Hematologic Characteristics of Patients with Active Pulmonary, Extra-Pulmonary and Disseminated Tuberculosis: A Study of over Six Hundred Patients

Background: Many inflammatory cells, cytokines, acute phase reactants as well as platelets are recruited in the battle against the invading mycobacterium. As a result, alterations in the hematologic profile of infected patients are anticipated. Objectives: The primary objective was to investigate the various hematologic characteristics of patients with active tuberculosis. The secondary objective was to study the correlation between such hematologic characteristics and the type of tuberculosis including pulmonary, extra-pulmonary, and disseminated. Methods: This was a retrospective, descriptive study investigating the hematological findings in adult patients (aged 18 years or older) with active, bacteriologically-confirmed tuberculosis infection. Results: Among the 605 confirmed active tuberculosis cases, 465 (78.8%) were pulmonary, 104 (17.6%) extra-pulmonary, and 21 (3.6%) disseminated type. The mean age at diagnosis was 33.4 ± 11.4 years and males constituted 80.2% of cases. Peripheral leukocytosis was observed in 177 (30.1%) and leukopenia in 7 (1.2%) (Pulmonary type of tuberculosis was significantly associated with leukocytosis (P = 0.000)). Neutrophilia, lymphocytosis, monocytosis, eosinophilia, and basophilia were observed in 15.3%, 3.1%, 10.4%, 6.3% and 4.7% respectively. Thrombocytopenia and thrombocytosis were observed in 3.9% and 26.7% respectively. Anemia was observed in 44.8% of all cases with 4.4% had severe anemia and 60.3% had anemia of chronic diseases. Erythrocyte sedimentation rate was high in 77.2% of cases and ≥100 mm/hr in 5%. C-reactive protein was high in 93.4% and it exceeded 40 mg/L in 69.3%. Conclusion: There is a wide range of variability in the leukocyte and differential leukocyte abnormalities observed in patients with active tuberculosis. Leukocytosis can be seen in one-third of patients with pulmonary tuberculosis. Anemia of chronic diseases is the most common type of anemia observed in tuberculosis patients. Erythrocyte sedimentation rate and C-reactive protein are elevated in the majority of patients with active tuberculosis. Levels of the sedimentation rate can be useful indices to determine the extent of the disease.