Leukemoid reaction: Difference between revisions

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Leukemoid reaction should be differentiated from other causes of leucocytosis. The below table discusses different causes of leucocytosis:
{|
! rowspan="5" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Category
! rowspan="5" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Condition
! rowspan="5" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Etiology
! colspan="4" rowspan="3" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Mechanism
! rowspan="5" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Congenital
! rowspan="5" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Acquried
! colspan="11" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Clinical manifestations
! colspan="8" rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Para−clinical findings
! colspan="1" rowspan="5" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Gold standard
! rowspan="5" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Associated findings
|-
! rowspan="4" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Demography
! rowspan="4" style="background: #4479BA; color: #FFFFFF; text-align: center;" |History
! colspan="3" rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Symptoms
! colspan="6" rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Signs
|-
! colspan="8" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Lab Findings
|-
! rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Physiologic
! colspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Increased bone marrow production
! rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Demargination of peripheral blood neutrophils
! colspan="1" rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Appearance
! rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Fever
! rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Abdominal pain
! rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;" |BP
! rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Asplenia
! rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Hepatosplenomegaly
! rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Lymphadenopathy
! rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Joint involvement
! rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Other
! colspan="3" style="background: #4479BA; color: #FFFFFF; text-align: center;" |CBC
! rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;" |PBS
! rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Bone marrow exam
! rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;" |ESR/CRP
! rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;" |BUN/Cr
! rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;" |LFT
|-
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Autonomous
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Reactive
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |WBC
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |HB
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Plt
|-
! rowspan="5" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Hematologic
! align="center" style="background:#DCDCDC;" |[[Granulocytosis|Hereditary neutrophilia]]<ref name="HerringSmith1974">{{cite journal|last1=Herring|first1=William Benjamin|last2=Smith|first2=Laurin Gresham|last3=Walker|first3=Richard Isley|last4=Herion|first4=John Carroll|title=Hereditary neutrophilia|journal=The American Journal of Medicine|volume=56|issue=5|year=1974|pages=729–734|issn=00029343|doi=10.1016/0002-9343(74)90642-1}}</ref>
| align="left" style="background:#F5F5F5;" + |
* Unknown
* Germline [[mutation]] in [[CSF3R]]
| align="center" style="background:#F5F5F5;" + | −
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + | −
| align="center" style="background:#F5F5F5;" + | −
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + | −
| align="center" style="background:#F5F5F5;" + |Rare [[Dominance relationship|autosomal dominant]] genetic disorder
| align="left" style="background:#F5F5F5;" + |
* Positive family history
| align="center" style="background:#F5F5F5;" + |Normal
| align="center" style="background:#F5F5F5;" + | −
| align="center" style="background:#F5F5F5;" + | −
| align="center" style="background:#F5F5F5;" + |Nl
| align="center" style="background:#F5F5F5;" + | −
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + | −
| align="center" style="background:#F5F5F5;" + | −
| align="center" style="background:#F5F5F5;" + | −
| align="center" style="background:#F5F5F5;" + |↑
| align="center" style="background:#F5F5F5;" + |Nl
| align="center" style="background:#F5F5F5;" + |Nl
| align="left" style="background:#F5F5F5;" + |
* Normal [[Granulocyte|granulocytes]]
* [[Histiocyte|Histiocytes]] of Gaucher type
| align="center" style="background:#F5F5F5;" + |Nl
| align="center" style="background:#F5F5F5;" + |Nl
| align="center" style="background:#F5F5F5;" + |Nl
| align="center" style="background:#F5F5F5;" + |Nl
| align="center" style="background:#F5F5F5;" + |Molecular testing
| align="left" style="background:#F5F5F5;" + |
* High [[leukocyte alkaline phosphatase]]
* Progress to [[leukemia]]
|-
! align="center" style="background:#DCDCDC;" |[[Myeloproliferative neoplasm|Myeloproliferative neoplasms]]<ref name="pmid20052751">{{cite journal |vauthors=Tefferi A |title=Leukocytosis as a risk factor for thrombosis in myeloproliferative neoplasms-biologically plausible but clinically uncertain |journal=Am. J. Hematol. |volume=85 |issue=2 |pages=93–4 |date=February 2010 |pmid=20052751 |doi=10.1002/ajh.21614 |url=}}</ref>
| align="center" style="background:#F5F5F5;" + |
*Unknown
*[[Mutation]]
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + |Elderly
| align="left" style="background:#F5F5F5;" + |Exposure to
*[[Chemotherapy]]
*[[Radiation therapy]]
*[[Tobacco smoking|Tobacco smoke]]
| align="left" style="background:#F5F5F5;" + |
* [[Petechia|Petechiae]]
* [[Purpura]]
* Diffuse erythematous [[rash]]
| align="center" style="background:#F5F5F5;" + |±
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + |Nl
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |−
| align="left" style="background:#F5F5F5;" + |
*[[Shortness of breath]]
*[[Fatigue]]
| align="center" style="background:#F5F5F5;" + |↑/↓
| align="center" style="background:#F5F5F5;" + |↓
| align="center" style="background:#F5F5F5;" + |↑/↓
| align="left" style="background:#F5F5F5;" + |
*Large [[Platelet|platelets]]
*Ovalomacrocytosis
*Basophilic stippling
*[[Howell-Jolly body]]
*Pelger-Huet anomaly
*Ring [[Sideroblastic anemia|sideroblasts]]
| align="left" style="background:#F5F5F5;" + |
*Impaired [[myeloid]] maturation
*[[Congenital dyserythropoietic anemia|Dyserythropoiesis]]
*Dysgranulopoiesis
*Dysmegakaryocytopoiesis
*Hypercellular [[bone marrow]]
*[[Fibrosis]]
| align="center" style="background:#F5F5F5;" + |↑
| align="center" style="background:#F5F5F5;" + |Nl
| align="center" style="background:#F5F5F5;" + |Nl
| align="center" style="background:#F5F5F5;" + |[[Bone marrow examination]] + clinical manifestation
| align="left" style="background:#F5F5F5;" + |
*[[Thrombosis]] at unusual sites
*[[Thrombosis]] in younger patients
*Might transformed to [[acute leukemia]]
|-
! align="center" style="background:#DCDCDC;" |[[Polycythemia vera]]<ref name="pmid26336886">{{cite journal |vauthors=Boiocchi L, Gianelli U, Iurlo A, Fend F, Bonzheim I, Cattaneo D, Knowles DM, Orazi A |title=Neutrophilic leukocytosis in advanced stage polycythemia vera: hematopathologic features and prognostic implications |journal=Mod. Pathol. |volume=28 |issue=11 |pages=1448–57 |date=November 2015 |pmid=26336886 |doi=10.1038/modpathol.2015.100 |url=}}</ref>
| align="left" style="background:#F5F5F5;" + |
*Autonomous [[Red blood cell|erythrocyte]] production
*[[JAK2]] mutation (> 95%)
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |Mean age >60 years old
| align="left" style="background:#F5F5F5;" + |
*[[Stroke]]
*[[Visual system|Visual disturbance]]
| align="center" style="background:#F5F5F5;" + |
* Facial [[Hypervolemia|plethora]]
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |↑
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + |−
| align="left" style="background:#F5F5F5;" + |
*Painful [[erythema]]
| align="center" style="background:#F5F5F5;" + |Nl to ↑
| align="center" style="background:#F5F5F5;" + |↑
| align="center" style="background:#F5F5F5;" + |↑
| align="left" style="background:#F5F5F5;" + |
*Elevated normochromic, normocytic [[Red blood cell|RBCs]]
*[[Thrombocytosis]]
*≥ 10% immature myeloid precursors
*Leukoerythroblastic picture
| align="left" style="background:#F5F5F5;" + |
* Increased [[myeloid]]:[[Red blood cell|erythroid]] ratio due to granulocytic proliferation
| align="center" style="background:#F5F5F5;" + |Nl
| align="center" style="background:#F5F5F5;" + |Nl
| align="center" style="background:#F5F5F5;" + |Nl
| align="center" style="background:#F5F5F5;" + |[[Bone marrow examination]] + clinical manifestation
| align="left" style="background:#F5F5F5;" + |
*[[Stroke]]
*[[Venous thrombosis]]
*[[Myelofibrosis]]
*[[Acute leukemia]]
|-
! align="center" style="background:#DCDCDC;" |[[Microangiopathic hemolytic anemia]] (MAHA)<ref name="pmid27288467">{{cite journal |vauthors=Morton JM, George JN |title=Microangiopathic Hemolytic Anemia and Thrombocytopenia in Patients With Cancer |journal=J Oncol Pract |volume=12 |issue=6 |pages=523–30 |date=June 2016 |pmid=27288467 |doi=10.1200/JOP.2016.012096 |url=}}</ref>
| align="left" style="background:#F5F5F5;" + |
* [[Microvascular disease|Microangiopathy]]
* [[Leukemoid reaction]]
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + |Any
| align="left" style="background:#F5F5F5;" + |
* [[Coagulopathy|Bleeding disorder]]
* Positive family history
| align="left" style="background:#F5F5F5;" + |
* [[Pallor]]
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + |↓
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |
*[[Shortness of breath]]
*[[Fatigue]]
| align="center" style="background:#F5F5F5;" + |↑
| align="center" style="background:#F5F5F5;" + |↓
| align="center" style="background:#F5F5F5;" + |↑
| align="left" style="background:#F5F5F5;" + |
* Fragmented [[Red blood cell|RBCs]]
* [[Red blood cell|Schistocytes]]
| align="center" style="background:#F5F5F5;" + |NA
