Leukemoid Reaction: Difference between revisions
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==Background== | ==Background== | ||
* Markedly elevated leukocyte (particularly neutrophil) count without hematologic malignancy | * Markedly [[leukocytosis|elevated leukocyte]] (particularly neutrophil) count without hematologic malignancy | ||
* Cutoff is variable, 25-50k<ref>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.</ref> | * Cutoff is variable, 25-50k<ref>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.</ref> | ||
==Literature Review== | ===Literature Review=== | ||
=== Retrospective review of 135 patients with WBC >25k <ref>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.</ref> === | ==== Retrospective review of 135 patients with WBC >25k <ref>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.</ref> ==== | ||
* 48% infection | * 48% infection | ||
* 15% malignancy | * 15% malignancy | ||
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* 12% glucocorticoid or granulocyte colony stimulating therapy | * 12% glucocorticoid or granulocyte colony stimulating therapy | ||
=== Retrospective review of 173 patients with WBC >30k <ref>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.</ref> === | ==== Retrospective review of 173 patients with WBC >30k <ref>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.</ref> ==== | ||
* 48% infection (7% C. difficile) | * 48% infection (7% C. difficile) | ||
* 28% tissue ischemia | * 28% tissue ischemia | ||
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* 5% malignancy | * 5% malignancy | ||
=== Observational study of 54 patients with WBC >25k <ref>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.</ref> === | ==== Observational study of 54 patients with WBC >25k <ref>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.</ref> ==== | ||
* Consecutive patients presenting to the emergency department | * Consecutive patients presenting to the emergency department | ||
* Compared to age-matched controls with moderate leukocytosis (12-24k) | * 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. | * 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== | ==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== | |||
*Treat underlying condition | |||
==Disposition== | |||
==External Links== | ==External Links== | ||
* [https://ddxof.com/leukemoid-reaction/ Leukemoid Reaction on ddxof] | *[https://ddxof.com/leukemoid-reaction/ Leukemoid Reaction on ddxof] | ||
==References== | ==References== | ||
<references/> | <references/> | ||
[[Category:Heme/Onc]] | |||
Latest revision as of 21:47, 11 January 2023
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.