1. Fragile neutrophils in surgical patients: A phenomenon associated with critical illness
- Author
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Falco Hietbrink, Karlijn J P van Wessem, Enja Blasse, Leo Koenderman, Robert J. van Bourgondiën, Luke P. H. Leenen, Lillian Hesselink, Roy Spijkerman, Saskia Haitjema, Wouter W. van Solinge, Pien Hellebrekers, and Albert Huisman
- Subjects
0301 basic medicine ,Male ,Critical Care and Emergency Medicine ,Neutrophils ,Physiology ,Gastroenterology ,chemistry.chemical_compound ,White Blood Cells ,Leukocyte Count ,0302 clinical medicine ,Animal Cells ,Medicine and Health Sciences ,Immune Response ,Trauma Medicine ,Multidisciplinary ,Hematology ,Middle Aged ,Body Fluids ,Blood ,Cell Processes ,030220 oncology & carcinogenesis ,Surgical Procedures, Operative ,Medicine ,Female ,Cellular Types ,Anatomy ,Surgical patients ,Research Article ,medicine.medical_specialty ,Cell Survival ,Science ,Phagocytosis ,Immune Cells ,Critical Illness ,Immunology ,Trauma Surgery ,Surgical and Invasive Medical Procedures ,03 medical and health sciences ,Hematology analyzer ,Signs and Symptoms ,Internal medicine ,medicine ,Humans ,In patient ,Propidium iodide ,Aged ,Inflammation ,Blood Cells ,business.industry ,Critically ill ,Biology and Life Sciences ,Cell Biology ,Staining ,030104 developmental biology ,chemistry ,Critical illness ,Clinical Medicine ,business - 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.
- Published
- 2020