| align="center" style="background:#F5F5F5;" + |↑
| align="center" style="background:#F5F5F5;" + |↑
| align="center" style="background:#F5F5F5;" + |↑
| align="center" style="background:#F5F5F5;" + |[[Bone marrow examination]] + clinical manifestation
| align="left" style="background:#F5F5F5;" + |
* Non-immune [[hemolysis]]
* Elevated [[Lactate dehydrogenase|LDH]]
* Elevated [[alkaline phosphatase]]
* Negative [[Coombs test|direct Coomb's test]]
* [[Thrombosis]]
|-
! align="center" style="background:#DCDCDC;" |Leukoerythroblastosis<ref name="pmid25562031">{{cite journal |vauthors=Canbolat Ayhan A, Timur C, Ayhan Y, Kes G |title=Leukoerythroblastosis Mimicking Leukemia: A case report |journal=Iran J Pediatr |volume=24 |issue=3 |pages=332–3 |date=June 2014 |pmid=25562031 |pmc=4276592 |doi= |url=}}</ref>
| align="left" style="background:#F5F5F5;" + |
* Space-occupying lesions in the [[bone marrow]]
* [[Infection]]
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + |Any
| align="left" style="background:#F5F5F5;" + |
* [[Coagulopathy|Bleeding disorder]]
| align="left" style="background:#F5F5F5;" + |
* [[Pallor]]
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + |Nl
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |−
| align="left" style="background:#F5F5F5;" + |
* [[Satiety|Early satiety]]
* [[Fatigue]]
| align="center" style="background:#F5F5F5;" + |↑
| align="center" style="background:#F5F5F5;" + |↓
| align="center" style="background:#F5F5F5;" + |↓
| align="left" style="background:#F5F5F5;" + |
* Nucleated red cells
* [[Reticulocyte|Reticulocytosis]]
* [[Poikilocytosis|Poikilocytes]]
* Circulating immature [[White blood cells|white cells]], generally [[Myelocyte|myelocytes]] and [[Promyelocyte|promyelocytes]]
| align="left" style="background:#F5F5F5;" + |
* Circulating immature [[White blood cells|white cells]], generally [[Myelocyte|myelocytes]] and [[Promyelocyte|promyelocytes]]
* [[Myelofibrosis]]
| align="center" style="background:#F5F5F5;" + |↑
| align="center" style="background:#F5F5F5;" + |Nl
| align="center" style="background:#F5F5F5;" + |↑
| align="center" style="background:#F5F5F5;" + |[[Bone marrow examination|Bone marrow biopsy]]
| align="left" style="background:#F5F5F5;" + |
* [[Bone marrow|Marrow]] infiltrative disorders
* [[Physical trauma|Trauma]]
* [[Sepsis|Septicemia]]
* Massive [[hemolysis]]
* [[Macrocytic anemia|Megaloblastic anemia]]
* [[Hematopoiesis|Extramedullary hematopoiesis]]
|-
! rowspan="12" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Immunology/
Rheumatology
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Condition
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Etiology
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Physiologic
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Autonomous increased bone marrow production
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Reactive increased bone marrow production
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Demargination of peripheral blood neutrophils
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Congenital
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Acquried
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Demography
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |History
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Appearance
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Fever
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Abdominal pain
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |BP
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Asplenia
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Hepatosplenomegaly
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Lymphadenopathy
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Joint involvement
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Other signs
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |WBC
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |HB
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Plt
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |PBS
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Bone marrow exam
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |ESR/CRP
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |BUN/Cr
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |LFT
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Gold standard
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Associated findings
|-
! align="center" style="background:#DCDCDC;" |[[Leukocyte adhesion deficiency]]<ref name="pmid26434744">{{cite journal |vauthors=Levy-Mendelovich S, Rechavi E, Abuzaitoun O, Vernitsky H, Simon AJ, Lev A, Somech R |title=Highlighting the problematic reliance on CD18 for diagnosing leukocyte adhesion deficiency type 1 |journal=Immunol. Res. |volume=64 |issue=2 |pages=476–82 |date=April 2016 |pmid=26434744 |doi=10.1007/s12026-015-8706-5 |url=}}</ref>
| align="left" style="background:#F5F5F5;" + |
* [[Primary immunodeficiency]]
* Failure to express [[CD18]]
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |Rare [[autosomal recessive]], [[Leukocyte adhesion deficiency|LAD]] II more in Middle East and Brazil
| align="left" style="background:#F5F5F5;" + |
* Positive family history
| align="left" style="background:#F5F5F5;" + |
* Characteristic facial appearance, short stature, limb malformations, and severe [[Developmental disability|developmental delay]] in [[Leukocyte adhesion deficiency|LAD]] II
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |Nl
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |−
| align="left" style="background:#F5F5F5;" + |
* Signs of different [[Infection|infections]]
| align="center" style="background:#F5F5F5;" + |↑
| align="center" style="background:#F5F5F5;" + |↓
| align="center" style="background:#F5F5F5;" + |↓/↑
| align="left" style="background:#F5F5F5;" + |
* Leukocytosis
| align="left" style="background:#F5F5F5;" + |
* Leukocytosis
| align="center" style="background:#F5F5F5;" + |Nl
| align="center" style="background:#F5F5F5;" + |Nl
| align="center" style="background:#F5F5F5;" + |Nl
| align="center" style="background:#F5F5F5;" + |[[Flow cytometry]]
| align="left" style="background:#F5F5F5;" + |
* Recurrent [[Infection|bacterial infections]]
* Delay in [[umbilical cord]] sloughing
* Inability to form [[Abscess|abscesses]]
|-
! align="center" style="background:#DCDCDC;" |Cryopyrin-associated periodic syndromes<ref name="pmid30035647">{{cite journal |vauthors=Labrousse M, Kevorkian-Verguet C, Boursier G, Rowczenio D, Maurier F, Lazaro E, Aggarwal M, Lemelle I, Mura T, Belot A, Touitou I, Sarrabay G |title=Mosaicism in autoinflammatory diseases: Cryopyrin-associated periodic syndromes (CAPS) and beyond. A systematic review |journal=Crit Rev Clin Lab Sci |volume=55 |issue=6 |pages=432–442 |date=September 2018 |pmid=30035647 |doi=10.1080/10408363.2018.1488805 |url=}}</ref>
| align="left" style="background:#F5F5F5;" + |
* Unknown
* [[Mutation]]
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |[[Dominance relationship|Autosomal dominant]] autoinflammatory syndrome
| align="left" style="background:#F5F5F5;" + |
* Positive family history
| align="left" style="background:#F5F5F5;" + |
* [[Urticaria|Hive]]-like [[rash]] without [[Itch|itching]]
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |Nl
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + | +
| align="left" style="background:#F5F5F5;" + |
* Red eyes
* [[Nausea and vomiting|Vomiting]]
* [[Headache]]
| align="center" style="background:#F5F5F5;" + |↑
| align="center" style="background:#F5F5F5;" + |↓
| align="center" style="background:#F5F5F5;" + |↓/↑
| align="left" style="background:#F5F5F5;" + |
* Leukocytosis
| align="left" style="background:#F5F5F5;" + |
* Leukocytosis
| align="center" style="background:#F5F5F5;" + |↑
| align="center" style="background:#F5F5F5;" + |Nl
| align="center" style="background:#F5F5F5;" + |↑
| align="center" style="background:#F5F5F5;" + |[[Genetic testing|Genetic tests]]
| align="left" style="background:#F5F5F5;" + |
* [[Blindness]]
* [[Hearing impairment|Hearing loss]]
|-
! align="center" style="background:#DCDCDC;" |[[Rheumatoid arthritis]]<ref name="pmid20870100">{{cite journal |vauthors=Scott DL, Wolfe F, Huizinga TW |title=Rheumatoid arthritis |journal=Lancet |volume=376 |issue=9746 |pages=1094–108 |date=September 2010 |pmid=20870100 |doi=10.1016/S0140-6736(10)60826-4 |url=}}</ref><ref name="pmid24568138">{{cite journal |vauthors=Glant TT, Mikecz K, Rauch TA |title=Epigenetics in the pathogenesis of rheumatoid arthritis |journal=BMC Med |volume=12 |issue= |pages=35 |date=February 2014 |pmid=24568138 |pmc=3936819 |doi=10.1186/1741-7015-12-35 |url=}}</ref>
| align="left" style="background:#F5F5F5;" + |
* [[Immunity (medical)|Immune]] mediated
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + |Any, more in young women, between 30-60 years old
| align="left" style="background:#F5F5F5;" + |
* Positive family history
* [[Smoking|Cigarette smoking]]
* [[Obesity]]
| align="left" style="background:#F5F5F5;" + |
* Deformed [[Joint|joints]]
* [[Rheumatoid nodule|Rheumatoid nodules]]
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |Nl
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + | +
| align="left" style="background:#F5F5F5;" + |
* [[Weight loss]]
* [[Fatigue]]
* [[Dry eyes]] and mouth
| align="center" style="background:#F5F5F5;" + |↑
| align="center" style="background:#F5F5F5;" + |↓
| align="center" style="background:#F5F5F5;" + |↑
| align="left" style="background:#F5F5F5;" + |
* Leukocytosis
| align="center" style="background:#F5F5F5;" + |NA
| align="center" style="background:#F5F5F5;" + |↑
| align="center" style="background:#F5F5F5;" + |Nl
| align="center" style="background:#F5F5F5;" + |Nl
| align="center" style="background:#F5F5F5;" + |Clinical manifestation + positive [[Anti-citrullinated protein antibody|anti-CCP antibodies]]
| align="left" style="background:#F5F5F5;" + |
* [[Osteoporosis]]
* [[Infection|Infections]]
* [[Carpal tunnel syndrome]]
* Multi-organ involvement
* [[Lymphoma]]
|-
! align="center" style="background:#DCDCDC;" |[[Juvenile rheumatoid arthritis|Juvenile onset rheumatoid arthritis]]<ref name="pmid23763801">{{cite journal |vauthors=Naz S, Mushtaq A, Rehman S, Bari A, Maqsud A, Khan MZ, Ahmad TM |title=Juvenile rheumatoid arthritis |journal=J Coll Physicians Surg Pak |volume=23 |issue=6 |pages=409–12 |date=June 2013 |pmid=23763801 |doi=06.2013/JCPSP.409412 |url=}}</ref>
