The effect of age, sex, parity, haemoglobin level, and oral contraceptive preparations on the normal leucocyte count

Ethnic differences in age-related changes of postpartum hemoglobin levels

OBJECTIVE

Postpartum hemoglobin (Hb) levels may impact maternal and breast-fed newborn well being and health. Yet, the sources of variation in maternal postpartum Hb levels are poorly understood. We set to investigate whether age has an effect on postpartum Hb levels, and if this effect is similar in different ethnic groups.

STUDY DESIGN

The birth records of over 200,000 births in a tertiary medical center were scanned for the first and second births to Jewish and Bedouin mothers in Israel. Age trends in Hb levels were analyzed using linear and bi-linear models. Confounding factors were eliminated by testing the significance of the preferred model in homogenous sub-populations.

RESULTS

In Jewish Israeli mothers, postpartum hemoglobin level follow a bi-linear trend, peaking at the age of 27-31 years, both during the first and second births. In Israeli Bedouin mothers, a linear decline is observed through all ages.

CONCLUSION

These results suggest an ethnic difference in the age trends of postpartum Hb levels. Clinically, significant changes may occur between the ages of 27 and 30 years.

Influence of low-dose oral contraception on peripheral blood lymphocyte subsets at particular phases of the hormonal cycle

OBJECTIVE

To investigate the effects of low-dose oral hormonal contraception on the immune system during certain phases of the hormonal cycle.

DESIGN

Prospective, nonrandomized, controlled study.

SETTING

Academic research setting.

PATIENT(S)

Women with regular menstrual cycle using hormonal oral contraception (OC; Cileste, 250 microg of norgestimat and 35 microg of ethinylestradiol, or Marvelon, 150 microg of desogestrel and 30 microg of ethinylestradiol) and women not using hormonal or other forms of contraception.

INTERVENTION(S)

Peripheral blood lymphocyte subsets were determined by flow cytometry on the first day of menstruation (day 1), in the follicular phase (day 8), midcycle (day 15), and in the luteal phase (day 22).

MAIN OUTCOME MEASURE(S)

Levels of lymphocyte subpopulations.

RESULT(S)

Women using OC had significantly higher levels of CD3+ CD8+ cells throughout their pill cycle compared to controls. Furthermore, women taking Cileste had lower levels of natural killer (NK) cells during their cycle and also women taking Marvelon but only from days 8-15. Within the pill cycle of Cileste we observed an increase in CD20+ and CD20+ CD5+ cells from days 1-8.

CONCLUSION(S)

Cytotoxic lymphocytes, which are responsible for first-line immune defense, and B cells, which are involved in autoimmune disorders, are affected by OC.

Hematologic reference ranges in a population of patients with schizophrenia

The potential hematotoxic effects of antipsychotic drugs are well known and may limit the use of some effective therapies. Although some previous studies have suggested that patients with schizophrenia may have altered "normal" values, only limited data were available. It is now believed that biological values do not usually follow a normal distribution; therefore, reference ranges are frequently used when interpreting laboratory tests in clinical practice and in research. However, it may be important to use disease-specific hematologic reference ranges when evaluating laboratory test results for patients with schizophrenia. In this study, data taken from patients with schizophrenia prior to treatment in previous phase II and phase III pharmaceutical studies were analyzed to produce reference ranges for a variety of hematologic parameters. An increased variability was shown in the reference ranges for all white blood cell indices between patients with schizophrenia and the population without schizophrenia. Certain reference values also showed heterogeneity for gender, age, and racial descent. This study suggests that abnormal hematologic findings in patients with schizophrenia should be assessed in the context of a valid reference range. This information will be of value to psychiatrists, laboratory scientists, and other physicians who encounter hematologic problems in patients with schizophrenia, as well as in the assessment of the adverse effects of new therapeutic agents.

Leukocytosis in acute pulmonary embolism

PURPOSE

The purpose of this investigation is to assess the level of leukocytosis in acute pulmonary embolism (PE).

BACKGROUND

Limited data exist regarding leukocytosis in acute PE. One reason that the prevalence of leukocytosis in acute PE is unknown, despite an extensive number of investigations of PE, may relate to the fact that acute PE is usually associated with other conditions that themselves may cause leukocytosis.

METHODS

Hospital records of 386 patients with a diagnosis of acute PE were reviewed retrospectively. Patients with no other possible or definite cause of leukocytosis were analyzed separately. A diagnosis of PE was made by a high-probability interpretation of the ventilation/perfusion lung scan or pulmonary angiogram.

