title: Peripheral blood leukocyte counts in cytomegalovirus infected heart transplant patients: impact of acute disease versus subclinical infection.
abstract: BACKGROUND
  Cytomegalovirus (CMV)-associated leucopenia in heart transplant patients is poorly characterized.
  
  
  METHODS
  We conducted a retrospective analysis of timing, degree, and type of leukopenia in four groups of patients: cases (n=20); controls (n=20); subclinical early infection (n=21), and subclinical late infection (n=22). In the cases, white blood cells (WBC) count at diagnosis was compared to prediagnosis; and cases were compared to controls. Subclinical cases (early and late) were identified by measurement of CMV DNA in peripheral blood mononucleocytes, and WBC was compared to those of the cases and controls.
  
  
  RESULTS
  First, in human heart transplant recipients the total leukocyte count decreased prior to the time of diagnosis of CMV disease: cases: 5.4+/-2.1 x 10/microL vs. 3.7+/-2.1x10/muL (P<0.01); subclinical early: 8.1+/-4.1 x 10/microL vs. 6.9+/-1.6 x 10/microL (P<0.01). Second, the leukocyte populations most reduced during CMV disease are the neutrophils: 4.4 x 10/microL (78%) to 2.5 x 10/microL (69%) (P<0.05), and monocytes 0.6 x 10/microL (11%) to 0.3 x 10/microL (7.5%) (P<0.05). Third, the reduction in leukocyte count that occurs during CMV disease appears to be independent of immunosuppressive therapy (using cyclosporine A, mycophenolate mofetil, or azathioprine and prednisone). Finally, subclinical CMV infection in stable long-term heart transplant patients without disease is unassociated with a reduction in the leukocyte count.
  
  
  CONCLUSIONS
  Aside from implications for early diagnosis, CMV-associated decrease in monocytes is important because viral infections like Epstein-Barr virus cause monocytosis. The absence of leucopenia in subclinical late infections is a new important finding.
authors.affiliation: Heart Transplantation Unit, Division of Cardiovascular Medicine, Stanford University Medical Center, Stanford, CA 94305, USA.
authors.forename: Margaret E
authors.initials: ME
authors.lastname: Cooke
authors.forename: Luciano
authors.initials: L
authors.lastname: Potena
authors.forename: Helen
authors.initials: H
authors.lastname: Luikart
authors.forename: Hannah A
authors.initials: HA
authors.lastname: Valantine
mesh_terms: D000328:Adult; D000368:Aged; D001379:Azathioprine / Q000008:administration & dosage; D016022:Case-Control Studies; D015331:Cohort Studies; D003587:Cytomegalovirus; D003586:Cytomegalovirus Infections / Q000175:diagnosis*; D004279:DNA, Viral / Q000097:blood; D003937:Diagnosis, Differential; D005260:Female; D016027:Heart Transplantation; D006454:Hemoglobins / Q000032:analysis; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage; D007958:Leukocyte Count; D007970:Leukopenia / Q000175:diagnosis* / Q000821:virology*; D008297:Male; D008875:Middle Aged; D009173:Mycophenolic Acid / Q000008:administration & dosage / Q000031:analogs & derivatives; D010976:Platelet Count; D012189:Retrospective Studies
chemical_list: D004279:DNA, Viral; D006454:Hemoglobins; D007166:Immunosuppressive Agents; D009173:Mycophenolic Acid; D001379:Azathioprine