Annals of Thoracic Medicine Official publication of the Saudi Thoracic Society, affiliated to King Saud University
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Year : 2015  |  Volume : 10  |  Issue : 1  |  Page : 73
Neutrophil/lymphocyte ratio, a possible diagnostic marker in clinical practice

1 Department of Chest Diseases, Gulhane Military Medical Faculty, Ankara, Turkey
2 Department of Hematology, Gazi University Medical Faculty, Kecioren, Ankara, Turkey

Date of Web Publication12-Dec-2014

Correspondence Address:
Nesrin Ocal
Department of Chest Diseases, Gulhane Military Medical Faculty, Ankara
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/1817-1737.146895

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How to cite this article:
Ocal N, Ocal R, Yegin ZA. Neutrophil/lymphocyte ratio, a possible diagnostic marker in clinical practice. Ann Thorac Med 2015;10:73

How to cite this URL:
Ocal N, Ocal R, Yegin ZA. Neutrophil/lymphocyte ratio, a possible diagnostic marker in clinical practice. Ann Thorac Med [serial online] 2015 [cited 2023 Apr 2];10:73. Available from:


We read with great interest Iliaz et al.'s [1] article titled "Value of neutrophil/lymphocyte ratio in the differential diagnosis of sarcoidosis and tuberculosis," which was published in Annals of Thoracic Medicine (Vol. 9, Issue 4, October-December 2014). This retrospective study touched on an important issue, the differential diagnosis of sarcoidosis and tuberculosis, which is a serious difficulty in clinical practice. However, we think that the content of this study has some confusing points and to clarify these complexities would prove the results of this valuable study. In this letter, we would like to make some suggestions to eliminate these confusions.

Primarily, being a retrospective study brings together some difficulties and shortcomings. So that, in this study some points remain unclear. There are some unenlightened issues about the patients included in the study. 'Biopsy-proven' phrases were used for patients with sarcoidosis, but sufficient information was not given about the medical history of tuberculosis. Considering that, there are many publications claiming that mycobacteria bacilli causes the pathogenesis of sarcoidosis and many patients take unnecessary anti-tuberculosis treatment, a detailed investigation of tuberculosis is very important. [2],[3] If there was more information about the stages of sarcoidosis, extrapulmonary involvements and most importantly bone marrow involvements, these points would have been more clear.

There are also some questions that require answers about tuberculosis group, such as "are these cases 'new case', 'recurrent tuberculosis case', 'chronic case' or 'miliary tuberculosis case'". No description was given if the patients had cavity, bone marrow involvement or hemoptysis. However, these clinical situations are closely associated with disease progression and complete blood count values will vary significantly in miliary tuberculosis and bone marrow involvements. [4].

Another confused point is the selection type of the control group. We're not sure if a control group in a retrospective study may be sufficiently randomized and reflect the real healthy society. A detailed description that claims that patients were selected randomly, autoimmune and other chronic diseases were investigated, history of drug use was questioned, latent/active tuberculosis was examined with TST (tuberculin skin test), could reduce this complexity. It was stated that other infectious causes have been ruled out, but, exclusion procedure was not explained in the text. If this exclusion has been done according to complete blood count and acute phase reactants, it means that the only people who had completely normal laboratory values ​​were taken in the control group and it can't be said that this group was randomized and accurately reflect the society. To make comparison with this group is indistinguishable from comparing the results with the normal laboratory values.

There was no information about the laboratory devices used for complete blood counts and other acute phase reactants measurements. This casts doubt whether there is sufficient standardization. On the other hand, the blood cells were automatically calculated and it is known that these devices cannot show the immature cells correctly as peripheral blood smear does.

Besides all these points, it should be said that this study is a remarkable and important research, which sheds light on a very important clinical issue. Thanks to the authors.

   References Top

Iliaz S, Iliaz R, Ortakoylu G, Bahadir A, Bagci BA, Caglar E. Value of neutrophil/lymphocyte ratio in the differential diagnosis of sarcoidosis and tuberculosis. Ann Thorac Med 2014;9:232-5.  Back to cited text no. 1
[PUBMED]  Medknow Journal  
Baygin N, Tozkoparan E. Paradoxical relationship between TNF-alpha antagonists and sarcoidosis. Semin Arthritis Rheum 2014;43:e2.  Back to cited text no. 2
Saboor SA, Johnson NM, McFadden J. Detection of mycobacterial DNA in sarcoidosis and tuberculosis with polymerase chain reaction. Lancet 1992;339:1012-5.  Back to cited text no. 3
Lee YH, Hong YC, Yang CF, Wu HT, Huang LJ, Tzeng CH, et al. Severe extensive bone marrow necrosis from miliary tuberculosis without granulomas and pulmonary presentations. J Chin Med Assoc 2010;73:208-11.  Back to cited text no. 4


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