The reactive lymphocyte: a morphological indicator of Platelet counts in Dengue seropostive patients
Keywords:
Dengue, lymphocyte, thrombocytopenia, leukopenia, peripheral smearAbstract
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 informationÂ
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.
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