Transworld Medical Journal

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Original Research Paper

Pulmonary Tuberculosis and its hematological

correlates
Pravat Kumar Thatoi,* Sagar Khadanga
Department of Medicine, SCB Medical College, Odisha
Abstract
Background: There is a paucity of literature in the hematological changes associated with
tuberculosis.
Aims: To evaluate the hematological parameters in pulmonary tuberculosis patients.
Methods and Materials: One hundred patients of pulmonary tuberculosis with sputum positive for
acid fast bacilli (AFB) were studied for various hematological parameters by means of hemogram by
automated cell counter and peripheral smear examination.
Results: Anemia was seen in 74% of patients; 71% had a normal leukocyte count. Leucocytosis as a
response to infection was observed in 26 patients. Three had leucopenia. Thrombocytosis was
observed in 24 while thrombocytopenia was observed in 9. 99% patients had increased erythrocyte
sedimentation rate (ESR). Two patients had pancytopenia.
Conclusions: While many of the haematological traits such as anemia and increased ESR are
consistent with reported literature and reinforce the fact that they can be valuable tools in monitoring
pulmonary tuberculosis. Other findings such as thrombocytosis and pancytopenia suggest the need for
further research in this field.
Keywords: Pulmonary tuberculosis, anemia, leucocytosis, thrombocytosis, pancytopenia.
Transworld
of
mycobacterial
Medical Journal. All
infection. Little is
Introduction
rights reserved.
known about the

Tuberculosis (TB) is a highly prevalent chronic

infectious disease caused by Mycobacterium
tuberculosis bacilli. Globally, TB remains at an
epidemic level affecting one third of world
1
population. About one third of India population
are infected with it. The emergence of human
immunodeficiency virus (HIV) infection has made
2
the situation worse. Around 10% of TB cases are
in the first and second decade of life. It affects
3
three times as many men as women.
Reversible peripheral blood abnormalities are
commonly associated with pulmonary TB. Insight
into the relationship between hematological
abnormalities and mycobacterial infection has
come from an understanding of the immunology
Tel.: +91 9437170150
Email: drpravatthatoi@yahoo.co.in,

prevalence of these
hematological
abnormalities
and
the
effect
of
antituberculosis
treatment on the
various
hematological
parameters in the
Indian
subcontinent.

This
study
undertaken
analyse
hematological
parameters

was
to
the
in

patients with sputum smear positive for AFB and pulmonary

to evaluate their diagnostic and prognostic tuberculosis patients
whose sputum was
significance.
positive for AFB. The
Materials and methods
blood cell counts
were analyzed using
During a period from Jan 2012 to Dec 2012, fully
automated
hematological parameters were studied in

hematology analyzer
Sysmex KX 21, using
EDTA anticoagulated
fresh venous blood
sample.

Thatoi PK / Transworld Medical Journal 1(1)

1113
All patients
had
a
detailed
hemogram
including
hemoglobi
n
(Hb),
total
leukocyte
count
(TLC),
differential
leukocyte
count
(DLC),
platelet
count,
hematocrit
(HCT),
mean
corpuscula
r
volume
(MCV),
mean
corpuscula
r
hemoglobi
n
(MCH),
mean
corpuscula
r
hemoglobi
n
concentrati
on (MCHC),
erythrocyt
e
sedimentat
ion
rate
(ESR), and
peripheral
blood
smear (PS)
to
study
the
RBC
and
WBC
morpholog
y. The data
were
entered in
Excel chart
and
analyzed.
Descriptive
statistics

were used
for
the
analysis.

Results
Of the 100
subjects
there were
71 males
and
29
females
with mean
age of 41
years.
Mean age
for males
was
42
years and
mean age
for
females
was
35
years.
In males,
the
Hb
value
ranged
from
6.9g/dl to
16.3 g/dl
with
the
mean
being 11.5
g/dl.
In
females,
the mean
Hb
level
was 10g/dl
ranging
from
7.1g/dl to
14.4g/dl.
In
28%
cases Hb
was
less
than
10gm/dl.
(Table 1)
The
definition
of anemia
used
in
this study
was
hemoglobi
n

concentr
ation less
than
13g/dl in
men and
12 g/dl in
5
women.
Anemia
was
typed
based on
the MCV,
MCH and
periphera
l
smear
findings.
Anemia
was
present
in
74
patients.
Normocyt
ic anemia
was the
most
common
type and
was
found in
49
(66.2%)
patients.
Microcyti
c anemia
was next
common
type and
was seen
in
22
patients.
Three
patients
had
macrocyti
c anemia
in which
the MCV
was more
than 100
fl.
In spite of
the
infection,
71
patients
had
a
normal
leucocyte
count.
Lecocytos

is
as
a
response
to infection
was
observed
in
26
patients of
which
21(80.7%)
were males
and
5
(19.3%)
were
females.
All patients
with
leucocytosi
s
had
neutrophili
a.
Three
patients
had
leucopenia.
Thrombocy
tosis
was
observed
in
24
patients
while
thrombocyt
openia was
observed
in
9
patients.
Interestingl
y
thromoboc
ytosis was
observed
in patients
who
had
leucocytosi
s.
99%
of
patient had
increased
ESR. Only
one patient
had
a
normal
ESR.
13
patients
had
ESR
ranging
from 20 to
40 mm in
first hour,
30 patients

