{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,23]],"date-time":"2026-03-23T10:30:03Z","timestamp":1774261803730,"version":"3.50.1"},"reference-count":21,"publisher":"Oxford University Press (OUP)","issue":"6","license":[{"start":{"date-parts":[[2020,1,11]],"date-time":"2020-01-11T00:00:00Z","timestamp":1578700800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/journals\/pages\/open_access\/funder_policies\/chorus\/standard_publication_model"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2020,6,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>Early identification of patients at risk of severe dengue disease (DD) is critical to guide its management. We evaluated whether the atypical lymphocyte count (ALC), generated from the Sysmex automated full blood count analyzer, is predictive of severe thrombocytopenia secondary to Dengue infection.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>We prospectively collected data on patients admitted with DD between December 2017 and October 2018. ALC data were extracted from the Sysmex XS500i analyzer from day 1 to day 7 of admission. Clinical data were obtained from patients' medical records.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>We enrolled 256 patients with DD. A negative correlation between ALC on admission and platelet count on day 5 to day 7 (Spearmen's correlation; day 5:-0.485, day 6:-0.428 and day 7:-0.344) (p=0.001) was observed. Based on receiver operator characteristic curve analysis, we found that an ALC of &amp;gt;0.5x103\/L had 90% sensitivity and 70% specificity for severe thrombocytopenia (platelet count &amp;lt;50x109\/L) on day 5. The positive and negative predictive values were 74.4 and 91.2%, respectively (power 84.7).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>We propose that ALC on admission may be a novel negative predictive factor for severe thrombocytopenia on day 5 to day 7 of DD. Further studies are required to validate our findings and evaluate whether ALC is predictive of other complications of DD.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/trstmh\/trz128","type":"journal-article","created":{"date-parts":[[2019,11,12]],"date-time":"2019-11-12T12:11:38Z","timestamp":1573560698000},"page":"424-432","source":"Crossref","is-referenced-by-count":10,"title":["The atypical lymphocyte count: a novel predictive factor for severe thrombocytopenia related to dengue"],"prefix":"10.1093","volume":"114","author":[{"given":"Visula","family":"Abeysuriya","sequence":"first","affiliation":[{"name":"Nawaloka Hospital Research and Education Foundation, Nawaloka Hospitals PLC, Colombo, Sri Lanka"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Clarice Shi Hui","family":"Choong","sequence":"first","affiliation":[{"name":"Department of Haematology- Oncology, National University Cancer Institute, National University Health System Singapore"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Basuru Uvindu","family":"Thilakawardana","sequence":"first","affiliation":[{"name":"Nawaloka Hospital Research and Education Foundation, Nawaloka Hospitals PLC, Colombo, Sri Lanka"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Primesh","family":"de Mel","sequence":"first","affiliation":[{"name":"Nawaloka Hospital Research and Education Foundation, Nawaloka Hospitals PLC, Colombo, Sri Lanka"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Malka","family":"Shalindi","sequence":"first","affiliation":[{"name":"Nawaloka Hospital Research and Education Foundation, Nawaloka Hospitals PLC, Colombo, Sri Lanka"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Chandima","family":"de Mel","sequence":"first","affiliation":[{"name":"Nawaloka Hospital Research and Education Foundation, Nawaloka Hospitals PLC, Colombo, Sri Lanka"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lal","family":"Chandrasena","sequence":"first","affiliation":[{"name":"Nawaloka Hospital Research and Education Foundation, Nawaloka Hospitals PLC, Colombo, Sri Lanka"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Suranjith