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Revision as of 17:19, 24 April 2012

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-In-Chief: Lakshmi Gopalakrishnan, M.B.B.S. [2]

Synonyms and keywords: Granulocytosis, neutrophilia

Overview

Leukocytosis is an elevation of the white blood cell count (the leukocyte count) above the normal range. The normal adult human leukocyte count in peripheral blood is 4.4-10.8 x 109/L. A white blood count of 11.0 x 109/L or more suggests leukocytosis. Often, the word refers to an increased neutrophil granulocyte count, as neutrophils are the main granulocytes. An increase in eosinophil granulocyte is known as eosinophilia. Granulocytosis can be a feature of a number of disease processes including infection, especially bacteria; malignancy, most notably leukemia (it is the main feature of chronic myelogenous leukemia, CML) and autoimmune disease. Although it may be a sign of illness, leukocytosis in-and-of itself is not a disorder, nor is it a disease. It is simply a laboratory finding.

Epidemiology and Demographics

Leukocytosis is very common in acutely ill patients. It occurs in response to a wide variety of conditions, including viral, bacterial, fungal, or parasitic infection, cancer, hemorrhage, and exposure to certain medications or chemicals including steroids. Leukocytosis can also be the first indication of neoplastic growth of leukocytes.

Pathophysiology

The mechanism that causes leukocytosis can be of several forms: an increased release of leukocytes from bone marrow storage pools, decreased margination of leukocytes onto vessel walls, decreased extravasation of leukocytes from the vessels into tissues, or an increase in number of precursor cells in the marrow.

Classification Scheme

Leukocytosis can be subcategorized by the type of white blood cell that is increased in number.

A leukocyte count above 25 to 30 x 109/L is termed a leukemoid reaction, which is the reaction of a healthy bone marrow to extreme stress, trauma, or infection. (It is different from leukemia and from leukoerythroblastosis, in which immature blood cells are present in peripheral blood.)

