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 Table of Contents  
ORIGINAL ARTICLE
Year : 2021  |  Volume : 8  |  Issue : 3  |  Page : 263-267

Altered leukogram and hematological parameters among leukemia patients


1 Department of Haematology and Blood Transfusion, National Hospital, Abuja, Nigeria
2 Medical Laboratory, Asokoro District Hospital, Abuja, Nigeria
3 Department of Logistics and Supply Chain Management, Malaysia University of Science and Technology, Petaling Jaya, Malaysia
4 Department of Preventive and Community Dentistry, Obafemi Awolowo University Teaching Hospitals’ Complex, Ile-Ife, Nigeria
5 Department of Haematology and Blood transfusion, Federal Medical Centre, Makurdi, Benue State, Nigeria
6 Department of Compliance and Quality Control, Management Sciences for Health, Akesis, Abuja, Nigeria
7 Department of Public Health, Triune Biblical University Global Extension, NY, USA

Date of Submission11-May-2021
Date of Acceptance29-Jun-2021
Date of Web Publication03-Sep-2021

Correspondence Address:
Dr. Andrew Nuhu Yashim
Department of Haematology and Blood Transfusion, National Hospital, Abuja.
Nigeria
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/mgmj.mgmj_24_21

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  Abstract 

Background: The incidence of leukemia is increasing in developing countries, particularly in Africa. Cancer-associated inflammation is a significant factor in the improvement and survival of people with cancer. This study aimed to evaluate changes in leukogram and other hematological parameters among leukemia patients in Abuja, Nigeria. Materials and Methods: The study comprised 30 leukemia patients attending the Oncology Department of National Hospital Abuja, Nigeria, from July 2019 to August 2020, and 20 healthy people. Three milliliters of blood was collected from each participant into an ethylene diamine tetra-acetic acid bottle and analyzed for full blood and differential counts using the Mythic 22 (Orphee, Switzerland) five-part differential hematology analyzer. CD4 and CD8 T cells were analyzed by flow cytometry. Data analysis was done using IBM-SPSS software, SPSS Inc., Chicago, IL, version 25.0. T-test was used to compare means between groups, and the significant value was set as P < 0.05. Results: All hematological parameters were significantly lower (P < 0.05) in leukemia patients than those in controls except for monocytes and basophils. In addition, white blood cell count was significantly higher in leukemia patients (13.0 ± 0.57 × 109/L) than that in controls (6.11 ± 1.14 × 109/L) (P < 0.05). CD4 (775.40 ± 82.91 cells/µL) and CD8 counts (634.40 ± 101.43 cells/µL) were significantly higher in controls than those in leukemia patients. Furthermore, CD4/CD8 ratio was significantly higher (P < 0.05) among controls (1.24 ± 0.15) than that in leukemia patients (1.17 ± 0.09). Conclusion: The study found that changes in hematological parameters and leukogram are significantly associated with leukemia. The use of therapies to boost immune response in patients with leukemia is recommended.

Keywords: Cancer, hematological parameters, leukemia, leukocyte


How to cite this article:
Yashim AN, Obazee DY, Ajani OF, Adewole OM, Swem C, Abiodun PO, Sanni OF. Altered leukogram and hematological parameters among leukemia patients. MGM J Med Sci 2021;8:263-7

How to cite this URL:
Yashim AN, Obazee DY, Ajani OF, Adewole OM, Swem C, Abiodun PO, Sanni OF. Altered leukogram and hematological parameters among leukemia patients. MGM J Med Sci [serial online] 2021 [cited 2021 Sep 21];8:263-7. Available from: http://www.mgmjms.com/text.asp?2021/8/3/263/325534




