Sandbox: Leukocytosis
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Maria Fernanda Villarreal, M.D. [2]
Synonyms and keywords:
Overview
Leukocytosis is an elevation of the white blood cell count above the normal range. 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.
Historical Perspective
- Leukocytosis was first discovered by Paul Kautchakoff, in 1846.
Classification
- Leukocytosis may be classified into 5 subtypes:
- Neutrophilia (most common)
- Lymphocytosis
- Monocytosis
- Eosinophilia
- Basophilia.
- Leukocytosis may also be classified into 2 groups:
- 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.[1]
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Hematopoietic growth factors in leukocytosis
Courtesy of Wikipedia
Pathophysiology
- The pathogenesis of leukocytosis is characterized by:
- 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
- On microscopic histopathological analysis, characteristic findings of leukocytosis, include:
Causes
- To see a comprehensive list of all causes of leukocytosis, please click here
| Causes of leukocytosis | ||||
|---|---|---|---|---|
| Neutrophilic leukocytosis (neutrophilia) |
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| Eosinophilic leukocytosis (eosinophilia) |
| |||
| Basophilic leukocytosis Basophilia |
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| Monocytosis | ||||
| Lymphocytosis |
| |||
Epidemiology and Demographics
- The prevalence of leukocytosis is approximately [number or range] per 100,000 individuals worldwide.
- In [year], the incidence of leukocytosis was estimated to be [number or range] cases per 100,000 individuals in [location].
Age
- Patients of all age groups may develop leukocytosis.
- Leukocytosis in neonates is more common, compared to children and adults.
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:
- Physiologic processes (eg, stress, exercise, pregnancy)
Natural History, Complications and Prognosis
- The majority of patients with leukocytosis are initially symptomatic.
- Early clinical features, include:
- Fever
- Hyperhidrosis
- Fatigue
- Common complications of leukocytosis, include:
- 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.
Diagnosis
Symptoms
- Leukocytosis is usually symptomatic.
- Symptoms of leukocytosis are often unspecific, such as:
- 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:
Other Diagnostic Studies
- Leukocytosis may also be diagnosed using [diagnostic study name].
- Findings on [diagnostic study name] include [finding 1], [finding 2], and [finding 3].
Treatment
Medical Therapy
- There is no treatment for leukocytosis; the mainstay of therapy is supportive care.
- The mainstay of therapy for leukocytosis is [medical therapy 1] and [medical therapy 2].
- [Medical therapy 1] acts by [mechanism of action1].
- Response to [medical therapy 1] can be monitored with [test/physical finding/imaging] every [frequency/duration].
References
- ↑ Leukocytosis. Wikipedia. https://en.wikipedia.org/wiki/Leukocytosis Accessed on May 23, 2016
- ↑