Journal OF MILITARY PHARMACO - MEDICINE N02 - 2021 A STUDY ON THE CHANGES OF COMPLETE BLOOD COUNT IN DEPRESSION PATIENTS Pham Thi Thu1, Le Van Quang2, Nguyen Tat Dinh3 SUMMARY Objectives: To study the changes in some complete blood count indexes in depressed patients Subjects and methods: Descriptive retrospective study Case group: 138 depressed patients were treated in the Psychiatric Department, Military Hospital 103, discharged from st st January , 2019 to December 31 , 2019 Control group: 164 healthy people giving from kidney st donors at the Urology Department, Military Hospital 103 were discharged from January , th 2019 to June 30 , 2020 Data were analyzed by SPSS 20 Results and conclusions: Among depressed patients, there was an increase in the number of leukocytes, neutrophils and monocytes, a decrease in the number of erythrocytes and hemoglobin (p < 0.05) Mean corpuscular volume and mean corpuscular hemoglobin was higher in the study group compared to the control group Meanwhile mean corpuscular hemoglobin concentration was lower than that in the control group Red cell distribution width in the case group was statistically higher than that in the control group (p < 0.05) The number and volume of platelets in depressed patients was smaller than in healthy people, statistical significance (p < 0.05) * Keywords: Depression; Complete blood count INTRODUCTION Depression is a common chronic disease in the world, and associated with a wide range of impairment and secondary morbidity [1] Today, there are many studies on the pathogenesis of depressive disorders in addition to the role of genes and neurotransmitters, including the role of inflammation Many studies show an association between depression and inflammatory factors such as cortisol, CRP, interleukin, white blood cell count [2] Several indicators of complete blood count are important factors in the evaluation of inflammatory processes Some studies show an increase in the number of leukocytes and neutrophils, a decrease in the percentage of lymphocytes in depressed patients [3, 4, 5] In addition, there are the changes in other indexes of complete blood count in depression In Vietnam, there have not been any studies on this issue Therefore, we carried out this study aiming: To study the changes in some complete blood count indexes in depressed patients Department of Psychiatry, Military Hospital 103, Vietnam Military Medical University Naval Commando Brigade 126 Department of Psychiatry, Military Hospital 103, Vietnam Military Medical University Corresponding author: Pham Thi Thu (thu41b@gmail.com) Date received: 24/11/2020 Date accepted: 27/01/2021 125 Journal OF MILITARY PHARMACO - MEDICINE N02 - 2021 SUBJECTS AND METHODS Subjects - Case group: 138 depressed patients treated in the Psychiatric Department of Military Hospital 103 were discharged from January 1st, 2019 to December 31st, 2019 + Diagnosis of depression: According to ICD 10 diagnotic criteria + Exclusion criteria: Patients with combined severe somatic disease and patients with white blood cell counts above 10 G/L - Control group: 164 healthy people giving kidney donors at the Urology Department of Military Hospital 103 were discharged from January 1st, 2019 to June 30th, 2020 Methods * Study design: Descriptive retrospective study Complete blood count were tested by machine in the Hematology Department, Military Hospital 103 Venous blood had been taken after one day since patient was admitted to the hospital * Data analysis: By SPSS 20.0 version RESULTS AND DISCUSSION Gender and age group Table 1: Gender and age group Variables Gender Age Groups Case group Control group n (%) Male 83 (60.1) 100 (61.0) Female 55 (39.9) 64 (39.0) ≤ 30 66 (47.8) 75 (45.7) 31 - 50 44 (31.9) 68 (41.5) ≥ 51 28 (20.3) 21 (12.8) p > 0.05 > 0.05 The results showed that 60.1% of patients in the case group were male, this rate in the control group was 61.0% Subjects in both groups were mainly less than 30 years old (47.8% in the case group and 45.7% in the control group) and from 31 to 50 years old There were no statistically significant differences in gender and age between the case group and the control group (p > 0.05) In general population, depression was more common in women than in men (female/male ratio: 2/1) [1], however at Military Hospital 103, the majority of patients were military personnel, thus most of them were male and young, which was consistent with the gender and age group of donors 126 Journal OF MILITARY PHARMACO - MEDICINE N02 - 2021 The blood cell count indexes Table 2: The blood cell