A white blood cell (WBC) count may be distinctive for patients with neuromyelitis optica spectrum disorder (NMOSD) compared to other neurological disorders, according to a recent study published in Scientific Reports.

“Although the total and differential WBC counts did not differ significantly among the 3 demyelinating disease groups, hierarchical clusters, and canonical plots suggested different WBC count profiles between AQP4-IgG-positive NMOSD group and the other 2 disease groups,” the authors wrote.

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This observational prospective study included 70 patients with multiple sclerosis (MS), 26 patients with myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD), and 13 with NMOSD. The totality of the NMOSD group was positive for the antiaquaporin-4 antibody. Most participants were female, with 75.71%, 69.23%, and 84.61% of the cases for each disease, respectively. Sex and age-matched healthy individuals constituted the control groups for each entity.

All individuals underwent blood testing before receiving any treatment, and all 13 patients with NMOSD had their blood drawn at the onset of the disease. The 3 demyelinating disorders exhibited comparable total and differential WBC counts, with values overall higher than their matched controls.

Moreover, the NMOSD group had increased levels of neutrophil, and monocyte counts, higher monocyte-to-lymphocyte ratio, and neutrophil-to-lymphocyte ratio, while the eosinophil and basophil counts were lower when compared to the control group.

Interestingly, the WBC count profile of patients with MOGAD resembled more that of the MS group vs the NMOSD group. This finding contrasts with previous literature reports in which biomarkers seem similar among patients with NMOSD or MOGAD. For example, the characteristic cerebrospinal fluid cytokine profile of predominant expression of cytokines related to the T helper 17 lymphocytes (Th17) is present in both demyelinating entities, while MS showcases a different pattern.

Although further research is needed to identify and understand these immunological patterns, the study noted that patients with NMOSD usually have a past medical history positive for autoimmune disorders and/or malignancies.

“The different backgrounds of patients with different comorbid conditions and preceding clinical episodes heralding attacks in AQP4-IgG-positive NMOSD may be a possible explanation for this discrepancy,” the authors concluded.


Akaishi T, Misu T, Fujihara K, et al. White blood cell count profiles in anti-aquaporin-4 antibody seropositive neuromyelitis optica spectrum disorder and anti-myelin oligodendrocyte glycoprotein antibody-associated disease. Sci Rep. Published online April 20, 2023. doi:10.1038/s41598-023-33827-3