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Neutrophil hypersegmentation in children receiving angiotensin converting enzyme inhibitors

Vedat Okutan1, A Emin Kürekçi, S Umit Sarici

  • 1Department of Pediatrics, Gülhane Military Medical Academy, Ankara, Turkey.

The Turkish Journal of Pediatrics
|December 24, 2008
PubMed

Insights

Angiotensin converting enzyme inhibitors, like captopril and enalapril, were linked to neutrophil hypersegmentation in children with heart disease. This previously unreported finding suggests a potential impact on the hematopoietic system from these common cardiac medications.

Area of Science:

  • Pediatric Cardiology
  • Hematology
  • Pharmacology

Background:

  • Angiotensin converting enzyme (ACE) inhibitors are widely used for pediatric cardiac conditions.
  • The bone marrow's renin-angiotensin system may influence hematopoietic processes.
  • A potential link between ACE inhibition and hematopoietic changes, specifically granulocyte morphology, was hypothesized.

Purpose of the Study:

  • To prospectively investigate the effect of ACE inhibitors on neutrophil morphology, particularly segmentation, in children.
  • To compare neutrophil morphology in children with cardiac disease on ACE inhibitors versus healthy controls.

Main Methods:

  • A prospective study involving 40 children (2-16 years) on ACE inhibitors (captopril or enalapril) and 40 age/sex-matched healthy controls.
  • Comprehensive blood tests including complete blood count and peripheral blood smear analysis.
  • Blinded evaluation of peripheral blood smears by pediatric hematologists to assess neutrophil segmentation.

Main Results:

  • Significantly higher incidence of neutrophil hypersegmentation in the ACE inhibitor group compared to controls.
  • Mean neutrophil lobe count was significantly elevated in children receiving ACE inhibitors.
  • Neutrophil hypersegmentation associated with ACE inhibitor use in children is a novel finding.

Conclusions:

  • ACE inhibitor use in children with cardiac disease is associated with neutrophil hypersegmentation.
  • The underlying pathophysiological mechanisms require further investigation.
  • This finding highlights a potential, previously unrecognized effect of ACE inhibitors on the hematopoietic system.

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