  Introduction Top


The incidence of leukemia is increasing in developing countries, particularly in Africa. “A group of cancers originating from the bone marrow is generally called leukemia.”[1] It grows in the production of blood cells that have undergone a malignant transition, leading to the formation of numerous malfunctioning cells that are unregulated.[2] Leukemia is a “neoplastic clonal disorder of hemopoietic or neoplastic blood disorders characterized by the proliferation and development of immature hematopoietic cells in the bone marrow and blood.”[2],[3] The World Health Organization[4] rated leukemia as the thirteenth most common cancer with 474,519 cases and as the cause for the tenth highest cancer deaths with 311,594 cases of all ages and genders worldwide in 2020. In Nigeria, when analyzing the burden of cancer, leukemia was rated the third highest with a 2.3% incidence and a 3.2% mortality rate behind breast, cervix/uteri, and colorectum cancers in 2018.[5]

According to the report of Durosinmi[6] in the book titled “A Design Handbook of Haemato-oncology Chemotherapy for Medical Students and Doctors,” chronic lymphocytic leukemia (CLL) is the most common leukemia in Africa, with about 40% of cases in Osun State, Nigeria, whereas in the Niger-Delta region of Nigeria, chronic myelogenous leukemia was reported as the most common subtype with 33.3%. In contrast, CLL, prolymphocytic leukemia, and acute myeloid leukemia accounted for 20.8%, 20.8%, and 16.7% of cases, respectively.[7] Most of these findings in Nigeria correlated with the hematological parameters and the patients’ clinical symptoms.

Patients with abnormal hematological markers such as platelet (PLT) irregularities can experience minor bleeding to deadly hemorrhage.[8] In the peripheral blood-stained film, blast cells and smudge cells indicate leukemia disease, and these criteria are used as predictive indices of leukemia infection.[2],[9] Thrombocytopenia is a typical characteristic of liver disease in 30%–64% of leukemia infections.[10],[11] Splenomegaly in acute leukemia is known to be the primary cause of reduced PLT count.[12]

Cancer-associated inflammation is a significant factor in the improvements and survival of people with cancers. Systemic inflammatory response is due to various causes and is associated with circulating white blood cells (WBCs).[2],[13] Hematological analyses are done routinely in a range of clinical situations, and such tests can accurately exhibit the severity of the inflammatory reaction in patients.[14],[15] This study, therefore, aimed to evaluate altered leukogram and hematological parameters among leukemia patients at the Oncology Department, National Hospital, Abuja, Nigeria.


  Materials and methods Top


This study was conducted at the Oncology Department, National Hospital, Abuja, after obtaining permission from the ethical research committee at the beginning of the study. The study duration was from July 2019 to August 2020. The sample size for the study comprised 30 newly diagnosed leukemia patients and 20 healthy subjects as controls. Patients aged below 18 years were excluded from the study.

Sample collection

Three milliliters of whole blood was collected from each study participant for the study into ethylene diamine tetra-acetic acid (K3EDTA) bottle for full blood count (packed cell volume [PCV], total leukocyte count, and differential WBC count) using the Mythic 22 (Orphee, Switzerland) five-part differential hematology analyzer, at the National Hospital Laboratory, Abuja. In addition, CD4 and CD8 T cell counts were carried out by flow cytometry upon diagnosis.

Data analysis

Data analysis was done using IBM-SPSS software, SPSS Inc., Chicago, IL, version 25.0. T-test was used to compare means between groups, and the significant value was set as P < 0.05.


  Results Top


The study comprised 30 leukemia patients (cases) and 20 healthy controls. There were 22 (73.3%) males and eight (246.7%) females in the leukemia group, whereas the control group comprised 10 (50.0%) males and females each. The mean age of the cases was 38.9 ± 8.8 years, with a minimum and maximum of 26 and 62 years, respectively. The controls had an average age of 39.0 ± 7.5 years with a minimum and maximum of 30 and 60 years, respectively.

