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'''For patient information click [[{{PAGENAME}} (patient information)|here]]'''
__NOTOC__
{{DiseaseDisorder infobox |
{{SI}}                                                                  
  Name          = Leukocytosis |
{{CMG}} {{AE}} {{MV}} {{LG}}
  ICD10          = {{ICD10|D|72|8|d|70}} |
  ICD9          = {{ICD9|288.3}}, {{ICD9|288.6x}} |
{{SK}}  Elevated white blood cell count; Right-shift leukocytosis; Left-leukocytosis
  Image          = |
  Caption        = |
==Overview==
  ICDO          = |
  OMIM          = |
  DiseasesDB    = |
  MedlinePlus    = |
  eMedicineSubj  = |
  eMedicineTopic = |
}}
{{Leukocytosis}}
{{CMG}}; {{AOEIC}} {{LG}}


'''''Synonyms and keywords:''''' The terms [[Granulocytosis]] and [[neutrophilia]] refer to an elevation of one particular type of white blood cell, the [[granulocyte]] or [[neutrophil]].
'''Leukocytosis''' is an elevation of the white blood cell count above the normal range (greater than 11,000 per mm3). Leukocytosis is frequently a sign of an [[Inflammation|inflammatory response]], most commonly the result of [[infection]], but may also occur following certain parasitic infections, [[bone tumor|bone tumors]], strenuous exercise, emotional stress, pregnancy,  anesthesia, and epinephrine administration. Leukocytosis may be classified into 5 subtypes: [[neutrophilia]] (most common), [[lymphocytosis]], [[monocytosis]], [[eosinophilia]], and [[basophilia]]. Other classification, include: Left shift or right shift leucocytosis. The pathogenesis of leukocytosis is characterized by the increase of leukocytes (primarily neutrophils), followed by the proliferation and release of granulocyte and monocyte precursors in the bone marrow which is stimulated by several products of inflammation including C3a and G-CSF.<ref name="pmid24750674">{{cite journal |vauthors=Chabot-Richards DS, George TI |title=Leukocytosis |journal=Int J Lab Hematol |volume=36 |issue=3 |pages=279–88 |year=2014 |pmid=24750674 |doi=10.1111/ijlh.12212 |url=}}</ref>


==[[Leukocytosis overview|Overview]]==
==Historical Perspective==
*Leukocytosis was first discovered by Paul Kautchakoff, in 1846.<ref name="pmid24750674">{{cite journal |vauthors=Chabot-Richards DS, George TI |title=Leukocytosis |journal=Int J Lab Hematol |volume=36 |issue=3 |pages=279–88 |year=2014 |pmid=24750674 |doi=10.1111/ijlh.12212 |url=}}</ref>


==[[Leukocytosis historical perspective|Historical Perspective]]==
==Classification==
*Leukocytosis may be classified into 5 subtypes:<ref name="pmid11087187">{{cite journal |vauthors=Abramson N, Melton B |title=Leukocytosis: basics of clinical assessment |journal=Am Fam Physician |volume=62 |issue=9 |pages=2053–60 |year=2000 |pmid=11087187 |doi= |url=}}</ref>
:*[[Neutrophilia]] (most common)
:*[[Lymphocytosis]]
:*[[Monocytosis]]
:*[[Eosinophilia]]
:*[[Basophilia]].


==[[Leukocytosis pathophysiology|Pathophysiology]]==
*Leukocytosis may also be classified into 2 groups:<ref name="pmid11087187">{{cite journal |vauthors=Abramson N, Melton B |title=Leukocytosis: basics of clinical assessment |journal=Am Fam Physician |volume=62 |issue=9 |pages=2053–60 |year=2000 |pmid=11087187 |doi= |url=}}</ref>
:*'''Left shift''' (most common)
::*Immature leukocytes increase
::*Proliferation and release of granulocyte and monocyte precursors in the bone marrow
::*Usually stimulated by several products of inflammation including C3a and G-CSF
:*'''Right shift'''
::*Reduced count or lack of "young neutrophils"
::*Associated with the presence of "giant neutrophils


==[[Leukocytosis causes|Causes]]==
*Other variant of leukocytosis is the leukemoid reaction.
*The image below demonstrates a graphic figure that illustrates hematopoietic growth factors in leukocytosis.<ref name="wiki> Leukocytosis. Wikipedia. https://en.wikipedia.org/wiki/Leukocytosis Accessed on May 23, 2016 </ref>
<gallery>
Image: Hematopoietic growth factors.png|Hematopoietic growth factors in leukocytosis<br><SMALL> Courtesy of Wikipedia </SMALL>
</gallery>


