Green Inclusions in Neutrophils and Monocytes Are an Indicator of Acute Liver Injury and High Mortality

Patel, Nisha; Hoffman, Corey M.; Goldman, Bruce; Bentley, Karen de Mesy; Burack, W. Richard; Evans, Andrew

doi:10.1159/000477794

Cited by 11 publications

(16 citation statements)

References 4 publications

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“…, especially as other comorbidity factors are of importance in these critically ill patients. Some patients showing these inclusions present other relevant biological findings like elevated levels of LDH (this study and) 4 or lactic acidosis, which has been associated with a combined mortality rate of 75% (this study and Ref 1,[3][4][5]7. ).…”

mentioning

confidence: 59%

“…In the past decade, nine publications encompassing 70 cases have reported green cytoplasmic inclusions in neutrophils and occasionally in monocytes in patients suffering from acute liver damage. [1][2][3][4][5][6][7][8][9] The presence of these cytoplasmic deposits within the neutrophils is most probably due to a lipofuscin-like substance released from necrotic liver parenchymal cells and taken up by phagocytosis. 3,7 Biological findings described in these patients are as follows: (a) elevated liver transaminases associated with acute liver tissue damage, (b) elevated lactate dehydrogenase (LDH) levels probably secondary to hepatic necrosis, and (c) elevated lactate values, seen as a predictor of survival.…”

Section: Dear Editorsmentioning

confidence: 99%

“…In a previous study published, active screening for green neutrophilic inclusions resulted in a higher number of cases identified (13 cases vs 11) and decrease in mortality rate (from 72% to 42%). 7 Using digital imaging, an active screening should be easy to implement and yield more cases in the near future, pleading in favor of reporting them, with a benefit for the patients. In our first case, the percentage of inclusions was very low (2%), matching previous reports.…”

Section: Dear Editorsmentioning

confidence: 99%

“…1,2 Other studies refer to multiple or incidental neutrophils with green inclusions. [5][6][7][8] It is reasonable to think that the higher the number of neutrophils with inclusions, the more extensive the tissue damage, as more lipofuscin-like substance is released from the necrotic tissue and taken up by neutrophils. The percentage of neutrophils with inclusions could be useful as a prognostic value and in the patient follow-up.…”

Section: Dear Editorsmentioning

confidence: 99%

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Green inclusions in neutrophils: A critical finding that must be reported

Vicente‐Steijn

Tomé

Maduell

et al. 2019

Int J Lab Hematology

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mentioning

confidence: 59%

Section: Dear Editorsmentioning

confidence: 99%

Section: Dear Editorsmentioning

confidence: 99%

Section: Dear Editorsmentioning

confidence: 99%

See 2 more Smart Citations

Green inclusions in neutrophils: A critical finding that must be reported

Vicente‐Steijn

Tomé

Maduell

et al. 2019

Int J Lab Hematology

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“…34 Various hypotheses for the contents of these granules are discussed in the haematology literature. [35][36][37][38][39] Figure 2 shows one of the cookies we distributed, decorated as neutrophil containing a death granule.…”

Section: Costume Contestmentioning

confidence: 99%

Clinical pathology resident education during the COVID-19 pandemic

2020

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COVID-19 arrived at our medical centre in March 2020 with substantial force. Clinical pathology concepts began to have a new, direct relevance to our residents’ lives. As we wondered ‘Have I been exposed? Do I need to self-isolate? Are the tests reliable? Am I protecting myself adequately while handling specimens?’, these questions drew new interest in laboratory methods, test interpretation and limitations, supply chain issues, safety and quality. By incorporating SARS-CoV-2 teaching points into laboratory medicine lectures, we enlivened concepts of sensitivity, specificity, predictive value and methodologic issues in serologic, molecular and antigen testing for pathology residents. We drew from the emerging literature on SARS-CoV-2 to create lectures and added details from our own institutional experience with COVID-19. When the pandemic fades from memory, clinical pathology education can still benefit from mnemonics, analogies, anecdotes and creative efforts that capture the attention of the audience.

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Toll‐like receptor 10 controls TLR2‐induced cytokine production in monocytes from patients with Parkinson's disease

Sobrinho

Gomes

Silva

et al. 2021

J of Neuroscience Research

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Peripheral inflammation, particularly mediated by monocytes, can cause neuroinflammation in Parkinson's disease (PD). We investigated the mechanism of TLR2-induced cytokine impairment in peripheral monocytes from PD patients and the association between the presence of CD14 + TLR10 + monocytes and PD severity. Peripheral blood mononuclear cells from PD patients and healthy individuals were evaluated for TLR expression on monocyte subsets (CD14 and CD16 expression) using flow cytometry. Moreover, cytokines were evaluated using flow cytometry after stimulation with Pam 3 Cys (TLR2/TLR1 agonist) in the absence or presence of neutralizing antibodies to TLR10. The severity of PD was assessed using the unified PD rating scale (UPDRS) and motor activity, anxiety (BAI), depression (BDI), and fatigue (PD Fatigue Scale-16) scales. The frequency of CD14 + TLR10 + monocytes and expression intensity of TLR2 and TLR10 were higher in patients with PD than healthy individuals. The frequency of intermediate monocytes (CD14 ++ CD16 + ) was not significantly increased in patients with PD, but was the main monocyte subset expressing TLR10.The TLR2/TLR1-impaired cytokine production TNFα, in PD patients was reversed by neutralizing TLR10. The high frequency of total CD14 + TLR10 + monocytes was associated with a reduction in the severity of PD according to the evaluation of motor and nonmotor symptoms. Peripheral monocytes from patients with PD showed phenotypic and functional alterations. The expression of TLR10 on monocytes can protect against PD by controlling TLR2-induced cytokine production. Furthermore, data suggested that a low frequency of CD14 + TLR10 + monocytes indicates the severity of PD. The results identified new opportunities for the development of novel PD neuroprotective therapies.

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Green Inclusions in Neutrophils and Monocytes Are an Indicator of Acute Liver Injury and High Mortality

Cited by 11 publications

References 4 publications

Green inclusions in neutrophils: A critical finding that must be reported

Green inclusions in neutrophils: A critical finding that must be reported

Clinical pathology resident education during the COVID-19 pandemic

Toll‐like receptor 10 controls TLR2‐induced cytokine production in monocytes from patients with Parkinson's disease

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