- Leukocytosis is defined as an elevated white blood cell (WBC) count greater than 11,000 per mm3 (11.0 × 109 per L).
- The most common type of leukocytosis is neutrophilia.
- Neutrophilia can be defined as an increase in the absolute number of mature neutrophils to greater than 7,000 per mm3 [7.0 × 109 per L].
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Differentiating Symptoms
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Differentiating physical exam findings
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Differentiating Labs
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| Physiological variation
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Birth
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| Adult
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| Pregnancy
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| Primary
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Congenital
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Heridatary neutrophilia
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| Chronic idiopathic neutrophilia
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| Down syndrome
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| LAD
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| Acquired
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CML
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| Polycythemia Vera
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| Secondary
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Infection
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Acute
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| Chronic
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| Connective tissue disorders
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RA
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| JRA
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| IBD
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| Chronic hepatitis
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| Drug induced
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Steriod
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| Lithium
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| Beta agonists
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| Cytokines
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| Marrow stimulation
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Hemolytic anemia
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| Immature thrombocytopenia
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| Post splenectomy
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| Metabolic
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Diabetic coma
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| Acidosis
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| Thyroid strom
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| Acute Gout
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| Seizures
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Differential diagnosis of Lymphocytosis
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Pathophysiology
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Symptoms
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History
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Physical Examination
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Laboratory Findings
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CBC
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Blood smear
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Immunophenotype
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| Monoclonal B lymphocytosis
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- Monoclonal population of B lymphocytes <5000 cells/microL
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- Without other features of
- Lymphadenopathy
- Organomegaly
- Extra-medullary involvement
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- Active or prior infections
- History of hematologic malignancy
- Medications
- Family history of chronic lymphocytic leukemia (CLL)
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- Fever
- Lymphadenopathy
- Hepatosplenomegaly
- Joint redness
- Abdominal pain
- Lung findings.
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- Lymphocytosis ≥4000 lymphocytes/microL
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- Lymphocytes in MBL have no distinguishing appearance
- Appear as small, mature mononuclear cells.
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- Does not require bone marrow examination or imaging for diagnosis
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| Congenital B cell lymphocytosis
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| Large granular lymphocyte leukemia
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- T-cell (T-LGL)
- Natural killer cell (NK-LGL)
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- Recurrent infections
- Fever
- Night sweats
- Unintended weight loss
- Lymphadenopathy
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- Pancytopenia
- Splenomegaly
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- CD3, CD57, CD56
- CD3-, CD56+
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| Chronic lymphocytic leukemia
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| Sezary syndrome
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| Mantle cell lymphoma
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| Follicular lymphoma
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| Splenic marginal zone lymphoma
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| Acute lymphoblastic leukemia
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| Acute Promyelocytic Leukemia
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| Diffuse Large Cell Lymphoma
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- Enlarged painful lymph node
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- Neurological or gastrointestinal manifestations
- History of environmental and/or infectious disease exposure
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- Lymphadenopathy
- Splenomegaly
- Low-grade fever
- Pedal edema:
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Differential for Eosinophilia
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Pathophysiology
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Symptoms
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History
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Physical Examination
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Laboratory Findings
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| Parasitic Infections
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Vary depending on the organism
- GI
- STD
- Neurological
- Swollen lymph nodes and muscle aches or pains
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- Rash
- Fever
- Lymphadenopathy
- Ulcers
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- +Stool examination
- + Serologic testing
- Urinalysis
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| Allergy/ Atopic Diseases
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- Allergic hypersensitivity
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| Hypereosinophilic syndromes (HES)
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- Activation of tyrosine kinases
- Clonal eosinophilic proliferation
- Overproduction of eosinophilopoietic cytokines.
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| Acute myelogenous leukemias
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- Mutation of myeloblast freezes the cell in its immature state and prevent differentiation.
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- Persistent or frequent infections.
- Anemia leads to fatigue, paleness, and shortness of breath.
- Thrombocytopenia leads to bruising or bleeding with minor trauma.
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| Hodgkin's, T- and B-cell lymphomas)
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| Tumors
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| Systemic mastocytosis
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