Novel Parameters of Extended Complete Blood Cell Count Under
Novel Parameters of Extended Complete Blood Cell Count Under
Novel Parameters of Extended Complete Blood Cell Count Under
Background: We first describe a patient tion, patients with limited infections, and pa-
who developed urosepsis from an ordinary tients with sepsis. Data were collected with
urinary tract infection. In this case, the a Sysmex XE-5000 hematological analyzer.
new hematological parameters of immature Results: In patients (n = 22) without any
leukocytes, that is, the high-fluorescence signs of infection, both values are very low.
lymphocyte cell (HFLC) and immature gran- In patients with limited local infections (n
ulocyte (IG) counts peaked early, whereas = 10), moderate elevations of the IG and
the established infection parameters, that HFLC counts are seen. In patients with sep-
is, C-reactive protein (CRP) and total white sis (n = 6), the IG and HFLC counts are
blood cell count showed less dynamic re- significantly higher. Conclusion: The total IG
garding infection and therapy. Methods: To count seems to be useful for distinguishing a
investigate this phenomenon in greater de- septic patient from a nonseptic (P < 0.004).
tail, the novel parameters HFLC and IG Hematological parameters have the advan-
counts are investigated retrospectively in a tage of being measured easily during rou-
cohort of 38 patients who were admitted to tine blood cell analysis. J. Clin. Lab. Anal.
the anesthesia intensive care unit. Three 28:130–135, 2014.
C 2014 Wiley Periodi-
C 2014 Wiley Periodicals, Inc.
New Parameters of the Blood Cell Count and Sepsis 131
1000
100
Leuko
values / concentration
IG%
HFLC%
10 PCT [ng/ml]
CRP [mg/l]
Temperature
Linear (Temperature)
1
0 2 4 6 8 10 12 14
0,1
days
Reference values
CRP <0.5 mg/L
PCT <0.5 ng/mL
Fig. 1. Case study of a patient who developed urosepsis from an ordinary urinary tract infection. Although the conventional parameters CRP
(∼200 mg/l), leukocytes (∼10 109 /l), and PCT (∼1 ng/l) did not show any change in response to the onset of sepsis, the new parameters derived
from blood cell counts, percentage of HFLC and IG, were significantly increased from day 7 onwards and dynamically reacted in response to
antibiotic therapy. CRP in milligram per liter reference range <0.5mg/l; PCT in nanogram per milliliter reference range <0.5 ng/l; leukocytes in
109 /l, reference range 3.8–9.8 . 109 /l.
9
9
HFLC# / [10 /l] IG/ [10 /l]
0.15 0.8
* 0.6 *
0.10
IG# 0.4
HFLC
0.05
0.2
0.00 0.0
Fig. 2. This figure gives the key findings and demonstrates it in absolute cell counts. Differences in absolute amounts of HFLCs and absolute
amounts of IGs among patients with no infections (n, N = 22), patients with local infections (i, N = 10), and patients with sepsis (s, N = 6). All
of the patients with sepsis had elevated IG-cell counts, and two septic patients had increased HFLC counts. *Significant difference based on the
unpaired t-test (P < 0.01).
Based on microbiological evidence of sepsis, it was con- 2). Blood samples for the analysis of complete blood cell
cluded that the patient was infected with several bacterial count were obtained by venipuncture within the first 24
pathogens. These pathogens were later identified in the mi- hr of ICU admission. The blood samples were drawn
crobiological laboratory as Pseudomonas aeruginosa and into ethylene diamine tetra acetic acid tubes (Sarstedt,
extended spectrum beta-lactamase (ESBL) positive Es- Nümbrecht, Germany) and were transported to the
cherichia coli. As part of the immune response, the patient chemical and hematological laboratory department. All
also started to develop a proliferation of neutrophil gran- analyses were performed within 45–60 min after blood
ulocytes in the sense of a left shift, including immature sampling.
and adult leukocytes. These increases in immature blood
cell populations were compared to the classical inflamma-
Statistical Methods
tory serum parameters, CRP, and PCT, as well as to the
total white blood cell (WBC) count. All cell counts are Statistical calculations were performed with SPSS
measured on a Sysmex XE 5000 hematological analyzer. Statistics software (IBM, 2011) and with R-project soft-
ware. An unpaired Student’s t-test was used to test for
statistical differences.
