Sandbox: Leukocytosis: Difference between revisions
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{{CMG}} {{AE}} {{MV}} | {{CMG}} {{AE}} {{MV}} | ||
{{SK}} | {{SK}} Elevated white blood cell count; Right-shift leukocytosis; Left-leukocytosis | ||
==Overview== | ==Overview== | ||
'''Leukocytosis''' is an elevation of the white blood cell count above the normal range. 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. | '''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> | ||
==Historical Perspective== | ==Historical Perspective== | ||
*Leukocytosis was first discovered by Paul Kautchakoff, in 1846. | *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> | ||
==Classification== | ==Classification== | ||
*Leukocytosis may be classified into 5 subtypes: | *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) | :*[[Neutrophilia]] (most common) | ||
:*[[Lymphocytosis]] | :*[[Lymphocytosis]] | ||
| Line 20: | Line 20: | ||
:*[[Basophilia]]. | :*[[Basophilia]]. | ||
*Leukocytosis may also be classified into 2 groups: | *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) | :*'''Left shift''' (most common) | ||
::*Immature leukocytes increase | ::*Immature leukocytes increase | ||
| Line 30: | Line 30: | ||
*Other variant of leukocytosis is the leukemoid reaction. | *Other variant of leukocytosis is the leukemoid reaction. | ||
*The image below demonstrates a graphic figure that illustrates | *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> | <gallery> | ||
Image: | | Image: Hematopoietic growth factors.png|Hematopoietic growth factors in leukocytosis<br><SMALL> Courtesy of Wikipedia </SMALL> | ||
</gallery> | </gallery> | ||
==Pathophysiology== | ==Pathophysiology== | ||
*The pathogenesis of leukocytosis is characterized by: | *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 | :*An increased release of leukocytes from bone marrow storage pools | ||
:*Decreased margination of leukocytes onto vessel walls | :*Decreased margination of leukocytes onto vessel walls | ||
:*Decreased extravasation of leukocytes from the vessels into tissues | :*Decreased extravasation of leukocytes from the vessels into tissues | ||
:*Increase in number of precursor cells in the marrow | :*Increase in number of precursor cells in the marrow | ||
==Causes== | ==Causes== | ||
| Line 52: | Line 51: | ||
! Neutrophilic <br> leukocytosis <br> ([[neutrophilia]]) | ! Neutrophilic <br> leukocytosis <br> ([[neutrophilia]]) | ||
| | | | ||
*Acute [[bacterial infection]]s, especially [[pyogenic infection]]s | *Acute [[bacterial infection]]s, especially [[pyogenic infection]]s | ||
*[[Sterile inflammation]] | *[[Sterile inflammation]] | ||
** [[Tissue necrosis]] | ** [[Tissue necrosis]] | ||
| Line 103: | Line 102: | ||
==Epidemiology and Demographics== | ==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=== | ===Age=== | ||
*Patients of all age groups may develop leukocytosis. | *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> | ||
*Leukocytosis is more | |||
===Gender=== | ===Gender=== | ||
*Leukocytosis affects men and women equally. | *Leukocytosis affects men and women equally. | ||
===Race=== | ===Race=== | ||
*There is no racial predilection for leukocytosis. | *There is no racial predilection for leukocytosis. | ||
==Risk Factors== | ==Risk Factors== | ||
*Common risk factors in the development of leukocytosis, include: | *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== | == Natural History, Complications and Prognosis== | ||
*The majority of patients with leukocytosis | *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 | *Early clinical features, include:<ref name="wiki"> Leukocytosis. Wikipedia. https://en.wikipedia.org/wiki/Leukocytosis Accessed on May 23, 2016 </ref> | ||
* | :*Fever | ||
*Common complications of leukocytosis, include: | :*Hyperhidrosis | ||
:*Fatigue | |||
*Prognosis is generally depends on the underlying etiologies. | *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 == | ||
| Line 140: | Line 145: | ||
=== Symptoms === | === Symptoms === | ||
*Leukocytosis is usually symptomatic. | *Leukocytosis is usually symptomatic. | ||
*Symptoms of leukocytosis are often unspecific, such as: | *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: | *Obtain history of the following: | ||
:*Clinical features | :*Clinical features | ||
| Line 148: | Line 159: | ||
=== Laboratory Findings === | === Laboratory Findings === | ||
*Laboratory findings consistent with the diagnosis of leukocytosis, include: | *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 | |||
== Treatment == | == Treatment == | ||
=== Medical Therapy === | === 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> | ||
==References== | ==References== | ||
{{Reflist|2}} | {{Reflist|2}} | ||
[[Category: Oncology]] | [[Category: Oncology]] | ||
Latest revision as of 19:47, 23 May 2016
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: 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]
- Neutrophilia (most common)
- Lymphocytosis
- Monocytosis
- Eosinophilia
- Basophilia.
- 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
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
- ↑ 1.0 1.1 Chabot-Richards DS, George TI (2014). "Leukocytosis". Int J Lab Hematol. 36 (3): 279–88. doi:10.1111/ijlh.12212. PMID 24750674.
- ↑ 2.0 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.
- ↑ 3.0 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