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Transient regression in lymphocyte count in B-cell chronic lymphocytic leukemia after viral infection.

Transient regression in the lymphocyte count of a patient with B-cell chronic lymphocytic leukemia (B-CLL) after viral infection is reported. A similar event occurred under natural interferon-alpha (IFN-alpha) treatment. It was confirmed that the event was not caused by a direct cytotoxic effect of IFN-alpha by analyzing the DNA fragmentation to estimate apoptotic and necrotic cell death before and after the administration of IFN-alpha. The study also suggested that the event was not caused by a cytostatic effect of IFN-alpha.

Adult↗

[Interrelationship between the duration of HIV infection, viral load and CD4 positive lymphocyte count].

BACKGROUND: The decline in CD4+ lymphocytes occurs at different rates in patients with HIV infection. A longer duration of HIV infection and a higher level of viral replication, represented by the viral load, are associated with a lower CD4+ lymphocyte count. However, the interelationship between these variables is still not well known. PATIENTS AND METHODS: 107 HIV-infected patients for whom the date of infection was known, were included in a transversal study, in which the CD4+ lymphocyte count and the plasma viral load were analysed, the last using an isothermal amplification method (NASBA). Patients were not receiving antiretroviral drugs or suffered intercurrent infections at the time of the study. RESULTS: The mean duration of HIV infection was 8.6 +/- 2.9 years. The mean CD4+ lymphocyte count was 366 +/- 264 x 10(6)/l. The mean plasma viraemia was 4.3 +/- 0.9 logs. In a linear regression model, the CD4+ lymphocyte count was explained in 21.7% of cases by the duration of HIV infection, meanwhile the viral load justified up to 36.2 of CD4+ cell variability. When both parameters were combined, up to 58.4% of CD4+ lymphocyte values were explained. In this model, changes of 1 log in viral load had a 4-fold higher effect on the CD4+ cell count than each year of HIV infection. CONCLUSIONS: The duration of HIV infection and, particularly the viral load strongly influences the current CD4+ lymphocyte count, although other variables should exist (virus with syncytium-inducing phenotype, age of the patient and his immunegenetic repertoire) influencing the different decline seen in CD4+ T-cells.

CD4 Lymphocyte Count↗

Effects of X-rays and cigarette smoking on leukocyte, lymphocyte and mitotic index values and SCE rates: the relationship between mitotic index and lymphocyte count.

Many previous studies revealed that smoking increases leukocyte and lymphocyte counts while exposure to X-rays decreases these counts. However the relationships between lymphocyte life span and smoking as well as X-rays were not well documented. The primary aim of this study was to determine relationships between smoking X-rays (in combination and individually) and life span of lymphocytes. Blood samples from 200 healthy individuals, half of which were X-ray exposed individuals, were collected. Half of X-ray exposed and of non-X-ray exposed individuals were smokers. There were equal numbers of male and female participants. Two lymphocyte cultures, one for the sister chromatid exchange (SCE) analysis and the other for the determination of mitotic index values were prepared using one part of the blood samples collected from the individuals. From the other part of the blood sample leukocyte and lymphocyte counts were determined with a haemogram device. Evaluation of the findings suggested that leukocyte count, lymphocyte count, mitotic index were relatively lower for the X-ray exposed individuals. In addition these values were higher for smokers than nonsmokers in general. The highest SCE rates were recorded for smoking radiology technicians. The most important finding is that lymphocyte life span is relatively low in smokers and in X-ray exposed males.

Adult↗

Serial CD4 lymphocyte counts and development of AIDS.

Low CD4 lymphocyte counts are associated with increased risk of progression to AIDS in human immunodeficiency virus (HIV) infection. We investigated the extent to which the timing of progression to AIDS can be explained solely in terms of decline of the CD4 lymphocyte count in 111 haemophiliacs followed for up to 11 years since infection with HIV. A median of 10 CD4 lymphocyte counts were made per patient. By applying a simple linear model for the decline in CD4 lymphocyte counts over time, we estimated the date of development of AIDS in 96 patients who had at least 5 determinations. 84% (81 of 96) of patients were correctly classified as to development of AIDS before Jan 1, 1990 (p less than 0.0001), with this model. The results suggest that differences in the time at which patients with HIV will progress to AIDS can largely be explained by differences in rates of decline of CD4 lymphocyte counts.

Acquired Immunodeficiency Syndrome↗

[Comparative study of the peripheral lymphocyte count in controls and in patients with chronic lymphocytic leukemias 4 hours after injection of hydrocortisone (author's transl)].

