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Acute abdomen in pregnancy
Published in Hung N. Winn, Frank A. Chervenak, Roberto Romero, Clinical Maternal-Fetal Medicine Online, 2021
Nicole Fearing, William L. Holcomb
The physiologic leukocytosis (as high as 15,000/mm3) during pregnancy and the wide range of normal values limit the usefulness of the leukocyte count for the diagnosis of appendicitis (21). Severe disease may be present when the leukocyte count is normal (20). Greater than 80% polymorphonuclear leukocytes are often present when appendicitis complicates pregnancy (21,25). Again, however, the test is not sufficiently sensitive to rule out disease and it discriminates poorly between those patients with and those without appendicitis. Ten to twenty percent of pregnant patients with appendicitis have an abnormal urinalysis, usually showing pyuria alone (25,27). Bacteriuria indicates a urinary tract infection. Asymptomatic bacteriuria is common enough in pregnancy that it may well occur coincidentally with appendicitis (31). Ultrasound may be the initial radiologic evaluation tool for diagnosis of appendicitis. However, it may be variable in its results due to operator performance, the gravid uterus, or a retrocecal appendix. MRI and CT are gaining popularity as evaluation tools. A recent systematic review from 2009 showed good sensitivity and specificity of both when ultrasound was normal or inconclusive (18).
Tuberculosis in Childhood and Pregnancy
Published in Lloyd N. Friedman, Martin Dedicoat, Peter D. O. Davies, Clinical Tuberculosis, 2020
Lindsay H. Cameron, Jeffrey R. Starke
Confirming a diagnosis of tuberculous meningitis can be extremely difficult. The TST and IGRAs are negative in up to 50% of cases, and 20%–50% of children have a normal chest radiograph.76 The most important laboratory test for the diagnosis of tuberculous meningitis is examination and culture of the lumbar cerebrospinal fluid (CSF). The CSF leukocyte count usually ranges from 10 to 500 cells/μL. Polymorphonuclear leukocytes may be present initially and may portend a poorer prognosis, but a lymphocyte predominance is more typical. The CSF glucose is usually between 20 and 40 mg/dL, whereas the CSF protein level is elevated and may be markedly high (400–5,000 mg/dL). The success of the microscopic examination of stained CSF and mycobacterial cultures correlates with the volume of the CSF sample. When a minimum of 10 mL of lumbar CSF is available, the acid-fast stain of the CSF sediment is positive in up to 30% of cases and the culture is positive in up to 70% of cases. Unfortunately, a volume of 1–2 mL is usually all that can be obtained from a young child. Polymerase chain reaction (PCR) testing of the CSF can improve diagnosis. Cultures of other body fluids can help confirm the diagnosis.
The Hematologic 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
On rare occasions the bone marrow may completely stop producing erythrocytes, a condition called aplastic anemia, Aplastic anemia usually results from exposure of bone marrow to toxic chemicals, antineoplastic agents, or large doses of ionizing radiation, so the onset is rapid. The red blood cells already in circulation are normal (normochromic and normocytic), but the RBC count progressively diminishes since aging cells are no longer replaced. Concomitantly, leukocyte and thrombocyte production are also affected, so the patient exhibits leukopenia (decreased leukocyte count) and thrombocytopenia.
