Study of Hematological Changes and Neutrophil to Lymphocytes Ratio in Type 2 Lepra Reaction Cases

Type 2 Lepra reaction (T2R) is an immune mediated systemic inflammatory response in leprosy patients with high bacterial load. Various cytokines e.g., TNF-α, INF-γ, IL-1β, IL-17A, IL-6 play important role in pathogenesis of ENL. Cytokines response affects the bone marrow derived cells lines and reflects as qualitative and quantitative changes in peripheral blood cells, which in T2R may serve as inflammatory marker for diagnosis and grading of reaction. The aim of study was to assess hematologic changes e.g., Hb, Total WBC count, neutrophils (%), lymphocytes (%), Platelet count, mean platelets volume (MPV), red cell distribution width (RDW) (%), neutrophils (%) to lymphocytes (%) ratio (NLR) in type 2 lepra reaction (T2R). A retrospective analysis was carried out at the tertiary care center. Data were collected with inclusion of all case record of leprosy & T2R from January 2018 to December 2021. Data of Hb, RDW, TC, Neutrophils (%), Lymphocytes (%), Platelets, MPV) were obtained for non-reaction leprosy (LL & BL) as well as during each episode of T2R patients. It was observed that there was significant low Hb while raised TC, RDW, NLR were found in T2R, which were more prominent in severe reaction. For diagnosis of T2R, AUC of NLR was 0.930 (0.885-0.975) with cut off value 6.08 (sensitivity 78.4%, specificity 92.2%, accuracy 90.2%). For severity of T2R, AUC was 0.833 (0.713, 0.953) with cut off value 9.1 (sensitivity 77.3%, specificity 82.8%, accuracy 77.3%). The limitation of study was small sample size and no objective scoring like EESS (ENLIST ENL Severity Scale). T2R patients with multiple episodes were already taking systemic corticosteroids and other infective conditions may also have effect on leucocyte count. There is significantly low Hb with raised TC, RDW, NLR in T2R. Hematologic changes are more prominent in severe reactions. NLR has value in grading severity of T2R.