Question

Readthebelowparagraphrelatedtoanexperimentandanswerthequestionsgivenbelow.

From April to September 2018, a comparative cross-sectional study was conducted among pulmonary tuberculosis patients (n=40) and control patients (n=40). About 5 mL venous blood and 2– 5 mL sputum samples were collected and examined by Cell Dyn 1800 hematology analyzer and cultured using Mycobacteria Growth Indicator Tube (BACTEC MGIT 960), respectively. Independent t-test was performed with the help of SPSS version 20 software, and p-value < 0.05 was considered as statistically significant difference. The proportion of male to female in the pulmonary tuberculosis patients (PTB) and the control patients was 1.7 (25/15). Two-sample independent t-test revealed that the mean values of hemoglobin level (P=0.002), hematocrit (P=0.018), mean cell hemoglobin concentration (P=0.001) and relative lymphocyte percentage (P=0.036) of PTB were significantly lower than the control group. Moreover, significantly higher mean values were also observed in total white blood cell count (P=0.004), platelet count (P< 0.001) and erythrocyte sedimentation rate (P< 0.001). Among the hematologic abnormalities detected, thrombocytosis and anemia presented in 65% and 25% of PTB patients, respectively.

Explain the hematological implications of this study. (Write a report)

Answer 1

Ans:

Statistically significant mean differences were observed in hemoglobin, hematocrit, mean cell hemoglobin concentration, relative lymphocyte percentage, white blood cell count, platelet count and erythrocyte sedimentation rate values. Therefore, the utilization of these data is important in providing preliminary information for appropriate diagnosis and significant management of pulmonary tuberculosis. Among the hematologic abnormalities detected, thrombocytosis and anemia presented in 65% and 25% of pulmonary tuberculosis (PTB) patients, respectively.

Some hematologic implications of this study includes:

• This study showed a significant decrease in mean hemoglobin (p.0.002) and hematocrit values (p.0.018) of the pulmonary tuberculosis patients as compared to the control patients. The reason for decrease in hemoglobin could be due to utilization of iron as heme by Mycobacterium tuberculosis.
• In this study, the mean total WBC count showed significantly higher (p=0.004) in those with PTB than the control patients.
• The increased polymorphonuclear leukocytes and macrophages occur as a part of immunity against the bacterial pathogen. But, in this study, the relative lymphocyte percentage showed significantly lower (p=0.036) than that of control subjects.
• Erythrocyte sedimentation rate increased with changes in plasma proteins, particularly increases in fibrinogen, immunoglobulins, and C-reactive protein in a wide range of infectious, inflammatory, degenerative, and malignant conditions. In this study, significantly elevated (p<0.001) ESR values were observed in the cases as compared to the control patients.
• Based on study findings, thrombocytosis was detected in 65% of the PTB patients, and the increment of platelet count in the PTB patients than the control group in this study was statistically significant (p<0.001). Such incremental count could be related to elevated interleukins during the acute phase of infection.

This study revealed mean values of hemoglobin level, hematocrit, mean cell hemoglobin concentration, relative lymphocyte percentage of PTB showed statistical downfall whereas total white blood cell count, platelet count and erythrocyte sedimentation rate values of PTB patients showed statistically significant increments over the control patients. PTB patients found to have lymphopenia rather than lymphocytosis and relative to different studies low burden of anemia was observed in PTB patients. Therefore, these data are important in the diagnosis and management of pulmonary tuberculosis and further such study needs to be elaborated by more large-scale studies.