| align="left" style="background:#F5F5F5;" + |
* [[Immunity (medical)|Immune]] mediated
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + |Children under the age of 16
| align="left" style="background:#F5F5F5;" + |
* Positive family history
| align="left" style="background:#F5F5F5;" + |
*Blotchy [[rash]] on a child's arms and legs
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |Nl
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + | +
| align="left" style="background:#F5F5F5;" + |
* [[Fatigue]]
* [[Dry eyes]] and mouth
| align="center" style="background:#F5F5F5;" + |↑
| align="center" style="background:#F5F5F5;" + |↓
| align="center" style="background:#F5F5F5;" + |↑
| align="left" style="background:#F5F5F5;" + |
* Leukocytosis
| align="center" style="background:#F5F5F5;" + |NA
| align="center" style="background:#F5F5F5;" + |↑
| align="center" style="background:#F5F5F5;" + |Nl
| align="center" style="background:#F5F5F5;" + |Nl
| align="center" style="background:#F5F5F5;" + |Clinical manifestation + laboratory findings
| align="left" style="background:#F5F5F5;" + |
* [[Uveitis]]
* [[Infection|Infections]]
* Multi-organ involvement
|-
! align="center" style="background:#DCDCDC;" |[[Still's disease|Adult Still's disease]]<ref name="pmid25613167">{{cite journal |vauthors=Kadavath S, Efthimiou P |title=Adult-onset Still's disease-pathogenesis, clinical manifestations, and new treatment options |journal=Ann. Med. |volume=47 |issue=1 |pages=6–14 |date=February 2015 |pmid=25613167 |doi=10.3109/07853890.2014.971052 |url=}}</ref>
| align="left" style="background:#F5F5F5;" + |
* [[Immunity (medical)|Immune]] mediated
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + |Rare [[autoimmune disease]]
| align="center" style="background:#F5F5F5;" + |NA
| align="left" style="background:#F5F5F5;" + |
* Nonpruritic salmon-colored [[rash]] (usually over [[trunk]] or [[Limb (anatomy)|extremities]] while [[Fever|febrile]])
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |Nl
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + | +
| align="left" style="background:#F5F5F5;" + |
* [[Headache]]
* [[Pharyngitis|Sore throat]]
* [[Weight loss]]
* [[Muscle pain]]
| align="center" style="background:#F5F5F5;" + |↑
| align="center" style="background:#F5F5F5;" + |↓
| align="center" style="background:#F5F5F5;" + |↑
| align="left" style="background:#F5F5F5;" + |
* Leukocytosis
| align="center" style="background:#F5F5F5;" + |NA
| align="center" style="background:#F5F5F5;" + |↑
| align="center" style="background:#F5F5F5;" + |Nl
| align="center" style="background:#F5F5F5;" + |Nl
| align="center" style="background:#F5F5F5;" + |Diagnosis of exclusion
| align="left" style="background:#F5F5F5;" + |
* High [[ferritin]]
* Negative [[Antinuclear antibodies|ANA]]
* [[Meningitis|Aseptic meningitis]]
*[[Sensorineural hearing loss]]
|-
! align="center" style="background:#DCDCDC;" |[[Kawasaki disease]]<ref name="pmid25399940">{{cite journal |vauthors=Sundel RP |title=Kawasaki disease |journal=Rheum. Dis. Clin. North Am. |volume=41 |issue=1 |pages=63–73, viii |date=2015 |pmid=25399940 |doi=10.1016/j.rdc.2014.09.010 |url=}}</ref>
| align="left" style="background:#F5F5F5;" + |
* [[Immunity (medical)|Immune]] mediated
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + |[[Autoimmune disease]], more in Asian ethnicity boys
| align="center" style="background:#F5F5F5;" + |NA
| align="left" style="background:#F5F5F5;" + |
* Diffuse [[maculopapular]] erythematous [[rash]] in the [[Sex organ|genital]] area, and red [[Eye|eyes]], [[Lip (disambiguation)|lips]], [[Hand|palms]] or [[Sole (foot)|soles]] of the feet
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + |Nl
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + | +
| align="left" style="background:#F5F5F5;" + |
* Strawberry [[tongue]]
* [[Pharyngitis|Sore throat]]
* [[Diarrhea]]
* Bilateral [[Conjunctiva|conjunctival]] inflammation
| align="center" style="background:#F5F5F5;" + |↑
| align="center" style="background:#F5F5F5;" + |↓
| align="center" style="background:#F5F5F5;" + |↑
| align="left" style="background:#F5F5F5;" + |
* Leukocytosis
| align="center" style="background:#F5F5F5;" + |NA
| align="center" style="background:#F5F5F5;" + |↑
| align="center" style="background:#F5F5F5;" + |Nl
| align="center" style="background:#F5F5F5;" + |Nl
| align="center" style="background:#F5F5F5;" + |Diagnostic criteria
| align="left" style="background:#F5F5F5;" + |
* Medium-sized-vessel [[vasculitis]]
* [[Coronary artery aneurysm]]
|-
! align="center" style="background:#DCDCDC;" |[[Inflammatory bowel disease|IBD]]<ref name="pmid24415861">{{cite journal |vauthors=Zhang YZ, Li YY |title=Inflammatory bowel disease: pathogenesis |journal=World J. Gastroenterol. |volume=20 |issue=1 |pages=91–9 |date=January 2014 |pmid=24415861 |pmc=3886036 |doi=10.3748/wjg.v20.i1.91 |url=}}</ref>
| align="left" style="background:#F5F5F5;" + |
* [[Immunity (medical)|Immune]] mediated
* [[Mutation]]
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + |[[Autoimmune disease]], more in young
| align="left" style="background:#F5F5F5;" + |
* [[Stress (medicine)|Stress]]
* Positive family history
| align="left" style="background:#F5F5F5;" + |
* [[Pyoderma gangrenosum]]
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + |Nl
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + | +
| align="left" style="background:#F5F5F5;" + |
* [[Nausea and vomiting|Vomiting]]
* [[Diarrhea]]
* [[Rectal bleeding]]
| align="center" style="background:#F5F5F5;" + |↑
| align="center" style="background:#F5F5F5;" + |↓
| align="center" style="background:#F5F5F5;" + |↑
| align="left" style="background:#F5F5F5;" + |
* Leukocytosis
| align="center" style="background:#F5F5F5;" + |NA
| align="center" style="background:#F5F5F5;" + |↑
| align="center" style="background:#F5F5F5;" + |Nl
| align="center" style="background:#F5F5F5;" + |Nl
| align="center" style="background:#F5F5F5;" + |[[Colonoscopy]] and [[biopsy]]
| align="left" style="background:#F5F5F5;" + |
* [[Primary sclerosing cholangitis]]
* [[Euthyroid sick syndrome|Non-thyroidal illness syndrome]]
* [[Deep vein thrombosis|DVT]]
* [[Cryptogenic organizing pneumonia|Bronchiolitis obliterans organizing pneumonia]]
|-
! align="center" style="background:#DCDCDC;" |[[Sarcoidosis]]<ref name="pmid25473783">{{cite journal |vauthors=Modaresi Esfeh J, Culver D, Plesec T, John B |title=Clinical presentation and protocol for management of hepatic sarcoidosis |journal=Expert Rev Gastroenterol Hepatol |volume=9 |issue=3 |pages=349–58 |date=March 2015 |pmid=25473783 |doi=10.1586/17474124.2015.958468 |url=}}</ref>
| align="left" style="background:#F5F5F5;" + |
* [[Immunity (medical)|Immune]] mediated
* Unknown
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + |[[Autoimmune disease]], more in young African American women
| align="left" style="background:#F5F5F5;" + |
* Positive family history
| align="left" style="background:#F5F5F5;" + |
* [[Rash|Rashes]]
* [[Erythema nodosum]]
* [[Granuloma annulare]]
* [[Lupus pernio]]
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + |Nl
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + | +
Bilateral [[Hilar lymphadenopathy|hilar adenopathy]]
| align="center" style="background:#F5F5F5;" + | +
| align="left" style="background:#F5F5F5;" + |
* [[Fatigue]]
* [[Weight loss]]
* [[Blurred vision|Blurry vision]]
* [[Dyspnea|Shortness of breath]]
* [[Cough]]
| align="center" style="background:#F5F5F5;" + |↑
| align="center" style="background:#F5F5F5;" + |↓
| align="center" style="background:#F5F5F5;" + |↑
| align="left" style="background:#F5F5F5;" + |
* Leukocytosis
| align="center" style="background:#F5F5F5;" + |NA
| align="center" style="background:#F5F5F5;" + |↑
| align="center" style="background:#F5F5F5;" + |Nl
| align="center" style="background:#F5F5F5;" + |Nl
| align="center" style="background:#F5F5F5;" + |Diagnosis of exclusion
| align="left" style="background:#F5F5F5;" + |
* [[Interstitial lung disease]]
* Systemic [[Inflammation|inflammatory]] disease
|-
! align="center" style="background:#DCDCDC;" |[[Hepatitis|Chronic hepatitis]]<ref name="pmid26092643">{{cite journal |vauthors=Gish RG, Given BD, Lai CL, Locarnini SA, Lau JY, Lewis DL, Schluep T |title=Chronic hepatitis B: Virology, natural history, current management and a glimpse at future opportunities |journal=Antiviral Res. |volume=121 |issue= |pages=47–58 |date=September 2015 |pmid=26092643 |doi=10.1016/j.antiviral.2015.06.008 |url=}}</ref>
| align="left" style="background:#F5F5F5;" + |
* [[Infection]]
* [[Autoimmunity|Autoimmune]]
* [[Ischemia|Ischemic]]
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + |Elderly
| align="left" style="background:#F5F5F5;" + |
* [[Alcoholism|Alcohol use]]
* Acute [[infection]]
| align="left" style="background:#F5F5F5;" + |
* [[Jaundice]]
* [[Ascites]] and [[peripheral edema]]
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + |↓
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + | +
| align="left" style="background:#F5F5F5;" + |
* [[Fatigue]]
* [[Weight loss]]
* [[Nausea and vomiting]]
| align="center" style="background:#F5F5F5;" + |↑
| align="center" style="background:#F5F5F5;" + |↓
| align="center" style="background:#F5F5F5;" + |↑
| align="left" style="background:#F5F5F5;" + |
* Leukocytosis
| align="center" style="background:#F5F5F5;" + |NA
| align="center" style="background:#F5F5F5;" + |↑
| align="center" style="background:#F5F5F5;" + |↑
| align="center" style="background:#F5F5F5;" + |↑
| align="center" style="background:#F5F5F5;" + |[[Liver biopsy]]
| align="left" style="background:#F5F5F5;" + |
* [[Hirsutism]]
* [[Amenorrhea]]
* [[Coagulopathy]]
* [[Hepatic encephalopathy]]
* [[Esophageal varices]]
* [[Hepatorenal syndrome]]
* [[Liver mass|Liver cancer]]
|-
! align="center" style="background:#DCDCDC;" |[[Sweet's syndrome|Sweet syndrome]]<ref name="pmid30247226">{{cite journal |vauthors=Das A, Burmeister R, Chhaya R, Eisenga B, Kumar A |title=Sweet Syndrome in a Patient With Systemic Lupus Erythematosus |journal=J Clin Rheumatol |volume= |issue= |pages= |date=September 2018 |pmid=30247226 |doi=10.1097/RHU.0000000000000904 |url=}}</ref>
