Leukocytosis

Leukocytosis: Excerpt from In A Page: Pediatric Signs and Symptoms

Normal white blood cell (WBC) counts fluctuate with age, so determination of leukocytosis should be based on the absolute number of cells per microliter of blood (not on the percentage of cells in the differential count) and compared with normal values for age. Often the specific diagnosis can readily be determined by knowing the specific class of white cell that is elevated and the duration of the elevation.

Differential Diagnosis

• Neutrophilia
  –Increased production: Chronic infection or inflammation, tumor, drug-related, myeloproliferative disorders, chronic idiopathic neutrophilia, leukemoid reaction (Down syndrome, sepsis), chronic blood loss
  –Increased release from marrow/ demargination: Corticosteroids, stress, exercise, hypoxia, endotoxin, acute infection
  –Decreased removal from circulation due to splenectomy/asplenia, corticosteroids, leukocyte adhesion deficiency
  –Others: Hemolysis, infarction, diabetic ketoacidosis, renal failure, hepatic failure, thyrotoxicosis

• Lymphocytosis
  –Infection: EBV, CMV
  –Heme/onc: Leukemia, neutropenia
  –Endocrine: Thyrotoxicosis, Addison

• Basophilia
  –Infection: Sinusitis, Varicella, smallpox
  –Endocrine: Hypothyroidism, ovulation, pregnancy, stress
  –Drugs
  –Heme/onc: Hemolytic anemia, Hodgkin disease, CML, polycythemia vera
  –Inflammatory/collagen vascular disease

• Monocytosis
  –Infection: Syphilis, tuberculosis, subacute bacterial endocarditis, malaria, typhoid fever, Rocky Mountain spotted fever
  –Heme/onc: Recovering marrow, hemolysis/hemolytic anemia, leukemias, Hodgkin disease, non-Hodgkin lymphoma, postsplenectomy, myeloproliferative disorders, congenital and acquired neutropenia, metastatic solid tumors
  –Chronic inflammatory, collagen vascular

• Eosinophilia: Can be inherited
  –Allergy/asthma; parasitic infection
  –Heme/onc: Hodgkin disease, leukemias, immunodeficiency, postsplenectomy, solid tumors, pernicious anemia
  –Chronic inflammatory/collagen vascular/
• Other: Rheumatoid arthritis, periarteritis nodosa, cirrhosis, Loeffler syndrome, sarcoid, dialysis

Workup and Diagnosis

• History: Duration of leukocytosis; fever, frequent infections, cough, acute illness; symptoms associated with malignancy (malaise, lethargy, night sweats, bruising, weight loss, bone pain, epistaxis, bleeding gums, hematochezia, petechiae); known allergies/sensitivities; joint symptoms; bowel habits (diarrhea with parasites), travel; steroid use; radiation therapy; failure to thrive, delayed puberty
• Family history: Myeloproliferative disease, hematologic malignancies, sarcoid, hepatosplenomegaly, early infant death
• Physical exam: General appearance, growth parameters; iritis, uveitis, mucositis, allergic shiners, pharyngeal cobblestoning; rash, purpura, petechiae, ecchymoses, striae; lymph nodes; hepatomegaly, splenomegaly; thryoid exam; joint swelling, decreased range of motion
• Labs
  –CBC with differential and peripheral smear, ESR
  –Leukocyte alkaline phosphatase
  –Liver and renal function
  –Stool hemoccult
  –Specific infectious titers
  –Specific autoimmune or rheumatologic tests
• Studies (as indicated by history and physical exam)
  –CXR
  –Bone marrow exam

Treatment

• Dependent upon diagnosis
• If malignancy is suspected, prompt multimodal treatment, based upon specific diagnosis, should be obtained at a tertiary pediatric oncology center
• If likely cause is evident (trauma/stress, acute infection, drugs) removal of the offending agent and watchful waiting is often sufficient
• Leukopheresis is prudent for extremely elevated WBCs to prevent pulmonary and cerebrovascular congestion/infarction

Book Source Details

• Book Title: In A Page: Pediatric Signs and Symptoms
• Author(s): Jonathan E. Teitelbaum, Kathleen O. Deantonis, Scott Kahan
• Year of Publication: 2007
• Copyright Details: In A Page: Pediatric Signs and Symptoms, Copyright © 2007 Lippincott Williams & Wilkins.

More About Leukocyte Adhesion Defect

• Back to disease: Leukocyte Adhesion Defect: Introduction
• Next Book Extract About Leukocyte Adhesion Defect: LEUKOCYTOSIS (Differential Diagnosis in Primary Care)
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Copyright notice for book excerpts: Copyright © 2008 Lippincott Williams & Wilkins. All rights reserved.

More About This Book: Title: In A Page: Pediatric Signs and Symptoms Authors: Jonathan E. Teitelbaum, Kathleen O. Deantonis, Scott Kahan Publisher: Lippincott Williams & Wilkins Copyright: 2007 ISBN: 1-4051-0427-9

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