Reactive leukocytosis

Reactive leukocytosis
Updated: 09/26/2020
© Jun Wang, MD, PhD

General features
  • Usually a reaction to physiological (stress, exercise) or pathological (inflammation, underlying neoplasm, allergic reactions, hereditary) processes
  • Results of elevated levels of growth factor, cytokines, etc
Specific terms
  • Left shift: Increased circulating immature leukocytes, usually neutrophils, caused by releasing of stored leukocytes, associated with bacterial infection
  • Leukemoid reaction: Neutrophils above 50 x 103/mm3, more immature cells, particularly myelocytes, associated with severe infection, intoxications, severe hemorrhage, acute hemolysis, etc
  • Leukoerythroblastic reaction: Nucleated red blood cells and immature myelocytes in circulation, associated with severe marrow function disruption, may be seen in myelofibrosis, may mimic myeloid neoplasms.
Neutrophilia
  • Usually associated with acute infection, steroid usage, inflammations, metabolic disorders such as ketoacidosis and Cushing disease, drugs such as cortical steroid, poisoning, etc
  • May be hereditary, or physiological
  • Infections not associated with neutrophilia: Typhoid fever, paratyphoid fever, mumps, measles, tuberculosis, etc
  • Shift neutrophilia: Shift of marginal to circulating, usually transient, associated with vigorous exercise, seizure, paroxysmal tachycardia or epinephrine injection, NO left shift
  • True neutrophilia: Most common type in association with infection, left shift may present
Eosinophila
  • Peripheral blood eosinophils > 600/mm3
  • Usually associated with parasite infections, allergic reactions, neoplasms, connective tissue disorders, endocrine disorders and certain medications through hypersensitivity reaction
  • Drugs with known association with eosinophilia: NSAID, ACE inhibitor, nitrofurantoid, tetracyclines, etc
Basophilia
  • Basophils > 0.2 x 103/mm3
  • Reactive basophilia: Occasionally seen in allergic reaction, inflammation, chronic renal diseases, certain infections such as influenza, chicken box and smallpox
  • Neoplasia most commonly associated with benign basophilia: Chronic myelogenous leukemia
Monocytosis
  • Monocytes > 1.0 x 103/mm3
  • Recovery phase of infection
  • May be associated with myeloproliferative neoplasm, chronic neutropenia, drug reactions, post splenectomy state, inflammatory disorders, infection, alcoholic liver disease, etc
Reactive lymphocytosis
  • Absolute lymphocytes count (ALC) > 10 x 103/mm3
  • Polyclonal, infectious (viral, bacteria, etc) or noninfectious (drug, stress, etc), ALC 20 – 30 x 103/mm3
  • Flow cytometry to rule out monoclonal (neoplastic) lymphocytosis


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