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Hesselink L, Spijkerman R, Hellebrekers P, van Bourgondiën RJ, Blasse E, Haitjema S, Huisman A, van Solinge WW, Van Wessem KJP, Koenderman L, Leenen LPH, Hietbrink F. Fragile neutrophils in surgical patients: A phenomenon associated with critical illness. PLoS One 2020; 15:e0236596. [PMID: 32750099 PMCID: PMC7402494 DOI: 10.1371/journal.pone.0236596] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Accepted: 07/08/2020] [Indexed: 01/15/2023] Open
Abstract
Leukocyte viability (determined by e.g. propidium iodide [PI] staining) is automatically measured by hematology analyzers to check for delayed bench time. Incidental findings in fresh blood samples revealed the existence of leukocytes with decreased viability in critically ill surgical patients. Not much is known about these cells and their functional and/or clinical implications. Therefore, we investigated the incidence of decreased leukocyte viability, the implications for leukocyte functioning and its relation with clinical outcomes. An automated alarm was set in a routine hematology analyzer (Cell-Dyn Sapphire) for the presence of non-viable leukocytes characterized by increased fluorescence in the PI-channel (FL3:630±30nm). Patients with non-viable leukocytes were prospectively included and blood samples were drawn to investigate leukocyte viability in detail and to investigate leukocyte functioning (phagocytosis and responsiveness to a bacterial stimulus). Then, a retrospective analysis was conducted to investigate the incidence of fragile neutrophils in the circulation and clinical outcomes of surgical patients with fragile neutrophils hospitalized between 2013–2017. A high FL3 signal was either caused by 1) neutrophil autofluorescence which was considered false positive, or by 2) actual non-viable PI-positive neutrophils in the blood sample. These two causes could be distinguished using automatically generated data from the hematology analyzer. The non-viable (PI-positive) neutrophils proved to be viable (PI-negative) in non-lysed blood samples, and were therefore referred to as ‘fragile neutrophils’. Overall leukocyte functioning was not impaired in patients with fragile neutrophils. Of the 11 872 retrospectively included surgical patients, 75 (0.63%) were identified to have fragile neutrophils during hospitalization. Of all patients with fragile neutrophils, 75.7% developed an infection, 70.3% were admitted to the ICU and 31.3% died during hospitalization. In conclusion, fragile neutrophils occur in the circulation of critically ill surgical patients. These cells can be automatically detected during routine blood analyses and are an indicator of critical illness.
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Affiliation(s)
- Lillian Hesselink
- Department of trauma surgery, University Medical Center Utrecht, Utrecht, the Netherlands
- Center for Translational Immunology, Wilhelmina Children’s Hospital, Utrecht, the Netherlands
- * E-mail: (FH); (LH)
| | - Roy Spijkerman
- Department of trauma surgery, University Medical Center Utrecht, Utrecht, the Netherlands
- Center for Translational Immunology, Wilhelmina Children’s Hospital, Utrecht, the Netherlands
| | - Pien Hellebrekers
- Department of trauma surgery, University Medical Center Utrecht, Utrecht, the Netherlands
- Center for Translational Immunology, Wilhelmina Children’s Hospital, Utrecht, the Netherlands
| | | | - Enja Blasse
- Department of Clinical Chemistry and Hematology, Utrecht, the Netherlands
| | - Saskia Haitjema
- Department of Clinical Chemistry and Hematology, Utrecht, the Netherlands
| | - Albert Huisman
- Department of Clinical Chemistry and Hematology, Utrecht, the Netherlands
| | | | | | - Leo Koenderman
- Center for Translational Immunology, Wilhelmina Children’s Hospital, Utrecht, the Netherlands
- Department of Respiratory Medicine, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Luke P. H. Leenen
- Department of trauma surgery, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Falco Hietbrink
- Department of trauma surgery, University Medical Center Utrecht, Utrecht, the Netherlands
- * E-mail: (FH); (LH)
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Hebeda KM, Tzankov A, Boudova L, Saft L, Hasserjian RP, de Boer M, Fend F, Orazi A, Leguit R. Challenges in Diagnosing Myelodysplastic Syndromes in the Era of Genetic Testing: Proceedings of the 13th Workshop of the European Bone Marrow Working Group. Pathobiology 2018; 86:62-75. [PMID: 29982244 PMCID: PMC6482987 DOI: 10.1159/000489678] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2018] [Accepted: 04/30/2018] [Indexed: 11/19/2022] Open
Abstract
The 13th workshop of the European Bone Marrow Working Group in Utrecht, The Netherlands, was devoted to studying myelodysplastic syndromes (MDS) and their boundaries. The panel received 44 cases submitted to the 3 invited categories, which included: reactive cytopenias with dysplasia, idiopathic cytopenia of undetermined significance, clonal haematopoiesis of indeterminate potential, idiopathic dysplasia of uncertain significance and overt MDS. For this summary, we have selected 17 cases that highlight difficulties in separating true MDS from other causes of cytopenia and the intricate relationship between clonal haematopoiesis and true MDS. In addition, cases of overt MDS with challenging features were also selected. All cases were stained for p53 expression. Using instructive submitted cases we discuss the following: (1) cytopenia with clonal haematopoiesis not fulfilling MDS criteria, (2) cytopenia and/or dysplasia with germline mutations and/or familial history suggesting an underlying gene defect, (3) MDS based on a recurrent chromosomal abnormality and (4) overt MDS with diagnostic difficulties due to concurrent treatment or disease. The lively discussion in the open forum of the workshop illustrated the need for better integrative understanding of the evolution of acquired genetic abnormalities in haematopoiesis, and the challenge of diagnosing true MDS in cytopenic patients with genetic abnormalities, either germline or acquired.
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Affiliation(s)
- Konnie M Hebeda
- Department of Pathology, Radboud University Medical Center, Nijmegen, The
| | - Alexandar Tzankov
- Institute of Pathology, University Hospital Basel, Basel, Switzerland
| | - Ludmila Boudova
- Department of Pathology, Charles University Hospital, Pilsen, Czech Republic
| | - Leonie Saft
- Department of Pathology and Cytology, Karolinska University Hospital and Institute, Stockholm, Sweden
| | - Rob P Hasserjian
- Department of Pathology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Mirthe de Boer
- Department of Pathology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Falko Fend
- Department of Pathology, University of Tuebingen, Tuebingen, Germany
| | - Attilio Orazi
- Department of Pathology and Laboratory Medicine, Weill Cornell Medical College, New York, New York, USA
| | - Roos Leguit
- Department of Pathology, University Medical Center Utrecht, Utrecht, The Netherlands
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