Leukocytosis
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Synonyms and keywords: Granulocytosis, neutrophilia
Overview
Leukocytosis is an elevation of the white blood cell count (the leukocyte count) above the normal range. The normal adult human leukocyte count in peripheral blood is 4.4-10.8 x 109/L. A white blood count of 11.0 x 109/L or more suggests leukocytosis. Often, the word refers to an increased neutrophil granulocyte count, as neutrophils are the main granulocytes. An increase in eosinophil granulocyte is known as eosinophilia. Granulocytosis can be a feature of a number of disease processes including infection, especially bacteria; malignancy, most notably leukemia (it is the main feature of chronic myelogenous leukemia, CML) and autoimmune disease.
Epidemiology and Demographics
Leukocytosis is very common in acutely ill patients. It occurs in response to a wide variety of conditions, including viral, bacterial, fungal, or parasitic infection, cancer, hemorrhage, and exposure to certain medications or chemicals including steroids. Leukocytosis can also be the first indication of neoplastic growth of leukocytes.
Pathophysiology
The mechanism that causes leukocytosis can be of several forms: 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, or an increase in number of precursor cells in the marrow.
Classification Scheme
Leukocytosis can be subcategorized by the type of white blood cell that is increased in number. Leukocytosis in which neutrophil count is elevated is neutrophilia; leukocytosis in which lymphocyte count is elevated is lymphocytosis; leukocytosis in which monocyte count is elevated is monocytosis; and leukocytosis in which eosinophil count is elevated is eosinophilia.
A leukocyte count above 25 to 30 x 109/L is termed a leukemoid reaction, which is the reaction of a healthy bone marrow to extreme stress, trauma, or infection. (It is different from leukemia and from leukoerythroblastosis, in which immature blood cells are present in peripheral blood.)
Differential Diagnosis of Leukocytosis
In alphabetical order. [1] [2]
- Acute and chronic non-Hodgkin's lymphoma
- Acute leukemia
- Bacterial infections
- Bronchitis
- Burns
- Chickenpox
- Chronic Myelogenous Leukemia
- Chronic polyarteritis
- Colitis
- Cushing's Syndrome
- Dermatitis
- Diabetic coma
- Down Syndrome
- Drugs, toxins
- Endocarditis
- Exercise
- Fungal infections
- Gangrene
- Gout
- Hairy Cell Leukemia
- Hemolytic anemia
- Hemorrhage
- Hyperthyroidism
- Infectious lymphocytosis
- Infectious mononucleosis
- Malignant tumors
- Measles
- Mumps
- Myelofibrosis
- Parasitic infections
- Polycythemia Vera
- Post-splenectomy
- Prolymphocytic leukemia
- Pyelonephritis
- Recovery from agranulocytosis
- Seizures
- Trauma
- Uremic coma
- Viral hepatitis
References