Leukemoid Reaction: Difference between revisions
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==Clinical Features== | ==Clinical Features== | ||
*Signs/symptoms of underlying pathology or asymptomatic | |||
==Differential Diagnosis== | ==Differential Diagnosis== | ||
*Infection | |||
**Any severe infection | |||
**Particularly [[c. diff]], [[TB]], [[shigella]] | |||
*Drugs/tox | |||
**[[Corticosteroids]] | |||
**G-CSF | |||
**[[Ethylene glycol]] | |||
*Tissue ischemia | |||
**[[Myocardial infarction]] | |||
**[[Mesenteric ischemia]] | |||
**[[Gangrene]] | |||
*Malignancy, [[paraneoplastic]] | |||
[[File:Leukemoid Reaction.png|Differential Diagnosis of Leukemoid Reaction]] | [[File:Leukemoid Reaction.png|Differential Diagnosis of Leukemoid Reaction]] | ||
==Management== | ==Management== | ||
*Treat underlying condition | |||
==Disposition== | ==Disposition== | ||
Revision as of 18:26, 15 August 2019
Background
- Markedly elevated leukocyte (particularly neutrophil) count without hematologic malignancy
- Cutoff is variable, 25-50k[1]
Literature Review
Retrospective review of 135 patients with WBC >25k [2]
- 48% infection
- 15% malignancy
- 9% hemorrhage
- 12% glucocorticoid or granulocyte colony stimulating therapy
Retrospective review of 173 patients with WBC >30k [3]
- 48% infection (7% C. difficile)
- 28% tissue ischemia
- 7% obstetric process (vaginal or cesarean delivery)
- 5% malignancy
Observational study of 54 patients with WBC >25k [4]
- Consecutive patients presenting to the emergency department
- Compared to age-matched controls with moderate leukocytosis (12-24k)
- Patients with leukemoid reaction were more likely to have an infection, be hospitalized and die.
Clinical Features
- Signs/symptoms of underlying pathology or asymptomatic
Differential Diagnosis
- Infection
- Drugs/tox
- Tissue ischemia
- Malignancy, paraneoplastic
Management
- Treat underlying condition
Disposition
External Links
References
- ↑ Sakka V, Tsiodras S, Giamarellos-Bourboulis EJ, Giamarellou H. An update on the etiology and diagnostic evaluation of a leukemoid reaction. Eur J Intern Med. 2006;17(6):394-398. doi:10.1016/j.ejim.2006.04.004.
- ↑ Reding MT, Hibbs JR, Morrison VA, Swaim WR, Filice GA. Diagnosis and outcome of 100 consecutive patients with extreme granulocytic leukocytosis. Am J Med. 1998;104(1):12-16.
- ↑ Potasman I, Grupper M. Leukemoid reaction: spectrum and prognosis of 173 adult patients. Clin Infect Dis. 2013;57(11):e177-e181. doi:10.1093/cid/cit562.
- ↑ Lawrence YR, Raveh D, Rudensky B, Munter G. Extreme leukocytosis in the emergency department. QJM. 2007;100(4):217-223. doi:10.1093/qjmed/hcm006.