Table-1.
Haematologi
cal profile

had ESR in
the range
of 40 60
mm,
35
had from
60 to 80
mm
and
11
patients
had
ESR
value
more than
100 mm.

12

Hb (Gm/dL)

T
N
(

<8
811
1114
>14
Total
Anaemia
Normocytis anaemia
Microcytic anaemia
Macrocytic anaemia
Leucocytosis
Thrombocytosis with leucocytosis
Leucopenia
Increased ESR
ESR (2040) in first hr
ESR (4060) in first hr
ESR (6080) in first hr
ESR ( more than 80) in first hr

9
3
4
1
1
7
4
2
3
2
2
9
9
1
3
3
1

Discussion
The present
study had
been an
attempt to
study a
complete
hematologica
l profile in
pulmonary
TB. The
prevalence
of anemia
and its types
in the
present
study was
similar to the
other
2,5,6
studies.
Various
researches
have
reported a
blunted
erythropoieti
n response
to anemia of
untreated
tuberculosis.
It is
postulated
that the
tumor
necrosis
factor
(TNF- ) and

other
cytokines
released by
activated
monocytes
suppress the
erythropoietin
production
leading to
2
anemia. The
incidence of
macrocytic
blood picture
is similar to a
study done by
6
Morris et al.
Leucocyte
response
varied
from
leucocytosis to
pancytopenia.
Mild
leucocytosis is
documented in
8-40%
of

patients with
pulmonary
tuberculosis.3
The
prevalence of
leucocytosis in
present study
was similar to
study done by
Singh KJ et
2
al. Although,
changes were
reported
in
relative
number of the
WBCs, these
had
not
proved useful
either
as
clinical
or
prognostic
7
value.
The reported
prevalence of

leucopenia in
pulmonary
tuberculosis
8
is 1-4%. The
results
of
present
study are in
agreement
with
these
studies.
Neutropenia
was
the
predominant
finding
in
these
patients,
which
may
be
a
consequence
of
the
combined
effect
of
hypersplenis
m, excessive

Thatoi PK / Transworld Medical Journal 1(1)

1113
disseminate
6,8
In
margination ofd TB.
our
study,
neutrophil
or
26%
had
marrow
thrombocyto
granulopoietic sis, which is
failure
close to the
mediated
byfindings of
the
T-Singh KJ et
2
lymphocyte
al.
Various
showing
inflammator
cells,
granulopoietic y
cytokines
inhibitor
activity.
Manyand
mediators
authors
are involved
reported
in
the
lymphocytopeni formation of
a in patientsgranulomato
lesions
with pulmonaryus
TB. The exactencountered
reason for thein
development oftuberculosis.
Among
lymphocytopeni them
a has not beeninterleukin-6
elucidated.
(IL-6)
has
Nevertheless, been known
the
role
ofto promote
platelet
cytokine
9
including TNF inproduction.
Studies
the
pathogenesis ofreported on
lymphocytopeni the value of
a
has
beenthe ESR as a
2
test
of
suggested.
activity
in
Previous
studies
havepulmonary
documented
TB
have
pancytopenia inconcluded
patient
with
disseminated that it is an
and military TBuseful
and but it is apractical
rare finding inmethod
of
patients
with
obtaining
8
pulmonary TB. dependable
In the present
study two casesinformation
about
the
had
pancytopenia actual
and
boneprogress or
marrow
retrogressio
examination
of
could not ben
done as thetuberculous
patients
werelesion,
not willing forbefore these
further
can
be
evaluation.
Thrombocytosis demonstrate
has
beend by other
reported
inclinical and
patients
withlaboratory
military
or

procedures.
Previous
studies have
documented
an elevated
ESR level in
majority of
patients
which
decreased
significantly
in those who
sputum
becomes
negative.
99%
of
patients
with
increased
ESR in the
present
study are in
concordance
with
the
reported
1
literature.

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reinf
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the
fact
that
they
can
be
valu
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tools
in
moni
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such
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PK.
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