What Can Cause A High White Blood Cell Count – Per L) in non-pregnant adults, is a relatively common finding with a wide differential. It is important for clinicians to distinguish malignant etiology from nonmalignant etiology, and to differentiate between the most common causes of nonmalignant leukocytosis.

Per L) is sometimes referred to as a leukemoid reaction. This level of elevation can occur in some severe infections, such as Clostridium difficile infection, sepsis, organ rejection, or in patients with solid tumors.

What Can Cause A High White Blood Cell Count

Per L) at 12 hours of life (95% confidence interval). At two weeks of age, this drops to about 5,000 to 20,000 per mm.

Rbc Blood Test: Normal Ranges And Diagnostic Uses

There is also a shift from relative lymphocyte to neutrophil predominance from early childhood to the teenage years and adulthood.

During pregnancy, there is a gradual increase in the normal WBC count (third trimester 95% upper limit = 13,200 per mm).

Per L) after cesarean delivery. Of note, positive bacterial cultures were not associated with leukocytosis or neutrophilia, making leukocytosis an unreliable discriminator for determining postpartum patients requiring antibiotic therapy.

The life cycle of leukocytes includes development and differentiation, storage in the bone marrow, margination in the vascular space, and migration into tissues. Stem cells in the bone marrow give rise to the erythroblast cell line, which becomes red blood cells; megakaryoblasts, which become platelets; lymphoblasts; and myeloblasts. Lymphoblasts develop into various types of T and B cell lymphocytes. Myeloblasts further differentiate into monocytes and granulocytes, a term that includes neutrophils, basophils, and eosinophils (Figure 1). After WBCs have matured in the bone marrow, 80% to 90% remain stored in the bone marrow. This large reserve allows for a rapid increase in the number of circulating WBCs within hours. A relatively small pool (2% to 3%) of leukocytes circulates freely in the peripheral blood.

Leukocytes In Urine: A Sign Of Urinary Tract Infection?

; the rest remains stored on the edge of the blood vessel wall or in the spleen. Leukocytes spend most of their life in storage. Once leukocytes are released into the circulation and peripheral tissues, their lifespan ranges from two to 16 days, depending on the type of cell.

Although the differential of the main type of WBC is important to evaluate the cause of leukocytosis, it is sometimes helpful to think of leukopenia and leukocytosis in absolute, rather than relative, terms. To calculate the absolute cell count, the total leukocyte count is multiplied by the differential percentage. For example, with a normal WBC count of 10,000 per mm

Per L) and the percentage of monocytes is up 12, the absolute number of monocytes is 12% or 0.12 times the number of WBC 10,000 per mm.

The most common type of leukocytosis is neutrophilia (an increase in the absolute number of mature neutrophils to more than 7,000 per mm).

Foods To Increase White Blood Cells And Boost Immunity

Per L]), which can occur from infection, stressful conditions, chronic inflammation, drug use, and other causes (Table 3).

Lymphocytosis (when lymphocytes make up more than 40% of the WBC count or an absolute count of more than 4,500 per mm).

Per L]) can occur in patients with pertussis, syphilis, viral infections, hypersensitivity reactions, and certain subtypes of leukemia or lymphoma. Lymphocytosis is more likely to be mild in children than in adults.

Epstein-Barr virus infection, tuberculosis or fungal disease, autoimmune disease, splenectomy, protozoan or rickettsial infection, and malignancy can cause monocytosis (monocytes make up more than 8% of the WBC count or an absolute count of more than 880 per mm).

Foods To Boost White Blood Cells (immunity)

Per L]), although uncommon, may indicate allergic conditions such as asthma, urticaria, atopic dermatitis or eosinophilic esophagitis, drug reactions, dermatological conditions, malignancies, connective tissue diseases, idiopathic hypereosinophilic syndrome, or parasitic infections, including helminths (tissue parasites more). intestinal-lumen parasites).

Per L]) is rare and cannot cause leukocytosis separately, but can occur with allergic or inflammatory conditions and chronic myelogenous leukemia.

Per L), can arise from various etiologies. Any source of stress can cause catecholamine-induced demarcation of WBCs, as well as increased release from the bone marrow storage pool. Examples include surgery, exercise, trauma, burns, and emotional stress.

Medications known to increase WBC counts include corticosteroids, lithium, colony-stimulating factor, beta agonists, and epinephrine. During the recovery phase after bleeding or hemolysis, rebound leukocytosis may occur.

Eosinophils: What Are They, What Do They Do, And More

Leukocytosis is one of the hallmarks of infection. In the acute stage of many bacterial infections, especially mature and immature neutrophils (Figure 2); sometimes, as the infection progresses, there is a shift to the predominance of lymphocytes. The release of less mature bands and metamyelocytes into the peripheral circulation causes a “left shift” in the WBC differential. Of note, some bacterial infections paradoxically cause neutropenia, such as typhoid fever, rickettsial infections, brucellosis, and dengue.