| align="left" style="background:#F5F5F5;" + |
* [[Immunity (medical)|Immune]] mediated
* Unknown
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + |Rare
| align="left" style="background:#F5F5F5;" + |
* [[Relapse]] and [[Remission (medicine)|remission]]
| align="left" style="background:#F5F5F5;" + |
* [[Tenderness (medicine)|Tender]], red, well-demarcated [[Papule|papules]] and [[Plaque|plaques]] on the [[head]], [[neck]], [[Leg|legs]], and arms
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + |Nl
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + | +
| align="left" style="background:#F5F5F5;" + |
* [[Conjunctivitis]]
* [[Iridocyclitis]]
* [[Aphthous ulcer|Oral aphthae]]
| align="center" style="background:#F5F5F5;" + |↑
| align="center" style="background:#F5F5F5;" + |↓
| align="center" style="background:#F5F5F5;" + |↑
| align="left" style="background:#F5F5F5;" + |
* Leukocytosis
| align="left" style="background:#F5F5F5;" + |
* Papillary and mid-dermal mixed infiltrate of [[Neutrophil|polymorphonuclear]] leukocytes with nuclear fragmentation and [[Histiocytic|histiocytic cells]]
| align="center" style="background:#F5F5F5;" + |↑
| align="center" style="background:#F5F5F5;" + |Nl
| align="center" style="background:#F5F5F5;" + |Nl
| align="center" style="background:#F5F5F5;" + |Diagnostic criteria
| align="left" style="background:#F5F5F5;" + |
* Cutaneous marker of systemic disease
* [[Acute myeloid leukemia|Acute myelogenous leukemia]]
* Immunologic disease
* Slight increase in [[alkaline phosphatase]]
|-
! align="center" style="background:#DCDCDC;" |[[Gout|Acute gout]]<ref name="pmid24334652">{{cite journal |vauthors=Dalbeth N, Zhong CS, Grainger R, Khanna D, Khanna PP, Singh JA, McQueen FM, Taylor WJ |title=Outcome measures in acute gout: a systematic literature review |journal=J. Rheumatol. |volume=41 |issue=3 |pages=558–68 |date=March 2014 |pmid=24334652 |pmc=4217650 |doi=10.3899/jrheum.131244 |url=}}</ref>
| align="left" style="background:#F5F5F5;" + |
* Elevated levels of [[uric acid]] in the [[blood]]
* [[Diet (nutrition)|Diet]]
* [[Genetics|Genetic]]
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + |Older males
| align="left" style="background:#F5F5F5;" + |
* [[Alcoholism|Alcohol use]]
* Acute [[infection]]
| align="left" style="background:#F5F5F5;" + |
* [[Tophus|Tophi]]
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + | +
| align="left" style="background:#F5F5F5;" + |
* [[Fatigue]]
| align="center" style="background:#F5F5F5;" + |↑
| align="center" style="background:#F5F5F5;" + |↓
| align="center" style="background:#F5F5F5;" + |↑
| align="left" style="background:#F5F5F5;" + |
* Leukocytosis
| align="center" style="background:#F5F5F5;" + |NA
| align="center" style="background:#F5F5F5;" + |↑
| align="center" style="background:#F5F5F5;" + |↑
| align="center" style="background:#F5F5F5;" + |Nl
| align="center" style="background:#F5F5F5;" + |Clinical manifestation
| align="left" style="background:#F5F5F5;" + |
* [[Arthritis]]
* Urate [[nephropathy]]
|-
! rowspan="6" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Medication
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Condition
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Etiology
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Physiologic
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Autonomous increased bone marrow production
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Reactive increased bone marrow production
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Demargination of peripheral blood neutrophils
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Congenital
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Acquried
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Demography
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |History
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Appearance
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Fever
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Abdominal pain
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |BP
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Asplenia
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Hepatosplenomegaly
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Lymphadenopathy
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Joint involvement
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Other signs
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |WBC
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |HB
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Plt
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |PBS
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Bone marrow exam
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |ESR/CRP
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |BUN/Cr
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |LFT
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Gold standard
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Associated findings
|-
! align="center" style="background:#DCDCDC;" |[[Steroid]]<ref name="pmid7304648">{{cite journal |vauthors=Shoenfeld Y, Gurewich Y, Gallant LA, Pinkhas J |title=Prednisone-induced leukocytosis. Influence of dosage, method and duration of administration on the degree of leukocytosis |journal=Am. J. Med. |volume=71 |issue=5 |pages=773–8 |date=November 1981 |pmid=7304648 |doi= |url=}}</ref>
| align="left" style="background:#F5F5F5;" + |
* Release of [[Granulocyte|granulocytes]] from the [[bone marrow]]
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + |Any
| align="left" style="background:#F5F5F5;" + |
* [[Steroid]] use
* [[Autoimmune disease]]
* [[Cancer|Malignancy]]
| align="center" style="background:#F5F5F5;" + |
* [[Obesity|Obese]]
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + |Nl to ↓
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |−
| align="left" style="background:#F5F5F5;" + |
* [[Abdominal pain]]
* [[Muscle weakness]]
* [[Growth failure]]
* [[Pubertal delay]]
| align="center" style="background:#F5F5F5;" + |↑
| align="center" style="background:#F5F5F5;" + |Nl to ↓
| align="center" style="background:#F5F5F5;" + |↑
| align="left" style="background:#F5F5F5;" + |
* [[Myelofibrosis|Megakaryocytic]]<nowiki/>fragments
* Large numbers of microspherocytes
| align="left" style="background:#F5F5F5;" + |
* Proliferation of [[Megakaryocyte|megakaryocytes]]
| align="center" style="background:#F5F5F5;" + |↑
| align="center" style="background:#F5F5F5;" + |↑
| align="center" style="background:#F5F5F5;" + |Nl
| align="center" style="background:#F5F5F5;" + |Clinical manifestation + history of drug consumption
| align="left" style="background:#F5F5F5;" + |
* [[Thrombosis|Thromboembolic]]<nowiki/>complications
* [[Cushing's syndrome|Cushing syndrome]]
* [[Diabetes mellitus]]
|-
! align="center" style="background:#DCDCDC;" |[[Filgrastim]] (Myeloid growth factor)<ref name="pmid24142827">{{cite journal |vauthors=Crawford J, Armitage J, Balducci L, Becker PS, Blayney DW, Cataland SR, Heaney ML, Hudock S, Kloth DD, Kuter DJ, Lyman GH, McMahon B, Rugo HS, Saad AA, Schwartzberg LS, Shayani S, Steensma DP, Talbott M, Vadhan-Raj S, Westervelt P, Westmoreland M, Dwyer M, Ho M |title=Myeloid growth factors |journal=J Natl Compr Canc Netw |volume=11 |issue=10 |pages=1266–90 |date=October 2013 |pmid=24142827 |doi= |url=}}</ref>
| align="left" style="background:#F5F5F5;" + |
* Release of [[Granulocyte|granulocytes]] from the [[bone marrow]]
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + |Any
| align="left" style="background:#F5F5F5;" + |
* [[Cancer|Malignancy]]
* [[Neutropenia]]
| align="left" style="background:#F5F5F5;" + |
* [[Alopecia|Hair loss]]
* Local skin reactions at the site of [[Injection (medicine)|injection]]
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |Nl to ↓
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + | +
| align="left" style="background:#F5F5F5;" + |
* [[Cough]]
* [[Chest pain]]
* [[Nausea and vomiting|Vomiting]]
| align="center" style="background:#F5F5F5;" + |↑
| align="center" style="background:#F5F5F5;" + |Nl to ↓
| align="center" style="background:#F5F5F5;" + |↑
| align="center" style="background:#F5F5F5;" + |NA
| align="center" style="background:#F5F5F5;" + |NA
| align="center" style="background:#F5F5F5;" + |↑
| align="center" style="background:#F5F5F5;" + |Nl
| align="center" style="background:#F5F5F5;" + |Nl
| align="left" style="background:#F5F5F5;" + |Clinical manifestation + history of drug consumption
| align="left" style="background:#F5F5F5;" + |
* [[Alveolus|Alveolar]] hemorrhage
* [[Acute respiratory distress syndrome]]
|-
! align="center" style="background:#DCDCDC;" |[[Lithium]]<ref name="pmid25735990">{{cite journal |vauthors=Aiff H, Attman PO, Aurell M, Bendz H, Ramsauer B, Schön S, Svedlund J |title=Effects of 10 to 30 years of lithium treatment on kidney function |journal=J. Psychopharmacol. (Oxford) |volume=29 |issue=5 |pages=608–14 |date=May 2015 |pmid=25735990 |doi=10.1177/0269881115573808 |url=}}</ref>
| align="left" style="background:#F5F5F5;" + |
* Unknown
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + |Any
| align="left" style="background:#F5F5F5;" + |
* [[Bipolar disorder]]
| align="left" style="background:#F5F5F5;" + |
* [[Weight gain]]
* [[Acne vulgaris|Acne]]
* Hand [[tremor]]
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |Nl
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |−
| align="left" style="background:#F5F5F5;" + |
* [[Confusion]]
* [[Constipation]] or [[diarrhea]]
* Decreased [[memory]]
* [[Xerostomia|Dry mouth]]
* [[Muscle weakness]]
| align="center" style="background:#F5F5F5;" + |↑
| align="center" style="background:#F5F5F5;" + |Nl to ↓
| align="center" style="background:#F5F5F5;" + |↑
| align="center" style="background:#F5F5F5;" + |NA
| align="center" style="background:#F5F5F5;" + |NA
| align="center" style="background:#F5F5F5;" + |Nl
| align="center" style="background:#F5F5F5;" + |↑
| align="center" style="background:#F5F5F5;" + |Nl
| align="center" style="background:#F5F5F5;" + |Clinical manifestation + history of drug consumption
| align="left" style="background:#F5F5F5;" + |
* [[Extrapyramidal system|Extrapyramidal side effects]]
* [[Goitre|Euthyroid goitre]]
* [[Hypothyroidism]]
* [[Renal insufficiency|Kidney damage]]
|-