L","family":"Seneviratne","sequence":"first","affiliation":[{"name":"Nawaloka Hospital Research and Education Foundation, Nawaloka Hospitals PLC, Colombo, Sri Lanka"},{"name":"Department of Surgery, Faculty of Medicine, University of Colombo, Sri Lanka"},{"name":"Institute of Immunity and Transplantation, Royal Free Hospital and University College London, London, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Christina","family":"Yip","sequence":"first","affiliation":[{"name":"Department of Laboratory Medicine, National University Health System Singapore"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Eng-Soo","family":"Yap","sequence":"first","affiliation":[{"name":"Department of Haematology- Oncology, National University Cancer Institute, National University Health System Singapore"},{"name":"Department of Laboratory Medicine, National University Health System Singapore"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sanjay","family":"de Mel","sequence":"first","affiliation":[{"name":"Department of Haematology- Oncology, National University Cancer Institute, National University Health System Singapore"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","published-online":{"date-parts":[[2020,1,11]]},"reference":[{"key":"2020060220000774800_ref1","doi-asserted-by":"crossref","first-page":"S7","DOI":"10.1038\/nrmicro2460","article-title":"Dengue: a continuing global threat","volume":"8","author":"Guzman","year":"2010","journal-title":"Nat Rev Microbiol."},{"key":"2020060220000774800_ref2","doi-asserted-by":"crossref","first-page":"68","DOI":"10.4103\/0019-5154.60357","article-title":"Dengue viral infections","volume":"55","author":"Gurugama","year":"2010","journal-title":"Indian J Dermatol."},{"key":"2020060220000774800_ref3","doi-asserted-by":"crossref","first-page":"h4661","DOI":"10.1136\/bmj.h4661","article-title":"Dengue fever","volume":"351","author":"Kularatne","year":"2015","journal-title":"BMJ."},{"key":"2020060220000774800_ref4","author":"World Health Organization and Special Program for Research and Training in Tropical Diseases","year":"2012"},{"key":"2020060220000774800_ref5","doi-asserted-by":"crossref","first-page":"653","DOI":"10.1093\/trstmh\/trz068","article-title":"A review of dengue diagnostics and implications for surveillance and control","volume":"113","author":"Raafat","year":"2019","journal-title":"Trans R Soc Trop Med Hyg."},{"key":"2020060220000774800_ref6","doi-asserted-by":"crossref","first-page":"1165","DOI":"10.1086\/343813","article-title":"High circulating levels of the dengue virus nonstructural protein NS1 early in dengue illness correlate with the development of dengue hemorrhagic fever","volume":"186","author":"Libraty","year":"2002","journal-title":"J Infect Dis."},{"key":"2020060220000774800_ref7","doi-asserted-by":"crossref","first-page":"2","DOI":"10.1002\/rmv.1971","article-title":"Liver involvement in dengue viral infections","volume":"28","author":"Dissanayake","year":"2018","journal-title":"Rev Med Virol."},{"key":"2020060220000774800_ref8","doi-asserted-by":"crossref","first-page":"83","DOI":"10.2149\/tmh.2011-S10","article-title":"Clinical manifestations and management of dengue\/DHF\/DSS","volume":"39","author":"","year":"2011","journal-title":"Trop Med Health."},{"key":"2020060220000774800_ref9","doi-asserted-by":"crossref","first-page":"170","DOI":"10.1016\/S0140-6736(06)69006-5","article-title":"The WHO dengue classification and case definitions: time for a reassessment","volume":"368","author":"Deen","year":"2006","journal-title":"Lancet."},{"key":"2020060220000774800_ref10","doi-asserted-by":"crossref","first-page":"670","DOI":"10.1093\/trstmh\/trz066","article-title":"Factors predicting the severity of dengue in patients with warning signs in Rio de Janeiro, Brazil (1986\u20132012)","volume":"113","author":"Gon\u00e7alves","year":"2019","journal-title":"Trans R Soc Trop Med Hyg."