Viral infections may cause leukocytosis initially, but persistent leukocytosis is not typical, except for lymphocytosis in some viral infections in young children.

A higher WBC count is indicative, but not definitive, of a significant infection. For example, the sensitivity and specificity of a high WBC count for the diagnosis of acute appendicitis are 62% and 75%, respectively.

To diagnose a serious bacterial infection without a source in a febrile child, the discriminatory value of leukocytosis is less than other biomarkers, such as C-reactive protein or procalcitonin.

High White Blood Cell Count? What You Should Know

Per L) is one of the criteria for systemic inflammatory response syndrome (or sepsis when there is a known infection), leukocytosis is only a poor predictor of bacteremia and is not an indication to take a blood culture.

Other causes of leukocytosis include functional asplenia (mainly lymphocytosis), smoking, and obesity. Patients with chronic inflammatory conditions, such as rheumatoid arthritis, inflammatory bowel disease, or granulomatous disease, may exhibit leukocytosis. Genetic causes include hereditary or chronic idiopathic neutrophilia and Down syndrome.

Leukocytosis can cause malignant disorders, such as acute or chronic leukemia (Figure 3), or myeloproliferative disorders, such as polycythemia vera, myelofibrosis, or essential thrombocytosis. A previous article on leukemia in American Family Physician reviewed the features and differentiation of malignant hematopoietic disorders.

Many solid tumors can cause leukocytosis in the leukemoid range, through bone marrow involvement or production of granulocyte colony-stimulating factor or granulocyte-macrophage colony-stimulating factor.

What Do High Immature Granulocyte Levels Mean?

(Figure 4). Chronic leukemia is most commonly diagnosed after an incidental finding of leukocytosis in a complete blood count in an asymptomatic patient. Patients with features suggestive of hematologic malignancy require prompt referral to a hematologist/oncologist (Table 5).

A systematic approach to patients with leukocytosis includes identifying historical clues that suggest potential causes (Figure 5). Fever and pain may be accompanied by infection or malignancy; Other constitutional symptoms, such as fatigue, night sweats, weight loss, easy bruising, or bleeding, may indicate malignancy.

Previous diagnoses or comorbid conditions causing chronic inflammation should be noted, as well as recent stressful events, medication use, smoking status, and history of splenectomy or sickle cell anemia. A history of a high WBC count is important, as its duration will help determine its cause. Leukocytosis that persists for several days has a different differential diagnosis (eg, infection, acute leukemia, stress reaction) than cases that persist for weeks to months (eg, chronic inflammation, some malignancies).

Physical examination should note erythema, swelling, or pulmonary findings suggestive of infection; murmurs suggestive of infective endocarditis; lymphadenopathy suggestive of a lymphoproliferative disorder; or splenomegaly indicative of chronic myelogenous leukemia or a myeloproliferative disorder; petechiae or ecchymoses; or painful, inflamed joints suggest a connective tissue disease or infection.

Types Of White Blood Cells: What The Numbers May Mean

Initial laboratory evaluation should include a complete blood count to confirm an elevated WBC level, with a differential cell count and review of a peripheral blood smear. Peripheral smears should be examined for toxic granulations (inflammation), platelet clumps (which may be mistaken for WBCs), the presence of immature cells, and uniformity of WBCs. In the evaluation of leukocytosis with a predominance of lymphocytes, a monomorphic population refers to chronic lymphocytic leukemia, while pleomorphic lymphocytosis (of different sizes and shapes) indicates a reactive process.

With all forms of leukocytosis, concomitant abnormalities in other cell counts (erythrocytes or platelets) suggest a primary bone marrow process and warrant a hematology/oncology evaluation.

As indicated by the history and examination findings, the physician should consider performing blood cultures, urine, and aspiration of joint or body fluids; study rheumatology; heterophile antibody test (mononucleosis spot test); and serological titers. Radiological studies may include chest x-rays (to identify infections, some malignancies, and some granulomatous diseases) and, as indicated by the history, computed tomography or bone scans. If a hematologic malignancy is suspected, additional confirmatory testing may include flow cytometry, cytogenetic testing, or molecular testing of bone marrow or peripheral blood.

Data Sources: The primary literature search was completed using Essential Evidence Plus and included a search of the Cochrane, POEM, and NICE guideline databases using the search term leukocytosis. Additionally, a PubMed search was conducted using the terms leukocytosis and white blood cells. Search dates: October 31 and December 17, 2014, and September 2015.

Basophilia: Meaning, Symptoms, And Causes

The authors thank Melissa King, MD, Department of Hematology/Oncology, Eglin Air Force Base Hospital, for reviewing the manuscript, and Niquanna Perez, Eglin Air Force Base laboratory service, for taking peripheral smear images.

The views expressed in this article are those of the author and do not necessarily reflect the official policy or position of the US government, the Department of Defense, or the US Air Force.

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