! align="center" style="background:#DCDCDC;" |[[Catecholamine|Catecholamines]]
([[epinephrine]])<ref name="pmid12417430">{{cite journal |vauthors=Bedoui S, Lechner S, Gebhardt T, Nave H, Beck-Sickinger AG, Straub RH, Pabst R, von Hörsten S |title=NPY modulates epinephrine-induced leukocytosis via Y-1 and Y-5 receptor activation in vivo: sympathetic co-transmission during leukocyte mobilization |journal=J. Neuroimmunol. |volume=132 |issue=1-2 |pages=25–33 |date=November 2002 |pmid=12417430 |doi= |url=}}</ref>
| align="left" style="background:#F5F5F5;" + |
* Stimulation of [[bone marrow]] myelopoiesis
* Egress into the circulation
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + |Any
| align="left" style="background:#F5F5F5;" + |
* [[Anaphylaxis]]
* [[Respiratory disease|Respiratory diseases]]
| align="left" style="background:#F5F5F5;" + |
* Acutely ill
* [[Diaphoresis|Diaphoretic]]
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |Nl to ↓
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |−
| align="left" style="background:#F5F5F5;" + |
* [[Dizziness]]
* [[Tremor]]
* [[Anxiety]]
* [[Dyspnea]]
| align="center" style="background:#F5F5F5;" + |↑
| align="center" style="background:#F5F5F5;" + |↑
| align="center" style="background:#F5F5F5;" + |↑
| align="left" style="background:#F5F5F5;" + |
* [[Myelofibrosis|Megakaryocytic]]<nowiki/>fragments
| align="left" style="background:#F5F5F5;" + |
* Proliferation of [[Megakaryocyte|megakaryocytes]]
| align="center" style="background:#F5F5F5;" + |↑
| align="center" style="background:#F5F5F5;" + |Nl
| align="center" style="background:#F5F5F5;" + |Nl
| align="center" style="background:#F5F5F5;" + |Clinical manifestation + history of drug consumption
| align="left" style="background:#F5F5F5;" + |
* [[Thrombosis|Thromboembolic]]<nowiki/>complications
|-
! align="center" style="background:#DCDCDC;" |[[Tretinoin|ATRA]]<ref name="pmid17257495">{{cite journal |vauthors=Bi KH, Jiang GS |title=Relationship between cytokines and leukocytosis in patients with APL induced by all-trans retinoic acid or arsenic trioxide |journal=Cell. Mol. Immunol. |volume=3 |issue=6 |pages=421–7 |date=December 2006 |pmid=17257495 |doi= |url=}}</ref>
| align="left" style="background:#F5F5F5;" + |
* Differentiating [[Promyelocyte|promyelocytes]]
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + |Any
| align="left" style="background:#F5F5F5;" + |
* [[Acne vulgaris|Acne]]
* [[Acute promyelocytic leukemia]]
| align="left" style="background:#F5F5F5;" + |
* [[Xeroderma|Skin dryness]]
* [[Alopecia|Hair loss]]
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |Nl
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |−
| align="left" style="background:#F5F5F5;" + |
* [[Dyspnea|Shortness of breath]]
* [[Headache]]
* [[Paresthesia|Numbness]]
* [[Depression]]
* [[Itch|Itchiness]]
* [[Nausea and vomiting|Vomiting]]
* [[Myalgia|Muscle pain]]
| align="center" style="background:#F5F5F5;" + |↑
| align="center" style="background:#F5F5F5;" + |Nl
| align="center" style="background:#F5F5F5;" + |Nl
| align="center" style="background:#F5F5F5;" + |NA
| align="center" style="background:#F5F5F5;" + |NA
| align="center" style="background:#F5F5F5;" + |↑
| align="center" style="background:#F5F5F5;" + |Nl
| align="center" style="background:#F5F5F5;" + |↑
| align="center" style="background:#F5F5F5;" + |Clinical manifestation + history of drug consumption
| align="left" style="background:#F5F5F5;" + |
* [[Teratology|Teratogen]]
* [[Thrombosis]]
* [[Idiopathic intracranial hypertension|Benign intracranial hypertension]]
* [[Hyperlipoproteinemia|Hypercholesterolemia]]
* [[Liver|Liver damage]]
|-
! rowspan="10" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Other
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Condition
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Etiology
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Physiologic
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Autonomous increased bone marrow production
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Reactive increased bone marrow production
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Demargination of peripheral blood neutrophils
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Congenital
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Acquried
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Demography
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |History
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Appearance
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Fever
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Abdominal pain
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |BP
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Asplenia
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Hepatosplenomegaly
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Lymphadenopathy
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Joint involvement
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Other signs
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |WBC
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |HB
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Plt
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |PBS
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Bone marrow exam
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |ESR/CRP
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |BUN/Cr
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |LFT
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Gold standard
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Associated findings
|-
! align="center" style="background:#DCDCDC;" |[[Infection|Infections]]<ref name="pmid24012414">{{cite journal |vauthors=Horasan ES, Dağ A, Ersoz G, Kaya A |title=Surgical site infections and mortality in elderly patients |journal=Med Mal Infect |volume=43 |issue=10 |pages=417–22 |date=October 2013 |pmid=24012414 |doi=10.1016/j.medmal.2013.07.009 |url=}}</ref>
| align="center" style="background:#F5F5F5;" + |
* [[Infection]]
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + |Any
| align="left" style="background:#F5F5F5;" + |
* Close contact
* [[Immunodeficiency]]
| align="left" style="background:#F5F5F5;" + |
* Acutely ill
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + |Nl to ↓
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |±
| align="center" style="background:#F5F5F5;" + |±
| align="center" style="background:#F5F5F5;" + |±
| align="left" style="background:#F5F5F5;" + |
* [[Fatigue]]
* [[Nausea and vomiting]]
| align="center" style="background:#F5F5F5;" + |↑
| align="center" style="background:#F5F5F5;" + |↓
| align="center" style="background:#F5F5F5;" + |↑
| align="left" style="background:#F5F5F5;" + |
* [[Howell-Jolly body|Howell-Jolly bodies]]
* Nucleated [[Red blood cell|RBCs]]
| align="left" style="background:#F5F5F5;" + |
* Proliferation of [[Megakaryocyte|megakaryocytes]]
| align="center" style="background:#F5F5F5;" + |↑
| align="center" style="background:#F5F5F5;" + |Nl
| align="center" style="background:#F5F5F5;" + |Nl
| align="center" style="background:#F5F5F5;" + |Clinical manifestation+ culture
| align="left" style="background:#F5F5F5;" + |
* Depends on etiology
|-
! align="center" style="background:#DCDCDC;" |[[Allergy]]<ref name="pmid29871797">{{cite journal |vauthors=Davis MDP, van der Hilst JCH |title=Mimickers of Urticaria: Urticarial Vasculitis and Autoinflammatory Diseases |journal=J Allergy Clin Immunol Pract |volume=6 |issue=4 |pages=1162–1170 |date=2018 |pmid=29871797 |doi=10.1016/j.jaip.2018.05.006 |url=}}</ref>
| align="left" style="background:#F5F5F5;" + |
* Unknown
* Activation of [[chloride]] transport
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + |Any
| align="left" style="background:#F5F5F5;" + |
* [[Anaphylaxis]]
* [[Respiratory|Respiratory diseases]]
| align="left" style="background:#F5F5F5;" + |
* Acutely ill
* [[Diaphoresis|Diaphoretic]]
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |Nl to ↓
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |−
| align="left" style="background:#F5F5F5;" + |
* [[Dizziness]]
* [[Tremor]]
* [[Anxiety]]
* [[Dyspnea]]
| align="center" style="background:#F5F5F5;" + |↑
| align="center" style="background:#F5F5F5;" + |↑
| align="center" style="background:#F5F5F5;" + |↑
| align="left" style="background:#F5F5F5;" + |
* [[Myelofibrosis|Megakaryocytic]]<nowiki/>fragments
| align="left" style="background:#F5F5F5;" + |
* Proliferation of [[Megakaryocyte|megakaryocytes]]
| align="center" style="background:#F5F5F5;" + |↑
| align="center" style="background:#F5F5F5;" + |Nl
| align="center" style="background:#F5F5F5;" + |Nl
| align="center" style="background:#F5F5F5;" + |Clinical manifestation
| align="center" style="background:#F5F5F5;" + |−
|-
! align="center" style="background:#DCDCDC;" |Post [[splenectomy]]<ref name="pmid29766137">{{cite journal |vauthors=Bilello JF, Sharp VL, Dirks RC, Kaups KL, Davis JW |title=After the embo: predicting non-hemorrhagic indications for splenectomy after angioembolization in patients with blunt trauma |journal=Trauma Surg Acute Care Open |volume=3 |issue=1 |pages=e000159 |date=2018 |pmid=29766137 |pmc=5887792 |doi=10.1136/tsaco-2017-000159 |url=}}</ref>
| align="left" style="background:#F5F5F5;" + |
* Unknown
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + |Any
| align="left" style="background:#F5F5F5;" + |
* Prior surgical removal of the [[spleen]]
* [[Sickle-cell disease|Sickle cell disease]]
| align="left" style="background:#F5F5F5;" + |
* Normal
| align="center" style="background:#F5F5F5;" + |±
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |Nl
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |↑
| align="center" style="background:#F5F5F5;" + |↓
| align="center" style="background:#F5F5F5;" + |↑
| align="left" style="background:#F5F5F5;" + |
* [[Howell-Jolly body|Howell-Jolly bodies]]
* Nucleated [[Red blood cell|RBCs]]
| align="left" style="background:#F5F5F5;" + |
* Proliferation of [[Megakaryocyte|megakaryocytes]]
| align="center" style="background:#F5F5F5;" + |↑
| align="center" style="background:#F5F5F5;" + |Nl
| align="center" style="background:#F5F5F5;" + |Nl
| align="center" style="background:#F5F5F5;" + |Clinical manifestation
| align="left" style="background:#F5F5F5;" + |