count indexes Mean variables Unit Case group Control group p G/L 7.46 ± 1.43 6.86 ± 1.36 < 0.05 % 58.64 ±10.10 53.85 ± 8.26 < 0.05 G/L 4.44 ± 1.41 3.74 ± 1.08 < 0.05 % 29.19 ± 8.49 32.69 ± 7.81 < 0.05 G/L 2.13 ± 0.60 2.25 ± 0.63 > 0.05 % 7.93 ± 1.97 7.77 ± 2.30 > 0.05 M G/L 0.62 ± 0.50 0.52 ± 0.17 < 0.05 RBC T/L 4.68 ± 0.46 4.92 ± 0.49 < 0.05 Hemoglobin g/L 140.92 ± 12.57 145.07 ± 12.59 < 0.05 Hematocrit L/L 0.42 ± 0.03 0.43 ± 0.05 > 0.05 Mean corpuscular volume Fl 90.17 ± 4.82 87.60 ± 4.56 < 0.05 Mean corpuscular hemoglobin pg 30.13 ± 1.78 29.52 ± 1.83 < 0.05 Mean corpuscular hemoglobin concentration g/L 333.99 ± 9.45 337.79 ± 10.09 < 0.05 Red cell distribution width % 13.38 ± 0.98 12.98 ± 0.85 < 0.05 G/L 240.08 ± 51.21 260.65 ± 62.35 < 0.05 fl 8.91 ± 1.13 9.42 ± 1.09 < 0.05 White blood cell N% N L% L M% Platelet Mean platelet volume The results showed that mean white blood cell count (WBC) of depressed patients was 7.46 G/L, while in healthy people it was 6.86 G/L There was a statistically significant higher number of leukocytes among depressed patients than healthy people (p < 0.05) The number and percentage of neutrophils (N and N%) in the case group was also significantly higher than in the control group (p < 0.05) The number of lymphocytes (L) in two groups was not statistically significant different, but the percentage of lymphocytes (L%) in the case group was statistically significant lower than in control group (p < 0.05), this was due to the fact that the increase in the percentage of neutrophils reduces the percentage of lymphocytes Similarly, the number of monocytes in the case group was significantly higher than in the control group (p < 0.05) but the increase in the percentage was not statistically significant due to the greater increase in neutrophils This result is consistent with other findings [3, 4, 5] The white blood cell count is an important factor in the inflammatory evaluation According to the study by Demir S et al, in depressed patients there was an increase in the number of leukocytes and neutrophils, a decrease in the percentage of lymphocytes, but the number of lymphocytes did not have a statistically significant change compared with control group [4] A study by Maes et al (1992) on 22 healthy people 127 Journal OF MILITARY PHARMACO - MEDICINE N02 - 2021 and 109 depressed patients found that there was a significant increase in leukocytes, neutrophils and monocytes in depressed patients In addition, the number of leukocytes, neutrophils, monocytes was linearly associated with the severity of depression [5] Regarding the indexes of erythrocytes, the results showed that the number of erythrocytes and hemoglobin was significantly lower in depressed patients than in the control group (p < 0.05), but no statistically significant difference was found on hematocrit The mean corpuscular volume and mean corpuscular hemoglobin in the case group were statistically higher than the control group (p < 0.05), but the mean corpuscular hemoglobin concentration in the case group was lower than the control group (p < 0.05) The indexes of mean corpuscular volume, mean corpuscular hemoglobin, mean corpuscular hemoglobin concentration in both two groups were within the normal range Vandoolaeghe E et al conducted a study on 47 depressed patients and 32 healthy people also found that depressed patients had a statistically significantly lower number of erythrocytes than healthy people Hemoglobin and hematocrit were also lower in the patient group, but there was no difference in mean corpuscular volume and mean corpuscular hemoglobin According to the author, this change was due to an inflammatory response rather than a deficiency of iron since the mean corpuscular volume and mean corpuscular hemoglobin did not decrease [3] According to Nemeth E et al, inflammatory factors reduce erythrocytes life, so the number of erythrocytes in patients with inflammatory 128 processes is lower than in healthy group [6] Our results show that the red cell distribution width in the case group is statistically higher than the control group Red cell distribution width is the test to evaluate the change in the size and shape of red blood cells A study by Liqiang in 2017 also found that depressed patients had a higher red cell distribution width than healthy people [7] Regarding the platelet indexes, the results showed that in the case group, the number of platelet as well as the mean platelet volume was significantly lower than the control group (p < 0.05) Platelets are a source of serotonin, a disruption of the serotonin