},{"key":"2020060220000774800_ref11","doi-asserted-by":"crossref","first-page":"157","DOI":"10.1002\/cyto.b.20150","article-title":"Identification and quantification of high fluorescence-stained lymphocytes as antibody synthesizing\/secreting cells using the automated routine hematology analyzer XE-2100","volume":"72","author":"Linssen","year":"2007","journal-title":"Cytometry B Clin Cytom."},{"key":"2020060220000774800_ref12","doi-asserted-by":"crossref","first-page":"685","DOI":"10.1515\/CCLM.2011.100","article-title":"Sensitivity and specificity of the high fluorescent lymphocyte count-gate on the Sysmex XE-5000 hematology analyzer for detection of peripheral plasma cells","volume":"49","author":"van Mirre","year":"2011","journal-title":"Clin Chem Lab Med."},{"key":"2020060220000774800_ref13","first-page":"27","article-title":"Characterization of atypical lymphocytes and immunophenotypes of lymphocytes in patients with dengue virus infection","volume":"25","author":"Jampangern","year":"2007","journal-title":"Asian Pac J Allergy Immunol."},{"key":"2020060220000774800_ref14","volume-title":"Haematology Society of Australia and New Zealand","author":"San Pedro","year":"2013"},{"key":"2020060220000774800_ref15","doi-asserted-by":"crossref","DOI":"10.1155\/2015\/313842","article-title":"Thrombocytopenia in dengue: Interrelationship between virus and the imbalance between coagulation and fibrinolysis and inflammatory mediators","volume":"2015","author":"de Azeredo","year":"2015","journal-title":"Mediators Inflamm."},{"issue":"5","key":"2020060220000774800_ref16","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0215061","article-title":"Atypical lymphocyte count correlates with the severity of dengue infection","volume":"14","author":"Clarice","year":"2019","journal-title":"PLoS One."},{"key":"2020060220000774800_ref17","author":"World Health Organization Regional Office for South Asia","year":"2011"},{"key":"2020060220000774800_ref18","doi-asserted-by":"crossref","first-page":"861","DOI":"10.1111\/ijlh.12422","article-title":"New parameters available on Sysmex XE-5000 hematology analyzers contribute to differentiating dengue from leptospirosis and enteric fever","volume":"37","author":"Oehadian","year":"2015","journal-title":"Int J Lab Hematol."},{"key":"2020060220000774800_ref19","doi-asserted-by":"crossref","first-page":"6","DOI":"10.18203\/2320-6012.ijrms20173979","article-title":"Correlation of thrombocytopenia with degree of atypical lymphocytosis as a prognostic indicator in dengue","volume":"5","author":"Joshi","year":"2017","journal-title":"Int J Res Med Sci."},{"key":"2020060220000774800_ref20","first-page":"2","article-title":"Managing dengue fever in primary care: a practical approach","volume":"9","author":"Lum","year":"2014","journal-title":"Malays Fam Physician."},{"key":"2020060220000774800_ref21","doi-asserted-by":"crossref","first-page":"130","DOI":"10.1186\/s13104-015-1085-0","article-title":"Trends of fluid requirement in dengue fever and dengue haemorrhagic fever: a single centre experience in Sri Lanka","volume":"8","author":"Kularatne","year":"2015","journal-title":"BMC Res Notes."}],"container-title":["Transactions of The Royal Society of Tropical Medicine and Hygiene"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/academic.oup.com\/trstmh\/article-pdf\/114\/6\/424\/33332583\/trz128.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"http:\/\/academic.oup.com\/trstmh\/article-pdf\/114\/6\/424\/33332583\/trz128.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2020,6,3]],"date-time":"2020-06-03T00:10:10Z","timestamp":1591143010000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/trstmh\/article\/114\/6\/424\/5699687"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,1,11]]},"references-count":21,"journal-issue":{"issue":"6","published-online":{"date-parts":[[2020,1,11]]},"published-print":{"date-parts":[[2020,6,1]]}},"URL":"https:\/\/doi.org\/10.1093\/trstmh\/trz128","relation":{},"ISSN":["0035-9203","1878-3503"],"issn-type":[{"value":"0035-9203","type":"print"},{"value":"1878-3503","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2020,6]]},"published":{"date-parts":[[2020,1,11]]}}}