* Incidental laboratory finding
* [[Thrombosis]]
|-
! align="center" style="background:#DCDCDC;" |[[Smoking|Cigarette smoking]]<ref name="pmid27688691">{{cite journal |vauthors=Lymperaki E, Makedou K, Iliadis S, Vagdatli E |title=Effects of acute cigarette smoking on total blood count and markers of oxidative stress in active and passive smokers |journal=Hippokratia |volume=19 |issue=4 |pages=293–7 |date=2015 |pmid=27688691 |pmc=5033137 |doi= |url=}}</ref>
| align="left" style="background:#F5F5F5;" + |
* Reduced [[Blood plasma|plasma]] volume
* Accelerated [[erythropoiesis]]
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + |Any
| align="left" style="background:#F5F5F5;" + |
* [[Smoking|Cigarette smoking]]
| align="left" style="background:#F5F5F5;" + |
* [[Cyanosis]]
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |Nl
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |−
| align="left" style="background:#F5F5F5;" + |
* [[Cough]]
* [[Dyspnea]]
| align="center" style="background:#F5F5F5;" + |↑
| align="center" style="background:#F5F5F5;" + |↑
| align="center" style="background:#F5F5F5;" + |↑
| align="center" style="background:#F5F5F5;" + |NA
| align="center" style="background:#F5F5F5;" + |NA
| align="center" style="background:#F5F5F5;" + |Nl
| align="center" style="background:#F5F5F5;" + |Nl
| align="center" style="background:#F5F5F5;" + |Nl
| align="center" style="background:#F5F5F5;" + |Clinical manifestation
| align="center" style="background:#F5F5F5;" + |−
|-
! align="center" style="background:#DCDCDC;" |[[Stress (medicine)|Stress]]/[[Physical exercise|exercise]]<ref name="pmid26477922">{{cite journal |vauthors=Simpson RJ, Kunz H, Agha N, Graff R |title=Exercise and the Regulation of Immune Functions |journal=Prog Mol Biol Transl Sci |volume=135 |issue= |pages=355–80 |date=2015 |pmid=26477922 |doi=10.1016/bs.pmbts.2015.08.001 |url=}}</ref>
| align="left" style="background:#F5F5F5;" + |
* Reduced plasma volume
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + |Athlete
| align="left" style="background:#F5F5F5;" + |
* [[Physical exercise|Exercise]]
| align="left" style="background:#F5F5F5;" + |
* Normal
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |Nl
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |↑
| align="center" style="background:#F5F5F5;" + |↑
| align="center" style="background:#F5F5F5;" + |↑
| align="left" style="background:#F5F5F5;" + |
* [[Howell-Jolly body|Howell-Jolly bodies]]
* Nucleated [[Red blood cell|RBCs]]
| align="left" style="background:#F5F5F5;" + |
* Proliferation of [[Megakaryocyte|megakaryocytes]]
| align="center" style="background:#F5F5F5;" + |↑
| align="center" style="background:#F5F5F5;" + |Nl
| align="center" style="background:#F5F5F5;" + |Nl
| align="center" style="background:#F5F5F5;" + |Clinical manifestation
| align="center" style="background:#F5F5F5;" + |−
|-
! align="center" style="background:#DCDCDC;" |[[Infant|Infancy]]<ref name="pmid26580401">{{cite journal |vauthors=Nouatin O, Gbédandé K, Ibitokou S, Vianou B, Houngbegnon P, Ezinmegnon S, Borgella S, Akplogan C, Cottrell G, Varani S, Massougbodji A, Moutairou K, Troye-Blomberg M, Deloron P, Luty AJ, Fievet N |title=Infants' Peripheral Blood Lymphocyte Composition Reflects Both Maternal and Post-Natal Infection with Plasmodium falciparum |journal=PLoS ONE |volume=10 |issue=11 |pages=e0139606 |date=2015 |pmid=26580401 |pmc=4651557 |doi=10.1371/journal.pone.0139606 |url=}}</ref>
| align="center" style="background:#F5F5F5;" + |Physiologic
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + |[[Infant|Infancy]]
| align="center" style="background:#F5F5F5;" + |−
| align="left" style="background:#F5F5F5;" + |
* Normal
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |Nl
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |↑
| align="center" style="background:#F5F5F5;" + |↑
| align="center" style="background:#F5F5F5;" + |↑
| align="center" style="background:#F5F5F5;" + |NA
| align="center" style="background:#F5F5F5;" + |NA
| align="center" style="background:#F5F5F5;" + |Nl
| align="center" style="background:#F5F5F5;" + |Nl
| align="center" style="background:#F5F5F5;" + |Nl
| align="center" style="background:#F5F5F5;" + |Clinical manifestation
| align="center" style="background:#F5F5F5;" + |−
|-
! align="center" style="background:#DCDCDC;" |[[Pregnancy]]<ref name="pmid26621538">{{cite journal |vauthors=Perseghin P |title=Erythrocyte exchange and leukapheresis in pregnancy |journal=Transfus. Apher. Sci. |volume=53 |issue=3 |pages=279–82 |date=December 2015 |pmid=26621538 |doi=10.1016/j.transci.2015.11.007 |url=}}</ref>
| align="center" style="background:#F5F5F5;" + |Physiologic
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + |[[Pregnancy]]
| align="center" style="background:#F5F5F5;" + |−
| align="left" style="background:#F5F5F5;" + |
* Normal
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |Nl
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |↑
| align="center" style="background:#F5F5F5;" + |↓
| align="center" style="background:#F5F5F5;" + |↑
| align="center" style="background:#F5F5F5;" + |NA
| align="center" style="background:#F5F5F5;" + |NA
| align="center" style="background:#F5F5F5;" + |Nl
| align="center" style="background:#F5F5F5;" + |Nl
| align="center" style="background:#F5F5F5;" + |Nl
| align="center" style="background:#F5F5F5;" + |Clinical manifestation
| align="center" style="background:#F5F5F5;" + |−
|-
! align="center" style="background:#DCDCDC;" |[[Platelet]] clumping<ref name="pmid25369589">{{cite journal |vauthors=Castrillo A, Álvarez I, Tolksdorf F |title=In vitro evaluation of platelet concentrates suspended in additive solution and treated for pathogen reduction: effects of clumping formation |journal=Blood Transfus |volume=13 |issue=2 |pages=281–6 |date=April 2015 |pmid=25369589 |pmc=4385077 |doi=10.2450/2014.0162-14 |url=}}</ref>
| align="center" style="background:#F5F5F5;" + |Spurious
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + |Any
| align="center" style="background:#F5F5F5;" + |−
| align="left" style="background:#F5F5F5;" + |
* Normal
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |Nl
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |↑
| align="center" style="background:#F5F5F5;" + |Nl
| align="center" style="background:#F5F5F5;" + |↑
| align="left" style="background:#F5F5F5;" + |
* [[Cytoplasm|Cytoplasmic]] fragments
| align="center" style="background:#F5F5F5;" + |Nl
| align="center" style="background:#F5F5F5;" + |Nl
| align="center" style="background:#F5F5F5;" + |Nl
| align="center" style="background:#F5F5F5;" + |Nl
| align="center" style="background:#F5F5F5;" + |Clinical manifestation
| align="center" style="background:#F5F5F5;" + |−
|-
! align="center" style="background:#DCDCDC;" |[[Cryoglobulinemia|Mixed cryoglobulinemia]]<ref name="pmid25837517">{{cite journal |vauthors=Cacoub P, Comarmond C, Domont F, Savey L, Saadoun D |title=Cryoglobulinemia Vasculitis |journal=Am. J. Med. |volume=128 |issue=9 |pages=950–5 |date=September 2015 |pmid=25837517 |doi=10.1016/j.amjmed.2015.02.017 |url=}}</ref>
| align="center" style="background:#F5F5F5;" + |Spurious
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + |Any
| align="left" style="background:#F5F5F5;" + |
* [[Cancer|Malignancy]]
* [[Autoimmune disease]]
* [[Infection]]
| align="left" style="background:#F5F5F5;" + |
* Atypical cutaneous [[Ulcer|ulcers]]
* Palpable [[purpura]]
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |Nl
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + | +
| align="left" style="background:#F5F5F5;" + |
* [[Headache]]
* [[Confusion]]
* Blurry or loss of [[Visual system|vision]]
* Generalized [[Muscle weakness|weakness]]
| align="center" style="background:#F5F5F5;" + |↑
| align="center" style="background:#F5F5F5;" + |Nl to ↓
| align="center" style="background:#F5F5F5;" + |↑
| align="left" style="background:#F5F5F5;" + |
* [[Cytoplasm|Cytoplasmic]] fragments
| align="center" style="background:#F5F5F5;" + |Nl
| align="center" style="background:#F5F5F5;" + |Nl
| align="center" style="background:#F5F5F5;" + |Nl
| align="center" style="background:#F5F5F5;" + |Nl
| align="center" style="background:#F5F5F5;" + |[[Skin biopsy]]
| align="left" style="background:#F5F5F5;" + |
* [[Vasculitis]]
* [[Neuropathy]]
* [[Raynaud's phenomenon|Raynaud phenomenon]]
|-
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Category
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Condition
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Etiology
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Physiologic
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Autonomous increased bone marrow production
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Reactive increased bone marrow production
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Demargination of peripheral blood neutrophils
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Congenital
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Acquried
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Demography
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |History
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Appearance
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Fever
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Abdominal pain
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |BP
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Asplenia
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Hepatosplenomegaly
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Lymphadenopathy
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Joint involvement
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Other signs
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |WBC
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |HB
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Plt
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |PBS
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Bone marrow exam
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |ESR/CRP
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |BUN/Cr
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |LFT
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Gold standard
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Associated findings
|}
|}



