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CC BY 4.0 · Aorta (Stamford)
DOI: 10.1055/a-2717-6200
DOI: 10.1055/a-2717-6200
Review Article
Full Blood Count and its Differentials in Acute Aortic Dissection: An Update and Future Perspectives
Authors
Abstract
Acute aortic dissection (AAD) is a potentially lethal condition with a high rate of misdiagnosis during the initial evaluation. In addition to established clinical variables, previous studies have consistently demonstrated a relationship between full blood count (FBC) and its various differentials with acute aortic syndromes, even identifying patients with worse outcome. Although FBC is a simple, inexpensive and routinely performed test, it is easily overlooked by clinicians. However, nearly all components of FBC, including white blood count, red blood cells, and platelets, may contribute to the underlying pathogenesis of AAD and therefore, we should fully explore and pinpoint precisely their potential diagnostic or prognostic performances. Herein, we summarize the results of such studies and discuss controversies regarding utility in future clinical practice.
Publication History
Received: 11 May 2025
Accepted: 07 October 2025
Article published online:
29 October 2025
© 2025. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)
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References
- 1 Isselbacher EM, Preventza O, Hamilton Black III J. et al; Peer Review Committee Members. 2022 ACC/AHA guideline for the diagnosis and management of aortic disease: a report of the American Heart Association/American College of Cardiology Joint Committee on Clinical Practice Guidelines. Circulation 2022; 146 (24) e334-e482
- 2 Evangelista A, Isselbacher EM, Bossone E. et al; IRAD Investigators. Insights from the international registry of acute aortic dissection: a 20-year experience of collaborative clinical research. Circulation 2018; 137 (17) 1846-1860
- 3 Nazerian P, Mueller C, Soeiro AM. et al; ADvISED Investigators. Diagnostic accuracy of the aortic dissection detection risk score plus d-dimer for acute aortic syndromes: the ADvISED prospective multicenter study. Circulation 2018; 137 (03) 250-258
- 4 Elefteriades JA, Farkas EA. Thoracic aortic aneurysm clinically pertinent controversies and uncertainties. J Am Coll Cardiol 2010; 55 (09) 841-857
- 5 Madjid M, Fatemi O. Components of the complete blood count as risk predictors for coronary heart disease: in-depth review and update. Tex Heart Inst J 2013; 40 (01) 17-29
- 6 Eggebrecht H, Naber CK, Bruch C. et al. Value of plasma fibrin D-dimers for detection of acute aortic dissection. J Am Coll Cardiol 2004; 44 (04) 804-809
- 7 Hazui H, Fukumoto H, Negoro N. et al. Simple and useful tests for discriminating between acute aortic dissection of the ascending aorta and acute myocardial infarction in the emergency setting. Circ J 2005; 69 (06) 677-682
- 8 Ohlmann P, Faure A, Morel O. et al. Diagnostic and prognostic value of circulating D-dimers in patients with acute aortic dissection. Crit Care Med 2006; 34 (05) 1358-1364
- 9 Morello F, Cavalot G, Giachino F. et al. White blood cell and platelet count as adjuncts to standard clinical evaluation for risk assessment in patients at low probability of acute aortic syndrome. Eur Heart J Acute Cardiovasc Care 2017; 6 (05) 389-395
- 10 Sbarouni E, Georgiadou P, Marathias A, Geroulanos S, Kremastinos DT. D-dimer and BNP levels in acute aortic dissection. Int J Cardiol 2007; 122 (02) 170-172
- 11 Li D, Liu S, Teng F. et al. Temporal change of leukocytes and chemokines in aortic dissection patient: relationship to regional lesion on aorta. Int J Cardiol 2013; 168 (03) 3065-3066
- 12 Hiratzka LF, Bakris GL, Beckman JA. et al American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. American Association for Thoracic Surgery; American College of Radiology; American Stroke Association; Society of Cardiovascular Anesthesiologists; Society for Cardiovascular Angiography and Interventions; Society of Interventional Radiology; Society of Thoracic Surgeons; Society for Vascular Medicine. 2010 ACCF/AHA/AATS/ACR/ASA/SCA/SCAI/SIR/STS/SVM guidelines for the diagnosis and management of patients with Thoracic Aortic Disease: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines, American Association for Thoracic Surgery, American College of Radiology, American Stroke Association, Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, Society of Interventional Radiology, Society of Thoracic Surgeons, and Society for Vascular Medicine. Circulation 2010; 121: e266-e369
- 13 Suzuki K, Kimura N, Mieno M, Hori D, Sezai A, Yamaguchi A, Tanaka M. Factors related to white blood cell elevation in acute type A aortic dissection. PLoS One 2020; 15 (02) e0228954
- 14 Wen D, Wu HY, Jiang XJ. et al Role of plasma C-reactive protein and white blood cell count in predicting in-hospital clinical events of acute type A aortic dissection. Chin Med J (Engl) 2011; 124 (17) 2678-2682
- 15 Sbarouni E, Georgiadou P, Analitis A, Voudris V. High neutrophil to lymphocyte ratio in type A acute aortic dissection facilitates diagnosis and predicts worse outcome. Expert Rev Mol Diagn 2015; 15 (07) 965-970