==[[Leukocytosis differential diagnosis|Differentiating Leukocytosis from other Diseases]]==
==Pathophysiology==
*The pathogenesis of leukocytosis is characterized by:<ref name="pmid11087187">{{cite journal |vauthors=Abramson N, Melton B |title=Leukocytosis: basics of clinical assessment |journal=Am Fam Physician |volume=62 |issue=9 |pages=2053–60 |year=2000 |pmid=11087187 |doi= |url=}}</ref>
:*An increased release of leukocytes from bone marrow storage pools
:*Decreased margination of leukocytes onto vessel walls
:*Decreased extravasation of leukocytes from the vessels into tissues
:*Increase in number of precursor cells in the marrow


==[[Leukocytosis risk factors|Risk Factors]]==
==Causes==


==[[Leukocytosis screening|Screening]]==
* '''To see a comprehensive list of all causes of leukocytosis, please click [[Leukocytosis causes|here]]'''


==[[Leukocytosis natural history, complications and prognosis|Natural History, Complications and Prognosis]]==
{|class="wikitable"
!colspan=5| Causes of leukocytosis
|-
! Neutrophilic <br> leukocytosis <br> ([[neutrophilia]])
|
*Acute [[bacterial infection]]s, especially [[pyogenic infection]]s
*[[Sterile inflammation]]
** [[Tissue necrosis]]
***[[Myocardial infarction]]
***[[Burn]]s
|-
! Eosinophilic <br> leukocytosis <br>([[eosinophilia]])
|
*[[Allergy|Allergic]] disorders
**[[Asthma]]
**[[Hay fever]]
**[[Drug allergies]]
**[[Allergic skin disease]]s
***[[Pemphigus]]
***[[Dermatitis herpetiformis]]
*[[Parasitic infection]]s
*Some forms of [[malignancy]]
**[[Hodgkin's lymphoma]]
**Some forms of [[Non-Hodgkin lymphoma]]
*[[Systemic autoimmune disease]]s (e.g. [[systemic lupus erythematosus|SLE]])
*Some forms of [[vasculitis]]
*[[Cholesterol embolism]] (transiently)
|-
! Basophilic <br> leukocytosis <br> [[Basophilia]]
|
*[[Myeloproliferative disease]], e.g. [[Chronic myelogenous leukemia]]
|-
! [[Monocytosis]]
|
*[[Chronic infection]]s
**[[Tuberculosis]]
**[[Bacterial endocarditis]]
**[[Rickettsiosis]]
**[[Malaria]]
*[[Systemic autoimmune diseases]], e.g. [[systemic lupus erythematosus|SLE]]
*[[Inflammatory bowel disease]]s, e.g. [[ulcerative colitis]]
|-
! [[Lymphocytosis]]
|
*[[Chronic (medicine)|Chronic]] [[infection]]s
**[[Tuberculosis]]
**[[Brucellosis]]
*[[Viral infection]]s
**[[Hepatitis]]
**[[Cytomegalovirus]] infection
**[[Infectious mononucleosis]]
*[[Pertussis]]
*Some forms of [[malignancy]], such as [[lymphocytic leukemia|lymphocytic leukæmias]]
|}
 
==Epidemiology and Demographics==
 
* Leukocytosis is very common.<ref name="pmid11087187">{{cite journal |vauthors=Abramson N, Melton B |title=Leukocytosis: basics of clinical assessment |journal=Am Fam Physician |volume=62 |issue=9 |pages=2053–60 |year=2000 |pmid=11087187 |doi= |url=}}</ref>
 
===Age===
*Patients of all age groups may develop leukocytosis.
*Normal white blood count differential changes with age.
*Leukocytosis in neonates is more common, compared to children and adults.<ref name="pmid11087187">{{cite journal |vauthors=Abramson N, Melton B |title=Leukocytosis: basics of clinical assessment |journal=Am Fam Physician |volume=62 |issue=9 |pages=2053–60 |year=2000 |pmid=11087187 |doi= |url=}}</ref>
===Gender===
*Leukocytosis affects men and women equally.
 
===Race===
*There is no racial predilection for leukocytosis.
 
