindis, Yasemin Yildiz-Kirazaldi, Filiz Kizilates, Jameela Alsalman, Yasemin Cag, Abu Hena Mostafa Kamal, Ilyas Dokmetas, Emine Kubra Dindar-Demiray, Ghaydaa Ahmed Shehata, Hakan Hasman, Ainur Sadykova, Ferran Llopis, Ergys Ramosaco, Mateja Logar, Handan Alay, Fatma Kesmez-Can, Yvon Ruch, Dilek Bulut, Mateja Jankovic Makek, Andrea Marino, Amjad Mahboob, Amani El-Kholy, Dirar Abdallah, Merve Sefa-Sayar, Ridvan Karaali, Selda Aslan, Razi Even Dar, Esam Abdalla, Helena Monzón-Camps, Rusmir Baljić, Dumitru Irina Mgdalena, Behrouz Naghili, Mohamed Elhassan Abbas Dafalla, Ameen S.S. Alwashmi, Cernat Roxana Carmen, Sergio Ramirez-Estrada, Marzena Wojewodzka-Zelezniakowicz, Ozay Akyildiz, Joanna Zajkowska, Rehab El-Sokkary, Nirav Pandya, Fatma Amer, Ilad Alavi-Darazam, Svjetlana Grgić, Ahmed Ashraf Wegdan, Jehan El-Kholy, Cansu Bulut-Avsar, Sholpan Kulzhanova, Meltem Tasbakan, Hema Prakash Kumari, Natalia Dirani, Kalyan Koganti, Aidos K. Konkayev, Michael M. Petrov, Antonio Cascio, Anna Liskova, Rosa Fontana Del Vecchio, Lorenza Lambertenghi, Nikolay Mladenov, Serkan Oncu, Jordi Rello
Microbiological diagnosis was applied in 178 (9.1%) patients. Urine (n = 34), blood (n = 24), sputum (n = 22), stool (n = 6), wound (n = 11), abscess (n = 4) cultures, and others (n = 4). Stool microscopy (n = 20), Gram stain (n = 9), CSF analysis (n = 1), influenza tests [n = 11; card test (n = 7), GeneXpert (n = 4)], PCR testing (n = 12), Rose-Bengal test (n = 2), immunochromatography for Streptococcus pyogenes (n = 6), virus isolation (n = 2), urine pneumococcal antigen test (n = 1), MALDI-TOF Mass Spectrometry (n = 1). In 448 (45.3%) out of 988 patients white blood cell count (WBC) was reported, there was leukocytosis and in 58 (5.9%) patients leucopenia was detected. The median of WBC was 10200 cells/ml (IQR, 7300-14000).