Patient's Query
Hello doctor,
I understand that a high vacuolated neutrophil result can be indicative of impending sepsis. Is it possible for someone to have this result and an infection that does not make the patient's symptoms visibly worse for a week? If so, could you give some examples of such infections? The patient is not on antibiotics. Can a high vacuolated neutrophil result indicate some sort of problem other than an infection?
Hi,
Welcome to icliniq.com.
I appreciate your knowledge. You are right; vacuolated neutrophils suggest that an infective etiology is more likely. But let me know; in such a case, usually neutrophilia is also seen. So vacuolated neutrophil interpretation should be done in accordance with total WBC (white blood corpuscles) and total neutrophil count.
Your clinical correlation and physical examination are also necessary. Vacuolations in neutrophils suggest the phagocytic function of it in infection, e.g., pneumonia, fungal infection, septicemia, typhoid, etc. Sometimes in inflammation also such cells are seen.
As you have rapid weight loss, the cause for that should be searched. Some of the causes are HIV, acute infection, COPD, gastrointestinal problems like celiac disease and inflammatory bowel disease, hyperthyroidism, diabetes, tuberculosis, etc. So the clinical correlation is necessary to do further work. Provide your other reports if they have been done, along with a full CBC (complete blood count) report.
I hope this helps.
Patient's Query
Hi doctor,
Thank you for the reply,
The patient recently had pneumonia but apparently recovered. The WBC has remained elevated due to pneumonia and so has the CRP. At that time the high vacuolated neutrophil result came through. The WBC was 13.5 x10^9/L, CRP was 66.0 mg/L, and the neutrophils were 7.0 x10^9/L. Now, a week later, his WBC is 15.3, CRP is up to 148.5 mg/L, but his neutrophils, which have been up and down, are now 6.6 x10^9/L. The patient is definitely unwell but does not appear to be any sicker.
Hi,
Welcome to icliniq.com.
So because of pneumonia infection weight loss is present. Neutrophilia and vacuolation in neutrophils are seen because of that. After one week, your total WBC count increases and your CRP is also high. In some patients, radiological and hematological recovery might take some time. But CRP remains elevated here. Hence, further workup needs to be done like sputum examination and sputum culture.
According to the culture report, further medication will be prescribed. If not improving, then suitable injectable medication and fluid resuscitation are given accordingly. During infections because of the release of some inflammatory mediator release appetite is also suppressed. Hence, weight loss occurs.
I hope this helps.
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Answered byDr. Goswami Parth Rajendragiri
Medically reviewed byDr. Vinodhini J.
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