Differential Diagnosis of Causes of Leukocytosis

By Organ System

Cardiovascular Endomyocardial fibrosis
Chemical / poisoning No underlying causes
Dermatologic Atopic dermatitis, Dermatitis herpetiformis, Erythema multiforme, Lepromatous leprosy, Pemphigus vulgaris, Psoriasis, Visceral larva migrans
Drug Side Effect Allopurinol, Aminophylline, Amitriptyline, Capreomycin, Caspofungin, Chlorpropamide, Clomipramine, Daptomycin, Desipramine, Dinoprostone, Dothiepin, Doxycycline, Enfuvirtide, Ethotoin, Etravirine, Filgrastim, Gold salts, Hydralazine, Imipramine, Lithium, Micafungin, Minocycline, Nalidixic acid, Nitrofurantoin, Nortriptyline, Olanzapine, Oxytetracycline, Pentostatin, Phenytoin, Plerixafor, Procarbazine, Radiotherapy, Sulphonamides, Sulprostone, Tryptophan, Vancomycin
Ear Nose Throat No underlying causes
Endocrine Adrenal cortex insufficiency, Hypothyroidism
Environmental Tobacco smoking
Gastroenterologic Colonic diverticulitis, Fasciola hepatica, Gallbladder empyema, Hepatitis A, Hepatitis B, Hepatosplenic T-cell lymphoma, Splenectomy, Ulcerative colitis,
Genetic Omenn syndrome
Hematologic Acute intermittent porphyria, Autoimmune lymphoproliferative syndrome type 1, Autoimmune lymphoproliferative syndrome type 2, Acute lymphoblastic leukemia, Acute myeloid leukemia, Acute promyelocytic leukemia, Burkitt lymphoma, Chronic lymphocytic leukaemia, Chronic myeloid leukaemia, Granulocyte colony stimulating factor, Granulocyte-macrophage colony stimulating factor, Hairy cell leukaemia, Hereditary neutrophilia, Hodgkin lymphoma, Hyperimmunoglobulinemia D and periodic fever syndrome, Leukocyte adhesion deficiency type 1, Leukocyte adhesion deficiency type 2, Leukocyte adhesion deficiency type 3, Leukemoid reaction, Lymphangitis, Mast cell leukemia, Myelofibrosis, Myeloma, Non-Hodgkin lymphoma, Acute pancreatitis, Polycythaemia rubra vera, Recurrent hereditary polyserositis, Waldenström's macroglobulinemia, Wiskott-Aldrich syndrome, X-linked lymphoproliferative disease
Iatrogenic No underlying causes
Infectious Disease Acanthocheilonemiasis, Allergic bronchopulmonary aspergillosis, Alveolar hydatid disease, Ancylostoma caninum, Ancylostoma duodenale, Angiostrongyliasis, Anisakiasis, Ascariasis, Brucellosis, Chickenpox, Clonorchiasis, Coccidioidomycosis, Congenital syphilis, Cytomegalovirus, Dicrocoelium dendriticum fluke, Dracunculiasis, Echinococcus granulosus, Epstein-Barr virus, Gnathostomiasis, Hantavirus, Hepatitis A, Hepatitis B, Heterophyiasis, Infectious mononucleosis, Lepromatous leprosy, Loa loa filariasis, Lymphangitis, Lymphatic filariasis, Mansonelliasis, Metagonimiasis, Mycobacterium tuberculosis, Neuroleptic malignant syndrome, Onchocerciasis, Opisthorchiasis, Paragonimiasis, Rubella, Sarcoptes scabiei, Schistosoma haematobium, Schistosoma mansoni, Strongyloidiasis, Toxocariasis, Toxoplasma, Trichinella spiralis, Visceral larva migrans, Whooping cough
Musculoskeletal / Ortho No underlying causes
Neurologic Neuroleptic malignant syndrome
Nutritional / Metabolic No underlying causes
Obstetric/Gynecologic No underlying causes
Oncologic Acute lymphoblastic leukemia, Acute myeloid leukemia, Acute promyelocytic leukemia, Burkitt lymphoma, Chronic lymphocytic leukaemia, Chronic myeloid leukaemia, Hairy cell leukaemia, Hodgkin lymphoma, Mast cell leukemia, Non-Hodgkin lymphoma, Paraneoplastic syndrome
Opthalmologic No underlying causes
Overdose / Toxicity No underlying causes
Psychiatric No underlying causes
Pulmonary Allergic bronchopulmonary aspergillosis, Alveolar hydatid disease, Bronchial asthma, Bronchiolitis obliterans organizing pneumonia, Churg-Strauss syndrome, Extrinsic allergic alveolitis, Severe acute respiratory syndrome, Simple pulmonary eosinophilia, Tobacco smoking, Tropical pulmonary eosinophilia, Visceral larva migrans, Wegener granulomatosis, Whooping cough
Renal / Electrolyte Interstitial nephritis, Wegener granulomatosis
Rheum / Immune / Allergy Allergic bronchopulmonary aspergillosis, Bronchial asthma, Churg-Strauss syndrome, Eosinophilia-myalgia syndrome, Eosinophilic cellulitis, Eosinophilic fasciitis, Eosinophilic pustular folliculitis, Extrinsic allergic alveolitis, Familial eosinophilia, Fasciola hepatica, Hypereosinophilic syndrome, Interleukin 1 receptor antagonist deficiency, Interleukin 2, Polyarteritis nodosa, Polymyositis, Rheumatoid disease, Serum sickness, Still disease, adult-onset, Systemic lupus erythematosus, Urate crystal arthropathy
Sexual Secondary syphilis
Trauma Cholesterol embolism
Urologic No underlying causes
Miscellaneous Angiolymphoid hyperplasia, Capillaria, Kimura disease, Kostmann disease

In alphabetical order[1] [2]

References

  1. Sailer, Christian, Wasner, Susanne. Differential Diagnosis Pocket. Hermosa Beach, CA: Borm Bruckmeir Publishing LLC, 2002:77 ISBN 1591032016
  2. Kahan, Scott, Smith, Ellen G. In A Page: Signs and Symptoms. Malden, Massachusetts: Blackwell Publishing, 2004:68 ISBN 140510368X

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