- 16 del Porto F, Proietta M, Tritapepe L. et al. Inflammation and immune response in acute aortic dissection. Ann Med 2010; 42 (08) 622-629
- 17 Chun H, Siu KM. A diagnostic and screening strategy with neutrophil counts in patients with suspected aortic dissection in a certain time window. World J Emerg Med 2023; 14 (04) 307-311
- 18 Chen Y, Dong K, Fang C. et al. The predictive values of monocyte-lymphocyte ratio in postoperative acute kidney injury and prognosis of patients with Stanford type A aortic dissection. Front Immunol 2023; 14: 1195421
- 19 Lin Y, Peng Y, Chen Y. et al. Association of lymphocyte to monocyte ratio and risk of in-hospital mortality in patients with acute type A aortic dissection. Biomarkers Med 2019; 13 (15) 1263-1272
- 20 Shao Y, Ye L, Shi HM. et al. Impacts of eosinophil percentage on prognosis acute type A aortic dissection patients. BMC Cardiovasc Disord 2022; 22 (01) 146
- 21 Qin X, Gao Y, Jiang Y. et al. The role of peripheral blood eosinophil counts in acute Stanford type A aortic dissection patients. Front Surg 2022; 9: 969995
- 22 Liu CL, Liu X, Zhang Y. et al. Eosinophils protect mice from angiotensin-II perfusion-induced abdominal aortic aneurysm. Circ Res 2021; 128 (02) 188-202
- 23 Bhat T, Teli S, Rijal J. et al. Neutrophil to lymphocyte ratio and cardiovascular diseases: a review. Expert Rev Cardiovasc Ther 2013; 11 (01) 55-59
- 24 Onuk T, Güngör B, Karataş B. et al. Increased neutrophil to lymphocyte ratio is associated with in-hospital mortality in patients with aortic dissection. Clin Lab 2015; 61 (09) 1275-1282
- 25 Lareyre F, Raffort J, Le D. et al. High neutrophil to lymphocyte ratio is associated with symptomatic and ruptured thoracic aortic aneurysm. Angiology 2018; 69 (08) 686-691
- 26 Zhang H, Guo J, Zhang Q. et al. The potential value of the neutrophil to lymphocyte ratio for early differential diagnosis and prognosis assessment in patients with aortic dissection. Clin Biochem 2021; 97: 41-47
- 27 Xie LF, Xie QG, Gao WP. et al. The prognostic value of preoperative systemic inflammatory response index in predicting outcomes of acute type A aortic dissection patients underwent surgical treatment. Front Immunol 2024; 15: 1388109
- 28 Li S, Lu J, Cheng W, Zhu J, Jin M. Factors associated with low admission platelet count in adults with acute aortic dissection. Ann Thorac Cardiovasc Surg 2019; 25 (03) 142-148
- 29 Zhang S, Qian H, Yang Q, Hu J, Gan C, Meng W. Relationship between the extent of dissection and platelet activation in acute aortic dissection. J Cardiothorac Surg 2015; 10: 162
- 30 Lancé MD, Sloep M, Henskens YM, Marcus MA. Mean platelet volume as a diagnostic marker for cardiovascular disease: drawbacks of preanalytical conditions and measuring techniques. Clin Appl Thromb Hemost 2012; 18 (06) 561-568
- 31 Sbarouni E, Georgiadou P, Analitis A, Voudris V. Significant changes in platelet count, volume and size in acute aortic dissection. Int J Cardiol 2013; 168 (04) 4349-4350
- 32 Xie X, Fu X, Zhang Y. et al. U-shaped relationship between platelet-lymphocyte ratio and postoperative in-hospital mortality in patients with type A acute aortic dissection. BMC Cardiovasc Disord 2021; 21 (01) 569
- 33 Kurtul A, Ornek E. Platelet to lymphocyte ratio in cardiovascular diseases: a systematic review. Angiology 2019; 70 (09) 802-818
- 34 Sbarouni E, Georgiadou P, Kosmas E, Analitis A, Voudris V. Platelet to lymphocyte ratio in acute aortic dissection. J Clin Lab Anal 2018; 32 (07) e22447
- 35 Bedel C, Selvi F. Association of Platelet to lymphocyte and neutrophil to lymphocyte ratios with in-hospital mortality in patients with type a acute aortic dissection. Braz J Cardiovasc Surg 2019; 34 (06) 694-698
- 36 Liu H, Qian SC, Zhang YY. et al. A novel inflammation-based risk score predicts mortality in acute Type A aortic dissection surgery: the additive anti-inflammatory action for aortopathy and arteriopathy score. Mayo Clin Proc Innov Qual Outcomes 2022; 6 (06) 497-510
- 37 Zhao Y, Hong X, Xie X. et al. Preoperative systemic inflammatory response index predicts long-term outcomes in type B aortic dissection after endovascular repair. Front Immunol 2022; 13: 992463
- 38 Newhall DA, Oliver R, Lugthart S. Anaemia: a disease or symptom. Neth J Med 2020; 78 (03) 104-110
- 39 Gan T, Hu J, Liu W. et al. Causal association between anemia and cardiovascular disease: a 2-sample bidirectional Mendelian randomization study. J Am Heart Assoc 2023; 12 (12) e029689
- 40 Zhang M, Sui W, Cheng C. et al. Erythropoietin promotes abdominal aortic aneurysms in mice through angiogenesis and inflammatory infiltration. Sci Transl Med 2021; 13 (603) eaaz4959
- 41 Li B, Wang Z, Hong J. et al. Iron deficiency promotes aortic medial degeneration via destructing cytoskeleton of vascular smooth muscle cells. Clin Transl Med 2021; 11 (01) e276
- 42 Xiao J, Borné Y, Gottsäter A, Pan J, Acosta S, Engström G. Red cell distribution width is associated with future incidence of abdominal aortic aneurysm in a population-based cohort study. Sci Rep 2020; 10 (01) 7230