Revision as of 21:21, 5 November 2018

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Jogeet Singh Sekhon, M.D. [2]

Overview

Leukemoid reaction is a reversible increase in production of white blood cells in response to a stimulus, with white blood cell count of more than 25000-30000 per mm3 . Leukocytosis is increase in white blood cell count of more than 10,000 per mm3 and when the count exceeds 25000, with more than 2% immature white blood cells but absence of any blast cells, differentiating it from leukemias. Leukemoid reaction is classified according to the type of hematopoietic lineage of the bone marrow. Leukemoid reactions are mostly triggered by bacterial or viral infections. Leukemoid reaction is differentiated from leukemias by the absence of blast cells on peripheral blood film and high LAP score. Leukemoid reaction can lead to serious complications such as tumor lysis syndrome and DIC. The treatment includes treating the underlying cause and leukapheresis.

Historical Perspective

  • Leukemoid reaction was discovered in 1926 by Krumbharr.

Classification

Leukemoid reaction can be classified according to the type of hematopoietic lineage of the bone marrow[1].

Pathophysiology

Hematopoietic growth factors in leukocytosis, By Hematopoietic_growth_factors.svg: Rod Flower; Humphrey P. Rang; Maureen M. Dale; Ritter, James M. (2007) Rang & Dale's pharmacology, Churchill Livingstone ISBN: 0-443-06911-5.User:Mikael Häggström and A. Radderivative work: Furfur - This file was derived from: Hematopoietic growth factors.svg:, CC BY-SA 3.0, https://commons.wikimedia.org/w/index.php?curid=31083166


Causes

Differentiating Leukemoid reaction from Other Diseases

Leukemoid reaction is differentiated from leukemia by following ways[11][12]:

Differential diagnosis of leukemia vs leukemoid reaction
Differentiating features Leukemia Leukemoid reaction
Causes Carcinogens Infectious agents, biologically active substances and

products of tissue destruction

Pathogenesis The transformation of normal haematopoietic

cells to a tumor

Activation of normal hematopoiesis and exit of immature leukocytes

into the bloodstream.

