[Clinical relevance of leukocyte differential in patients with marked leukocytosis in the emergency room]

White blood cell count and eosinopenia as valuable tools for the diagnosis of bacterial infections in the ED

Identifying an infection may be difficult in the ED. Neutrophilic leukocytosis is often used in the diagnosis of infection despite its lack of specificity in situations of stress. Our objective was to study the value of each parameter of the WBC count, in particular eosinopenia, to diagnose bacterial infections in the ED. We conducted a retrospective and observational study over a period of 6 months. All patients with one of the following diagnoses were eligible: pneumonia (9.9%), pyelonephritis (26.2%), prostatitis (8.4%), appendicitis (26.2%), cholecystitis (8.4%), and diverticular sigmoiditis (5%). A total of 466 infected patients were included for statistical analysis, and a control group of 466 uninfected patients was randomly selected in the same period of time. All leukocyte count parameters were significantly modified (p < 0.001) in the infected group compared with the control group. Neutrophils and total leukocytes remain the two most suitable parameters for the diagnosis of infections in the ED. Eosinopenia represented the most efficient parameter of the WBC count for the diagnosis of urinary and biliary tract infections. Deep eosinopenia presented a specificity of 94% for the diagnosis of infection. Any modification of the WBC count associated with an elevation of CRP (> 40 mg/L) or fever (> 38.5 °C) showed a high specificity for the diagnosis of infection. A careful analysis of the WBC count remains a valuable tool for the diagnosis of infection in the ED.

[Blood count results from hypertensive patients seen in laboratory of CHU-HJRB Antananarivo in 2013]

INTRODUCTION

The blood count is a routine laboratory test prescribed to patients suffering from high blood pressure. This study aims to describe the results of blood count from hypertensive patients and to identify conditions associated.

METHODS

This retrospective and descriptive study concerns the period from the 1st of December 2012 to 31 th of December 2013 in the laboratory of University Hospital Center CHU-HJRB of Antananarivo. All records of results from hypertensive patients who requested blood count have been exploited.

RESULTS

Among 151 hypertensive patients, 91 (60.3%) had pathological blood counts. Of these, 64 (70.4%) showed one type of abnormality and 27 (29.6%) had multiple abnormalities. The anaemia (33.91%), the leukocytosis (33.04%), the polycythemia (10.43%) and the leukopenia (9.57%) are the most frequent. Among the multiple abnormalities, anaemia associated with leukocytosis is the most observed (29.6%). The microcytosis anaemia (41%) and the neutrophil polymorphonuclear leukocytosis are the most dominant (47.4%). Patients in nephrology (90%) and in endocrinology (81.3%) are the most concerned (p = 0,008). Hypertensive under 20 years old (100%) and women (61.5%) are the most affected (p > 0, 05). The seizures (100%), the edema of the lower limbs (100%) and diabetes (70%) are the signs and pathology most encountered.

CONCLUSION

The blood count should be prescribed for all hypertensive patients to identify the affections that will be treated simultaneously with the high blood pressure. Thus, hypertensive patients will have a good follow-up and their life expectancy will be improved.

[Relevance of eosinopenia as marker of sepsis in the Emergency Department]

BACKGROUND

Several studies in internal medicine departments and in intensive care units have shown the interest of eosinopenia in the diagnosis of infected patients. The aim of the present study was to test the value of this marker in the Emergency Department (ED), either alone or associated with other common sepsis markers.

METHODS

We report on a retrospective and monocentric study. We reviewed the complete blood count (CBC) of all patients visiting the ED during one-week duration (in February 2014). Every element of the CBC and other inflammation markers (such as CRP) were analyzed.

RESULTS

During the week of our study, 725 patients had a CBC (33 exclusions) and 692 patients were included for analysis. The median age was 59 years (IQR: 16-100). One hundred and twenty-five patients (18.1%) had a sepsis. The ROC curve demonstrated a cut off level of 10/mm³ eosinophils for which the specificity for sepsis was 91%. The association of eosinopenia (< 10/mm³) and white blood cells (WBC) or CRP elevation also showed a good specificity in patients with sepsis.

CONCLUSION

In the ED, with a "simple" CBC, a profound eosinopenia appears to be very specific for sepsis, alone or in association with other markers of inflammation. Eosinopenia may become a helpful tool in our daily practice in the ED. Further studies are needed to further evaluate this marker.

[Initial patient assessment of infectious diseases and diagnostic steps with fever]

The initial assessment of patients with infectious diseases is challenging because of the extremely broad differential diagnosis as well as different host pathogen interactions influenced by a different immune status. The formal initial assessment, including the present and past medical history, thorough physical examination, clinical first impressions as well as routine laboratory analyses, is the basis of every preliminary diagnosis. Specific chief complaints have to be recognized in order to narrow down the differential diagnosis. In cases of life-threatening illnesses, such as septicemia, endocarditis, bacterial meningitis and severe pneumonia, the first diagnostic and therapeutic steps should be performed in a rapid sequence: bacterial blood samples, sputum and/or liquor samples are required and the initial antibiotic therapy has to be chosen empirically as the relevant bacterial spectrum related to the suspected illness must be covered. In less urgent cases it is recommended that a multi-step diagnostic approach be carried out which takes the differential diagnosis into account and prioritizes the probabilities. In the latter situation antibiotic treatment should be delayed to diagnose the infection correctly. Importantly, atypical courses must necessitate careful and critical reassessment of the diagnosis.