system plays an important role in the pathogenesis of depressive disorders In addition, platelets are variants in the inflammatory process The study by Liqiang also found that the case group had a statistically significantly larger platelet volume but found no statistically significant difference in platelet count The authors suggest that mean platelet volume may be useful marker of inflammation in depression [7] However, according to Sonmez, during the inflammatory process, activated platelets will stick to the white blood cells, focus on the inflammation site and aggregate, so that the number of platelets in circulation can decrease [8] Several studies of platelet volume in chronic inflammatory diseases such as chronic periodontitis found that the mean platelet volume in the patient group was statistically significantly smaller than the control group [9] The author believes that large activated platelets have been aggregated and sticked, the rest of the platelets circulating in the blood had small Journal OF MILITARY PHARMACO - MEDICINE N02 - 2021 size In addition, megakaryocytes in the bone marrow is interfered by inflammatory factors, resulting in produced small platelets [9] A study on panic disorder patients by Gul IG et al also found that the patients with panic disorder had a smaller platelet size than the control group The authors suggest that abnormal serotonin metabolism may lead to a decrease in platelet size [10] CONCLUSION Through this study, we found that many indicators of complete blood count vary in patients with depressive disorder, reflecting the association between depressive disorders and inflammation In particular, there was a statistically significant increase in the number of leukocytes, neutrophils and monocytes, a decrease in the number of red blood cells and hemoglobin among depressed patients (p < 0.05) Depressed patients had a higher mean corpuscular volume and mean corpuscular hemoglobin than the control group, mean corpuscular hemoglobin concentration was lower than the control group (p < 0.05) Red cell distribution width in the case group was statistically higher than the control group (p < 0.05) The number and volume of platelets in depressed patients was significantly smaller than in healthy people (p < 0.05) REFERENCES Kessler RC, Bromet EJ The epidemiology of depression across cultures Annu Rev Pulic Health 2013; 34:119-138 Haapakoski R, Mathieu J, Ebmeier KP, Alenius H, Kivimäki M Cumulative meta- analysis of interleukin-6 and 1β, tumour necrosis factor-α and C-reactive protein in patients with major depressive disorder Brain Behav Immun 2015; 49:206 Vandoolaeghe E, Nathalie De Vos, Demedts P, Wauters A, et al Reduced number of red blood cells, lowered hematocrit and hemoglobin, and increased number of reticulocytes in major depression as indicators of activation of the inflammatory response system: Effects of antidepressant drugs Hum Psychopharmacol Clin 1999; 14:45-52 Demir S, Atli A, Bulut M, et al Neutrophil-lymphocyte ratio in patients with major depressive disorder undergoing no pharmacological therapy Neuropsychiatr Dis Treat 2015; 11:2253-2258 Maes M, Van Der Planken M, Steven WJ, et al Leukocytosis, monocytosis and neutrophilia: Hallmarks of severe depression Journal of Psychiatric Research 1992; 26(2):125-134 Nemeth E, Ganz T Anemia of inflammation Hematol Oncol Clin North Am 2014; 28(4):671-681 Liqiang Cai, Luoyi Xu, Lili Wei, Wei Chen Relationship of mean platelet volume to MDD: A retrospective study Shanghai Arch Psychiatry 2017; 29(1):21-29 Sonmez O, Sonmez M Rostrum role of platelets in immune system and inflammation Porto Biomedical Journal 2017; 2(6):311-314 Reddy GJ, Chandra MR, Gupta AA, et al Mean platelet volume as an imflammatory marker in patients with chronic periodontitis A pilot study Indian J Dent Adv 2018; 10(4):155-159 10 Gul IG, Erylmaz G, Ozten E, Sayar GH Decreased mean platelet volume in panic disorder Neuropsychiatr Dis Trea 2014; 10:1665-1669 129 ... Platelets are a source of serotonin, a disruption of the serotonin system plays an important role in the pathogenesis of depressive disorders In addition, platelets are variants in the inflammatory... focus on the inflammation site and aggregate, so that the number of platelets in circulation can decrease [8] Several studies of platelet volume in chronic inflammatory diseases such as chronic... been aggregated and sticked, the rest of the platelets circulating in the blood had small Journal OF MILITARY PHARMACO - MEDICINE N02 - 2021 size In addition, megakaryocytes in the bone marrow