Association of maternal neutrophil count in early pregnancy with the development of gestational diabetes mellitus: a prospective cohort study in China
Published in Gynecological Endocrinology, 2022
Man Kong, Hongmei Zhang, Xianchang Liu, Yanyan Ge, Zhen Zhang, Rui Zhao, Yan Li, Shanshan Huang, Guoping Xiong, Xuefeng Yang, Liping Hao, Zhongxin Lu
Insufficient glucose control appears to be linked to adverse outcomes in GDM patients. However, evaluating insulin resistance to identify GDM may harm both the mother and fetus. Therefore, the oral glucose tolerance test is not recommended in early pregnancy to diagnose GDM [4]. However, once pregnant women are diagnosed with GDM, they should undergo clinical intervention, which puts considerable pressure on medical resources and incurs the financial burden of additional medical expenses. For these reasons, finding and evaluating other risk factors for GDM in early pregnancy may assist early treatment. Previous studies have shown that subclinical inflammation is involved in the pathophysiology of T2DM and GDM [5–7]. Leukocyte count has been widely used as a biomarker of systemic inflammation. Activated platelets secrete high levels of chemokines and also carry numerous inflammation-associated surface receptors [8]. Several studies showed an abnormal increase in inflammatory blood cell parameters including leukocyte count, neutrophil count, and the neutrophil-to-lymphocyte ratio, which usually serve as simple markers of inflammation for their ability to predict GDM, but the studies were marred by inadequate sample sizes and conflicting findings [9–12]. In this context, we used a prospective cohort study to evaluate the possible relationship between inflammatory blood cell levels and the risk of developing GDM.
Myeloid/lymphoid neoplasm with CEP110-FGFR1 fusion: An analysis of 16 cases show common features and poor prognosis
Published in Hematology, 2021
Meiyu Chen, Kai Wang, Xiaohui Cai, Xiuwen Zhang, Hongying Chao, Suning Chen, Hongjie Shen, Qian Wang, Ri Zhang
A 35-year-old female was presented with fatigue and purpura of 2-week duration in June 2016. She had no organomegaly. Initial investigations showed a leukocyte count of 62.99 × 109/L (neutrophils 30.87%, lymphocytes 7.0%, monocytes 5.0%, eosinophils 17.0%, and basophils 0%), haemoglobin 117 g/L, platelets 113 × 109/L. A high lactate dehydrogenase (LDH) was observed (540U/L; normal, <240 U/L). Bone marrow(BM) specimen showed hypercellularity with hypereosinophilia (28.0%). However, no definite blasts were found (Figure 1(a,b)). There was no evidence of parasitic allergic, or other known causes of eosinophilia. Testing for 4q12 PDGFRA, 5q33 PDGFRB, or 9q34 ABL1 gene rearrangements by fluorescence in situ hybridization (FISH) was also negative. Bone marrow cytogenetics revealed the translocation 46,XY,t(8;9) (p11;q33) in 15/17 metaphases, whereas FISH identified rearrangement of the FGFR1. Analysis by reverse transcriptase polymerase chain reaction analysis (RT–PCR) and sequencing revealed an in-frame CEP110-FGFR1 fusion transcript with a breakpoint at exon 38 of the CEP110 gene and exon 9 of the FGFR1 gene (Figure 1(c)). We detected the molecular mutations in the patient using next-generation sequencing (NGS) and DNA-based PCR Sanger sequencing of 51 genes known or suspected to have a role in myeloid malignancies, and identified one mutation, RUNX1p.Pro359fs, in BM samples at diagnosis. A definitive diagnosis of EMS was reached.
Clinical and biochemical differences between hantavirus infection and leptospirosis: a retrospective analysis of a patient series in Belgium
Published in Acta Clinica Belgica, 2020
Emma Bakelants, Willy Peetermans, Katrien Lagrou, Wouter Meersseman
Blood results are shown in Table 2. Ten patients had normal hemoglobin, the other six patients had normochromic, normocytic anemia. A raised leukocyte count was observed in four patients. White blood cell differentiation showed a tendency to lymphocytopenia and monocytosis. Eleven patients had thrombocytopenia, four patients had normal values of platelets, one patient had thrombocytosis. C-reactive protein (CRP)-reached variable values, spreading from 12.9 mg/l to 231.8 mg/l. Median value was 67.6 mg/l. Eleven patients presented with acute kidney failure. In our center acute kidney failure is defined as a creatinine value above 1.17 mg/dl. Four patients also had hypoalbuminemia. Eight patients had elevated transaminases. Total bilirubin was elevated in two patients. Seven patients had normal liver tests. Although myalgia was a frequent complaint, creatine kinases (CK’s) were elevated once. Lactate dehydrogenase (LDH) was elevated in 12 patients.