The peripheral lymphocyte count was investigated prior to and 4 h after a single intravenous injection of 400 mg of hydrocortisone (HSHC) in 23 controls and 43 patients with chronic lymphocytic leukemia. A reduction in the peripheral lymphocyte count was observed in all normal controls, the mean decrease being 51.9%, with differences according to age.

Aged↗

[Effect of duration and temperature of sample preservation on the result of peripheral blood CD4+ and CD8+ T lymphocyte count in HIV/AIDS patients].

BACKGROUND: By analyzing the CD4+ and CD8+ T lymphocyte count of whole blood from HIV/AIDS patients, which were stored at different temperatures for various durations, the authors studied the ideal preserving condition for whole blood and processed, in a purpose of guaranteeing the accuracy of clinical testing of CD4+ and CD8+ T lymphocyte count. METHODS: Blood from 34 HIV carriers/AIDS patients, were kept at 4 degrees C for 2, 24, 48, or 72 h, and tested for CD4+ and CD8+ T lymphocyte count using cytometric analysis. Part of the blood was processed, and kept at degrees C or room temperature for 2, 24, 48, or 72 h, then tested for CD4+ and CD8+ T lymphocyte count. The results were compared statistically in parallel. RESULTS: Whole blood and processed samples preserved at degrees C showed no statistical difference in CD4+ T lymphocyte count among different preserving durations (P greater than 0.05), but CD8+ T lymphocyte counts were significantly different at 72 h (P less than 0.05). Processed samples at 72 h were significantly different in CD4+ T lymphocyte count(P less than 0.05), and significantly different in CD8+ T lymphocyte count at 24 h (P less than 0.05). At room temperature, samples at different duration were not significantly different in CD4+ T lymphocyte count, but significantly different in CD8+ T lymphocyte count at 48 and 72 h (P less than 0.05). CONCLUSION: There were stable results for performing analysis of the CD4+ and CD8+ T lymphocyte count of the anticoagulated blood within 48 h. At room temperature, there were stable results for performing the analysis of CD4+ and CD8+ T lymphocyte count of processed samples within 24 h. Between 24 h and 48 h, although CD4+ count was stable, CD8+ count showed significant changes, so the ratio of CD4 to CD8 changed accordingly.

Acquired Immunodeficiency Syndrome↗

Decline in total T cell count is associated with onset of AIDS, independent of CD4(+) lymphocyte count: implications for AIDS pathogenesis.

We previously reported that blind T cell homeostasis, in which the total T cell count is maintained but the CD4(+) and CD8(+) subset composition of the T cells can vary, fails approximately 1.5 to 2.5 years before the onset of AIDS. The present study was premised on the hypothesis that if failure of T cell homeostasis (i.e., a decline in total T cell counts) is important in the pathogenesis of AIDS, it should be a significant predictor of AIDS after controlling for the CD4(+) lymphocyte count. Data from 1556 homosexual men with sufficient sequential T cell subset measurements were evaluated, representing 11,988 person-visits in men with known clinical outcomes over a period of more than 10 years. Using regression models that incorporated CD4(+) lymphocyte count and HIV-related symptoms (fever, thrush), it was determined that a yearly decline of more than 300 T cells/microliter of peripheral blood was an independent predictor of the onset of AIDS for subjects with CD4(+) lymphocyte counts of <500 cells/microliter. The results support an important role for failure of T cell homeostasis in the pathogenesis of AIDS.

Acquired Immunodeficiency Syndrome↗

Prognostic significance of the absolute lymphocyte count in acute pancreatitis.

The absolute lymphocyte count was calculated with 48 hours of admission in 154 patients with acute pancreatitis. Twenty-three patients had severe pancreatitis and 131 patients had mild pancreatitis. The mean absolute lymphocyte count for the severe group was 880 +/- 102 cells/mm3 and for the mild group, 1,115 +/- 116 cells/mm3. The absolute lymphocyte count accurately predicted 78 percent of the severe attacks and 86 percent of the mild attacks.

Acute Disease↗

[Determination of T- and B-lymphocyte counts in guinea pigs].

T lymphocytes of guinea-pigs were found to form spontaneous E-rosettes with rabbit red blood cells. The lymphocyte count constituted 32% of blood lymphocytes, 41% of lymph node cells. Meanwhile no T lymphocytes were detected in the bone marrow. The T lymphocyte subpopulation capable of forming "early" rosettes was demonstrated. B lymphocytes formed EAC-rosettes with sheep red blood cells. The B lymphocyte count in the blood, lymph nodes and bone marrow amounted to 10, 18 and 5%, respectively. The effects of incubation conditions, centrifugation, antibody types, and complement concentration, etc. on E- and EAC-rosette formation were defined.

