The reactive lymphocyte: a morphological indicator of Platelet counts in Dengue seropostive patients
Keywords:
Dengue, lymphocyte, thrombocytopenia, leukopenia, peripheral smear
Abstract
BACKGROUND: Dengue fever is an emerging cause of morbidity and mortality , i tropical countries, with increasing global incidences reaching epidemic proportions. Infected humans show rapid progression to severe and fatal outcomes based on their immunity . The peripheral smear is a cost effective and simple investigation, which provides a plethora of valuable information METHODS: This cross sectional study was carried out by studying the peripheral smears of seropositive dengue patients admitted in our hospital on day one of admission. Total leukocyte counts, absolute lymphocyte counts, platelet counts along with a detailed morphological assessment of reactive lymphocytes were done concurrently by three pathologists in a total of 300 cases with thrombocytopenia. Of these 100 cases each were in the three categories of thrombocytopenia >1,00000 (1), 51 – 10,00,000(2) < 50000(3).The size, basophilia, chromatin, nucleoli, cytoplasm and rosetting of RBCs with skirting were assessed in the reactive lymphocytes.RESULTS: It was observed that reactive lymphocytes almost the same size , having the same amount of cytoplasm as a mature lymphocyte ,with minimal basophilia ,condensed chromatin , & with prominent RBC resetting were associated with higher platelet counts( category 1). Larger lymphocytes, with abundant basophilic cytoplasm and with minimal cytoplasmic skirting were significantly associated with platelet counts and absolute lymphocytosis.CONCLUSION: In the present era of advanced automation, the morphological study of the reactive lymphocyte on peripheral smears is an indispensable and cost effective indicator of platelet counts and remains a valuable adjunct in prognosticating patients with Dengue fever.References
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14. Wim van der Meer, Warry van Gelder, Ries de Keijzer, and Hans Willems The divergent morphological classification of variant lymphocytes in blood smears J ClinPathol. 2007 Jul; 60(7): 838–839
15. Simon M.W. The atypical lymphocyte. International Journal of Paeditrics 2003 Vol. 18/No. 1:20 – 22
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18. Thanachartwet V, Oer-Areemitr N, Chamnanchanunt S Sahassananda D, Jittmittraphap A Suwannakudt P,Desakorn V Wattanathum A Identification of clinical factors associated with severe dengue among Thai adults: a prospective study BMC Infect Dis. 2015 Oct 14;15:420
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20. Tseng V, Morgan AS, Leith CP, Yang DT Efficient assessment of peripheral blood lymphocytosis in adults: developing new thresholds for blood smear review by pathologists Clin Chem Lab Med. 2014 Dec;52(12):1763-70
2. Rashmi MV, Hamsaveera H. Hametalological and biomedical markers as predictors of Dengue Infection Malays J Pathol. 2015 Dec;37(3):247-51
3. Donald S. Shepard, Yara A. Halasa, Brij Kishore Tyagi, S. Vivek Adhish, Deoki Nandan, K. S. Karthiga, Vidya Chellaswamy, Mukul Gaba, Narendra K. Arora, the INCLEN Study Group Economic and Disease Burden of Dengue Illness in India Am J Trop Med Hyg. 2014 December 3; 91(6): 1235–1242
4. World Health Organization (WHO). Global strategy for dengue prevention and control 2012–2020. Geneva: WHO; 2012
5. Lei HY, Yeh TM, Liu HS, Lin YS, Chen SH, Liu CC. Immunopathogenesis of dengue virus infection. J Biomed Sci. 2001; 8(5): 377-88
6. Chakravarti A, Roy P, Malik S, Siddiqui O, Thakur P. A study on gender-related differences in laboratory characteristics of dengue fever. Indian J Med Microbiol 2016;34:82-4
7. Jameel T, Mehmood K, Mujtaba G , Choudhry N ,Afzal N, Paul R.F Changing haematological parameters in dengue viral infection J Ayub Med Coll Abbottabad 2012;24(1)
8. Mehta R.C., Goswami H.M., Katara R.K., Patel P.S., Parikh U.V., Vegad M.M. and Jain P.Y. Importance of Complete blood count and Peripheral smear examination in early diagnosis of dengue patients Journal of Infectious Diseases Letters Volume 2, Issue 1, 2013, pp.-22-24.
9. Arshad I, Malik FA, Hussain A, Shahida A. Dengue fever clinico-pathologic correlations and their association with poor outcome. Professional Med J.2011; 18(1): 57-63
10. Rusmawati I, Asma Hanim H, Naznin M, Salman MS, Norlelawati AT. A descriptive study of blood films of patients serologically positive for dengue in Hospital Tengku Ampuan Afzan, Kuantan. IntMed J Malaysia. 2010; 9(2): 35-7
11. Dutta P, Khan SA, Borah J, Mahanta J. Demographic and clinical features of patients with dengue in Northeastern region of India: A retrospective cross sectional study during 2009-2011. J Virol Microbiol. 2012
12. Natasha Ali, Mohammad Usman, Naveen Syed, Mohammad Khurshid. Haemorrhagic manifestations and utility of haematological parameters in dengue fever: A tertiary care centre experience at Karachi. Scandinavian Journal of Infectious Diseases 2007; 39(1112)1025–8
13. Jampangern W, Vongthoung K, Jittmittraphap A, Worapongpaiboon S. Characterization of atypical lymphocytes and immunophenotypes of lymphocytes in patients with dengue virus infection. Asian Pac J Allergy Immunol. 2007 Mar;25(1):27-36
14. Wim van der Meer, Warry van Gelder, Ries de Keijzer, and Hans Willems The divergent morphological classification of variant lymphocytes in blood smears J ClinPathol. 2007 Jul; 60(7): 838–839
15. Simon M.W. The atypical lymphocyte. International Journal of Paeditrics 2003 Vol. 18/No. 1:20 – 22
16. Marshall A. Lichtman, Thomas J. Kipps, Uri Seligsohn, Kenneth Kaushansky, Josef T. Prchal Williams Haematology, eigth edition China ;McGraw –Hill companies:2010 pages 1144-1146
17. S M Lewis, B J Bain and I Bates Barbara B Jain Dacie and Lewis Practical Haematology. Churchill Livingstone 2006, Philadelphia tenth edition Chapter 5 ; Red cell morphology in health and disease Pages 108-110
18. Thanachartwet V, Oer-Areemitr N, Chamnanchanunt S Sahassananda D, Jittmittraphap A Suwannakudt P,Desakorn V Wattanathum A Identification of clinical factors associated with severe dengue among Thai adults: a prospective study BMC Infect Dis. 2015 Oct 14;15:420
19. Sun P, Kowalski EM, Cheng CK, Shawwa A, Liwski RS, Juskevicius R. Predictive significance of absolute lymphocyte count and morphology in adults with a new onset peripheral blood lymphocytosis J ClinPathol. 2014;67(12):1062-6
20. Tseng V, Morgan AS, Leith CP, Yang DT Efficient assessment of peripheral blood lymphocytosis in adults: developing new thresholds for blood smear review by pathologists Clin Chem Lab Med. 2014 Dec;52(12):1763-70
Published
2016-08-17
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