Duration Chronic Temporary and reversible
Genetic level Defect No defect
Splenomegaly Present Not present
Peripheral blood Immature cells, pancytopenia Mature and immature granulocytes with left shift
Bone marrow Increase in blasts and immature cells Myeloid hyperplasia and normal morphology
LAP score Low High
Toxic granules (suggestive of infection) Absent Present
Dohle inclusion bodies Absent Present


Leukemoid reaction should be differentiated from other causes of leucocytosis. The below table discusses different causes of leucocytosis:

Category Condition Etiology Mechanism Congenital Acquried Clinical manifestations Para−clinical findings Gold standard Associated findings
Demography History Symptoms Signs
Lab Findings
Physiologic Increased bone marrow production Demargination of peripheral blood neutrophils Appearance Fever Abdominal pain BP Asplenia Hepatosplenomegaly Lymphadenopathy Joint involvement Other CBC PBS Bone marrow exam ESR/CRP BUN/Cr LFT
Autonomous Reactive WBC HB Plt
Hematologic Hereditary neutrophilia[13] + + Rare autosomal dominant genetic disorder
  • Positive family history
Normal Nl + Nl Nl Nl Nl Nl Nl Molecular testing
Myeloproliferative neoplasms[14] + + + Elderly Exposure to ± + Nl + ↑/↓ ↑/↓ Nl Nl Bone marrow examination + clinical manifestation
Polycythemia vera[15] + + Mean age >60 years old + + Nl to ↑
  • Elevated normochromic, normocytic RBCs
  • Thrombocytosis
  • ≥ 10% immature myeloid precursors
  • Leukoerythroblastic picture
Nl Nl Nl Bone marrow examination + clinical manifestation
Microangiopathic hemolytic anemia (MAHA)[16] + + + Any + + + NA Bone marrow examination + clinical manifestation
Leukoerythroblastosis[17] + + Any + Nl + Nl Bone marrow biopsy
Immunology/

Rheumatology

Condition Etiology Physiologic Autonomous increased bone marrow production Reactive increased bone marrow production Demargination of peripheral blood neutrophils Congenital Acquried Demography History Appearance Fever Abdominal pain BP Asplenia Hepatosplenomegaly Lymphadenopathy Joint involvement Other signs WBC HB Plt PBS Bone marrow exam ESR/CRP BUN/Cr LFT Gold standard Associated findings
Leukocyte adhesion deficiency[18] + + Rare autosomal recessive, LAD II more in Middle East and Brazil
  • Positive family history
+ Nl ↓/↑
  • Leukocytosis
  • Leukocytosis
Nl Nl Nl Flow cytometry
Cryopyrin-associated periodic syndromes[19] + + Autosomal dominant autoinflammatory syndrome
  • Positive family history
+ Nl + ↓/↑
  • Leukocytosis
  • Leukocytosis
Nl Genetic tests
Rheumatoid arthritis[20][21] + + Any, more in young women, between 30-60 years old + Nl +
  • Leukocytosis
NA Nl Nl Clinical manifestation + positive anti-CCP antibodies
Juvenile onset rheumatoid arthritis[22] + + Children under the age of 16
  • Positive family history
  • Blotchy rash on a child's arms and legs
+ Nl + +
  • Leukocytosis
NA Nl Nl Clinical manifestation + laboratory findings
Adult Still's disease[23] + + Rare autoimmune disease NA + Nl + +
  • Leukocytosis
NA Nl Nl Diagnosis of exclusion
Kawasaki disease[24] + + Autoimmune disease, more in Asian ethnicity boys NA + + Nl + +
  • Leukocytosis
NA Nl Nl Diagnostic criteria
IBD[25] + + Autoimmune disease, more in young
  • Stress
  • Positive family history
+ + Nl + + +
  • Leukocytosis
NA Nl Nl Colonoscopy and biopsy
Sarcoidosis[26] + + Autoimmune disease, more in young African American women
  • Positive family history
+ + Nl + +

Bilateral hilar adenopathy

+
  • Leukocytosis
NA Nl Nl Diagnosis of exclusion
Chronic hepatitis[27] + + Elderly + + + + +
  • Leukocytosis
NA Liver biopsy
Sweet syndrome[28] + + Rare + + Nl + +
  • Leukocytosis
Nl Nl Diagnostic criteria
Acute gout[29] + + Older males + +
  • Leukocytosis
NA Nl Clinical manifestation
Medication Condition Etiology Physiologic Autonomous increased bone marrow production Reactive increased bone marrow production Demargination of peripheral blood neutrophils Congenital Acquried Demography History Appearance Fever Abdominal pain BP Asplenia Hepatosplenomegaly Lymphadenopathy Joint involvement Other signs WBC HB Plt PBS Bone marrow exam ESR/CRP BUN/Cr LFT Gold standard Associated findings
Steroid[30] + + + Any + Nl to ↓ Nl to ↓ Nl Clinical manifestation + history of drug consumption
Filgrastim (Myeloid growth factor)[31] + + + Any + Nl to ↓ + Nl to ↓ NA NA Nl Nl Clinical manifestation + history of drug consumption
Lithium[32]
  • Unknown
+ + + Any Nl Nl to ↓ NA NA Nl Nl Clinical manifestation + history of drug consumption
Catecholamines

(epinephrine)[33]

  • Stimulation of bone marrow myelopoiesis
  • Egress into the circulation
+ + + Any Nl to ↓ Nl Nl Clinical manifestation + history of drug consumption
ATRA[34] + + + Any Nl Nl Nl NA NA Nl Clinical manifestation + history of drug consumption
Other Condition Etiology Physiologic Autonomous increased bone marrow production Reactive increased bone marrow production Demargination of peripheral blood neutrophils Congenital Acquried Demography History Appearance Fever Abdominal pain BP Asplenia Hepatosplenomegaly Lymphadenopathy Joint involvement Other signs WBC HB Plt PBS Bone marrow exam ESR/CRP BUN/Cr LFT Gold standard Associated findings
Infections[35] + + + + Any
  • Acutely ill
+ + Nl to ↓ ± ± ± Nl Nl Clinical manifestation+ culture
  • Depends on etiology
Allergy[36]
  • Unknown
  • Activation of chloride transport
+ + + + Any Nl to ↓ Nl Nl Clinical manifestation
Post splenectomy[37]
  • Unknown
+ + + Any
  • Normal
± Nl + Nl Nl Clinical manifestation
Cigarette smoking[38] + + + Any Nl NA NA Nl Nl Nl Clinical manifestation
Stress/exercise[39]
  • Reduced plasma volume
+ + + Athlete
  • Normal
Nl Nl Nl Clinical manifestation
Infancy[40] Physiologic + + Infancy
  • Normal
Nl NA NA Nl Nl Nl Clinical manifestation
Pregnancy[41] Physiologic + + Pregnancy
  • Normal
Nl NA NA Nl Nl Nl Clinical manifestation
Platelet clumping[42] Spurious + Any
  • Normal
Nl Nl Nl Nl Nl Nl Clinical manifestation
Mixed cryoglobulinemia[43] Spurious + Any Nl + Nl to ↓ Nl Nl Nl Nl Skin biopsy
Category Condition Etiology Physiologic Autonomous increased bone marrow production Reactive increased bone marrow production Demargination of peripheral blood neutrophils Congenital Acquried Demography History Appearance Fever Abdominal pain BP Asplenia Hepatosplenomegaly Lymphadenopathy Joint involvement Other signs WBC HB Plt PBS Bone marrow exam ESR/CRP BUN/Cr LFT Gold standard Associated findings

Epidemiology and Demographics

Age

  • Patients of all age groups may develop leukemoid reaction[1][44].
  • Normal white blood cell count changes with age.
  • Leukemoid reaction in neonates is more common, compared to children and adults.

Gender

  • Leukemoid reaction affects men and women equally.

Race

  • There is no racial predilection for the development of leukemoid reaction.

Risk Factors

Screening

No screening is done for leukemoid reaction.

Natural History, Complications, and Prognosis

History

The majority of patients with leukemoid reaction have the following complaints[45][46]

Complications

Prognosis

  • Prognosis generally depends on the underlying etiologies.
  • If the white blood cell count reaches more than 50,000 per mm3, life threatening complications can occur.

Diagnosis

Symptoms

  • Obtain history of the following:

Laboratory findings

Electrocardiogram

No specific ECG changes in leukemoid reaction.

X-Ray

No specific x ray changes in leukemoid reaction.

Echocardiography and Ultrasound

No echocardiography and ultrasound findings.

CT

No CT scan findings in leukemoid reaction.

MRI

No specific MRI findings in leukemoid reaction.

Treatment

Medical Therapy

Surgery

The treatment depends on the underlying cause.

Primary prevention

Prevention and treatment of infections.

Secondary prevention

Treatment of underlying cause and reduction of white blood cell count.

See also

References

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