Animals↗

Chronic lymphocytic leukemia with low lymphocyte count.

BACKGROUND: A peripheral blood absolute lymphocyte count (ALC) of greater than 5 x 10(9)/l is considered the required minimum for diagnosis of chronic lymphocytic leukemia (CLL). Cases with low ALC (CLL-LLC), less than 5 x 10(9)/l, have not been included in the current staging systems, and would not be suspected of having CLL, or investigated for the disease, especially in the absence of clinical manifestations. On the other hand, the diagnostic value of the differential lymphocyte counts have not been emphasized. METHODS: Cell suspensions from peripheral blood of previously untreated cases of CLL-LLC (n = 12) and typical CLL (n = 189) were analyzed for immunologic evaluation of surface immunoglobulin (SIg), mouse erythrocyte rosettes, CD5, CD19, CD20, CD22, and CD2, as well as cytochemical evaluation of tartrate-resistant acid phosphatase (TRAP). The results in CLL-LLC were compared statistically with typical CLL. RESULTS: The ages of the 12 patients with CLL-LLC ranged from 47 to 84 years. The absolute lymphocyte counts ranged from 1.5 x 10(9)/l to 4.9 x 10(9)/l, and the percentage of lymphocytes in the differential leukocyte counts ranged from 52% to 93%. None of the patients had signs and symptoms of CLL or other conditions that may cause reactive lymphocytosis. CLL-LLC demonstrated similar characteristics to typical CLL, i.e., weak expression of monoclonal SIg, mouse rosette formation, positive CD5, high CD19 and CD20, negative CD22 and TRAP. No statistical differences existed between the immunologic markers or between SIg isotype distribution in the two groups. CONCLUSIONS: Cases of CLL-LLC constituted 6% of B-CLL and would have been missed if immunologic investigation was not carried out because of the absence of absolute lymphocytosis and clinical manifestations of CLL. Persistent relative lymphocytosis of > or = 50% of the differential leukocyte count in older individuals (older than 50 years of age), is an indication for further investigation of CLL by immunophenotyping of peripheral blood lymphocytes and examination of bone marrow.

Aged↗

Lymphocyte counts of patients who have had skin cancer.

BACKGROUND: Investigations of lymphocyte counts in patients with skin cancer have given conflicting results, possibly because homogeneous groups of patients were not studied. OBJECTIVE: Our purpose was to measure lymphocyte counts in patients with skin cancer to determine whether any abnormalities were associated with the number of cancers removed and to determine whether a lymphocyte count could identify patients at risk of the development of large numbers of cancers. METHODS: Apparently otherwise normal patients who had histologically confirmed skin cancers removed were studied. One group consisted of patients who had one skin cancer removed but had not had another within a minimum of 5 years. The other group consisted of patients who had had three or more skin cancers. Standard flow cytometry was used to determine the total lymphocyte count, CD4 (helper cell) count, and CD8 (cytotoxic cell) count. RESULTS: Ninety-six patients with multiple skin cancers, and 24 with one skin cancer were studied. Only basal cell carcinomas (BCCs) were removed from 84 patients and the results from this homogeneous group were as follows: women had a higher CD4 cell count than men (p < 0.05); patients with 20 or more BCCs had a lower lymphocyte count (p < 0.01); and patients with one BCC had a higher CD4/CD8 ratio than those who had multiple BCCs (p < 0.05). CONCLUSION: Differences were found between men and women, as well as between subgroups of patients with skin cancer. However, the range of lymphocyte counts was large and it was not possible to determine a threshold below which patients had a worse prognosis. A lymphocyte count is not a reliable way of predicting which patients will have a large number of skin cancers.

Adult↗

Lymphocyte count and mortality risk in older persons. The Leiden 85-Plus Study.

OBJECTIVES: To investigate whether a low peripheral blood lymphocyte count is associated with increased mortality risk in older persons and to determine whether this association could be ascribed to ill health. DESIGN: A cohort study with a total follow-up period of 1,602 person years. SETTING: Leiden, the Netherlands. PARTICIPANTS: Four hundred thirty-six community-dwelling residents aged 85 and older. MEASUREMENTS: Health status and leukocyte total and differential counts were assessed at baseline. Lymphocyte subsets were measured with a fluorescence-activated cell sorter. Age- and sex-adjusted mortality risks were estimated using Cox proportional hazard regression analysis. RESULTS: There was no association between lymphocyte count and mortality in persons with ill health (mortality risk lowest vs highest quartile=1.16; 95% confidence interval (CI)=0.85-1.58, P=.35), but mortality was dependent on lymphocyte count if disease was excluded (mortality risk lowest vs highest quartile=2.14; 95% CI=1.08-4.23, P=.03). A similar increase in mortality risk was found when the cluster designation (CD)4+, CD8+, and CD16+ lymphocyte subsets were analyzed. Within individuals, low values of the lymphocyte subsets were related and there was no compensatory increase in CD16+ lymphocyte counts. A low lymphocyte count was not associated with specific causes of death. CONCLUSION: A low lymphocyte count was associated with an increased mortality risk in older persons without apparent disease. This association was not only found for the total lymphocyte count but also for the CD4+, CD8+, and CD16+ lymphocyte subset counts.

