Letters to the Editor

RMMJ Rambam Maimonides Medical Journal Rambam Health Care Campus 2021 October; 12(4): e0035. ISSN: 2076-9172
Published online 2021 October 25. doi: 10.5041/RMMJ.10456.

Letter to the Editor Regarding First Admission Neutrophil–Lymphocyte Ratio and Ischemic Stroke

Rujittika Mungmunpuntipantip, Ph.D.1* and Viroj Wiwanitkit, M.D.2

1Private Academic Consultant, Bangkok, Thailand
2Honorary Professor, Department of Community Medicine, D. Y. Patil University, Pune, India

*To whom correspondence should be addressed. E-mail: rujittika@gmail.com

Keywords: Ischemic stroke, laboratory, neutrophil, lymphocyte ratio



We would like to share with you our thoughts on “First Admission Neutrophil–Lymphocyte Ratio May Indicate Acute Prognosis of Ischemic Stroke.”1

In the conclusion of their abstract, Alpua et al. state that “first admission NLR [neutrophil–lymphocyte ratio] can be used for acute prognosis of ischemic stroke.”1 We agree that NLR might be useful. However, it is also necessary to be concerned about quality control and test variability. The neutrophil and lymphocyte values received from different types of automated hematological analyzers may differ,2 hence precision analysis of the analyzer being used is necessary. There are also many possible confounding conditions that can result in aberration of either neutrophil or lymphocyte values. This is a main limitation for using NLR as a biomarker in laboratory medicine.3


NLR neutrophil-lymphocyte ratio.


Conflict of interest: No potential conflict of interest relevant to this article was reported.

Alpua, M.; Say, B.; Yardimci, I.; Ergün, U.; Kisa, U.; Ceylan, OD. First admission neutrophil–lymphocyte ratio may indicate acute prognosis of ischemic stroke. Rambam Maimonides Med J. 2021. p. e0021. https://doi.org/10.5041/RMMJ.10440.
Buttarello M, Gadotti M, Lorenz C, et al. Evaluation of four automated hematology analyzers. A comparative study of differential counts (imprecision and inaccuracy). Am J Clin Pathol. 1992;97:345–52. https://doi.org/10.1093/ajcp/97.3.345.
Wiwanitkit V. Share NLR as predictor: a concern in laboratory medicine aspect. Int J Colorectal Dis. 2011;26:1499. https://doi.org/10.1007/s00384-011-1166-z.