Leukocytosis
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-In-Chief: Lakshmi Gopalakrishnan, M.B.B.S. [2]
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. Although it may be a sign of illness, leukocytosis in-and-of itself is not a disorder, nor is it a disease. It is simply a laboratory finding.
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.
- Granulocytosis or neutrophilia: Leukocytosis in which neutrophil count is elevated
- Lymphocytosis: Leukocytosis in which lymphocyte count is elevated
- Monocytosis: Leukocytosis in which monocyte count is elevated is monocytosis
- Eosinophilia: 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 Causes of Leukocytosis
By Organ System
In alphabetical order[1] [2]
- Acanthocheilonemiasis
- Acute intermittent porphyria
- Acute lymphoblastic leukemia
- Acute myeloid leukemia
- Acute promyelocytic leukemia
- Adrenal cortex insufficiency
- Allergic bronchopulmonary aspergillosis
- Allopurinol
- Alveolar hydatid disease
- Aminophylline
- Amitriptyline
- Ancylostoma caninum
- Ancylostoma duodenale
- Angiolymphoid hyperplasia with eosinophilia
- Angiostrongyliasis
- Anisakiasis
- Ascariasis
- Atopic dermatitis
- Autoimmune lymphoproliferative syndrome type 1
- Autoimmune lymphoproliferative syndrome type 2
- Bronchial asthma
- Bronchiolitis obliterans organizing pneumonia
- Brucellosis
- Burkitt lymphoma
- Capillaria
- Capreomycin
- Caspofungin
- Chickenpox
- Chlorpropamide
- Cholesterol embolism
- Chronic lymphocytic leukaemia
- Chronic myeloid leukaemia
- Churg-Strauss syndrome
- Clomipramine
- Clonorchiasis
- Coccidioidomycosis
- Colonic diverticulitis
- Cytomegalovirus
- Daptomycin
- Dermatitis herpetiformis
- Desipramine
- Dicrocoelium dendriticum fluke
- Dinoprostone
- Dothiepin
- Doxycycline
- Dracunculiasis
- Echinococcus granulosus
- Endomyocardial fibrosis
- Enfuvirtide
- Eosinophilia-myalgia syndrome
- Eosinophilic cellulitis
- Eosinophilic fasciitis
- Eosinophilic pustular folliculitis
- Epstein-Barr virus
- Erythema multiforme
- Ethotoin
- Etravirine
- Extrinsic allergic alveolitis
- Familial eosinophilia
- Fasciola hepatica
- Filgrastim
- Gallbladder empyema
- Gnathostomiasis
- Gold salts
- Granulocyte colony stimulating factor
- Granulocyte-macrophage colony stimulating factor
- Hairy cell leukaemia
- Hantavirus
- Hepatitis A
- Hepatitis B
- Hepatosplenic T-cell lymphoma
- Heterophyiasis
- Hodgkin lymphoma
- Hydralazine
- Hypereosinophilic syndrome
- Hyperimmunoglobulinemia D and periodic fever syndrome
- Hypothyroidism
- Imipramine
- Infectious mononucleosis
- Interleukin 1 receptor antagonist deficiency
- Interleukin 2
- Interstitial nephritis
- Kimura disease
- Kostmann disease
- Lepromatous leprosy
- Leukocyte adhesion deficiency type 1
- Leukocyte adhesion deficiency type 2
- Leukocyte adhesion deficiency type 3
- Leukemoid reaction
- Lithium
- Loa loa filariasis
- Lymphangitis
- Lymphatic filariasis
- Mansonelliasis
- Mast cell leukemia
- Metagonimiasis
- Micafungin
- Minocycline
- Mycobacterium tuberculosis
- Myelofibrosis
- Myeloma
- Nalidixic acid
- Neuroleptic malignant syndrome
- Neutrophilia (hereditary)
- Nitrofurantoin
- Non-Hodgkin lymphoma
- Nortriptyline
- Olanzapine
- Omenn syndrome
- Onchocerciasis
- Opisthorchiasis
- Oxytetracycline
- Pancreatitis (acute)
- Paragonimiasis
- Paraneoplastic syndrome
- Pemphigus vulgaris
- Pentostatin
- Phenytoin
- Plerixafor
- Polyarteritis nodosa
- Polycythaemia rubra vera
- Polymyositis
- Procarbazine
- Psoriasis
- Radiotherapy
- Recurrent hereditary polyserositis
- Rheumatoid disease
- Rubella
- Sarcoptes scabiei
- Schistosoma haematobium
- Schistosoma mansoni
- Secondary syphilis
- Serum sickness
- Severe acute respiratory syndrome
- Simple pulmonary eosinophilia]
- Splenectomy
- Still disease (adult-onset)
- Strongyloidiasis
- Sulphonamides
- Sulprostone
- Syphilis (congenital)
- Systemic lupus erythematosus
- Tobacco smoking
- Toxocariasis
- Toxoplasma
- Trichinella spiralis
- Tropical pulmonary eosinophilia
- Tryptophan
- Ulcerative colitis
- Urate crystal arthropathy
- Vancomycin
- Visceral larva migrans
- Waldenström's macroglobulinemia
- Wegener granulomatosis
- Whooping cough
- Wiskott-Aldrich syndrome
- X-linked lymphoproliferative disease
References