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. 2014 Jun 21:7:31.
doi: 10.1186/1755-7682-7-31. eCollection 2014.

Changes in full blood count parameters in leptospirosis: a prospective study

Nipun Lakshitha De Silva  1 , Mjr Niloofa  2 , Narmada Fernando  2 , Lilani Karunanayake  3 , Chaturaka Rodrigo  1 , H Janaka De Silva  4 , Sunil Premawansa  5 , Shiroma M Handunnetti  2 , Senaka Rajapakse  1
Affiliations

Changes in full blood count parameters in leptospirosis: a prospective study

Nipun Lakshitha De Silva et al. Int Arch Med. .

Abstract

Background: Leptospirosis presents diagnostic challenges to clinicians, in settings where other acute febrile illness are prevalent. The patterns of serial changes in haematological parameters in leptospirosis has not been evaluated previously.

Methods: Clinical and laboratory data were collected prospectively from patients with leptospirosis in two hospitals in Sri Lanka. Leptospirosis was diagnosed based on WHO clinical criteria with confirmation using Microscopic Agglutination Test titre > 400 or 4 fold rise between acute and convalescent samples. Full blood count parameters were analysed up to the 14(th) day of illness.

Results: Data from 201 patients with leptospirosis were available. Leukocyte counts and absolute neutrophil counts showed a decline over the first 5 days of illness, then rose until the end of the second week. On day 3 of fever, the majority (75%) had normal leukocyte counts, and by day 5, leukocytosis was seen only in 38.1%; leucopenia was an uncommon finding. Lymphopenia was seen in over half on day 5, declining to just under a quarter of patients by day 10. Platelets declined over the first 6 days and then gradually rose. Thrombocytopenia was seen in nearly three-fourths of patients by day 5. Haemoglobin and haematocrit levels declined over the course of illness. Total white cell and neutrophil counts were higher, and haemoglobin and haematorcrit were significantly lower, in patients with severe disease.

Conclusions: Neither leukocytosis nor lymphopenia were prominent features, while thrombocytopenia was seen during the 3(rd) to 5(th) day of illness, with dropping haemoglobin levels. Neutrophilia and low haemoglobin levels appear to predict severe disease. These findings may be of use to clinicians in differentiating leptospirosis from other acute infections like dengue, and could help in predicting severe leptospirosis.

Keywords: Leptospirosis; Lymphocytes; Neutrophils; Platelets.

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Figures

Figure 1
Figure 1
Changes in haematological parameters over the course of illness. Points indicate mean values, error bars represent standard error.
Figure 2
Figure 2
Comparison of neutrophil and lymphocyte counts (/mm3) in mild and severe disease over the course of illness. N-mild: neutrophil count in mild disease; N-severe: neutrophil count in severe disease; L-mild: lymphocyte count in mild disease; L-severe: lymphocyte count in severe disease.
Figure 3
Figure 3
Comparison of haemoglobin levels (g/dL) and platelet counts (/mm3) in mild and severe disease over the course of illness. Hb-mild: haemoglobin in mild disease; Hb-severe: haemoglobin in severe disease; platelets-mild: platelet count in mild disease; platelet-severe: platelet count in severe disease.
See this image and copyright information in PMC

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