Aged↗

Reliability of the total lymphocyte count as a parameter of nutrition.

To evaluate the total lymphocyte count as a means of nutritional assessment, body composition studies (a proven method of nutritional assessment) and total lymphocyte determinations were performed simultaneously in 153 patients. The total lymphocyte count correlated poorly with both the body cell mass and the nutritional state measured by the Nae to Ke ratio. For diagnosing malnutrition, the total lymphocyte count had a false-positive rate of 34% and a false-negative rate of 50%. In a group of 78 patients who received total parenteral nutrition for 2 weeks, the total lymphocyte count did not accurately reflect the nutritional changes. Due to its poor sensitivity and specificity, the total lymphocyte count is of no value as a measure of the nutritional state.

Body Composition↗

Microbiological infections in HIV positive Bahraini patients with low CD4+ T-lymphocyte count.

The correlation of CD4+ T-lymphocyte count and the distribution of pathogenic or opportunistic microbial infection most commonly found in HIV positive individuals differ from one area to the other. The present study reports such findings in 67 HIV positive Bahraini patients in the period May 1997 to Nov. 1998. CD4+ T-lymphocyte count was measured using flow cytometry. Bacterial and fungal cultures were performed. Serological diagnosis was performed when indicated. Viral study was done serologically. The distribution of CD4+ T-lymphocyte count in the studied group was: 21 patients (31.3%) less than 100 cells/microl, 5 patients (7.5%) 100-200 cells/microl, 25 patients (37.3%) 201-500 cells/microl and 16 patients (23.9%) with count more than 500 cells/microl. Among patients with low CD4 count (less than 100 cells/microl) (n=21), microbial infections varied from fungal infections 66%, bacterial infections 57% and viral infections 4.8%. Bacterial infections included Salmonellosis (14.3%), Staphylococcus epidermidis (14.3%), Pseudomonas aeruginosa (9.5%), H. influenzae (9.5%), Legionellosis (4.8%) and E. coli (4.8%). Fungal infection included Candida albicans (52.4%), Pneumocystis carinii (9.5%), Cryptococcus neoformans (4.8%). Viral infection included H. simplex to (4.8%). Fungal infections were the highest common infection in thus study. The most common microbial infection was Candida albicans. P. carinii and Cryptococcus neoformans were less common than found in other studies world wide.

AIDS-Related Opportunistic Infections↗

Relative lymphocyte count: a prognostic indicator of mortality in elderly patients with congestive heart failure.

BACKGROUND: A reduction in the relative lymphocyte count is a marker of the stress response; however, its prognostic value remains undetermined. The objective of this study was to investigate the predictive value of the relative lymphocyte count for survival in elderly patients with congestive heart failure (CHF). METHODS AND RESULTS: One thousand two hundred seventy-four consecutive patients above the age of 65 years hospitalized with heart disease were enrolled in the CHF Italian Study and followed up for 3 years. Of these, 413 patients were excluded because of factors that could affect the lymphocyte count. Of the remaining 861 patients, 423 (49%) met the criteria for the diagnosis of CHF (mean age 76 +/- 7 years, 51% men), of whom 162 patients (38%) had a relative lymphocyte count < or = 20%. The 3-year all-cause mortality in patients with CHF and a relative lymphocyte count < or = 20% was 64% compared with 40% in patients with a relative lymphocyte count > 20% (P < .0001). The age- and sex-adjusted hazard ratio for death in patients with CHF and low relative lymphocyte count was 1.76 (95% confidence interval 1.34-2.32, P = .0001). After adjustment for baseline differences and variables associated with or known to affect lymphocyte count, the hazard ratio remained significantly different from 1.0 (hazard ratio 1.73, 95% confidence interval 1.21-2.48, P = .0026). CONCLUSION: A low relative lymphocyte count is an independent marker of poor prognosis in elderly patients with CHF. The relative lymphocyte count is a simple, accurate, widely available, and inexpensive marker that can help to identify elderly patients with CHF who are at increased risk for mortality. The pathophysiologic mechanism of this observation remains to be determined.

