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Haematology
Published in Michael McGhee, A Guide to Laboratory Investigations, 2019
Morphological descriptions of neutrophilsShift to the left: the presence of immature granulocytes. It occurs as a reaction to pyogenic bacterial infection or after burns or haemorrhage.Shift to the right (hypersegmented neutrophils): the appearance of neutrophils with >5 nuclear lobes. Characteristic of vitamin B12 or folate deficiency when accompanied by macrocytosis or renal failure, or as a congenital anomaly in the absence of macrocytosis.Toxic granulation: seen in infections and other toxic states, and is of no special significance.Leucoerythroblastic anaemia: occurs in severe infections, myeloproliferative disorders and in cases where infiltration of the bone marrow has occurred. A bone marrow biopsy is mandatory.
Non-specific Laboratory Tests in the Critical Care Unit
Published in Cheston B. Cunha, Burke A. Cunha, Infectious Diseases and Antimicrobial Stewardship in Critical Care Medicine, 2020
An elevated WBC count as well as an increase in the number of immature polymorphonuclear cells (i.e., bands) in the leukocyte differential count have long been considered as markers for infection in a febrile CCU patient [19–21]; however, the band neutrophilia contributes relatively little new information beyond that provided by an elevated WBC. Inflammation due to non-infectious causes as well as due to other factors such as young age [22] and demargination of WBCs after steroid use [23,24] was also recognized to contribute to leukocytosis, which made the use of this marker somewhat controversial [25]. Moreover, the clinical use of the WBC count and the leukocyte differential count as markers for bacterial infection was interrupted in the 1990s by the introduction of fully automated hematology analyzers [26–31]. Evaluation of these automated hematology analyzers found that in normal patients and in patients with reactive disorders, the analyzers’ automated differential provides true and accurate results. The diagnostic value of the elevated WBC and the neutrophil left shift in predicting inflammatory and infectious processes has continued to be evaluated using automated hematology analyzers [32–39]. A number of conclusions have been made from these studies. The first, and most important, is that an elevated WBC count has many potential etiologies. A repeat complete blood count with peripheral smear often provides helpful information, with the findings of immature granulocytes (i.e., bands) and toxic granulation suggesting infection. Stressors capable of producing an increase in WBCs include surgery, exercise, trauma, and emotional stress [38]. Leukocytosis is a common finding in infection, and an elevated WBC with immature granulocytes and toxic granulation should prompt clinicians to look for other signs and symptoms of infection.
Detection of abnormal lymphocytes in the peripheral blood of COVID-19 cancer patients: diagnostic and prognostic possibility
Published in Hematology, 2022
Lobna Refaat, Mona S. Abdellateif, Ahmed Bayoumi, Medhat Khafagy, Eman Z. Kandeel, Hend A. Nooh
While the morphological abnormalities detected in the neutrophils in COVID-19 patients were toxic granulation, cytoplasmic vacuolization, aberrant nuclear projections, and/or abnormal nuclear shapes such as pi-shaped nuclei, fetus-shaped nuclei, C and donut-shaped nuclei. The pseudo-Pelger-Huet abnormality and smudged neutrophils were also seen [14,15,19]. Regarding the monocytes, it showed large coalescing cytoplasmic vacuoles, clumped chromatin, and granulations [15,19,20]. These changes were attributed to the infection of the virus to monocytes through the ACE2 receptors, and the response of monocytes to the virus by vacuolization and increased granulation is seen morphologically, in addition to the increased expression of CD80. The CD206 and secretion of IL6, IL10, and TNFα were detected as a part of the hyper inflammation state [13]. While platelets appeared giant and clumping [15,20].
“The Value of Clinical Examination in Preterm Newborns after Neonatal Sepsis: A Cross-sectional Observational Study.”
Published in Developmental Neurorehabilitation, 2022
Marina Ortega Golin, Fabíola Isabel Suano Souza, Laércio da Silva Paiva, Roseli Oselka Sacardo Sarni
Laboratory parameters included: complete blood count with three or more altered parameters according to Rodwell et al18 and/or C-reactive protein > 0.5 mg/L; negative or not performed blood culture; no evidence of infection at another site; and established and maintained antimicrobial therapy. Rodwell et al18 considered the following hematological parameters: leukocytosis (white blood cells [WBC] ≥ 25,000 at birth, or ≥ 30,000 between 12 to 24 hours, or > 21,000 at over 48 hours of life), leukopenia (WBC ≤ 5,000); neutrophilia or neutropenia; increased number of immature neutrophils; increased neutrophilic index; ratio of immature over segmented neutrophils ≥ 0.3; neutrophils with toxic granulation and vacuolization; and thrombocytopenia Neonatal sepsis: risk factor for development 295 (< 150,000 platelets).
A New Zealand White rabbit model of thrombocytopenia and coagulopathy following total body irradiation across the dose range to induce the hematopoietic-subsyndrome of acute radiation syndrome
Published in International Journal of Radiation Biology, 2021
Isabel L. Jackson, Ganga Gurung, Yannick Poirier, Mathangi Gopalakrishnan, Eric P. Cohen, Terez-Shea Donohue, Diana Newman, Zeljko Vujaskovic
Results of repeat hematological analysis demonstrated a progressive decline in white blood cell (WBC) counts over the course of the first five days post-exposure (Figure 2(A)). The WBC nadir was radiation dose-dependent with the lowest counts observed on approximately the 5th day post-TBI in the 8.5 and 9.5 Gy arms. Lymphocytes were depleted as early as the first-day post-exposure (Figure 2(B)). At this time, neutrophil mobilization was evident and was followed by a rapid decline through day 3 post-TBI (Figure 2(C)). This was followed by a transient rise in absolute neutrophil count prior to a second wave of decline between days 10 and 15 (Table 1). Features of infection and sepsis, such as toxic granulation and left shift of neutrophils on peripheral blood smears were infrequent or absent, respectively.