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Challenging the use of the lymphocyte to white cell count ratio in the diagnosis of infectious mononucleosis by analysis

Challenging the use of the lymphocyte to white cell count ratio in the diagnosis of infectious mononucleosis by analysis of a large cohort of monospot test results

Lennon, P.,* O’ Neill, J.P.,* Fenton, J.E.€ & O’ Dwyer, T.*

*Department of Otolaryngology, Head and Neck Surgery, Mater Misericordiae University Hospital, Dublin, Ireland, and University of Limerick, Limerick, Ireland

Objective: We investigated the hypothesis that a lymphocyte ⁄ white cell count ratio should be used as a diagnostic indicator of infectious mononucleosis. Design: Retrospective study to compare lymphocyte counts and white blood cell counts, against the criterion standard, the mononucleosis spot test.

Setting: Department of Otolaryngology, Mater Misericordiae University Hospital, Dublin, Ireland. Participants: We reviewed 1000 patients who had Monospot assays, 500 positive and 500 negative.

Main outcome measures: The lymphocyte counts and white blood cell ratio was calculated and compared with the monospot result to calculate the sensitivity and speci?city at various ratios.

Results: The lymphocyte counts and white blood cell ratio was signi?cantly different in the positive and negative monospot groups (P < 0.05). The mean lymphocyte counts and white blood cell ratio in the positive group was 0.49 and the mean lymphocyte to white cell count ratio in the monospot negative group was 0.29.A ratio of 0.35 had a speci?city of 72% and a sensitivity of 84% for the detection of glandular fever.

A higher ratio will give a greater speci?city, but a lower sensitivity, and vice versa.

Conclusions: The mean lymphocyte to white cell count ratio is not suf?cient to diagnose or exclude infectious mononucleosis. Thus, this study does not con?rm the conclusions of earlier studies.

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