Aged↗

Use of total lymphocyte count for informing when to start antiretroviral therapy in HIV-infected children: a meta-analysis of longitudinal data.

BACKGROUND: Total lymphocyte count has been proposed as an alternative to the percentage of CD4+ T-cells to indicate when antiretroviral therapy should be started in children with HIV in resource-poor settings. We aimed to assess thresholds of total lymphocyte count at which antiretroviral therapy should be considered, and compared monitoring of total lymphocyte count with monitoring of CD4-cell percentage. METHODS: Longitudinal data on 3917 children with HIV infection were pooled from observational and randomised studies in Europe and the USA. The 12-month risks of death and AIDS by most recent total lymphocyte count and age were estimated by parametric survival models, based on measurements before antiretroviral therapy or during zidovudine monotherapy. Risks were derived and compared at thresholds of total lymphocyte count and CD4-cell percentage for starting antiretroviral therapy recommended in WHO 2003 guidelines. FINDINGS: Total lymphocyte count was a powerful predictor of the risk of disease progression despite a weak correlation with CD4-cell percentage (r=0.08-0.19 dependent on age). For children older than 2 years, the 12-month risk of death and AIDS increased sharply at values less than 1500-2000 cells per muL, with little trend at higher values. Younger children had higher risks and total lymphocyte count was less prognostic. Mortality risk was substantially higher at thresholds of total lymphocyte count recommended by WHO than at corresponding thresholds of CD4-cell percentage. When the markers were compared at the threshold values at which mortality risks were about equal, total lymphocyte count was as effective as CD4-cell percentage for identifying children before death, but resulted in an earlier start of antiretroviral therapy. INTERPRETATION: In this population, total lymphocyte count was a strong predictor of short-term disease progression, being only marginally less predictive than CD4-cell percentage. Confirmatory studies in resource-poor settings are needed to identify the most cost-effective markers to guide initiation of antiretroviral therapy.

Aging↗

Interpretation of chest radiographs in AIDS patients: usefulness of CD4 lymphocyte counts.

Specific infections and neoplasms that are complications of acquired immunodeficiency syndrome (AIDS) occur within various CD4 lymphocyte count ranges. Knowledge of how these counts correlate with radiographic appearances of these entities can limit the differential diagnosis because certain conditions are uncommon above a specific count. In patients with CD4 lymphocyte counts above 200 cells/mm3 and radiographic findings of cavitary and noncavitary consolidation, bacterial pneumonia and Mycobacterium tuberculosis are the major diagnostic considerations. As the CD4 lymphocyte count falls, these infections are still common; however, cavitation is seen less frequently with Mycobacterium tuberculosis, and unusual bacterial infections, including those caused by Rhodococcus equi and Nocardia asteroides, should be considered. In patients with counts below 200 cells/mm3, Pneumocystis carinii pneumonia is the most common infection, usually manifesting radiographically as a reticular interstitial pattern. At CD4 lymphocyte counts of 50-200 cells/mm3, disseminated fungal infection and Kaposi sarcoma become prevalent. In patients with advanced AIDS and counts below 50 cells/mm3, radiographic nodular or reticular patterns may indicate AIDS-related lymphoma and cytomegalovirus and Mycobacterium avium-intracellulare infections. When CD4 lymphocyte counts are applied to interpretation of chest radiographs in AIDS patients, the working differential diagnosis of a radiographic pattern can be tailored to the clinical situation of a given patient.

AIDS-Related Opportunistic Infections↗

Prediction of progression to AIDS by analysis of CD4 lymphocyte counts in a haemophilic cohort.

Serial CD4 lymphocyte counts were recorded in 112 anti-HIV-positive haemophiliacs who were followed for up to 8 years after seroconversion. The patients remained at low risk of developing AIDS until their CD4 lymphocyte count fell to 0.25 X 10(9)/l. From this point, the risk increased as their count approached zero. Using this result and on the assumption (which is evaluated) that the underlying trend over time in CD4 lymphocyte counts is linear, the predicted rate of progression to AIDS was calculated for the cohort. It was estimated that 73% (95% confidence limits 60-86%) of the cohort will develop AIDS within 15 years of HIV-seropositivity. During 8 years of follow-up, this cohort had shown similar rates of progression to AIDS to other cohorts--haemophilic and otherwise--suggesting that this estimate may well have general applicability. The method described could be used to plan the provision of health-care resources for groups of anti-HIV-positive patients as it allows the number of new cases of AIDS to be predicted year by year, even when the patients' dates of seroconversion are unknown.

Acquired Immunodeficiency Syndrome↗