Study Collective
To determine the clinical relevance of the new extended
RESULTS
blood cell count parameters in greater detail, HFLCs and
IGs were measured in the whole blood of 38 patients from Including the patient with urosepsis, the changes within
the ANE-ICU following surgical interventions, together the cellular parameters in detail, the HFLC and IG counts
with routine laboratory measurements. The results were were present before any changes in the cytokine levels were
collected and statistically analyzed retrospectively. Sys- measurable. Therefore, it is possible that cellular prolifer-
temic inflammatory host response (SIRS) was defined ac- ation occurs more quickly than any serum changes. Fig-
cording to the ACCP/SCCM consensus criteria (27) with ure 1 gives the different inflammatory values as CRP and
the presence of two or more of the following symptoms: PCT and the different cell counts in comparison for the
patient with urosepsis.
r Fever, with a body temperature of <38◦ C, or hypother- Figure 2 provides an overview of the results from this
mia, with a temperature <36◦ C. study. In patients without any signs of an additional
r Tachycardia, with a heart rate of <90 beats/min. infection (n = 22), the HFLC and IG counts were very
r Tachypnea, with a respiratory frequency of <20, or low. The reference range for both the HFLC and IG
hyperventilation (pCO2 < 4.3 kPa). and/or counts is <0.01 Gpt/l (<0.2%). For patients with local
r Leukocytosis (>12 Gpt/l) or leukopenia (<4 Gpt/l) or limited infections (n = 10), such as urinary tract infections
<10% bands or left shift. and infected wounds, these values increased slightly. In
contrast, IG values (absolute number and %) were greatly
SIRS is a precondition for the diagnosis of sepsis. Sepsis increased in all of the patients with sepsis (n = 6), two of
was defined as the presence of SIRS (condition 1) and whom had HFLC values that were also clearly increased.
an additional proven microbiological etiology (condition The changes in IG values between the patients without
Number 10 22 6
Age [years] 56 58 63
Gender
Male 6 15 3
Female 4 7 3
Previous diseases with relation to Yes, patients are Yes, patients are postoperation Yes, patients are postoperation, and/or with
the actual hospitalization postoperation and/or with traumata traumata, and/or liver cirrhoses, and/or other
organ failures, and/or multiorgan failures
Clinical status Stable Stable Critical
Immature lymphocytesa n-HFLC i-HFLC s-HFLC
Immature granulocytesa n-IG i-IG s-IG
signs of an infection and the patients with sepsis were though the immature cell count differed significantly from
statistically significant (P < 0.01). These results suggest the established inflammatory markers CRP and PCT. Of
that the parameters of the newly extended blood cell note, the novel parameters were slower to normalize fol-
count could become the basis of novel approaches for lowing the initiation of antibiotic therapy, in contrast to
diagnosing and treating sepsis. The changes became more the rapid decrease in the serum markers of CRP and PCT.
extensive with the degree of disease. Patients with sepsis Even after the patient was discharged from the ICU to the
demonstrated higher values than patients with moderate regular floor, the immature cell count levels still had not
local infections who, in turn, had higher values than did decreased, whereas the inflammatory marker PCT had
those patients without any signs of infection. Table 1 already normalized. The present case revealed that the
gives an overview of the three different patient groups immature cells demonstrated a faster increase in number
investigated here: patients without signs of infection, compared to the older, more established cells; however, the
patients with local infections, and patients with sepsis. immature cells seemed to normalize much more slowly.
HFLCs. This result might have occurred because most 3. Nahm C, Choi J, Lee J. Delta neutrophil index in automated im-
severe sepsis cases are caused by bacteria and granulo- mature granulocyte counts for assessing disease severity of patients
with sepsis. Ann Clin Lab Sci 2008;38(3):241–246.
cytes and therefore also IGs are more sensitive to bacteria,
4. Schottmüller H, Bingold K. Die Septische Erkrankung. Handbuch
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the present study, by counting immature cells, it is possible 538.
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The present study has several limitations. These 13. Brun-Buisson C, Doyon F, Carlet J. Bacteremia and severe sepsis
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Crit Care Med 1996;154:617–624.
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15–21.
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ture clinical cases of sepsis patients can be generated. This 17. Shiga S, Fujimoto H, Mori Y, et al. Immature granulocyte count
after liver transplantation. Clin Chem Lab Med 2002;40:775–
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The newly extended blood cell count parameters de- 18. Nigro K, O’Riordan M, Molloy E, Walsh M, Sandhaus L. Perfor-
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sepsis and for monitoring the effectiveness of their treat- of neonatal sepsis. Am J Clin Pathol 2005;123:618–624.
ment. This has to be investigated in future studies in more 19. Davis H, Bigelow N. Comparison of neutrophil CD64 expression,
manual myeloid immaturity counts, and automated hematology
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