As shown in [Table 1], all hematological parameters were significantly lower (P < 0.05) in leukemia patients than those in controls except for monocytes, basophils, and eosinophils. WBC was significantly higher in leukemia patients (13.0 ± 0.57 × 109/L) than that in controls (6.11 ± 1.14 × 109/L) (P < 0.05). As shown in [Table 2], both CD4 (775.40 ± 82.91 cells/µL) and CD8 counts (634.40 ±101.43 cells/µL) were significantly higher in controls than those in leukemia patients. In addition, CD4/CD8 ratio was significantly higher (P < 0.05) among controls (1.24 ± 0.15) than that in leukemia patients (1.17 ± 0.09).
Table 1: Hematological parameters and leukocytes of leukemia patients and healthy subjects

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Table 2: Immunological parameters of leukemia patients and healthy subjects

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  Discussion Top


This study showed that leukemia is more common among males than females (male:female = 3:1) and mostly among middle-aged people (38.9 ± 8.8 years) after excluding the pediatric population. These findings are similar to the findings of a similar study conducted in Kaduna State, also in the north central region of Nigeria. The result is also consistent with reports from Australia, New Zealand, North America, and western Europe, in which the male-to-female leukemia ratio was found to be 4:1.[16] A similar study in Pakistan also found higher leukemia incidence among males than females with a male-to-female ratio of 2.1:1.[17] However, some other studies reported almost similar leukemia incidence among males and females.[18],[19],[20] Furthermore, there were significant decreases in hemoglobin (Hgb) and PCV levels among leukemia patients, showing that the leukemia patients in this study were anemic. The findings agree with those of previous studies documenting similar associations between Hgb and PCV with anemia in cancer patients.[2],[12],[17],[21]

Furthermore, most leukemia patients in our study had significantly reduced PLTs and increased WBC (P < 0.001). This finding is consistent with several studies that associated high WBC and reduced PLTs with leukemia infection, resulting in a proliferation of unusual WBC in the bone marrow.[19],[20],[22],[23],[24] These findings revealed synthetic characteristics of the organs and may still indicate prognostic markers.[14],[17],[19]

The present study found significantly reduced CD4 and CD8 count and CD4/CD8 ratio among leukemia patients compared with the control group. This result is consistent with that of previous studies that associated cancer with reduced CD4 and CD8 count and CD4/CD8 ratio.[25],[26],[27],[28],[29],[30],[31] Previous studies have emphasized the relevance of CD4 in secreting cytokines (such as interleukin-2) needed for the development and proliferation of CD8+ T cells.[32],[33],[34] It has also been reported that the immunization of CD8+ T cells against cancers requires the activation of CD4+.[32] CD4 cell counting, as per the World Health Organization, is an important diagnostic test required to detect and control the disease of priority such as cancer, tuberculosis, HIV, and other sexually transmitted diseases.[35] The CD4 count is classified into the following four groups: minimum (<200 cells/µL), low (200–349 cells/µL), moderate (350–499 cells/µL), and high (>500 cells/µL).[25],[35] In that case, such a patient is at risk of getting an opportunistic infection because CD4 level remains the best measurement of a patient’s immune and clinical status, for diagnostic decision-making and for determining the risk of opportunistic infections.[25],[36] The mean CD4 count observed among leukemia patients in this study was at the minimum level (<200 cells/µL), which is an indication of the patients’ high risk or vulnerability to opportunistic infections. These infections do not affect people with healthy immune systems but affect people whose immune systems have been weakened by infections such as cancer and HIV.[25]

The low CD4/CD8 ratio among leukemia patients seen in this study indicates inflammatory infection, which is also consistent with studies showing that CD4+ cell proportion and CD4+/CD8+ cell ratio in patients with cancer are significantly lower than those in healthy people.[28],[31],[37],[38]


  Conclusion Top


The present study found that changes in hematological parameters were significantly associated with leukemia. In addition, the clinical course of leukemia is associated with a decrease in CD4 and CD8 cell counts, indicating the significance of the immune system in leukemia progression. Therefore, the use of therapies to boost immune response in patients with leukemia is recommended.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

Ethical consideration

The study was conducted at the Oncology Department, National Hospital Abuja, Nigeria, after obtaining permission from the ethical research committee at the beginning of the study.



 
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