RESULTS

Among patients with PE in whom other possible or defined causes for leukocytosis were eliminated, 52 of 266 (20%) had a WBC count > 10,000/mm3. None had a WBC count that was > or = 20,000/mm3. Patients with the pulmonary hemorrhage/infarction syndrome had an increased WBC count in 32 of 183 (17%) vs 20 of 83 (24%) in patients who did not have pulmonary hemorrhage/infarction syndrome (not significant).

CONCLUSION

A modest leukocytosis may accompany (and possibly be caused by) PE. Its presence should not dissuade the clinician from objectively pursuing the diagnosis of PE.

Dexamethasone-induced leucocytosis in pregnancy

The effect of intramuscular dexamethasone administration in late pregnancy on the maternal peripheral white cell count was examined in 20 women. The mean total white cell count increased from a baseline of 11.3 x 10(9)/L (SD 2.3) to 16.2 x 10(9)/L (SD 4.6) on day 1, normalising thereafter. This 43% increase represented composite changes in the neutrophil and lymphocyte counts which, on average, increased by 62% and decreased by 22%, respectively. It is concluded that prenatal dexamethasone induces a significant neutrophilia on the first day following administration. This information may be helpful when monitoring for infection.

Lymphocyte numbers in endogenous depression

The blood counts of 80 patients with depression were examined (50 unipolar, 30 bipolar). Many had reduced numbers of circulating lymphocytes. This abnormality was more common in the unipolar group (52%) than in the bipolar group (27%). When those patients with an abnormal dexamethasone suppression test response in both groups were compared, the relative and absolute lymphocyte counts were significantly lower in unipolars. Although cortisol hypersecretion may reduce lymphocyte numbers it is not yet clear whether the findings can be satisfactorily explained in this way.

Factors affecting leukocyte count in healthy adults

The relationships between white blood cell (WBC) count, smoking, and other health variables were determined among 35,000 apparently healthy men and women. The effect of smoking on the WBC count was greater than that of all other variables. The leukocyte level and the variance in WBC count values increased with increased smoking intensity. The relationship between smoking intensity and leukocyte level is expressed quantitatively by the following regression equation: WBC (10(3)/mm3) = 7.1 + 0.05(SM), where SM has seven values according to the smoking level. Multiple regression analysis with additional variables other than smoking did not much improve the predictive value of the equation. The effect of smoking on WBC count could be only partially explained by an inflammatory process, e.g., chronic bronchitis. Relationships of statistical significance (but mostly with r values of less than 0.10) were found between WBC count and the following variables: hemoglobin, heart rate, weight (or Quetelet index), cholesterol, uric acid, creatinine, sex, ethnic origin, systolic blood pressure, height, blood sugar, and diastolic blood pressure. The normal WBC count range for smokers differs from that of nonsmokers and is shifted to the right according to the smoking level. This may have both a diagnostic and prognostic significance in different clinical settings.

Prenatal and postnatal maternal leucocyte ascorbic acid concentrations

Leucocyte ascorbic acid was measured in 79 pregnant women in the 34th to 38th week of gestation and on the first, and third or fifth days post partum. No differences were found for time of year or age of the subjects. There was a significantly lower vitamin C status in social classes IV and V. The leucocyte ascorbic acid concentration fell significantly on the first day post partum and rose again to initial values by the fifth day. In late pregnancy 40 per cent of all subjects had leucocyte ascorbic acid concentrations less than the lower limit of normal (100 nmol/10(8) leucocytes). This rose to 75 per cent on the first day post partum.

A sex difference in the platelet count

A study of the platelet counts of 868 blood donors aged 18-65 showed a higher mean count in women than in men, the difference in the premenopausal age groups being highly significant (P less than 0.001) and of the order of 40-70 x 10(9)/1. The mean counts of women taking a contraceptive pill did not differ significantly from those who were not.

Normal haematological values: sex difference in neutrophil count

Blood counts were performed on 100 male and 100 female staff to establish normal ranges for our hospital. Neutrophil counts were found to be on average 0.66 times 10-9/1 (660/mm-3) higher in women than in men. Statistically this difference was highly significant and was not due to the fact that many of the women were taking oral contraceptives. The neutrophil counts of the men and women were also on average 0.50 times 10-9/1 (500/mm-3) greater in the afternoon than in the morning. A correlation was observed between the neutrpphil and the monocyte counts.