==Risk Factors==
*Common risk factors in the development of leukocytosis, include:<ref name="pmid11087187">{{cite journal |vauthors=Abramson N, Melton B |title=Leukocytosis: basics of clinical assessment |journal=Am Fam Physician |volume=62 |issue=9 |pages=2053–60 |year=2000 |pmid=11087187 |doi= |url=}}</ref>
:*Physiologic processes (eg, stress, exercise, pregnancy)
:*Drugs (e.g.corticosteroids, lithium, beta agonists)
:*Trauma
:*Stress
 
== Natural History, Complications and Prognosis==
*The majority of patients with leukocytosis are initially symptomatic.<ref name="wiki"> Leukocytosis. Wikipedia. https://en.wikipedia.org/wiki/Leukocytosis Accessed on May 23, 2016 </ref>
*Early clinical features, include:<ref name="wiki"> Leukocytosis. Wikipedia. https://en.wikipedia.org/wiki/Leukocytosis Accessed on May 23, 2016 </ref>
:*Fever
:*Hyperhidrosis
:*Fatigue
*Common complications of leukocytosis, include:<ref name="wiki"> Leukocytosis. Wikipedia. https://en.wikipedia.org/wiki/Leukocytosis Accessed on May 23, 2016 </ref>
:*Tumor lysis syndrome
:*Disseminated intravascular coagulopathy
:*Acute respiratory failure
:*Pulmonary hemorrhage
:*CNS infarction
:*Splenic infarction
:*Myocardial ischemia
:*Renal failure
*Prognosis is generally depends on the underlying etiologies.<ref name="wiki"> Leukocytosis. Wikipedia. https://en.wikipedia.org/wiki/Leukocytosis Accessed on May 23, 2016 </ref>


== Diagnosis ==
== Diagnosis ==


[[Leukocytosis history and symptoms| History and Symptoms]] | [[Leukocytosis physical examination | Physical Examination]] | [[Leukocytosis laboratory findings | Laboratory Findings]] | [[Leukocytosis other diagnostic studies|Other Diagnostic Studies]]
=== Symptoms ===
*Leukocytosis is usually symptomatic.
*Symptoms of leukocytosis are often unspecific, such as:<ref name="wiki"> Leukocytosis. Wikipedia. https://en.wikipedia.org/wiki/Leukocytosis Accessed on May 23, 2016 </ref>
:*Weight loss
:*Fevers of unknown origin
:*Hyperhidrosis
:*Chronic pain
:*Fatigue
:*Dyspnea
:*Malaise
*Obtain history of the following:
:*Clinical features
:*Duration (e.g. days, weeks, months)
:*Remainder of complete blood count


==Treatment==
=== Laboratory Findings ===
[[Leukocytosis medical therapy|Medical Therapy]] | [[Leukocytosis primary prevention|Primary Prevention]]  | [[Leukocytosis secondary prevention|Secondary Prevention]] | [[Leukocytosis cost-effectiveness of therapy|Cost-Effectiveness of Therapy]] | [[Leukocytosis future or investigational therapies|Future or Investigational Therapies]]
*Laboratory findings consistent with the diagnosis of leukocytosis, include:<ref name="wiki"> Leukocytosis. Wikipedia. https://en.wikipedia.org/wiki/Leukocytosis Accessed on May 23, 2016 </ref>
:*White blood cell count above the normal range
::*Greater than 11,000 per mm3


==[[Leukocytosis case study one|Case #1]]==
== Treatment ==
=== Medical Therapy ===
*The treatment for leukocytosis will depend on the underlying condition.<ref name="wiki"> Leukocytosis. Wikipedia. https://en.wikipedia.org/wiki/Leukocytosis Accessed on May 23, 2016 </ref>


==Related Chapters==
==References==
*[[Granulocytosis]]
{{Reflist|2}}
*[[Neutrophilia]]
*[[Eosinophilia]]
*[[Monocytosis]]
*[[Lymphocytosis]]
*[[Basophilia]]


[[Category:Laboratory Test]]
[[Category:Laboratory Test]]

Revision as of 19:49, 23 May 2016

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Maria Fernanda Villarreal, M.D. [2] Lakshmi Gopalakrishnan, M.B.B.S. [3]

Synonyms and keywords: Elevated white blood cell count; Right-shift leukocytosis; Left-leukocytosis

Overview

Leukocytosis is an elevation of the white blood cell count above the normal range (greater than 11,000 per mm3). Leukocytosis is frequently a sign of an inflammatory response, most commonly the result of infection, but may also occur following certain parasitic infections, bone tumors, strenuous exercise, emotional stress, pregnancy, anesthesia, and epinephrine administration. Leukocytosis may be classified into 5 subtypes: neutrophilia (most common), lymphocytosis, monocytosis, eosinophilia, and basophilia. Other classification, include: Left shift or right shift leucocytosis. The pathogenesis of leukocytosis is characterized by the increase of leukocytes (primarily neutrophils), followed by the proliferation and release of granulocyte and monocyte precursors in the bone marrow which is stimulated by several products of inflammation including C3a and G-CSF.[1]

