Leukocytosis¶
Kenna Koehler
Background¶
- Common progenitor cells (stem cells) are located in the bone marrow and give rise to erythrocytes, myeloblasts, megakaryoblasts
- Normal WBC can vary by age and pregnancy, for the purpose of this section will assume this is for an average, non-pregnant adult
- Chronic mild neutrophilic leukocytosis (10-20k) is common with tobacco use and obesity, both due to mechanisms related to chronic inflammation
- Reactive (typically 11k-30k) - surgery, exercise, trauma, burns, emotional stress
- Leukemoid reaction (typically 50k-100k) - severe infections (fulminant C difficile), organ rejection
- If greater than 100k, think leukemia or myeloproliferative disorder
Evaluation¶
- Neutrophilia (neutrophil count >7k)
- Bacterial infection, pregnancy, rheumatologic disease, steroids, beta agonists, lithium, colony-stimulating factors, splenectomy or functional asplenia, congenital (hereditary/chronic idiopathic neutrophilia), Down syndrome, leukocyte adhesion deficiency, malignancy, smoking, obesity
- Lymphocytosis (>40% of WBC count or >4,500k/mm3)
- Infections (pertussis, syphilis, CMV, EBV, hepatitis A/B/C, toxo), hypersensitivity reactions, thyrotoxicosis, Addison's disease, hematologic malignancies, “reactive”
- Monocytosis (>8% of WBC count or >880/mm3)
- Infections (TB, fungal disease, protozoa, tick-borne), autoimmune disease, malignancy (CMML)
- Eosinophilia (>500/mm3)
- Hypersensitivity (asthma, urticaria, atopic dermatitis, eosinophilic esophagitis), drug reactions, malignancies, connective tissue disease, idiopathic hypereosinophilic syndrome, infections (helminths, Scarlet fever, Hansen's disease), sarcoidosis, SLE
- Hypereosinophilia if AEC>1500, typically merits heme evaluation
- Hypereosinophilic syndrome: AEC>1500 and organ dysfunction from eosinophils
- Basophilia (>100/mm3)
- CML, thyroid disease, IBC, chronic dermatitis, infections (varicella)
Last update:
2022-06-24 23:35:57