Historical Perspective

  • Leukocytosis was first discovered by Paul Kautchakoff, in 1846.[1]

Classification

  • Leukocytosis may be classified into 5 subtypes:[2]
  • Leukocytosis may also be classified into 2 groups:[2]
  • Left shift (most common)
  • Immature leukocytes increase
  • Proliferation and release of granulocyte and monocyte precursors in the bone marrow
  • Usually stimulated by several products of inflammation including C3a and G-CSF
  • Right shift
  • Reduced count or lack of "young neutrophils"
  • Associated with the presence of "giant neutrophils
  • Other variant of leukocytosis is the leukemoid reaction.
  • The image below demonstrates a graphic figure that illustrates hematopoietic growth factors in leukocytosis.[3]
  • Hematopoietic growth factors in leukocytosis Courtesy of Wikipedia
    Hematopoietic growth factors in leukocytosis
    Courtesy of Wikipedia

Pathophysiology

  • The pathogenesis of leukocytosis is characterized by:[2]
  • An increased release of leukocytes from bone marrow storage pools
  • Decreased margination of leukocytes onto vessel walls
  • Decreased extravasation of leukocytes from the vessels into tissues
  • Increase in number of precursor cells in the marrow

Causes

  • To see a comprehensive list of all causes of leukocytosis, please click here
Causes of leukocytosis
Neutrophilic
leukocytosis
(neutrophilia)
Eosinophilic
leukocytosis
(eosinophilia)
Basophilic
leukocytosis
Basophilia
Monocytosis
Lymphocytosis

Epidemiology and Demographics

  • Leukocytosis is very common.[2]

Age

  • Patients of all age groups may develop leukocytosis.
  • Normal white blood count differential changes with age.
  • Leukocytosis in neonates is more common, compared to children and adults.[2]

Gender

  • Leukocytosis affects men and women equally.

Race

  • There is no racial predilection for leukocytosis.

Risk Factors

  • Common risk factors in the development of leukocytosis, include:[2]
  • Physiologic processes (eg, stress, exercise, pregnancy)
  • Drugs (e.g.corticosteroids, lithium, beta agonists)
  • Trauma
  • Stress

Natural History, Complications and Prognosis

  • The majority of patients with leukocytosis are initially symptomatic.[3]
  • Early clinical features, include:[3]
  • Fever
  • Hyperhidrosis
  • Fatigue
  • Common complications of leukocytosis, include:[3]
  • Tumor lysis syndrome
  • Disseminated intravascular coagulopathy
  • Acute respiratory failure
  • Pulmonary hemorrhage
  • CNS infarction
  • Splenic infarction
  • Myocardial ischemia
  • Renal failure
  • Prognosis is generally depends on the underlying etiologies.[3]

Diagnosis

Symptoms

  • Leukocytosis is usually symptomatic.
  • Symptoms of leukocytosis are often unspecific, such as:[3]
  • Weight loss
  • Fevers of unknown origin
  • Hyperhidrosis
  • Chronic pain
  • Fatigue
  • Dyspnea
  • Malaise
  • Obtain history of the following:
  • Clinical features
  • Duration (e.g. days, weeks, months)
  • Remainder of complete blood count

Laboratory Findings

  • Laboratory findings consistent with the diagnosis of leukocytosis, include:[3]
  • White blood cell count above the normal range
  • Greater than 11,000 per mm3

Treatment

Medical Therapy

  • The treatment for leukocytosis will depend on the underlying condition.[3]

References

  1. ↑ 1.0 1.1 Chabot-Richards DS, George TI (2014). "Leukocytosis". Int J Lab Hematol. 36 (3): 279–88. doi:10.1111/ijlh.12212. PMID 24750674.
  2. ↑ 2.0 2.1 2.2 2.3 2.4 2.5 Abramson N, Melton B (2000). "Leukocytosis: basics of clinical assessment". Am Fam Physician. 62 (9): 2053–60. PMID 11087187.
  3. ↑ 3.0 3.1 3.2 3.3 3.4 3.5 3.6 3.7 Leukocytosis. Wikipedia. https://en.wikipedia.org/wiki/Leukocytosis Accessed on May 23, 2016


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